AMD and a Healthy Diet: How they Relate

While there is still no concrete answer as to why some do not develop age-related macular degeneration (AMD) and other’s do, significant studies have proven the importance of a healthy diet and the mitochondria.

AMD is the leading cause of vision loss for those over 60 years of age in the developing countries. For decades we have studies that show the genetics and environmental factors associated with AMD. There have been over 20 genetics modification associated with AMD but there is no single gene that “causes AMD in all cases.” The genes most highly associated with AMD are found in the complement system, an important system related to controlling the inflammation in our body. A change in the complement factor H (CFH) gene from a low risk gene to a high risk gene has been associated with 43% of those developing AMD.

However, some people who have this high risk CFH gene but never develop AMD. This leads us to believe that the genetics are not the entire answer. The other factor has to do with the environment. Smoking is the leading risk factor, along with aging, exposure to sunlight and higher body mass index (obesity). But again there are obese people that smoke and never develop AMD. So, while the environmental risk factors are important, they do not answer the entire question of “why do some people get AMD but others do not?”

Recently, researchers have recognized that a major factor in the dry form of AMD is that the retinal cells begin to die off. Therefore, they have looked at important factors that keep cells alive. The mitochondria are one of the most important elements that protect the cells in the body. These subunits or organelles, produce energy for the cells, acting like batteries for the cells. And just like the batteries in a flashlight – if the batteries are not working then the flashlight dies. The same thing happens with cells – when the mitochondria are not healthy, then the cells eventually will die. Therefore to protect ourselves, it is important to keep the mitochondria healthy. One way to do this is to eat healthy foods. Over the past 20 years, the National Eye Institute (NEI) has conducted a series of studies that have identified foods and supplements that are good for the retinal cells and also the mitochondria.

 

super greens, spinachThe National Eye Institute has recommended that people who are high-risk for developing AMD eat diets rich in green leafy vegetables, whole fruits, any type of nuts and omega 3 fatty acids. Many of these foods have anti-oxidant properties that help to “turn off” genes involved with inflammation, an important factor of retinal diseases. Salmon, mackerel and sardines have the highest levels of omega-3 fatty acids. An analysis that combined the data from 9 different studies showed that fish intake at least twice a week was associated with reduced risk of early and late AMD. Other studies show that Omega-3 fatty acids improve mitochondrial function, decreases production of reactive oxygen species (free radicals that damage cells) and leads to less fat accumulation in the body. The green leafy vegetables contain important protective macular pigments (carotenoids) called lutein and zeaxanthin that reduce the risk of AMD by 43%. High levels of lipid or fat deposits in the body (obesity) can “soak-up” the lutein and zeaxanthin so that they are not available to protect the retina.

The goal is to increase the omega-3 fatty acid and carotenoid levels to protect the eye. Below is a list of foods that are eye healthy:

Foods that have lutein or zeaxanthin:

– 6mg/d of lutein and zeaxanthin – decreased

– Lutein/zeaxanthin content – ug/100g wet weight

– Kale, cooked – 15,798

– Spinach, raw – 11,935

– Spinach, cooked – 7,053

– Lettuce, raw – 2,635

– Broccoli, cooked – 2,226

– Green peas, cooked – 1350

Source: Johnson, et al 2005 Nutr Rev 63:9

 

To help kickstart an eye healthy diet, here is a list of “eye-healthy recipes” that provide nutritional support for the mitochondria and retinal cells.

Asparagus Soup
Kale Chips
Quinoa Collard Green Wraps with Summer Vegetables
Smoked Salmon Rillettes

Sources:
Geoffrey K. Broadhead, John R. Grigg, Andrew A. Chang, and Peter McCluskey Nutrition Reviews. Dietary modification and supplementation for the treatment of age-related macular degeneration VR Vol. 73(7):448–462

Chong et al., Dietary omega-3 fatty acid and fish intake in the primary prevention of age-related macular degeneration: a systematic review and meta-analysis. Arch Ophthalmol 2008;126:826–33.

5/19/16

courtesy of the
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Myopic Degeneration

Did you ever wonder while growing up what your friends with the thick glasses meant when they said they were “nearsighted”?  What exactly does it mean to be nearsighted, and what issues related to vision arise from this?

Think of your eye as a camera, which has a segment to focus the light coming into it. In the eye, this focusing segment is made up of the cornea, the clear front part of the eye, the pupil, and the natural lens inside the eye behind the pupil. Like any camera, the eye has a film to make the images, and this is the retina. The retina is a thin tissue lining the entire inside of the eye like wallpaper.

Myopic Degeneration
Figure 1. Normal retina inside the eye, the optic nerve and the blood vessels

Another term for nearsightedness is myopia. When someone is myopic, they see well up close but cannot see far away. A myopic eye is longer than average in length from the front of the eye to the back of the eye. In a sense, light and images from far away cannot reach the back of the eye where the camera film, the retina, resides. Therefore, glasses or contact lens are needed to help focus the light on to the retina to see clearly. Some people may elect to have refractive surgery to correct near sightedness. Because the eye is longer than average, the tissues inside it, like the retina, can become abnormally thinned due to stretching. It should be noted that people with myopia have an increased risk for retinal tear or detachment of the retina which can lead to rapid loss of vision. If sudden flashing lights, new floaters, or darkening of peripheral vision are seen, an eye care professional should be expeditiously consulted for an evaluation.

Myopic Degeneration
Figure 2. Myopic degeneration

Progressive thinning of the retina resulting from elongation of the eyeball is termed myopic degeneration. Individuals with more severe nearsightedness or high myopia are at greater risk for developing myopic degeneration. When thinning and atrophy occur at the part of the retina that affects central vision (macula), vision may deteriorate gradually and may not be correctable.  You can see in the Figure 2 that there are some white and black discolorations that were not present in Figure 1. These changes exemplify myopic degeneration. Glasses or contact lenses cannot correct for myopic degeneration because there is actual damage of the retina tissue when it is stretched out. There is no reversal for the actual thinning of the retina and the damage to the retina.

Myopic degeneration
Figure 3. Myopic degeneration with choroidal neovascularization

When the retina is stretched out and the eye is elongated, sometimes abnormal blood vessels can develop just below the retina. These blood vessels, termed choroidal neovascularization, can interfere with focusing of the light or bleed and can cause sudden decreased vision. The reddish discoloration in Figure 3 exemplifies bleeding from choroidal neovascularization in myopic degeneration. Fortunately there is a treatment in the form of medications that can be injected into the eye that can stop the growth of these abnormal bleeding vessels, if they are found early before permanent damage occurs to the eye.  Therefore, early diagnosis as well as treatment of choroidal neovascularization can be helpful in limiting the degree of vision loss from these bleeding blood vessels.

Not everyone with myopia develops myopic degeneration, and there is currently no algorithm to predict its development. Self-testing one eye at a time using an Amsler grid, which looks like a graph paper, to check for any distortion of straight lines on a regular basis can be a useful tool to identify any early changes. Those with myopic degeneration should have a regular dilated eye examination with an eye care professional for early detection of any treatable changes.

Image References
1.Normal Retina. Jason Calhoun MD. ASRS Image Bank.
2.Myopic degeneration. Gerrardo Garcia Aguirre MD. ASRS Image Bank.
3.Myopic degeneration and CNVM. David Callanan MD. ASRS Image Bank.

4/6/16

Judy Kim - Myopic Degeneration

Judy E. Kim, MD
Medical College of Wisconsin
NEHEP Planning Committee Member

 
 
 
 
 
Alessa Crossan - Myopic Degeneration

Alessa Crossan, MD
Medical College of Wisconsin