Research Bibliography

7. Cataract: Relationship Between Nutrition and Oxidation
Taylor A.
Journal of the American College of Nutrition, 1993 Apr, 12(2):138-46 Pub type: Journal Article; Review; Review, Tutorial. (UI: 93217072)

Abstract:
Opacification of the lens, or cataract, is causally related to the precipitation of proteins or other constituents upon aging. Proteins in the lens are unusually long lived and are subject to extensive damage, including (photo) oxidation. Accumulation of damaged proteins also appears to be due in part to attenuated activity of some proteolytic pathways, which in younger tissue may serve to identify and remove such moieties. The damaged proteins accumulate, aggregate, and precipitate.

Compared with other health problems, surgery to remove cataract and related visits to physicians consume the largest proportion of the Medicare budget, i.e., $3.2 billion annually in the United States. The situation is exacerbated in many parts of the world where there is a dearth of ophthalmologists to perform the required number of procedures. Historically efforts to delay cataract assumed a low profile in ophthalmologic research.

Recent data, however, indicate that consuming elevated levels of antioxidants such as ascorbate, carotenoids, and tocopherol is associated with delayed development of various forms of cataract. The same beneficial relationship to vision pertains to plasma antioxidant status and to fruit and vegetable intake.

Thus, it seems that assuring optimal antioxidant intake can extend lens function. It has been estimated that in the United States over half of the cataract extractions and associated costs would be obviated if cataract could be delayed by 10 years. The data reviewed indicate that optimizing nutrition will help achieve that objective.

8. Cataracts & N-Acetyl-Carnosine (NAC)
A study was designed to document and quantify the changes in lens clarity over 6 and 24 months in 2 groups of 49 volunteers (76 eyes) with an average age of 65.3 +/- 7.0 enrolled at the time of diagnosis of senile cataracts of minimal to advanced opacification.The patients received N-acetylcarnosine, 1% sol (NAC) (26 patients, 41 eyes = Group II), placebo composition (13 patients, 21 eyes) topically (two drops, twice daily) to the conjunctival sac, or were untreated (10 patients, 14 eyes); the placebo and untreated groups were combined into the control (reference) Group I.

Patients were evaluated upon entry, at 2-month (Trial 1) and 6-month (Trial 2)-intervals for best corrected visual acuity (b/c VA), by ophthalmoscopy and the original techniques of glare test (for Trial 1), stereocinematographic slit-image and retro-illumination photography with subsequent scanning of the lens. The computerized interactive digital analysis of obtained images displayed the light scattering/absorbing centers of the lens into 2-D and 3-D scales.

The intra-reader reproducibility of measuring techniques for cataractous changes was good, with the overall average of correlation coefficients for the image analytical data 0.830 and the glare test readings 0.998. Compared with the baseline examination, over 6 months 41.5% of the eyes treated with NAC presented a significant improvement of the gross transmissivity degree of lenses computed from the images, 90.0% of the eyes showed a gradual improvement in b/c VA to 7-100% and 88.9% of the eyes ranged a 27-100% improvement in glare sensitivity.

Topographic studies demonstrated less density and corresponding areas of opacification in posterior subcapsular and cortical morphological regions of the lens consistent with VA up to 0.3. The total study period over 24 months revealed that the beneficial effect of NAC is sustainable. No cases resulted in a worsening of VA and image analytical readings of lenses in the NAC-treated group of patients. In most of the patients drug tolerance was good. Group I of patients demonstrated the variability in the densitometric readings of the lens cloudings, negative advance in glare sensitivity over 6 months and gradual deterioration of VA and gross transmissivity of lenses over 24 months compared with the baseline and 6-month follow-up examinations.

Statistical analysis revealed the significant differences over 6 and 24 months in cumulative positive changes of overall characteristics of cataracts in the NAC-treated Group II from the control Group I.The N-acetylated form of natural dipeptide L-carnosine appears to be suitable and physiologically acceptable for nonsurgical treatment for senile cataracts.

Peptides 2001 Jun;22(6):979-94

9. Glutathione - Antioxidant (2000)
Glutathione, which is particularly concentrated in the lens, has been shown to have a hydroxyl radical-scavenging function in lens epithelial cells. Giblin FJ. Glutathione: a vital lens antioxidant. J Ocul Pharmacol Ther 2000 Apr; 16(2):121-35.

An age-dependent drop in glutathione blood status and a significantly lower level of glutathione has been found in older individuals compared to younger ones. Moreover, an increase of oxidized glutathione by-product over time suggests more oxidation and the incumbent higher risk of age-related eye diseases. Brubaker RF, et al. Ascorbic acid content of human corneal epithelium.

Invest Ophthalmol Vis Sci 2000 Jun;41(7):1681-3.

10. Glutathione Lens Transparency: Cataracts
The reducing compound glutathione (GSH) exists in an unusually high concentration in the lens where it functions as an essential antioxidant vital for maintenance of the tissue's transparency - and a protection against cataracts. In conjunction with an active glutathione redox cycle located in the lens epithelium and superficial cortex, GSH detoxifies potentially damaging oxidants such as H2O2 and dehydroascorbic acid.

Recent studies have indicated an important hydroxyl radical-scavenging function for GSH in lens epithelial cells, independent of the cells' ability to detoxify H2O2. Depletion of GSH or inhibition of the redox cycle allows low levels of oxidant to damage lens epithelial targets such as Na/K-ATPase, certain cytoskeletal proteins and proteins associated with normal membrane permeability. The level of GSH in the nucleus of the lens is relatively low, particularly in the aging lens, and exactly how the compound travels from the epithelium to the central region of the organ is not known.

Recently, a cortical/nuclear barrier to GSH migration in older human lenses was demonstrated by Sweeney et al. The relatively low ratio of GSH to protein -SH in the nucleus of the lens, combined with low activity of the glutathione redox cycle in this region, makes the nucleus especially vulnerable to oxidative stress, as has been demonstrated with use of in vivo experimental animal models such as hyperbaric oxygen, UVA light and the glutathione peroxidase knockout mouse. Effects observed in these models, which are currently being utilized to investigate the mechanism of formation of human senile nuclear cataract, include an increase in lens nuclear disulfide, damage to nuclear membranes and an increase in nuclear light scattering. A need exists for development of therapeutic agents to slow age-related loss of antioxidant activity in the nucleus of the human lens to delay the onset of cataracts.

