Vol.3, # 3
January 21, 2006

Q: What is macular degeneration and what are some natual therapies? - Layperson

A:  Macular degeneration is a painless, degenerative eye disease that affects more than 10 million Americans. It is the leading cause of legal blindness in persons over the age of 55 in the United States. While complete blindness does not occur in most people with the disorder, macular degeneration often interferes with reading, driving, or performing other daily activities.

There are two forms of macular degeneration. Dry macular degeneration affects about 90% of those with the disease and causes gradual loss of central vision, initially only in one eye. Wet macular degeneration, which accounts for 90% of all severe vision loss from the disease, involves a very sudden loss of central vision.

 
Signs and Symptoms

Macular degeneration is accompanied by the following signs and symptoms:

  • Slightly blurred vision
  • Dry type: a blurred spot in the central field of vision, which may become larger and darker
  • Wet type: straight lines that appear wavy and the rapid loss of central vision; sometimes, wet macular degeneration starts with a sudden blind spot
What Causes It?

Dry macular degeneration occurs from the breakdown of the light sensitive cells in the center of the retina, called the macula. Wet macular degeneration occurs when new blood vessels behind the retina grow toward the macula and leak blood and fluid.

Who's Most At Risk?

People with the following conditions or characteristics are at risk for developing macular degeneration:

  • Age—the risk increases with age
  • Cigarette smoking
  • Family history of macular degeneration
  • Cardiovascular disease
  • Elevated levels of cholesterol
  • Light eye color
  • Excessive exposure to sunlight
What to Expect at Your Provider's Office

Your eye care professional can detect macular degeneration during an eye examination that includes the following:

  • Testing with an eye chart to measure your ability to see at various distances.
  • Pupil dilation—drops are placed in your eyes to widen the pupils and reveal more of the retina.
  • Checking for presence of drusen (tiny yellow deposits in the retina).
  • Testing with Amsler's grid, which involves covering one eye and staring at a black dot in the center of a checkerboard-like grid. If the straight lines in the pattern appear wavy or some of the lines appear to be missing, these may be signs of wet macular degeneration.

    Amsler Grid Testing of Central Vision

    K. Bailey Freund, MD

    An Amsler grid is a useful tool for monitoring your central visual field. It is an important way to detect early and sometimes subtle visual changes in a variety of macular diseases such as age-related macular degeneration and diabetic macular edema. It is also helpful in monitoring changes in vision once they have been detected. With the Amsler grid, each eye is tested separately by you. This helps you to recognize visual symptoms which are in one eye only. Amsler grids can be obtained from your eyecare practitioner or through our research department at (212)605-3777.

    Examples of two different Amsler grids. Both are useful for monitoring central vision. The grid on the right is a modified Amsler grid (Yannuzzi card) intended to be carried in the wallet or purse for daily self-assessment.

    Instructions for using the Amsler grid

    • Test your vision with adequate lighting.

    • Wear your reading glasses or look through the reading portion of your bifocals (if you normally read with spectacles).

    • Hold the Amsler grid at normal reading distance (about 14 inches).

    • Cover one eye at a time with the palm of your hand.

    • Stare at the center dot of the chart at all times.

    • Do not let your eye drift from the center dot.

    Ask yourself the following questions as you check each eye separately:

    • Are any of the lines crooked or bent?

    • Are any of the boxes different in size or shape from the others?

    • Are any of the lines wavy, missing, blurry, or discolored?

    (Note: If using a rectangular card like the one above on the right (Yannuzzi card), you should check each eye with the card held both vertically and horizontally.)

    If the answer to any of these questions is "yes" (and this is a new finding for you), you should contact your doctor immediately for an examination. Sometimes these changes may mean that there is leakage or bleeding in the back of the eye causing swelling of the retina

  • Fluorescein angiography—a special dye is injected into a vein in the arm and pictures are taken as the dye passes through the blood vessels in the retina.
Treatment Options
Prevention

If you have wet macular degeneration, you will test your eyes daily at home using an Amsler's grid. You should report any distortion immediately to reduce the risk of vision loss. Other preventive measures include increasing your dietary intake of flavonoids and carotenoids (see section on Nutrition), using ultraviolet eye protection, estrogen replacement therapy, and moderate red wine consumption.

 
Treatment Plan

There is no known cure for macular degneration; however, there are procedures that can help slow vision loss.

Complementary Treatment and Recommended Vitamins, Supplements, Herbs & Other Nutritional Products

Essential: Pure Focus - Pure Focus liquid based formula for vision health.

