Month: February 2015

By Dr. Lisa Lex

Offering guidance to our patients when there is either a family history of age-related macular degeneration (AMD) or evidence that a patient has clinical signs of the disease is sometimes challenging.

I always begin with the non-controversial advice: wear UV protection (wrap-around style for true outdoor enthusiasts) and a brimmed hat when outside.  I remind them “that the sun does to your eyes what it does to your skin–prematurely ages them.”

If they smoke I discuss the effects their habit has on ocular health, tripling the risk of AMD. I encourage them that if they have tried to quit before that they should keep trying as evidence shows that the more attempts at quitting, the more likely they are to eventually succeed.

Recommending patients take a systemic supplement can have potential consequences, however. I prefer to keep things as simple and safe as possible.   Betacarotene in large amounts has the potential to increase lung cancer in those who are smokers.  It also interferes with the absorption of two other important carotenoids, lutein and zeaxanthin. Vitamin E in amounts higher than recommended (22.5 IU or 400-800 mixed tocopherols) are suspected to increase the risk of hemorrhagic strokes as well as prostate cancer. It also can interfere with the absorption of statins and increase the risk of heart failure in diabetics.  Zinc’s recommended daily requirement of 15 mg is far exceeded in vitamins targeted for eye health and can cause genitourinary and gastrointestinal disorders. So what’s an eye doc to do?

I inquire specifically of the patient, in addition to their medications, what supplements they are taking. The list can be alarmingly long and I remind them to share that list with their doctor. In an attempt to offer what I know to be safe, and potentially effective, I encourage my patients to eat good amounts of colorful fruits and vegetables. We know kale, spinach, eggs (yolks), corn, orange peppers and grapes are excellent sources of ingredients that help maintain macular health. It may also be helpful to take a 6-20 mg capsule of lutein in a formula with zeaxanthin, preferably 2 mg.  For those who are deficient, the AREDS2 study found both a slowing of the progression of AMD and a decrease in cataract in those supplementing these two carotenoids. A multivitamin may also be beneficial, but better if they find one that contains little to no betacarotene.

Most importantly, I write down my recommendations and advise the patient of the confusion that awaits them in the vitamin aisle. There are SO many choices and if directions and ingredients are not looked at carefully, there is a chance that a little good could do a lot of harm.

February is AMD Awareness Month

… a good time to think about nutrition in eyecare

By: Larry A. Hookway

I tend to spend time speaking to my patients about nutrition.   I think nutrition education is a major failing of our health care education and is often either, at best, ignored by most health care providers or, at worst, bad advice is given.   In addition, the media constantly often reports sensational results of new studies that are often contradictory which makes it hard for our patients to know what to do.

The supplements that I discuss with patients are in the following list:

AMD

• Eat spinach, kale, collard greens, orange bell peppers, egg yolks and cold water fish. These provide lutein, zeaxanthin, and omega 3 from whole foods (always the best way).
• Mild Dry AMD
  • Good   Lutein 10mg   Zeaxanthin 2mg
  • Better    One of the supplements sold only in doctors’ offices (MacuHealth, Restore, MaxiVision, etc)

Explanation to patient:   These supplements build up the macular pigment level to an optimal level.  The macular pigment is a yellow filter that filters out high energy blue light and not only helps protect the delicate photoreceptors but also improves vision by reducing the glare caused by the blue light.  (Like having yellow sunglasses built right into the retina).

• Moderate to Severe AMD AREDS 2 formula

Explanation to patient: The largest study shows that people with moderate to severe have 25% less vision loss if they take this supplement.  There is a controversy now about whether zinc is good for all patients.  The jury is still out on this with some experts saying that we need to do genetic testing to determine if it is safe.

Dry Eye

• Good: 1000 to 2000mg of Omega 3 in Fish Oil

Explanation to patient:  Dry eye is a chronic inflammatory process in the eyelids.  Fish oil is anti-inflammatory and also helps the eye produce its normal oil layer. As a bonus fish oil lowers bad LDL cholesterol and triglycerides and increases HDL (good) cholesterol.  (do not use if taking Coumadin).

• Better: Supplements like BioTears, MaxiTears and EZ Tears. These have Omega 3, some have black currant seed oil which is an anti-inflammatory Omega 6 (GLA ) and some have turmeric, Vitamin E and green tea leaf extract.  BioTears also has lactoferrin which helps prevent infections by viruses and bacteria.

Diabetes

• High Fiber Diet: A study by the University of Texas Southwestern Medical Center showed that people who increased their fiber to 24 to 50mg daily dramatically improved blood sugar levels. This was as effective as some diabetic medications.  (13 servings per day of a mixture of fruits, vegetables, beans, brown rice, and whole grain bread or pasta)
• Cinnamon: A study by the Human Research Center in Bettsville, Maryland showed that one-half teaspoon of cinnamon daily makes cells more sensitive to insulin. After 40 days the patients experienced lower sugar spikes.
• EyePromise DVS: This elatively new supplement for diabetics was designed by Paul Chous, O.D., a leading speaker and researcher on ocular nutrition. It is designed to maintain healthy blood vessels.  To see the complete ingredient list go to eyepromise.com.

Vitamin D

• In Ohio we should be remind our patients to supplement with Vitamin D in the winter. Vitamin D has large role in immune health, bone and muscle health and is involved in preventing cancer formation.  Some studies estimate that over 50% of adults are deficient.   The minimum daily requirement is 400 IU but this is expected to be increased.   2000 to 4000 IU is considered safe.  The body makes 10,000 units in 30 minutes in the summer around noon with a lot of skin exposed and no sunscreen.   In the winter in Ohio even if you had skin exposed the body would not make Vitamin D.

Future:

We are on the verge of big changes in medicine.  The human genome will enable us to personalize our treatment of our patients. It is also likely that the epidemic of diabetes will lead to research on how to prevent or delay onset of diabetes.

If you are interested in nutrition I recommend ONS (Ocular Nutrition Society) web site:  www.ocularnutritionsociety.org