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  • Age-related macular degeneration

    | Description |

    A group of degenerative diseases of the retina that cause progressive, painless loss of central vision1 Affects one in seven people over the age of 50 in Australia and is the most common cause of legal blindness1 2 forms: dry AMD results in gradual vision loss; wet AMD results in sudden vision loss. The dry form can develop into wet MD1 There is no cure, however research indicates that

    diet and lifestyle changes, including the use of an appropriate nutritional supplementation may slow down the progression of the disease1

    | Management principles |

    Slow progression of the disease through diet and lifestyle changes and supplementation where appropriate Monitor condition with regular check ups

    Complementary medicines

    | Primary recommendations |

    ZINC AND ANTIOXIDANTS

    Mechanism of action Antioxidants such as vitamin E and C are found in high concentrations in the eye.14 Oxidative damage to the retina may be involved in the pathogenesis of AMD11 Zinc is also found in high concentration in the eye and functions in various antioxidant enzymes and compounds. There can be an age-related decline in zinc levels in the eye which may increase vulnerability to free radical damage14

    ResearchThe Age-Related Eye Disease Study (AREDS) is one of the only studies for which there is good, long-term evidence for the benefi ts of high dose nutrients for people diagnosed with dry AMD.1AREDS investigated the effect of zinc and antioxidant nutrients on AMD progression and loss of visual acuity in

    high risk patients over 5 years.11 There was a 25% risk reduction for progression to advanced AMD in patients with intermediate stage AMD in both eyes, or late stage AMD in one eye There was a 19% risk reduction of at least moderate visual acuity loss in patients at high risk of developing advanced AMD. The decreased risk was considered a result of the decreased risk of progression to advanced AMD There was no benefi t in patients with no signs of AMD 10 year follow up the zinc group had reduction in all-cause mortality (HR 0.83)12

    Adverse effects Mild gastrointestinal distress may occur with doses of zinc 50-150 mg/d16

    Interactions Separate zinc supplements from tetracycline and quinolone antibiotics, and penicillamine by at least 2 hours17

    ZINC AND ANTIOXIDANTS

    EYE HEALTH

    | Practice points|

    The Macular Disease Foundation recommend patients diagnosed with age-related macular degeneration (AMD), in consultation with a healthcare professional, should consider taking a daily dose of:18

    | Zinc 80 mg | | Vitamin C 500 mg | | Lutein 10 mg |

    | Copper 2 mg | | Vitamin E 400 IU | | Zeaxanthin 2 mg |

    For those at risk of AMD, dietary, or supplemental lutein and zeaxanthin at above dose may reduce risk for developing AMD16

    Encourage monitoring. Changes in vision should be reported immediately to an eye specialist. Recommend daily use of an Amsler grid plus regular check ups1

  • | Diet and lifestyle recommendations |

    Decrease foods that may increase risk: red meat2, trans fat3,4, vegetable oils (not olive)5, processed baked goods4, alcohol >3 drinks per day5

    Increase foods that may decrease risk: fi sh and omega-3 fatty acids3,6,7, olive oil3, nuts7, dietary carotenoids and antioxidants (found in brightly-coloured fruit and vegetables)5, low glycaemic index (GI)8

    Weight management: overall and abdominal obesity increases risk for progression to advanced AMD9,10

    Physical activity decreases risk of AMD5,9

    Quit smoking. Smokers are 3-4x more likely to develop MD, and may develop the disease 5-10 years earlier.1 There is good evidence that causally associates AMD and smoking.5

