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Ask the Expert: Holistic Approaches to Macular Degeneration

Dr. Neal Adams Neal Adams, MD
Board-certified Ophthalmologist at Suburban Hospital

Most people take their vision for granted. While most expect their vision to decline with age, macular degeneration is significantly different from needing bifocals. It's a potentially vision-threatening condition. It's also one where prevention and treatment, especially proper nutrition, can make a huge difference. Dr. Neal Adams, a nationally-recognized retina specialist, answers questions from the public about new holistic approaches to macular degeneration, as well as the latest treatment options.

Is there only one type of macular degeneration?

There are actually many different types of macular degeneration. To step back, the macula is the name for the center of the retina, where all the light gets focused; the macula creates the main part (middle part) of the image that gets sent to the brain. The retina and macula are full of neurons – brain cells that sense light and interpret the light signals to create pictures. Different factors combine together to cause the light sensing cells of the macula to deteriorate or degenerate over time. This deterioration of the neurons of the macula is called neurodegeneration. You may have heard of other types of neurodegenerative disorders such as Alzheimer’s disease, Parkinson’s disease, and ALS (Lou Gehrig’s disease). Macular degeneration is similar to these disorders, in that the neurons degenerate over time.

Age-related macular degeneration, also known as AMD or ARMD, is the most common type, in which age is the biggest risk factor. Debris called “drusen” from the metabolically active cells in the retina accumulates with age; this drusen slowly damages the neurons of the macula. Myopic macular degeneration is a form in which extreme near-sightedness thins out the macula. Another type is a condition called polypoidal choroidal vasculopathy, in which bleeding is a predominant feature.

What is the difference between dry and wet macular degeneration?

The different types of macular degeneration come in a dry and wet form. Dry macular degeneration is the most common form of macular degeneration. In this, neurons of the macula degenerate, usually from dry debris (drusen) accumulating behind the macula; this debris causes inflammation, blocks nutrients, and produces toxins. An important study from some number of years ago showed that over 95 percent of people over the age of 43 had drusen in their retinas!

The wet form is when blood vessels break through cracks behind the retina and start to grow uncontrollably. These abnormal blood vessels then start to bleed and leak fluid, hence the term “wet.” They can wreak havoc on the macula, disrupting the light-sensing cells and often causing rapid vision loss.

What are the risk factors for macular degeneration?

There are many risk factors for macular degeneration, including some that we cannot control. Age is the biggest risk factor, and, of course, we can’t control the aging process. Our genes are another risk factor we cannot control, and some genes predispose to macular degeneration. However, there are many risk factors that we can control. These controllable risk factors include nutrition, excess sunlight exposure, high blood pressure, smoking, heart health, cholesterol and weight, among others.

I like to keep my treatment options very natural, but was not sure if this was possible when caring for my vision. What is the holistic approach to treating and preventing macular degeneration?

The holistic approach involves as much prevention as possible. The traditional approach to macular degeneration has been to monitor for signs of progression of macular degeneration and intervene if and when it becomes wet. The holistic approach starts with identifying and reducing those controllable risk factors. I work closely with the patient’s primary care team to identify the risk factors and mitigate the risks early on.

Should my primary care doctor be involved in the process of managing my risk factors?

Yes, absolutely. These days, patient care is a team approach. The health of your whole body is so important to the health of your eyes.

I have read that a proper diet helps with your vision. What is the role of nutrition in macular degeneration?

The macula is the most metabolically active, and metabolically demanding, tissue in our whole bodies. Therefore, it needs to be in tip-top shape to function at its best. Nutrients such as vitamins, minerals and antioxidants are required by our bodies to keep our cells functioning properly. Nowhere is that requirement more important than in our macula – we need good nutrition to keep our macula at its best.

My physician said I should eat foods that are high in antioxidants for eye health; what is an antioxidant? What foods are high in antioxidants?

An antioxidant is a nutrient that prevents oxidation, a process where a chemical compound in a cell loses electrons. Oxidation leads to toxic changes in proteins, membranes, and DNA, which can ultimately lead to injury to the cells and to eye disease. An antioxidant prevents oxidation. The retina contains high levels of antioxidant activity, and eating wholesome foods that are full of antioxidants – such as fruits and vegetables – can boost this protective activity. Some top sources of antioxidants include apples, berries, peppers, coffee, tea, and dark chocolate (without the sugar and fat, of course).

I’ve always heard carrots are good for your eyes, but wasn’t sure if this was just a myth. Are carrots actually good for your eyes? What else can I eat that will give me the same benefits as carrots?