Essential: Vital Eyes Complete - Vital Eyes Complete 60 capsules

Essential: Microcurrent Stimulation 100ile Purchase Option - Microcurrent Stimulation (MicroStim or MCS)

Essential: CoQ10 & L-Carnitine 60 softgels - CoQ10 & L-Carnitine 60 softgels

Very Important: Taurine (L-Taurine) - 2 oz bottle - Taurine (L-Taurine) reduces the oxidative damage caused by sunlight to the eyes, and stimulates the body's ability to clean up waste by-products that accumulate in the retina.

Helpful: Macular Degeneration Magistral Homeopathic Formula - Macular Degeneration Magistril 1 oz Homeopathic Formula

Helpful: Astaxanthin 4 mg 60 softgels (ASTA2) - Astaxanthin is a fat-soluble carotenoid and antioxidant that kills off free radicals in the body

Helpful: Digestive Enzymes - Digestive Enzymes-V 60 Vcaps

Helpful: PaleoGreens - PaleoGreens 265 gms - excellent Green drink combining a variety of organic vegetables, organic fruits and wheatgrasses.

Helpful: Vizu-All Plus contains the herbs:

Vaccinium myrtillus (bilberry) is the principal ingredient in Vizu-All Plus and has an impressive history in the natural treatment of eye disorders. It is routinely recommended in Europe as an addition to conventional medical treatment, particularly for eye disorders. Medically active components of bilberry include flavonoid compounds known as anthocyanosides, which work to counteract cell damage caused by free radicals. By strengthening the tiny blood vessels of the eye, bilberry helps to facilitate delivery of essential oxygen and nutrients to the eye and has been shown to be effective in the prevention and treatment of degenerative diseases of the retina. It also reduces the incidence of hemorrhage in the eye, often associated with diabetes. Further studies have demonstrated the effectiveness of bilberry in treating and preventing cataracts and glaucoma - two very common eye disorders in older people. Because of this, it is recommended that all people over the age of 50 take Vizu-All Plus daily to prevent eye disorders and promote optimal visual health.

Aspalathus linearis (Rooibos) is found only on the slopes of the Cedarberg mountains in the Western Cape of South Africa and has been used medicinally for thousands of years by the indigenous people of that area. It is used as an effective all round tonic and restorative, to reduce digestive complaints, improve liver functioning and balance blood sugar levels. Like bilberry, Rooibos also has powerful anti-oxidant properties, mainly due to its superoxide dismutase (SOD) mimetic properties. SOD is an enzyme in the body which is especially designed to neutralize unstable oxygen molecules (free radicals) as soon as they occur and can therefore help to prevent a broad spectrum of diseases. Due to its high mineral content, Rooibos is also instrumental in the maintenance of healthy metabolism, bones, skin and teeth. Rooibos can help to control blood sugar levels, lower blood pressure and enhance immune functioning. It is an extremely nutritious herb, containing Vitamin C, Alphahydroxy Acid, potassium, copper, magnesium, calcium, iron, zinc, manganese and fluoride.

Sutherlandia frutescens, (also called Kanker Bossie or Cancer Bush) was originally used by the indigenous Khoi and San peoples of Southern Africa and is indigenous to this region. Although it is well known in the traditional treatment of internal cancers, Sutherlandia is also effective in a wide range of ailments, including diabetes. Research has shown that Sutherlandia contains the active ingredients canavanine, pinitol, and ,the amino acid GABA. Pinitol is a well-known anti-diabetic agent (Narayanan et al, 1987). Recent research has confirmed the adaptogenic properties of Sutherlandia as well as its anti-oxidant effects (Swaffer et al. 1995, Crooks and Rosenthal, 1994, Ostlund and Sherman, 1996)

Nutrition is a valuable treatment for dry macular degeneration. It may also help prevent both wet and dry types related to aging.

 
Nutrition

Antioxidants that protect your retina—such as carotenoids, selenium, zinc, and vitamins C and E—may either delay the progression of macular degeneration if you already have the eye condition (meaning that your vision won't get worse as quickly) or prevent the development of this serious eye disorder. Two particular carotenoids, lutein and zeaxanthin, may be particularly beneficial. Antioxidants can be obtained from foods or supplements.

