The Natural Connection

It is always a great day in medicine when a physician can offer a patient hope for a devastating illness that was once considered “incurable”. To be able to offer ten million people hope is a true cause for celebration. 

Over ten million Americans suffer from a condition called macular degeneration, the most common cause of vision loss in people over the age of 55. The number afflicted with the disability is expected to escalate as aging baby boomers develop the illness, and has recently been the focus of a lot of attention in the media. 

Age Related Macular Degeneration or AMD, is the breakdown of cells of the macula, the small central part of the retina that allows us to perceive color. The macula is also responsible for sharp central vision, which is necessary to be able to read, drive, or recognize faces. In the early stages of the disease, patients with AMD may notice that edges of buildings or doorways look wavy. In later stages, a blurry or blank spot may appear in the center of their visual field. While their peripheral vision may be intact, they might not see a car, for instance, that is headed straight towards them. 

While macular degeneration can occur in anyone as they age, it is more prevalent in whites and females. Smokers are at particular risk for the disorder. Other risk factors of slightly lower significance include light color eyes, history of hypertension or diabetes, and possibly increased exposure to sunlight at a young age. 

The disease exists in two forms--“wet” or neovascular AMD is the least common, but most serious form, and more frequently leads to blindness. In this type of AMD there is leakage of fluid into the macula from blood vessels under the retina. This leads to scarring and permanent vision loss. Thankfully, there are now promising new treatments using laser therapy for this form of AMD. 

The atrophic or “dry” form is the more common type of AMD. This form is characterized by deposits of debris in the retina called “drusen”, which are actually dead pigment cells in the macula.  Dry AMD usually progresses slowly over years, and leads to moderate vision loss. Some patients with dry AMD will progress to the wet form. Until recently, the dry form of AMD was described as “incurable”. 

For a number of years there has been speculation that nutritional factors played a role in AMD. In particular, there was interest in the group of vitamins and minerals called antioxidants. It was known, for instance, that patients who consumed diets high in an antioxidant called lutein found in vegetables such as kale, collards, chard, and spinach, had 57% less AMD than those who did not eat these foods. 

A large study recently reported in the Archives of Ophthalmology October 2001 confirms the role of  vitamins in macular degeneration. Nearly 5000 men and women ages 55-80 with AMD were followed for seven years in the Age-Related Eye Disease Study. Some participants took a combination supplement that included Vitamin C, Vitamin E, beta-carotene, zinc and copper. Others took the combination without zinc and copper, zinc alone, or a placebo. 

Over the course of the seven years, those patients with early AMD taking the combination antioxidant-zinc-copper regimen had reduced risk of disease progression to the advanced form by 25%. The impressive results lead the Editor of the Journal, Dr. Lee M Jampol, to recommend to ophthalmologists that all patients with moderate dry AMD be considered for a supplement program of antioxidants and zinc. 

This is not a program that is without risks. The doses of the supplements used were extremely high—much higher than can be obtained from dietary sources or regular multi-vitamin preparations, and can themselves have side effects. The high dose of zinc (80 mg) used in the study, for instance, can cause anemia. Copper was added to prevent this. More importantly, beta- carotene in other independent studies has been linked to increases in lung cancer in smokers. The study recommended that patients who smoke, or recently quit smoking, not use beta- carotene for this reason. 

Any patient who has been diagnosed with macular degeneration should discuss the findings and recommendations of the Age-Related Eye Disease Study with their ophthalmologist. And always have hope, that for some people at least, things are never as “incurable” as they first may seem. Doctors must just keep looking for answers, and patients must keep asking the questions. 

For further information on macular degeneration, write to The Natural Connection, c/o Dr. Pauline Bellecci, PO Box 777, Waycross, GA 31501 or contact us on our web site www.swampdocs.com 

©2000-2003 Pauline M. Bellecci, MD