J Ocul Pharmacol Ther 2000 Apr;16(2):121-35

11. Leafy Green Veggies Protect Eyes
In a recent study published in the December issue of the Journal of Nutrition, researchers examined the effects of lutein and zeaxanthin on samples of human eye lens cells in the laboratory. They also compared the effects of these antioxidants on the cells to the effects of another antioxidant thought to improve eye health, vitamin E. Researchers treated the cells with various concentrations of the antioxidants and then exposed them to ultraviolet radiation. "The dose of UVB radiation we used on the cells is about the same amount a person receives when they get a mild tan," says Bomser. Adding lutein and zeaxanthin to the cells reduced signs of ultraviolet damage by 50%-60%. Vitamin E reduced the same signs of damage by 25%-32%. "Lutein and zeaxanthin accumulate in the retina and in the lens of the eye, but we're not sure how they reach the eye in the first place," says Bomser. "They travel through the bloodstream, but the lens doesn't have a blood supply." This study provides new evidence that these antioxidants, which are found in plants such as spinach, kale, and collard greens, can indeed help prevent cataracts by protecting the eyes from the damaging effects of ultraviolet sunlight. Source: Chitchiumroonchokchai, C. Journal of Nutrition, December 2004; vol 134: pp 3225-3232

12. Lipoic acid - Cataracts
Studies have shown beneficial effects of lipoic acid treatment on cataracts in rats. It may be of therapeutic use in preventing human cataracts and their associated complications. Lipoic acid has also been used to treat glaucoma. Kilic F; Handelman GJ; Serbinova E; Packer L; Trevithick JR. Modelling cortical cataractogenesis 17: in vitro effect of a-lipoic acid on glucose-induced lens membrane damage, a model of diabetic cataractogenesis. Biochem Mol Biol Int, 1995 Oct, 37:2, 361-70

13. Long Term Lutein Supplementation Improves Visual Acuity in Age-Related Cataracts
In a 24-month study, visual acuity and glare sensitivity improved in the lutein group, with visual acuity significantly improved over baseline (p>005).

Olmedill B. et al: Lutein, but not alpha tocopherol, supplementation improves visual function in patients with age-related cataracts: A 2 year double-blind, placebo controlled study. Nutrition 19:21-24, 2003

14. Low levels of vitamin E
Low blood levels of vitamin E were associated with approximately twice the risk of both cortical and nuclear cataracts, compared to median or high levels. Vitale, et al. Epidemiology 1993 May;4(3):195-203

15. Low levels of vitamin E - Cataracts
Like low levels of beta-carotene, a low level of vitamin E also increases cataract risk and reduces photooxidation. Roberton, J.M. A possible role for vitamin C and E in cataract prevention. American Journal of Clinical Nutrition 53 (1991): 3465-3515

16. Lutein (1995) and Zeaxanthin - Cataracts & Cancer
(a) Xanthophylls Lutein and zeaxanthin) are the only carotenoids detected inhuman lens. Elevated plasma or nutrient intake levels of antioxidant vitamins, such as carotenoids, ... are associated with diminished risk for cataract... Elevated intake of spinach, which is high in lutein and zeaxanthin ..... was most consistently associated with a lower risk for cataract extraction. Elevations in lipid antioxidant status is associated with prolonged lens function.
(b) Xanthophylls are likely to eliminate the phototoxic blue light selectively. (c) There is a strong inverse association between elevated consumption of dark green vegetables, which are rich in lutein and zeaxanthin, and a decreased risk for oxidative stress related diseases such as cataract and cancer.
(d) Lutein and zeaxanthin are the only carotenoids that have been reported to be present in several sites of the human eye, such as the retina and the macula. Lutein and zeaxanthin are also the only carotenoids present inhuman lens. Consumption of spinach, which is rich in lutein and zeaxanthin showed a consistent inverse relationship with risk of cataract. Carotenoid intake is related to the risk for cataract. KJ Yeum etal, "Measurement of Carotenoids, Retinoids, and Tocopherols in Human Lenses," Investigative Ophthalmology and Visual Science, December, 1995, Vol. 36. No. 13, pp. 2756-2761.

17. lutein (1999) (dietary) and cryptoxanthin - Cataracts
Dietary lutein and cryptoxanthin were associated with 70% lower risk of nuclear cataracts in those under age 65. Lyle, et al. Am J Clin Nutr 1999 Feb;69(2):272-7

18. Lutein (1999) and Cataract Prevention
Harvard Study Shows Relationship Between Higher Intake of Lutein and Lower Incidence of Cataracts

Researchers at the Harvard Medical School now report that the carotenoids lutein and zeaxanthin may be particularly effective in preventing cataracts. Their studies involved almost 80,000 females nurses and over 35,000 male health professionals who were enrolled in 1980 and 1986 respectively. The female study group completed diet questionnaires in 1980 and 1984 and were then followed up until 1992 at which time 1471 cataract extractions had been performed. The male group completed diet questionnaires in 1986 and were followed up until 1994 at which time 840 cataract extractions had been performed.

The researchers found that nurses with a high intake of lutein and zeaxanthin had a 22 per cent lower risk of cataract extraction than did women with the lowest intake. Among the men, the 20 per cent with the highest intake had a 19 per cent lower risk when compared with the 20 per cent with the lowest intake. The researchers found a significant protective effect of spinach, kale and broccoli, but found no significant effects of other carotenoids and could not confirm a previously reported protective effect of vitamin A. They conclude that lutein and zeaxanthin may reduce the risk of cataract formation and recommend daily consumption of fruits and vegetables high in carotenoids. Chasan-Taber, Lisa, et al. A prospective study of carotenoid and vitamin A intakes and risk of cataract extraction in US women. American Journal of Clinical Nutrition, Vol. 70, October 1999, pp. 509-16 Brown, Lisa, et al. A prospective study of carotenoid intake and risk of cataract extraction in US men. American Journal of Clinical Nutrition, Vol. 70, October 1999, pp. 517-24 Mares-Perlman, Julie A. Too soon for lutein supplements. American Journal of Clinical Nutrition, Vol. 70, October 1999, pp. 431-2 (editorial)

19. Lutein, Zeaxanthin and Vitamin E Reduce Risk of Cataracts Jan. 2008 Study
An observational 10-year study of more than 35,000 middle-aged U.S. women observed the women’s use of dietary supplements and occurrence of cataracts.* The study found significant evidence that women who got more lutein, zeaxanthin and vitamin E were less likely to develop cataracts than women who are lacking intake of these nutrients. In fact, the women who got the most lutein, zeaxanthin and vitamin E were 18% less likely to get cataracts. Archives of Ophthalmology (Arch. Ophthalmol. 2008;126:102-9) gathered from the Women's Health Study.

20. N-Acetyl-Carnosine and Cataracts
Carnosine's best-known effect, however, is its ability to prevent the formation of advanced glycated end products (protein crosslinks). Carnosine competes with proteins for the binding sites they would occupy on sugar molecules, making it the best glycation preventative currently recognized in the world of nutrition research.