It’s not a myth! Carrots contain a nutrient called beta-carotene, an orange-colored nutrient that the body converts to vitamin A. Vitamin A can control what genes are expressed on a day-to-day basis by cells in our body, including turning on the healthy signals in the retina. Vitamin A is also needed for the light-sensing function of the retina. Carrots are not the only source of vitamin A. Top sources of Vitamin A include sweet potatoes, pumpkin, squash, cantaloupe, salmon and trout; don’t limit yourself to just carrots.

A good healthy balanced diet with a wide variety of nutrients may help prevent and possibly reduce the progression of many eye conditions including macular degeneration. My book Healthy Vision is a resource for finding the right foods and nutrients.

Is there such thing as too much of a nutrient?

Definitely. Too much of a nutrient may be just as harmful as too little of a nutrient. Let’s take, for example, vitamin E. Vitamin E is a very powerful antioxidant that, at the appropriate dose, can protect the retina and may protect against macular degeneration. However, at high doses, vitamin E can increase the risk of bleeding complications and, more importantly, it can block other antioxidants. Taking a pill may not be right for everyone. It is certainly an easy one-size-fits-all solution, but nutrition for the eye is complex. I like to sit down with my patients to develop an approach tailored to their needs.

I read in your book that some of the research was done by astronauts. How is outer space research relevant to us?

Research in the International Space Station has identified nutritional weak links (mildly lowered levels of nutrients, the effects of which are compensated for by the body on Earth) related to eye disease. Specifically, astronauts with slightly lower levels of the nutrient folate in their bodies developed eye disease in space, while on Earth the eyes would adjust to compensate for the effects of nutritional strain. Over time, though, the nutritional strain may affect the health of the retina. This research emphasizes the importance of nutrition for good eye health. Folate, in this example, has such an important role in repairing damaged DNA in our bodies and reducing certain toxins in our cells that it may protect against many eye conditions, including macular degeneration. Oranges are full of folate; so are nuts, beans, broccoli, spinach, and papaya.

I’m an avid runner and was wondering if exercise helps your vision?

There are many health benefits of exercise. Increasing your blood flow is one of the top health benefits, and a recent research study showed that being physically active over a 20-year period decreases your risk of having poor vision by 60 percent. As part of a holistic approach and when combined with nutrition, exercise is a simple and powerful tool to healthy vision.

Should I wear sunglasses when I’m outside in the bright sun? Do I need ultraviolet (UV) protection for my retinas?

The surface of the eye naturally contains powerful UV blocking capability, so not much UV light actually gets inside the eye to the retina in the back. However, the heat energy from light gets into the eye, and the heat energy from the sun can burn the back of the eye. It makes sense to limit the heat energy from the sun with sunglasses. There are also nutrients that act like nature’s sunglasses, lutein and zeaxanthin. These nutrients are found in vegetables, and when we eat them, they get concentrated in the retina where they form a layer that protects our eyes from the damaging effects of the sun.

I’ve been diagnosed with wet macular degeneration, but do not want to get the injection treatment for it. Are there treatment options other than injections for wet macular degeneration?

Injections of various types of medicines, including antibody medications referred to as “anti-VEGF” drugs, are a mainstay of treatment for wet macular degeneration. However, there are other non-drug treatment options. There are various types of laser treatment available, including a very new form of micropulse laser. These treatment options depend on the type and features of the wet macular degeneration, so there is no one-size-fits-all treatment. It is important to evaluate the macular degeneration carefully and individually tailor a treatment option.

What should I do if I suspect I have macular degeneration or wish to prevent macular degeneration?

See your primary care doctor and your ophthalmologist. Treatment options are so individualized, it is important to take a holistic approach to preventing and treating macular degeneration, whether you’ve been diagnosed, are undergoing treatment, or are just concerned. This is important at all stages; if you have wet macular degeneration in one eye, it is also important to focus on prevention and protection for the other eye. As a note, you are always advised to seek medical care from a health care professional; the information above is a guide but not to be used for diagnosis, treatment, or as a substitute for professional medical care.

About Dr. Adams

Dr. Neal Adams is author of the new book Healthy Vision. He is a board-certified ophthalmologist and nationally-recognized leader in the field of retina. He is the former Chief of the Division of Visual Physiology at The Wilmer Eye Institute at Johns Hopkins. He spent 15 years at the Johns Hopkins University School of Medicine, where he trained and was invited to join the faculty. He was then recruited to Texas as Chairman of Ophthalmology at the new Foster School of Medicine. He returned back home to Maryland, where he has started his own practice focusing on the holistic approach to caring for patients.

Dr. Adams’ office is located at 2101 Medical Park Drive in Silver Spring. For more information, go to dcretina.com.

The office of Dr. Adams:

2101 Medical Park Drive, Suite 303
Silver Spring, MD 20902
301-754-1200