Macular Degeneration: Do supplements help?

richard leung_kings college hospitalAs the open enrollment period for Medicare advantage plans just came to a close, I have seen a big group of seniors start to take advantage of their new vision insurance. With the uptick in senior patients also came a sizable group of patients with Age-Related Macular Degeneration (ARMD), the leading cause of vision loss in persons older than 65 years old. ARMD is a debilitating disease which is divided into two subtypes, wet (10% of patients) and dry (90% of patients). Macular degeneration robs the patient of their central vision. Although wet macular degeneration is often more devastating, treatments have been developed to combat the primary cause – and statistically speaking, more patients will suffer from the dry variety.

Until 2001 there was no scientifically proven method to slow the progression of the dry ARMD. A study called AREDs proved that a specific vitamin formula could reduce a patient’s risk of conversion from moderate to severe dry macular degeneration by 25% over 5 years. With this study and its recently completed follow up study, AREDS 2, pharmaceutical companies began pouring money into the development of products that followed the scientifically proven formula and other products that claimed to “support eye health” but have not been proven in bias-free studies. As usual, if there is money to be made, someone will fill the void.

Many of my patients both with and without macular degeneration ask me if they should take a vitamin for their eyes. While I cannot say that vitamins will not be beneficial to a person’s vision, I do worry that my patients are spending their hard earned money on vitamins that are unproven in their ocular benefit. In fact, a recent study discovered that only 4 out of 11 top products contained the exact formulation recommended in the AREDs studies.

So what is a patient to do? First, if you have macular degeneration make sure you see your optometrist at their recommended intervals and get involved in your treatment by making sure you know the stage of your condition and the type of macular degeneration you have. If you have moderate degeneration or worse, your doctor should provide you with a specific recommendation for an AREDs or AREDs 2 formula supplement. If you do not have macular degeneration or have very mild degenerative changes you may not need vitamin supplements so long as you have a very good diet, exercise regularly, protect your eyes from ultraviolet light and refrain from smoking. I will say that patients who admit to poor diet or have a family member with macular degeneration may be at greater risk and should ask their optometrist about a multivitamin supplement. Additionally, smokers should really try quitting, as smokers have at least a 4x greater risk of macular degeneration. Smokers should also realize that some supplements have vitamin A which can be carcinogenic for them so they should be especially careful about which supplement they take. At the end of the day, being knowledgeable about your condition and seeking a doctor who is proactive will go a long way to keeping your sight.

In this holiday season I wish you all good health and a happy and peaceful 2015.

~ David C. Ardaya, O.D.
California Optometric Association

Vitamins for vision

Did you know that adding powerful antioxidants to your diet could improve your eye health?

Photo courtesy of

Photo courtesy of

It is true, adding certain nutrients to your diet every day, either through foods or supplements, can help save your vision. Researchers have linked nutrients such as lutein/zeaxanthin, vitamin C, vitamin E, and zinc to reducing the risk of certain eye diseases, including macular degeneration and cataract formation.

Here are some facts about these vision-saving nutrients:

  • Lutein and zeaxanthin reduce the risk of age-related vision problems, including age-related macular degeneration and cataracts. These important nutrients are found in green leafy vegetables, such as kale, spinach and turnip greens, as well as other foods, such as eggs.
  • Vitamin C (ascorbic acid) is an antioxidant found in fruits and vegetables. You can find it in fruits like oranges, kiwi, and strawberries, as well as vegetables like broccoli, mustard greens, and peppers. Scientific evidence suggests vitamin C lowers the risk of developing cataracts, and when taken in combination with other essential nutrients, can slow the progression of age-related macular degeneration and visual acuity loss.
  • Vitamin E in its most biologically active form is a powerful antioxidant. It can be found in nuts, like almonds, peanuts and pine nuts, dried apricots, sunflower seeds, fortified cereals and sweet potatoes. It is thought to protect cells of the eyes from damage caused by unstable molecules called free radicals, which break down healthy tissue.
  • Essential fatty acids are a necessary part of the human diet. They maintain the integrity of the nervous system, fuel cells and boost the immune system. Two omega-3 fatty acids have been shown to be important for proper visual development and retinal function.
  • Zinc is an essential trace mineral or ‘helper molecule’. It plays a vital role in bringing vitamin A from the liver to the retina in order to produce melanin, a protective pigment in the eyes. Zinc is highly concentrated in the eye, mostly in the retina and choroid, the vascular tissue layer lying under the retina.

Now we know that incorporating vitamins in our diet can provide protection from eye diseases that arrive later in life. No matter your age, be proactive in your health. Strive to include as many colors of fruits and vegetables as possible!