Carnosine has been found to significantly extend the life span of cultured cells and fruit flies, inhibit the toxic effects of the protein that accumulates in the brains of Alzheimer's patients, protect against the toxic effects of copper- zinc in the brain and enhance the state of balance (homeostasis) under which physiological systems work best. And, finally, it has been shown to prevent and/or reverse cataract.14,15

14. Quinn PJ, et al. Carnosine: its properties, functions and potential therapeutic applications. Mol Aspects Med 1992; 13(5):379-444. 15. Specht S, et al. Continuing damage to rat retinal DNA during darkness following light exposure. Photochem Photobiol 2000; 71(5):559-66.

When administered topically to the eye in the form of N-acetyl-L-carnosine-(functionally, a time-release form of carnosine), this dipeptide can move easily into both the water-soluble (aqueous) and lipid-containing parts of the eye. Once there, it helps to prevent DNA strand breaks induced by UV radiation and enhances DNA repair.16 Once it has entered the lipid areas of the eye, N-acetyl-L-carnosine partially breaks down and becomes L-carnosine.

Chinese and Russian researchers have studied cataract-preventive nutrients for nearly a decade. A Chinese study done by A.M. Wang in 1999, used 96 patients aged 60 years or older having senile cataracts of various degrees of maturity with the duration of the disease from 2 to 21 years. Patients instilled one to two drops of the carnosine-containing solution in each eye three to four times each day for a period of treatment ranging from three to six months. The level of eyesight improvement and the change of lens transparency were considered as an evaluation index of the curative effect of carnosine. The result showed that carnosine gives a pronounced effect on primary senile cataracts, the effective rate being 100%. For mature senile cataracts, the effect rate was 80%.17

17. Wang AM, et al. Use of carnosine as a natural anti-senescence drug for human beings. Department of Biochemistry and Department of Neurobiology, Harbin Medical University, China 1999.

The Russians most recent contribution was published in 2002 in the journal Drugs Research and Development.18 In two separate studies, they applied a one percent solution of N-acetyl-carnosine to the affected eyes of cataract patients twice a day. Only patients with mild cataracts-not anticipated to require surgery within the next two years-in one or both eyes were selected to participate. A matched control group received placebo drops, and another small matched group received no drops at all. The first study lasted six months, while the second continued for a total of 24 months. Tests of visual acuity and glare sensitivity were administered every two months in the first study and every six in the second.

After six months, a full 90% of eyes treated with N-acetyl-carnosine showed improvements in visual acuity ranging from 7% to 100%. Glare sensitivity improved 27% to 100% in 88.9% of carnosine recipients, and image analysis (a measurement of visual clarity) improved in 41.5% of treated eyes. Lens examination revealed fewer areas of lens opacity in the posterior subcapsular region. No worsening of vision was found in the eyes treated with N-acetylcarnosine, and all of these benefits were sustained through the 24 months that treatment continued.

These study results are evidence that N-acetyl-carnosine is one of the most important nutrients for cataract prevention. The entire body of research on carnosine reveals its promise as an anti-aging nutrient that works at several levels to protect multiple organ systems.

18. Babizhayev M, et al. Efficacy of N-acetylcarnosine in the treatment of cataracts. Drugs Research & Development 2002; 3(2):87-103.

21. NASA Study of Cataract in Astronauts (NASCA)
Cross-sectional data analysis revealed a small deleterious effect of space radiation for cortical cataracts and possibly for PSC cataracts. These results suggest increased cataract risks at smaller radiation doses than have been reported previously. SOURCE: Chylack LT Jr, Peterson LE, Feiveson AH, et al. NASA study of cataract in astronauts (NASCA). Report 1: Cross-sectional study of the relationship of exposure to space radiation and risk of lens opacity. Radiat Res 2009;172(1):10-20.

22. Riboflavin, vitamins C, E and carotene, niacin and thiamine
Dietary intake of riboflavin, vitamins C, E, and carotene, niacin, and thiamine significantly decreased the risk of all cataract types. Combining the different antioxidant nutrients produced the greatest effect. Leske, et al. Arch Ophthalmol 1991 Feb;109(2):244-51.

23. Smoking - Cataracts
Cigarette smoking causes about 20 percent of all cataracts. Men who smoke more than a pack a day increase their risk for cataracts by 205 percent.; for female smokers, risk increases 63 percent. Christan, W.G. et al. Cigarette smoking and the risks of cataract. Investigative Ophthalmology. In ARVO Abstracts, April 1991. Also, Christen, W.G., and Seddon, J.M. Cigarette smoking and cataract. American Journal of Preventive Medicine 9 (1993): 65-66.

24. Study Suggests Lutein and Zeaxanthin Offer Lens Protection
About 20 million Americans have vision-obstructing cataracts, with 500,000 new cases diagnosed annually. The estimated current cost of $3.4 billion annually to surgically extract cataracts is expected to increase along with the growing number of people over the age of 65. Among the risk factors associated with age-related cataracts, UV exposure and oxidative stress appear to be the most relevant. The lens is equipped with antioxidant mechanisms - such as glutathione peroxidase, vitamins C and E and carotenoids - to defend against the harmful effects of UV radiation and reactive oxygen species (ROS). Indeed, some epidemiologic studies suggest a reduced risk of developing various types of cataract with higher intake of vitamin C, E or lutein and zeaxanthin, the only carotenoids present in the lens and macula.

Although considerable efforts are being made to define the potential role of the xanthophylls lutein and zeaxanthin in the macula, information about their uptake and function in the lens is extremely limited. Epithelial cells, the outermost cellular layer of the lens, are exposed to UV irradiation not filtered by the cornea. UV-induced damage is mediated via production of ROS, and characterized by alterations in cell growth, morphology, changes in membrane potential, and oxidation of lipids, proteins and DNA. The present study examined the ability of xanthophylls to protect cultures of immortalized human lens epithelial cells (HLE) against UVB insult.

Results:

Cultured HLE cells accumulated xanthophylls and alpha tocopherol in a dose and time-dependent manner, with uptake of lutein exceeding that of zeaxanthin. Cultures were pretreated with either xanthophylls (2 µmol/L) or alpha tocopherol (10 µmol/L) for 4 hours, then exposed to 300 J/m2 UVB radiation - a dose roughly equivalent to that a person receives when they get a mild tan. Lipid peroxidation was observed to decrease by 47-57% compared with UVB-treated control cells.

The ability of xanthophylls and vitamin E to inhibit UVB-induced stress signaling was also assessed. Pretreatment with xanthophylls and alpha tocopherol inhibited UVB-induced activation of c-JUN NH2 terminal kinase and p38 activation by 50-60% and 25-32%, respectively. The concentration of Vitamin E required to significantly inhibit these stress signaling markers was roughly 10-fold higher than that of the xanthophylls, suggesting that xanthophylls are more potent for protecting HLE cells against UVB insult in this model.