Eating a diet high in vitamins C and E and carotenoids is likely all that you need to lower your chances of developing macular degeneration in the first place. (In other words, supplements are probably not necessary for prevention.) Vegetables rich in carotene include orange and yellow squash, and dark, leafy greens, such as kale, collards, spinach, and watercress.

If you already have macular degeneration, especially if it is somewhat advanced, and you decide, with the advice of your healthcare provider, to take supplements, the following are some suggested amounts of key nutrients:

  • Mixed carotenoids, 25,000 to 50,000 International Units (IU) a day
  • The carotenoid lutein, 5 milligrams (mg) a day
  • Selenium, 200 to 500 micrograms (mcg) a day
  • Zinc, up to 50 mg a day
  • Vitamin C, 60 to 2000 mg a day in divided doses; doses over 1000 mg a day may cause gastrointestinal problems, including nausea and diarrhea
  • Vitamin E, 50 to 1000 IU a day (usually 400 to 800 IU a day)

Flavonoids (such as quercetin, rutin, and resveritrol) may also play a role in preventing macular degeneration. A study of 3,072 adults with macular changes showed that moderate red wine consumption may offer some protection against the development or progression of macular degeneration. Red wine is high in certain flavonoids (including quercetin, rutin, and resveritrol) that have antioxidant activity; damage from oxidative stress is thought to contribute to the development of macular degeneration. Dark berries, such as blueberries, blackberries, and dark cherries, are high in flavonoids as well.

Omega-3 fatty acids may also offer some protection against macular degeneration. In a study of more than 3000 people over the age of 49, those who consumed more fish in their diet were less likely to have macular degeneration than those who consumed less fish. (Most types of fish are rich in omega-3 fatty acids). Similarly, a study comparing 350 people with macular degeneration to 500 without found that those with a proper ratio of omega-3 to omega-6 fatty acids and higher intake of fish in their diets were less likely to have this particular eye disorder. Another larger study found that consuming docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), two types of omega-3 fatty acids found in fish, four or more times per week may reduce the risk of developing macular degeneration. Notably, however, this same study suggests that alpha-linolenic acid (ALA; another type of omega-3 fatty acid) may actually increase the risk of this eye condition.

 
Herbs

Ginkgo (Ginkgo biloba), which contains flavonoids, may help halt or lessen some retinal problems. Clinical studies suggest that it may be useful in treating vision problems specifically due to macular degeneration. If you use anticoagulants, do not use ginkgo without close monitoring by your healthcare provider.

Bilberry (Vaccinium myrtillus) and grape seed (Vitis vinifera) are also high in flavonoids; therefore, they may help prevent and treat macular degeneration. Clinical studies suggest that these herbs may stop vision loss and improve visual sharpness. Here are the recommended doses:

  • Ginkgo standardized to 24%, 120 mg once or twice a day
  • Bilberry extract standardized to 25%, 120 to 240 mg twice a day
  • Grape seed, 50 to 150 mg once or twice a day
 
Homeopathy

Although scientific research does not necessarily support the use of homeopathy to treat or prevent macular degeneration specifically, an experienced homeopath would consider your individual case to decide whether treatment may be beneficial for you.

 
Acupuncture

Studies on acupuncture and macular degeneration have been mixed. In a study of 51 patients with macular problems, researchers found little change in visual sharpness or other symptoms after 12 acupuncture treatments. Another study showed a connection between low blood flow to the head and macular degeneration. Restoring normal blood pressure with acupuncture improved vision.

 
Prognosis/Possible Complications

Blindness is a possible outcome of macular degeneration. Low vision aids may help if you have partial blindness. Sometimes blood vessels build up underneath the retina, causing the retina to become detached or scarred. If this happens, the chances of preserving your central vision are poor. This condition, called subretinal neovascularization, occurs in about 20% of cases of age-related macular degeneration. The condition will likely recur even after laser treatment.

In short, eating a healthy diet high in minerals, vitamins, essential fatty acids, and amino acids may help slow down and possibly even prevent macular degeneration. Consult a healthcare professional familiar with macular degeneration

 

 

 


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DISCLAIMER:  The information in this column, is NOT intended to diagnose and/or treat any health related issues and is provided solely for informational purposes only. Consult the appropriate healthcare professional before making any changes to your healthcare regime. Even what may seem like simple changes in the diet for example, can interact with, and alter, the efficiency of medications and/or the body's response to the medications. Many herbs and supplements exert powerful medicinal effects. Neither the author, nor the website designers, assume any responsibility for the reader's use or misuse of this information.

© 2002 Nature's Corner