    REFERENCES 1. Macular Disease Foundation 2013. Macular Degeneration Booklet 2. Chong EW. Red meat and chicken consumption and its association with age-related macular degeneration. Am J Epidemiol 2009;169(7):867-76 3. Chong EW. Fat consumption and its association with age-related macular degeneration. Arch Opthalmol 2009;127(5):674-80 4. Seddon JM. Progression of age-related macular degeneration. Association with dietary fat, transaturated fat, nuts and fi sh intake. Arch Opthalmol 2003;121(12):1728-37 5. Kotsirilos V. A guide to evidence-based integrative and complementary medicine. Elsevier 2011 6. Reynolds R. Dietary omega-3 fatty acids, other fat intake, genetic susceptibility and progression to incident geographic atrophy. Opthalmol 2013;120(5):1020-28 7. Tan JS. Dietary fatty acids and the 10 year incidence of age-related macular degeneration. Arch Ophthalmol 2009;127(5):656-65 8. Kaushik S. Dietary glycemic index and the risk of age-related macular degeneration. Am J Clin Nutr 2008;88:110410 9. Seddon JM. Progression of age-related macular degeneration: association with body mass index, waist circumference, and waist-hip ratio. Arch Ophthalmol 2003;121(6):785-92 10. Jonasson F. Five-year incidence, progression and risk factors for age-related macular degeneration: the age, gene/environment susceptibility study. Opthalmol 2014;121(9):1766-72 11. Age-Related Eye Disease Study Research Group. A Randomized, Placebo-Controlled, Clinical Trial of High-Dose Supplementation with Vitamins C and E, Beta Carotene, and Zinc for Age-Related Macular Degeneration and Vision Loss. Arch Ophthamol 2001;119:1417-36 12. Chew EY. Long-term effects of vitamin C and E, -carotene, and zinc on age-related macular degeneration. AREDS report no. 35. Ophthalmol 2013 Aug;120(8):1604-11 13. The Age-Related Eye Disease Study 2 (AREDS2) Research Group. Lutein Zeaxanthin and Omega-3 Fatty Acids for Age-Related Macular Degeneration The Age-Related Eye Disease Study 2 (AREDS2) Randomized Clinical Trial. JAMA 2013;309(19):2005-15 14. Eperjesi F. Nutrition and the eye A practical approach. Philadelphia: Elsevier, 2006;175-17915. Whitehead AJ. Macular pigment: a review of current knowledge. Arch Ophthalmol 2006;124(7):1038-45 16. Braun L, Cohen M. Herbs and Natural Supplements 4th ed. Elsevier 2015 17. Blackmores Institute Complementary Medicine Interactions Guide 7th ed. 2015 18. Macular Disease Foundation 2014. Nutrition and Supplements for Macular Degeneration 19. San Giovanni JP. Age-Related Eye Disease Study Research Group. The relationship of dietary lipid intake and age-related macular degeneration in a case-control study: AREDS Report No. 20. Arch Ophthalmol 2007;125(5):671-9 20. Johnson EJ. Potential role of dietary n-3 fatty acids in the prevention of dementia and macular degeneration. Am J Clin Nutr 2006;83(6 Suppl):1494S-1498S. PMID: 16841859 21. Kangari H. Short-term Consumption of Oral Omega-3 and Dry Eye Syndrome. Ophthalmol 2013;120:2191-2196

    LUTEIN AND ZEAXANTHIN (LZ)

    Mechanism of action LZ are related carotenoids found in the eye. The eye contains a higher concentration of LZ than any other tissue14,15 They are deposited in the macula where they form the macular pigment which may help protect the eye from light-induced damage16 They also act as antioxidants14

    ResearchThe Age-Related Eye Disease Study 2 (AREDS2) is one of the only studies for which there is good, long-term evidence for the benefi ts of high dose nutrients for people diagnosed with AMD.1AREDS2 investigated LZ and/or omega-3 fatty acids EPA and DHA added to the original AREDS formula on progression to advanced AMD. Additionally, it assessed different forms of the original supplement with reduced

    zinc or no betacarotene.13

    Subgroup analysis found participants with the lowest levels of LZ in their diet, had a decreased risk of progression to advanced AMD with LZsupplementation.

    Adverse effectsUnlikely to cause adverse effects at recommended doses16

    InteractionsNo clinically signifi cant interactions noted in the literature

    | Secondary recommendation |

    Omega-3 fatty acids: whilst AREDS2 did not fi nd benefi t for omega-3 supplementation, observational studies have suggested that higher dietary intakes of EPA/DHA may help to reduce the risk of AMD.19,20 They may also benefi t dry eye.21

    LUTEIN AND ZEAXANTHIN (LZ)

    Contact [email protected] Healthcare Professional Advisory Service 1800 151 493 Website blackmoresinstitute.org