Conclusions

According to the researchers from Ohio State University, their results are the first to provide physical evidence suggesting that lutein and zeaxanthin decrease damage caused by UV radiation. "In addition to protective enzymes and compounds like vitamins C and E, we think that low concentrations of lutein and zeaxanthin in the eye's lens help shield the eye from the harmful effects of UVB radiation", they stated in a post-publication interview.

Reference

1. Jacques PF. The potential preventive effects of vitamins for cataract and age-related macular degeneration. Int J Vitam Nutr Res 69: 198-205, 1999.
2. Taylor A et al. Long-term intake of vitamins and carotenoids and odds of early age-related cortical and posterior subcapsular lens opacities. American Journal of Clinical Nutrition 75:540-9, 2002.
3. Chasen-Taber et al. A prospective study of carotenoid and vitamin A intakes and risk of cataract extraction in US women. American Journal of Clinical Nutrition 70:509-516, 1999.
4. Alves-Rodrigues A and Shao A. Review. The Science Behind Lutein. Toxicology Letters 150:57-83, 2004
5. Chitchumroonchokchai C et al. Xanthophylls and alpha tocopherol decrease UVB-induced lipid peroxidation and stress signaling in human lens epithelial cells. Journal of Nutrition 134:3225-32, 2004.

25. Sugar can impair the lens
All types of sugars, not just white sugar, can impair the len’s ability to keep itself clear. Gaby, A.R., and Wright, J.V. Nutritional Factors in Degenerative Eye Disorders: Cataract and Macular Degeneration. Wright/Gaby Nutritional Institute, 1991.

26. Vitamin A - Cataracts
In the Nurses Health Study, a large cohort of nurses had been following for almost 20 years. In this longitudinal study, increased dietary intake of Vitamin A was associated with a 39% reduction in risk of cataract extraction. Hankinson, S.E. Stampfer, M.J. et al. BMJ Vol.305,1992.

27. Vitamin A - Cataracts
In the Nutrition and Eye Disease Study, moderate levels of Vitamin A intake were associated overall with a 40% decreased risk of nuclear sclerotic opacity (p=0.0002). This risk was adjusted for age, sex, smoking, and heavy drinking. Among smokers, risk of cataract was reduced 50%. Mares-Perelman, J.A., Klein, B.E.K., et al. Relationship Between Lens Opacities and Vitamin and Mineral Supplement Use. Ophthalmology 1944;101:315-325.

28. Vitamin C - cataracts
The vitamin C content of the eye is 20 times greater than that in the blood. Results from some studies including the Beaver Dam Eye Study, suggest that people with high levels of vitamin C are at less risk of cataracts than those with low levels of vitamin C. Mares Perlman JA; Brady WE; Klein BE; Klein R; Haus GJ; Palta M; Ritter LL; Shoff SM. Diet and nuclear lens opacities. Am J Epidemiol, 1995 Feb, 141:4, 322-34

29. Vitamin C - Cataracts
In studies done since 1935, vitamin C has been shown to prevent and even reverse the negative effects of sugar on the eyes. Blondin, J., Baragi, V.K., Schwartz, E.R., Sadowski, J., and Taylor, A. Prevention of eye lens protein damage by dietary vitamin C. Federal Prodceedings 45 (1986): 478.

30. Vitamin C - cataracts & opacities
Subjects taking vitamin C supplements for more than 10 years had a 77% lower risk of early lens opacities (cataracts) and 83% lower risk of moderate lens opacities. Jacques, et al. The American Journal of Clinical Nutrition, Oct. 1997

31. Vitamin C - Cataracts (NHS)
Further results from the Nurses Health Study this study reported in 1997 in the American Journal of Clinical Nutrition also suggests that vitamin C supplements taken for long periods can reduce the development of cataracts. Researchers from the US Department of Agriculture and Harvard School of Public Health examined the link between cataract development and vitamin C supplement use over a ten to 12 year period. The subjects were 247 Boston area nurses aged from 56 to 71. The researchers performed detailed eye examinations to determine the degree of opacity (clouding) of the lenses of the eyes of the subjects. Results showed that use of vitamin C supplements for over ten years was associated with a 77 per cent lower prevalence of early lens opacities and an 83 per cent lower prevalence of moderate lens opacities. Jacques PF; Taylor A; Hankinson SE; Willett WC; Mahnken B; Lee Y; Vaid K; Lahav M. Long-term vitamin C supplement use and prevalence of early age-related lens opacities. Am J Clin Nutr, 1997 Oct, 66:4, 911-6

32. Vitamin C and Bioflavenoids Help Prevent Cataracts
Two studies show significant reductions in cataracts for those in the highest percentage of vitamin C intake.

In the first study, Japanese researchers followed 35,000 people. They evaluated the participants for their vitamin C intake and cataract formation. They found that those in the highest 20% of vitamin C intake had a 40% reduced risk of getting cataracts.

The second study followed 177 (116 women, 61 men) participants over the age of 60. In this study, the researchers found that if you are in the top 5% of vitamin C intake, your risk is reduced some 20% compared to the lowest 5%.

But that's not all this study found. If you ingest more than 3,290 mcg daily of lutein, your risk drops 14% compared to ingesting less than 256 mcg daily. Zeaxanthin had a smaller risk reduction, but mostly in men.

Interestingly, the study also found that sunlight exposure is also a major risk factor. If you were out in the sun a lot in your early years, your risk triples compared to being closeted indoors.

Ref: International Journal for Vitamin and Nutrition Research, 2006; 76(6); Nutr, 2007 January 30.

33. Vitamin C May Also Offer Protection Against Cataracts
The journal Ophthalmic Epidemiology published research regarding their study of age-related cataracts just this past April. The findings showed that higher plasma levels of Vitamin C reduced the prevalence of nuclear and posterior subcapsular cataracts.

1. Ferrigno L, Aldigeri R, Rosmini F, Sperduto RD, Maraini G; The Italian-American Cataract Study Group. Associations between plasma levels of vitamins and cataract in the Italian-American Clinical Trial of Nutritional Supplements and Age-Related Cataract (CTNS): CTNS Report #2. Ophthalmic Epidemiol. 2005 Apr;12(2):71-80.