~ Melissa Barnett, OD, FAAO
California Optometric Association

Age-related macular degeneration: what you need to know

US population – 318.8 million
US population over 60 – 60.5 million
US population with age-related macular degeneration – 15 million

Age-related macular degeneration (AMD) is the number one cause of blindness over the age of 60. As the population continues to age, AMD will continue to cause millions of people to lose their vision.

Image courtesy of Sohrab  Gollogly website at

Image courtesy of Sohrab
Gollogly website at

So what is AMD and how can it be treated?

Age-related macular degeneration is the breakdown of the light sensing tissue in the back of the eye – the retina. In the normal process of seeing, as light hits the nerves in the retina, the nerves go through a chemical change in order to send a signal to the brain saying, “light, hit me.” As the nerves go through this change, they slough off a lipo-protein material called drusen that is cleaned up by the layers below the retina. In the normal process of aging, these garbage collectors in the retina don’t do their job as well and with time, drusen begins to deposit. These cells are important, not only for cleaning up the debris of seeing, but also for bringing nutrients to the retinal. In AMD, there is a faster than normal aging in the retina, resulting in a greater buildup of drusen and eventually the loss of the light sensing nerves and loss of vision.

Most people who develop AMD develop a slow loss of vision over many years. This is the definition of “Dry” AMD. In about 15 percent of patients, the body’s response is to grow new blood vessels into the damaged area of the retina in order to try to fix the problem. These new blood vessels are poorly constructed and leak badly. This “Wet” form of AMD causes bleeding in the retina and a rapid loss of vision within weeks to months.

Unfortunately, there is no treatment for macular degeneration. In some cases, the use of lasers or injections of medications into the eye can “dry up” wet-AMD, but cannot stop the slow steady loss of vision. Fortunately, AMD does not cause complete blindness, only the loss of central vision. However, dealing with the loss of vision from AMD can be difficult. Fortunately, the use of magnifiers and other low vision devices prescribed by low vision specialists can help significantly with the activities of daily living.

The goal of treatment is early detection and mitigation of vision loss. Detection can only happen by the examination of the eye by a doctor of optometry or ophthalmology using special instruments to examine the inside of the eye.

Researchers at the National Eye Institute tested the use of nutritional supplements to protect against AMD. This Age-Related Eye Disease Study 2, AREDS2, found that daily supplements of certain vitamins and minerals can slow progression of vision loss in people who have intermediate AMD, and those who have severe AMD in one eye. The AREDS2 study recommends the following nutritional supplements for patients who have AMD:

  • 500 milligrams (mg) of vitamin C
  • 400 international units of vitamin E
  • 80 mg zinc as zinc oxide (25 mg in AREDS2)
  • 2 mg copper as cupric oxide
  • 15 mg beta-carotene, OR 10 mg lutein and 2 mg zeaxanthin

In addition, other factors increase the risk of developing AMD – smoking, obesity, UV light absorption, systemic vascular diseases, and poor nutrition. So it is important to quit smoking, wear glasses that inhibit UV light, eat a diet high in fruits and vegetables and have yearly eye exams to detect AMD in its early stages. Remember, there are no symptoms until the later stages of the disease, so eye examinations by doctors of optometry and ophthalmology are the only way to determine if you are at risk of developing vision loss from age-related macular degeneration.


~ Dr. Steven Sage Hider, OD
California Optometric Association


What did my doctor just say? Common terms your eye doctor will use and what they mean

Courtesy of riekhavoc (caughtup?) on Flickr

Courtesy of riekhavoc (caughtup?) on Flickr

Have you ever felt like you were not quite sure what just happened at your optometrist’s office? It is difficult enough to answer the “which is better, one or two?” questions and then at the end of the exam to try and understand the doctor’s explanations with difficult optometry terms without secretly worrying that you might have said something wrong!

Hopefully this blog will help you better understand some of the more common terms we use in our examinations.

1) First of all, most comprehensive exams will include a detailed case history. The doctor will want to know your family medical and ocular (eye) history. Some terms you may hear include the most common eye diseases – cataracts, glaucoma and macular degeneration.

  • Cataract is the term used when the natural lens of your eye becomes cloudy, causing blurred and distorted vision.
  • Glaucoma is the eye disease that causes your eye to have excessively high pressure, which can lead to long-term damage of the nerve in the eye.
  • Macular degeneration is a disease that affects your central or straight ahead vision.

Not only will the optometrist ask you about a family history of any of these conditions, they will also assess your eye health and your possible risk for developing any of them.

2) Next, the optometrist will perform a refraction to get you the best possible glasses or contacts that will correct your vision.

