Nutritional Treatment Program and Age-Related Macular Degeneration: Improved Vision One Year Later Table 1 The formula for the nutritional supplement that was provided to all subjects+
Ginkgo Biloba Extract
(Chymotrypsin 4 rag) 20 mg
Vitamin E (Succinate)
Vitamin B2 (Ribofiavin) 10 mg
Witch Hazel Leaves
(*)RDA has not been established
Manufactured by Nutri-West Box 950, Douglas WY 82633, 800-443-3333
There is increasing evidence that dietary factors, particularly antioxidants may prevent or impede the progression of age-related macular degeneration (AMD).( 1-11) The most recent example was a study of 356 cases with advanced stage ` acute macular degeneration compared to 520 control subjects, matched according to age and sex.( 12) The investigators evaluated the relationship between dietary intake of carotenoids and vitamins A, C, and E and the risk of neovascular AMD, the leading cause of irreversible blindness among adults.(13.14) They found a higher dietary intake of carotenoids was associated with a lower risk of AMD. In particular, a higher frequency of intake of spinach or collard greens was associated with a substantially lower risk of AMD. Less statistically significant was the influence of vitamins A (retinol), C and E in lowering the risk of AMD. Their conclusion, "Increasing the consumption of foods rich in certain carotenoids, in particular dark green, leafy vegetab les, may decrease the risk of developing advanced or exudative AMD."
Some health care practitioners have already recognized the importance of a healthy diet for the prevention and treatment of age-related eye disorders such as cataracts and macular degeneration. For many years, I have recommended a program that emphasized optimum nutrition for such patients. This report is a brief description of the program and of ten recent patients with AMD who followed the program and were evaluated one year later.
Subjects and Testing
The subjects were ten male and female Caucasian patients ages from 61 to 77 years. All subjects had a visual acuity loss associated with varying degrees of AMD. Retinal photographs showed either retinal pigment disorganization, multiple drusen or in one case, macular holes.
Examination consisted of a complete battery of vision tests and retinal photographs. Distance testing was at 20 feet using standard Snellen letters and at 10 feet using contrast sensitivity charts. Examinations were repeated every 60 days for six months and again at one year.
An extensive health history revealed general health disorders including use of medication. In addition, each subject received a series of forms to complete at home. The results provided details about the frequencies of foods regularly consumed as well as any vitamins or other nutritional supplements and their exercise habits.
Foods containing antioxidants. Subjects received a list of foods high in antioxidants and urged to consume some of these foods each day, specifically two fruits and three vegetables each day.
Nutritional supplements. Six tablets each day for 60 days, after which time dosage may be reduced or retained for remainder of year. See Table 1 for formulation.
Sun exposure. Protection from ultraviolet using appropriate eyewear and wide brim hat or cap recommended for bright days, between 10:00 a.m. and 3:00 p.m.
Exercise. Subjects encouraged to exercise daily
Visual acuity improved in some subjects within the first six months of treatment. These subjects took three supplements daily for the remainder of the year.
Table 2 shows information about the patient, and visual acuities before and after treatment. The acuities before treatment ranged from 20/25- to FV 3'. After treatment, all subjects had improved visual acuity ranging from one to 13 letters. Acuities recorded for 4 eyes did not deteriorate, but remained the same after treatment. Contrast sensitivity results confirmed the improvements in all cases. Retinal photographs at one year showed little if any change and no obvious further deterioration.
This study supports the potential efficacy of a nutritional program to retard the usual deterioration that occurs with AMD.
Charles Krall, OD, FAAO
1415 N. Sanborn Blvd.
Mitchell, South Dakota 57301 USA
(1.) Organisciak DT, Wang HM, Li Z, Li ZY, Tso MOM. The protective effect of ascorbate in retinal light damage to rats. Invest Ophthalmol Vis Sci. 1985;26:1580-1588.
(2.) Tso MOM, Woodford BJ, Lain KW. Distribution of ascorbate in normal primate retina and after photic injury: a biochemical, morphological correlated study. Curr Eye Res. 1984;3:181-191.
(3.) Ham WT, Mueller HA, Ruffolo JJ, et al. Basic mechanisms underlying the production of photochemical lesions in the mammalian retina. Curr Eye Res. 1984;3:165-174.
(4.) Katz ML, Parker KR, Handelman GJ, Bralnel, TL, Dratz EA. Effects of antioxidant nutrient deficiency on the retina and retinal pigment epithelium of albino rats: a light and electron microscopic study. Exp Eye Res. 1982;34:339-369.
(5.) Hayes KC. Retinal degeneration in monkeys induced by deficiencies of vitamin E or A. Invest Ophthalmol Vis Sci. 1974; 13:499-510.
(6.) Young RW. Solar radiation and age-related macular degeneration. Surv Ophthalmol. 1988;32:252-269.
(7.) Goldberg J, Flowerdew G, Smith E, Brody JA, Tso MOM. Factors associated with age-related macular degeneration: an analysis of data from the First National Health and Nutrition Examination Survey. Am J Epidemiol. 1988;128:700-710.
(8.) The Eye Disease Case-Control Study Group. Antioxidant status and neovascular age-related macular degeneration. Arch Ophthalmol. 1993; 111:104-109
(9.) Blumenkranz MS, Russell SR, Robey MG, Blumenkranz RK, Penneys N. Risk factors in age-related maculopathy complicated by chroroidal neo-vascularization. Ophthamology. 1986;96:552-558.
(10.) Marklin L.J., Bendick A. Free Radical Tissue Damage: protective role of antioxidant nutrients. FASEB J 1987; 1:441-5.
(11.) Newsome DA, Sevartz M, Leone N, et al. Oral zinc in macular degeneration. Arch Ophtalmol 1988; 106: 192-8.
(12.) Soddon JM, Ajani UA, Sperduto RD, Hiller R, Blair N, Burton TC, Farber MD, Grageudas ES, Hailer J, Miller DT, Yannuzzi LA, Willet W. Dietary carotenoids, vitamins A, C, and E, and advanced age-related macular degeneration. J. Am. Med. Assoc. 1994;272:1413-1420.
(13.) National Advisory Eye Council, Report of the Retinal and Choroidal Diseases Panel. Vision Research t A National Plan; 1983-1987. Bethesda, Md: US Dept of Health and Human Services; 1984. National Institutes of Health publication 83-2471.
(14.) Klein R, Klein B, Linton KLP. Prevalence of age-related maculopathy: the Beaver Dam Study. Ophthalmology. 1992;99:933-943. Table 2 Patient age, sex, and visual acuities before and after treatment
Number Subject Sex Age Before
F 61 OD 20/50 +2
OD 20/40 -2
OS 20/30 -1
OS +13 2
F 67 OD 20/200
OS +4 3
F 62 OD 20/25
OS +11 4
M 67 OD 20/40
OD 20/25 -2
OS 20/25 -2
OS 20/25 -2
OS 0 5
F 77 OD FV
OS 20/20 -1
OS +5 6
F 62 OD 20/400
OS 20/25 -1
OS +1 7
F 76 OD 20/70 -2
OD 20/70 -2
OS 20/25 -2
OS 20/25 +3
OS +5 8
M 75 OD 20/30 -2
OD 20/20 -2
OS 20/30 -1
OS +1 9
F 76 OD 20/25
OD 20/20 -1
OS 20/20 -1
OS +5 10
M 72 OD 20/40
OD 20/25 + 1
OD + 12
OS 20/25 + 1
OS + 12
Townsend Letter for Doctors & Patients.
By Charles Krall