34. Vitamin C Might Prevent Cataracts in Women
BOSTON, Feb 22, 2002 (United Press International via COMTEX) -- Women who take vitamin C supplements during their younger and middle-age years may reduce their chances of cataracts later in life, according to a new study released Friday. Researchers led by Allan Taylor of Tufts University in Boston came to that conclusion after analyzing data from the Nurses Health Study, an on-going study based on a group of women nurses in the Boston area whose diet, lifestyle and health status have been followed for the past 26 years. They looked at 492 non-diabetic study participants ages 53 to 73 and reviewed their diets, particularly their long-term vitamin supplement intake, extracted from food questionnaires dating from 1980 up to 1995. All of the women underwent eye examinations to screen for a variety of cataracts. Thirty-four percent of the group was found to have cortical opacities, a type of cataract where the fiber cells of the cortex deteriorate. Study results showed that among women age 60 and younger, daily vitamin C intake from both diet and supplements during the previous 13 to 15 years of the woman's life significantly minimized the chances of developing that one type of cataract. Among women younger than 60, consumption of 362 milligrams daily of vitamin C was linked with a 57 percent drop in cortical opacities. Routine use of vitamin C supplements for at least a decade was associated with an overall 60 percent reduction in cataracts when compared to no vitamin supplement use. Researchers also found women who never smoked and had high intakes of the nutrients folate and carotenoids also showed a reduction in cataracts. The findings suggest certain nutrients, when taken consistently and regularly throughout life, could potentially decrease the chances of one of the most common age-related conditions. The study is published in Friday's issue of American Journal of Clinical Nutrition.

35. Vitamin E - Cataracts
The Lens Opacity Case Control1 and Study and a Canadian study by Robertson, Donner and Trevithic2 each suggested about a 40-45% descreased risk of cataract or opacity with higher vitamin E intake through diet or supplement use.1 Leske MC, Chylack LT Jr, Wu S. The lens opacities case control study:risk factors for cataract. Arch Ophthalmol 1991;109;244-251. 2Robertson JM, Donner AP, Trevithick JR. A possible role for vitamins C and E in cataract prevention. Am J Clin Nutr 1991;53:346S-351S.

36. Vitamin E and Cataract Prevention 2008 Study
An observational 10-year study of more than 35,000 middle-aged U.S. women observed the women’s use of dietary supplements and occurrence of cataracts. The study found significant evidence that women who got more lutein, zeaxanthin and vitamin E were less likely to develop cataracts than women who are lacking intake of these nutrients. In fact, the women who got the most lutein, zeaxanthin and vitamin E were 18% less likely to get cataracts. These nutrients are hot topics in research right now, including the ongoing AREDS II study. Ref: *Christen, W. Archives of Ophthalmology, January 2008; vol 126: pp 102-109. WebMD Medical News: "Nutrients May Help Save Eyes." National Institutes of Health Office of Dietary Supplements: "Vitamin E." News release, JAMA/Archives.

37. Vitamin E, C, alpha-lipoic acid and taurine
Vitamin E, vitamin C, alpha-lipoic acid, and taurine appear to offer protection against lens damage caused by low level radiation. Bantseev, et al. Biochem Mol Biol Int 1997 Sept;42(6):1189-97.

Celiac Disease

1. Celiac Disease research summaries
Also see discussion of research

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6. Mora S, Barera G, Ricotti A, et al. Reversal of low bone density with a gluten-free diet in children and adolescents with celiac disease. Am J Clin Nutr 1998;67:477–81.
7. Mora S, Barera G, Beccio S, et al. Bone density and bone metabolism are normal after long-term gluten-free diet in young celiac patients. Am J Gastroenterol 1999;94:398–403.
8. McFarlane XA, Bhalla AK, Robertson DAF. Effect of a gluten free diet on osteopenia in adults with newly diagnosed coeliac disease. Gut 1996;39:180–4.
9. Baker PG, Read AE. Reversible infertility in male coeliac patients. BMJ 1975;2:316–7.
10. Sewell P, Cooke WT, Cox EV, Meynell MJ. Milk intolerance in gastrointestinal disorders. Lancet 1963;2:1132–5.
11. Haeney MR, Goodwin BJF, Barratt MEJ, et al. Soya protein antibodies in man: their occurrence and possible relevance in coeliac disease. J Clin Pathol 1982;35:319–22.
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13. Ament ME, Rubin CE. Soy protein—another cause of the flat intestinal lesion. Gastroenterology 1972;62:227–34.
14. Auricchio S, Follo D, de Ritis G, et al. Does breast feeding protect against the development of clinical symptoms of celiac disease in children? J Pediatr Gastroenterol Nutr 1983;2:428–33.
15. Udall JN, Colony P, Fritze L, et al. Development of gastrointestinal mucosal barrier. II. The effect of natural versus artificial feeding on intestinal permeability to macromolecules. Pediatr Res 1981;15:245–9.
16. Connon JJ. Celiac disease. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Philadelphia: Lea & Febiger, 1994, 1062.
17. Crofton RW, Glover SC, Ewen SWB, et al. Zinc absorption in celiac disease and dermatitis herpetiformis: a test of small intestinal function. Am J Clin Nutr 1983;38:706–12.
18. Solomons NW, Rosenberg IH, Sandstead HH. Zinc nutrition in celiac sprue. Am J Clin Nutr 1976;29:371–5.
19. Rude RK, Olerich M. Magnesium deficiency: possible role in osteoporosis associated with gluten-sensitive enteropathy. Osteoporos Int 1996;6:453–61.
20. Russell RM, Smith VC, Multak R, et al. Dark-adaptation testing for diagnosis of subclinical vitamin-A deficiency and evaluation of therapy. Lancet 1973;2:1161–4.
21. Basha B, Rao S, Han ZH, Parfitt, AM. Osteomalacia due to vitamin D depletion: neglected consequence of intestinal malabsorption. Am J Med 2000;108(4):296–300.
22. O’Mahony S, Howdle PD, Losowsky MS. Review article: management of patients with non-responsive coeliac disease. Aliment Pharmacol Ther 1996;10:671–80 [review].
23. Hallert C, Astrom J, Walan A. Reversal of psychopathology in adult celiac disease with the aid of pyridoxine (vitamin B6). Scand J Gastroenterol 1983;18:299–304.
24. Patel RS, Johlin FC Jr, Murray JA. Celiac disease and recurrent pancreatitis. Gastrointest Endosc 1999;50:823–7.
25. Carroccio A, Iacono G, Montalto G, et al. Pancreatic enzyme therapy in childhood celiac disease. A double-blind prospective randomized study. Dig Dis Sci 1995;40:2555–60.