  • A refraction is just the process of determining for each individual what are the best lenses to give you maximum visual clarity and comfort at both distance and near.
  • Myopia – nearsightedness or the ability to see better at near than at far.
  • Hyperopia or farsightedness, really means that it is more difficult to focus at near and at far distances.
  • Astigmatism: this refers to the shape of the front surface of the eye being more football shaped rather than basketball shaped.

3) There are a few terms you might hear specifically in an child’s exam.

  • Pursuits: slow, smooth eye tracking.
  • Saccades: fast reading eye tracking.
  • Accommodation: focusing.
  • Binocularity: the ability of the eyes to work together as a team.

4) Finally, there are some terms regarding glasses that it might help to define.

  • Progressive lenses are the kind of “no line bifocal” that you might hear about on TV. But, unlike a bifocal, where there are two areas of vision, near and far, progressives have an unlimited amount of areas as you look from distance to near in the lens.
  • Transition lenses are the kind that change to dark outside. They undergo an anti-reflective treatment, which eliminates all glare and allows for crisper vision, especially at night.

Hopefully, this quick explanation helps with some of the confusing terms in an eye exam. As for any others, always ask your optometrist to explain something that does not make sense.

~Lisa Weiss, OD, MEd, FCOVD
California Optometric Association

Vision and the aging eye

Courtesy of ORBIS US on Flickr

Courtesy of ORBIS US on Flickr

Many patients reach a certain life stage and realize they need to start thinking more about their vision and preventing eye problems.  This usually happens in their early to mid-forties when people notice reading is a lot easier when there’s plenty of light and the print is held further away.  Those who have seen an eye care provider for this problem should have already discovered that this is a normal aging process.  But how does one know when vision changes are normal or should be concerning?

Eye conditions that impact vision:

  • Presbyopia is the medical term for when the focusing muscles in the eye are not as flexible, causing poor focusing ability for objects nearby.  This typically occurs in the late thirties/early forties and is easily corrected with reading glasses or bifocal or progressive lenses.
  • Cataracts begin to develop in our forties and progress over time.  There is a natural clear crystalline lens in our eye which focuses light onto our retina.  With ultraviolet ray exposure, this lens can become more opaque and yellow over time, causing a dimming of vision and glare and haloes around lights.  The best way to prevent cataracts from progressing quickly is to protect the eyes with UV-blocking sunglasses anytime you are outdoors.  The good news about cataracts is that they can be easily removed and replaced with an artificial lens implant.  With the latest technology of intraocular lens implants such as muiltifocal lenses, patients are now able to see clearly at all distances without the use of glasses or reading glasses.
  • Glaucoma is a symptomless eye disease of the optic nerve head where the nerve slowly deteriorates over time.  Most patients who develop glaucoma will not have any symptoms until the late stages of the disease, when peripheral vision deteriorates and patients are left with tunnel vision.  There is no cure or preventative measure for glaucoma, however, it is easily treated with eyedrops.  The only way to determine if you have glaucoma is to have annual comprehensive eye examinations.

    Courtesy of Nargopolis on Flickr

    Courtesy of Nargopolis on Flickr

  • Macular Degeneration is another common eye disease that can cause debilitating vision loss.  This occurs when the macular region of the retina loses its integrity causing poor central vision with distortion or gray spots.  It is often detected upon routine examination, especially when photos of the retina are compared over time.  Fortunately, there have been extensive studies on macular degeneration and the field has changed dramatically over the last several years.  An important test in recent years is genetic testing to determine one’s risk factor for vision loss as a result of macular degeneration, as well as antioxidants that may be useful in reducing this risk.  Clear risk factors include a history of smoking, exposure to ultraviolet radiation, increased cholesterol levels and Caucasian women with lighter eyes and fairer complexions.
  • Retinal Detachment tends to occur more often in those who are older than 65.  The retina is a thin and fragile tissue that lines the back wall of the eye and sends visual information to the brain.  This tissue becomes more fragile over time and can easily develop a hole or tear leading to a retinal detachment.  If you experience flashes of light, new floaters, or a change in your vision, you need to be seen right away by your eyecare provider.

There are a myriad of eye conditions that can develop as one ages.  The most important and useful method of preventing vision loss is to stay healthy.  See your primary care physician regularly to evaluate and treat high blood pressure, high cholesterol, diabetes and other health conditions.  If you have uncontrolled health conditions, you can easily lose your vision to diabetic retinopathy, hypertensive retinopathy, or a stroke in the eye.

So, as I tell all my patients, see your physician regularly, eat green leafy vegetables, take your medications, and monitor your own blood pressure or blood sugar.  And of course, wear sunglasses outdoors and see your optometrist annually.

~Cindy P. Wang, OD, FAAO
California Optometric Association