Chronic Fatigue Syndrome (CFS)

1. Chronic Fatigue Syndrome research listing
1. De Lorenzo F, Hargreaves J, Kakkar VV. Pathogenesis and management of delayed orthostatic hypotension in patients with chronic fatigue syndrome. Clin Auton Res 1997;7:185–90.
2. Fulcher KY, White PD. Randomised controlled trial of graded exercise in patients with the chronic fatigue syndrome. Br Med J 1997;314:1647–52.
3. McCully KK, Sisto SA, Natelson BH. Use of exercise for treatment of chronic fatigue syndrome. Sports Med 1996;21:35–48 [review].
4. Blackwood SK, MacHale SM, Power MJ, et al. Effects of exercise on cognitive and motor function in chronic fatigue syndrome and depression. J Neurol Neurosurg Psychiatry 1998;65:541–6.
5. LaManca JJ, Sisto SA, DeLuca J, et al. Influence of exhaustive treadmill exercise on cognitive functioning in chronic fatigue syndrome. Am J Med 1998;105:59S–65S.
6. Paul L, Wood L, Behan WM, et al. Demonstration of delayed recovery from fatiguing exercise in chronic fatigue syndrome. Eur J Neurol 1999;6:63–9.
7. Clapp LL, Richardson MT, Smith JF, et al. Acute effects of thirty minutes of light-intensity, intermittent exercise on patients with chronic fatigue syndrome. Phys Ther 1999;79:749–56.
8. Shaw DL, Chesney MA, Tullis IF, Agersborg HPK. Management of fatigue: a physiologic approach. Am J Med Sci 1962;243:758–69.
9. Crescente FJ. Treatment of fatigue in a surgical practice. J Abdom Surg 1962;4:73.
10. Hicks J. Treatment of fatigue in general practice: a double-blind study. Clin Med 1964;Jan:85–90.
11. Formica PE. The housewife syndrome: treatment with the potassium and magnesium salts of aspartic acid. Curr Ther Res 1962;Mar:98–106.
12. Kaufman W. The use of vitamin therapy to reverse certain concomitants of aging. J Am Geriatr Soc 1955;3:927–36.
13. Ellis FR, Nasser S. A pilot study of vitamin B12 in the treatment of tiredness. Br J Nutr 1973;30:277–83.
14. Lawhorne L, Rindgahl D. Cyanocobalamin injections for patients without documented deficiency. JAMA 1989;261:1920–3.
15. Gaby AR. Literature Review & Commentary. Townsend Letter for Doctors & Patients 1997;Feb/Mar:27 [review].
16. Lapp CW, Cheney PR. The rationale for using high-dose cobalamin (vitamin B12). CFIDS Chronicle Physicians’ Forum 1993;Fall:19–20.
17. Heap LC, Peters TJ, Wessely S. Vitamin B status in patients with chronic fatigue syndrome. J R Soc Med 1999;92:183–5.
18. Kuratsune H, Yamaguti K, Takahashi M, et al. Acylcarnitine deficiency in chronic fatigue syndrome. Clin Infect Dis 1994;18(suppl 1):S62–7.
19. Plioplys AV, Plioplys S. Amantadine and L-carnitine treatment of chronic fatigue syndrome. Neuropsycholbiol 1997;35:16–23.
20. Forsyth LM, Preuss HG, MacDowell AL, et al. Therapeutic effects of oral NADH on the symptoms of patients with chronic fatigue syndrome. Ann Allergy Asthma Immunol 1999;82:185–91.
21. Cox IM, Campbell MJ, Dowson D. Red blood cell magnesium and chronic fatigue syndrome. Lancet 1991;337:757–60.
22. Howard JM, Davies S, Hunnisett A. Magnesium and chronic fatigue syndrome. Lancet 1992;340:426.
23. Clague JE, Edwards RH, Jackson MJ. Intravenous magnesium loading in chronic fatigue syndrome. Lancet 1992;340:124–5.
24. Gantz NM. Magnesium and chronic fatigue. Lancet 1991;338:66 [letter].
25. Hinds G, Bell NP, McMaster D, McCluskey DR. Normal red cell magnesium concentrations and magnesium loading tests in patients with chronic fatigue syndrome. Ann Clin Biochem 1994;31(Pt. 5):459–61.
26. Kuratsune H, Yamaguti K, Sawada M, et al. Dehydroepiandrosterone sulfate deficiency in chronic fatigue syndrome. Int J Mol Med 1998;1:143–6.
27. De Becker P, De Meirleir K, Joos E, et al. Dehydroepiandorsterone (DHEA) response to i.v. ACTH in patients with chronic fatigue syndrome. Horm Metab Res 1999;31:18–21.
28. Bou-Holaigah I, Rowe PC, Kan J, Calkins H. The relationship between neurally mediated hypotension and the chronic fatigue syndrome. JAMA 1995;274:961–7.
29. Whorwood CB, Shepard MC, Stewart PM. Licorice inhibits 11ß-hydroxysteroid dehydrogenase messenger ribonucleic acid levels and potentiates glucocorticoid hormone action. Endocrinology 1993;132:2287–92.v 30. Baschetti R. Chronic fatigue syndrome and liquorice. New Z Med J 1995;108:156–7 [letter].
31. Brown D. Licorice root—potential early intervention for chronic fatigue syndrome. Quart Rev Natural Med 1996;Summer:95–7.
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Computer Eye Strain

1. AOA Advises Daily Computer Users of the Risk of Computer Vision Syndrome
The AOA advises Americans who use computers daily at work or at home that they should be aware of the possibility of computer vision syndrome (CVS), which leaves them vulnerable to problems like dry eye, eye strain, neck and/or backaches, light sensitivity and fatigue. These symptoms can result from individual visual problems, poor work station configuration or improper work habits. According to the AOA's American Eye-Q survey of 1,005 Americans 18 years and older, 82 percent of respondents frequently work with a computer or a handheld electronic device and 42 percent spent three or more hours a day in front of a computer or handheld device. Additionally, 78 percent of Americans do not have their computer monitor positioned at the correct height (below eye level). Pre-existing uncorrected vision problems like hyperopia and astigmatism, inadequate eye focusing or eye coordination abilities and age-related eye issues may contribute to CVS, and the constant refocusing effort required while working at a computer stresses the eye muscles, affecting individuals' comfort and productivity. Forty-one percent of survey respondents have experienced eye strain; 45 percent have had neck or back pain after prolonged computer or handheld device use. Although many of these symptoms are temporary, some may continue experiencing visual problems, such as such as blurred distance vision, even after computer work has stopped. Yet only 11 percent of respondents said that they currently use special computer glasses or computer screen filters to help reduce glare and discomfort. The AOA's guidelines for preventing or reducing computer vision syndrome include having vision checked regularly, limiting the amount of continuous time before the computer, checking the arrangement and height of the monitor, checking the screen for glare, reducing the amount of lighting in the room to match the screen and reminding oneself to blink frequently.

2. Glaucoma (2004) linked to Heavy Computer Use
Spending too much time looking at a computer screen may raise your risk of the vision-robbing eye disease glaucoma, particularly if you're nearsighted, according to a new Japanese study. Glaucoma is a group of eye diseases that ultimately cause damage to the optic nerve. It can lead to blindness if not treated. Heavy computer users who were farsighted or nearsighted seemed to have a higher risk for visual field abnormalities, say the researchers. Source: Journal of Epidemiology and Community Health, December 2004; vol 58: pp 1021-1027

3. Lutein and Computer Eye Strain
A new study from Beijing-based researchers, published in the British Journal of Nutrition, has noted improvements in the sensitivity to contrast on a computer screen in subjects taking lutein! Thirty-seven healthy subjects between the ages of 22 and 30 with long-term computer display light exposure were studied. The subjects were observed following 12 weeks of lutein supplementation. There was a trend towards improved visual acuity and measures of contrast sensitivity in the subjects taking lutein verse the placebo group. The study concluded that “a higher intake of lutein may have beneficial effects on the visual performance. For abstract Click Here Editor's Note: Lutein is now added to the Astaxanthin as two nutrients that can help reduce Computer Eye Strain. For more information on what you can do to reduce and help prevent Computer Eye Strain, go to www.naturaleyecare.com/diseases.asp?d_num=14

4. Lutein, blackcurrant extract may reduce visual fatigue (2009)

Visual fatigue such as computer eye strain caused by staring at the computer for long hours, may be eased a daily supplement containing blackcurrant fruit extract (200 mg), lutein (5 mg), and zeaxanthin (1 mg), according to a randomized, double-blind, placebo-controlled cross-over trial.

The subjects were randomly assigned to receive either the lutein supplement, or placebo, for two weeks, followed by two weeks of washout, and a further two weeks with the opposite intervention.

After completing a two hour visual proof reading task, the researchers measured signs of visual fatigue, including so-called eye fixation related potentials (EFRP).

Source: Applied Ergonomics
Volume 40, Issue 6, Pages 1047-1054
“The effect of lutein supplementation on visual fatigue: A psychophysiological analysis”
Authors: A. Yagi, K. Fujimoto, K. Michihiro, B. Goh, D. Tsi, H. Nagai

5. Reducing Asthenopia (2002-2006 Studies) with Astaxanthin

A couple of randomized double blind placebo controlled pilot studies demonstrated the positive effects of astaxanthin supplementation on visual function. For example, a study by Nagaki et al., (2002), demonstrated that subjects (n=13) who received 5 mg astaxanthin per day for one month showed a 54% reduction of eye fatigue complaints. In a sports vision study led by Sawaki et al., they demonstrated that depth perception and critical flicker fusion had improved by 46% and 5% respectively on a daily dose of 6 mg (n=9). The effect of astaxanthin on visual performance prompted a number of other clinical studies to evaluate the optimum dose and identify the mechanism of action.

A study by Nakamura (2004), demonstrated significant improvements in reducing asthenopia and positive accommodation for the 4 mg (p<0.05) and 12 mg (p<0.01) groups. However, it was not until Nitta et al., (2005), who established the optimum daily dose at 6 mg (n=10) for a period of 4 weeks by comparing eye fatigue using a visual analogue scale (VAS) based questionnaire and accommodation values. Overall, the 6 mg group improved significantly better at week 2 and 4 of the test period. Furthermore, questionnaire results obtained by Shiratori et al., (2005) and Nagaki et al., (2006), also confirmed the previous findings that astaxanthin supplementation at 6 mg for 4 weeks improved symptoms associated with tiredness, soreness, dryness and blurry vision. Another study by Takahashi & Kajita (2005), also demonstrated that astaxanthin attenuates induced-eye fatigue, as opposed to treating eye fatigue, which suggests prevention rather than treatment. Astaxanthin treated groups (asthenopia negative) were able to recover quicker than the control group after heavy visual stimulus. Later, Iwasaki & Tawara (2006) also confirmed the same tendencies of subjective eye fatigue complaints in a randomized double-blind placebo controlled double-crossover study.

6. Studies Show Astaxanthin Reduces Eye Strain (Asthenopia)

A number of Japanese research studies show the benefit of supplementing with Astaxanthin in reducing eye strain and related symptoms.

A couple of randomized double blind placebo controlled pilot studies demonstrated the positive effects of astaxanthin supplementation on visual function. For example, a study by Nagaki et al., (2002), demonstrated that subjects (n=13) who received 5 mg astaxanthin per day for one month showed a 54% reduction of eye fatigue complaints.

In a sports vision study led by Sawaki et al., they demonstrated that depth perception and critical flicker fusion had improved by 46% and 5% respectively on a daily dose of 6 mg (n=9). The effect of astaxanthin on visual performance prompted a number of other clinical studies to evaluate the optimum dose and identify the mechanism of action.

A study by Nakamura (2004), demonstrated significant improvements in reducing asthenopia and positive accommodation for the 4 mg (p<0.05) and 12 mg (p<0.01) groups. However, it was not until Nitta et al., (2005), who established the optimum daily dose at 6 mg (n=10) for a period of 4 weeks by comparing eye fatigue using a visual analogue scale (VAS) based questionnaire and accommodation values. Overall, the 6 mg group improved significantly better at week 2 and 4 of the test period.

Furthermore, questionnaire results obtained by Shiratori et al., (2005) and Nagaki et al., (2006), also confirmed the previous findings that astaxanthin supplementation at 6 mg for 4 weeks improved symptoms associated with tiredness, soreness, dryness and blurry vision. Another study by Takahashi & Kajita (2005), also demonstrated that astaxanthin attenuates induced-eye fatigue, as opposed to treating eye fatigue, which suggests prevention rather than treatment.

Astaxanthin treated groups (asthenopia negative) were able to recover quicker than the control group after heavy visual stimulus. Later, Iwasaki & Tawara (2006) also confirmed the same tendencies of subjective eye fatigue complaints in a randomized double-blind placebo controlled double-crossover study.

Crohn's Disease

1. Crohn’s Disease
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Diabetes Mellitus

1. Diabetes Mellitus
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Diabetic Retinopathy

1. Alpha lipoic acid (1997) - Diabetic Retinopathy, Cataracts
Alpha Lipoic Acid can significantly reduce diabetic cataract formation, as well as neuropathy, and would seem to be an ideal neuroprotective substance in the treatment of all oxidative brain and neural disorders involving free radical processes. Packer, L., Ann N y Acad Sci 1994 Nov 17;738:257-64. Packer, L. Free Radic Biol Med 1997;22(1-2):359-78

2. Anthocyanosides, Vascular Permeability and Reduced Hemorrhaging (1981)
Thirty one patients with various types of retinopathy who were put on anthocyanosides showed a positive influence on both vascular permeability and resistance to hemorrhage. Those with diabetic retinopathy had the largest effect. Long term use of these plant nutrients is helpful in improving vascular permeability. Sharrer A. & Ober M. Klin Monatsbl Augenheilkd 1981 May;178(5):386-9 and Neumann, Munch Med Wochenschr 1973 May 18;115(20):952-4

3. Bilberry extract (1987) - diabetic retinopathy
79% of 37 patients with visible diabetic retinal abnormalities improved after taking 160 mg of bilberry extract twice daily, compared to 0% of the placebo control group, and 86% of those with abnormalities of angiography findings showed moderate to considerable improvement. Perossini, et al. Ann Ottalmol Clin Ocul 1987.

4. Bilberry extracts (1995-7) - diabetic retinopathy
(a) Studies confirmed the folk beliefs that bilberry extracts could improve visual acuity and lead to faster visual adjustments between light (eg, glare and darkness, ref 2). European physicians recommend bilberry extracts for other eye complaints (eg, retinitis pigmentosa, diabetic retinopathy). (pg. 1), (b) An experiment using a preparation of anthocyanosides from bilberry ... indicated vaso-protective and anti-edema effects in ... animals. (ref. 3) When vascular permeability is increased in rabbits .. A treatment of anthocyanosides from bilberry decreases vascular permeability. This is achieved when the drug interacts with collagen to increase its cross-links., c) Administration of anthocyanosides ... maintains normal blood barrier permeability and limits the increase in vascular permeability. "Topic: Bilberry Fruit," The Lawrence Review of Natural Products, October 1995, Pages 1-2.

12. Lipoic acid may be beneficial in improving nerve blood flow, reducing oxidative stress, and improving nerve conduction in diabetic neuropathy.3 The effects of lipoic acid on diabetic neuropathy have been studied in two German randomized, double-blind, placebo-controlled trials. In the first of these, 328 patients with Type II diabetes and symptoms of peripheral neuropathy were treated with either intravenous infusion of lipoic acid or placebo for three weeks. The results showed improvements in symptoms. In another study, patients with Type II diabetes and cardiac autonomic neuropathy were treated with a daily oral dose of 800 mg lipoic acid or placebo for four months. Two out of four symptoms test measurements were significantly improved in those taking the lipoic acid compared with placebo. Ziegler D; Gries FA. Alpha-lipoic acid in the treatment of diabetic peripheral and cardiac autonomic neuropathy. Diabetes, 1997 Sep, 46 Suppl 2:, S62-63-61

5. Bioflavenoids (1996) - diabetic retinopathy
Bioflavonoids were found to normalize blood vessels' permeability in diabetic patients. Valenci, et al. Diabet Med 1996 Oct;13(10):882-8

6. Chromium supplements (1995)
73% of type I and II diabetics who took chromium supplements reduced their requirement for insulin or oral hypoglycemic agents. Taking chromium and niacin together reduced fasting blood sugar levels and improved glucose tolerance. J Trace Elem Exp Med 1995: 8:183-90; Urberg M, Zemel MB, Metabolism 1987; 36:896-99

7. Chromium, (1997) vitamin E, magnesium, soluble fiber and taurine
Chromium, high-dose vitamin E, magnesium, soluble fiber, and possibly taurine appear likely to lessen risk for macrovascular disease (retinopathy) in diabetics. McCarty, Med Hypothesis 1997 Aug;49(2):143-52

8. Diabetic Retinopathy Occurs in Prediabetes
Diabetic retinopathy has been found in nearly 8 percent of pre-diabetic participants in the Diabetes Prevention Program (DPP), according to a report presented today at the American Diabetes Association's 65th Annual Scientific Sessions. Pre-diabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. The condition is sometimes called "impaired fasting glucose (IFG)" or "impaired glucose tolerance (IGT)," depending on the test used to diagnose it. People with pre- diabetes have an increased risk of developing type 2 diabetes, heart disease, and stroke.

9. Essential Fatty Acids - diabetic retinopathy
Evening primrose, borage and black currant oil are good sources of Omega-6 essential fatty acids including gamma-linolenic acid (GLA). Supplementation with GLA may offer a method to bypass the disturbance in omega-6 essential fatty acid metabolism associated with diabetes and diabetic retinopathy.(5) 5. Petrosian AM, Haroutounian JE, Adv Exp Med Biol 1998;442:407-13.

10. Ginkgo Biloba and Diabetic Retinopathy
According to the following double blind study, gingko biloba can help improve diabetic retinopathy by improving the flow of blood to the brain and extremeties. Lanthony P, Cosson JP. Evolution of color vision in diabetic retinopathy treated by extract of Ginkgo biloba. J Fr Ophthalmol 1988;11:671–74 [in French].

11. Gymnema Sylvestre and Diabetes Study

The Journal of Ethnopharmacology recently published a small study out of India that examined the effects of an extract of the leaves of Gymnema sylvestre on high blood sugar. Twenty-two people with type 2 diabetes were given 400 milligrams of the extract for 18 to 20 months as a supplement to their regular medical regimen of oral anti-hyperglycemic agents.

During that period, an unspecified number of the patients apparently showed significant reductions in blood glucose and A1c's. Five of them were reportedly able to discontinue their conventional anti-hyperglycemic drug and manage their blood glucose levels with the extract alone. Moreover, raised insulin levels were apparently found in the blood of the patients.

The authors, who published related research in 1990 in the same journal, believe that beta cell regeneration is the source of the improvement; however, members of the scientific community have previously questioned both their findings and their conclusions.

Sources: Journal of Ethnopharmacology

12. High serum levels of magnesium
Diabetic patients with high serum magnesium levels were less likely to develop severe diabetic retinopathy compared to those with low levels. Diabetes 1978 Nov;27(11):1075-7

13. Lipoic acid - diabetic retinopathy
Lipoic acid has been used to treat diabetics by improving glucose transport and metabolism.1 High intakes may increase the absorption of glucose into muscle tissue in Type II diabetes.2 Lipoic acid may also decrease the damaging effects on proteins of high glucose levels. Lipoic acid may be beneficial in improving nerve blood flow, reducing oxidative stress, and improving nerve conduction in diabetic neuropathy.3 The effects of lipoic acid on diabetic neuropathy have been studied in two German randomized, double-blind, placebo-controlled trials. In the first of these, 328 patients with Type II diabetes and symptoms of peripheral neuropathy were treated with either intravenous infusion of lipoic acid or placebo for three weeks. The results showed improvements in symptoms. In another study, patients with Type II diabetes and cardiac autonomic neuropathy were treated with a daily oral dose of 800 mg lipoic acid or placebo for four months. Two out of four symptoms test measurements were significantly improved in those taking the lipoic acid compared with placebo. Ziegler D; Gries FA. Alpha-lipoic acid in the treatment of diabetic peripheral and cardiac autonomic neuropathy. Diabetes, 1997 Sep, 46 Suppl 2:, S62-63-61

14. Low magnesium levels - diabetic retinopathy
Low magnesium levels might increase the risk of ischemic heart disease and severe retinopathy in diabetics, while chromium increases insulin sensitivity and raises the 'good' HDL cholesterol. Tuvemo, T. Pediatrician 1983-85;12(4):213-9

15. Low serum carotenoid levels
Low serum carotenoid levels were found to be directly related to an increased risk for diabetes and insulin resistance. Ford, et al. Am J Epidemiol 1999 Jan 15;149(2):168-76

16. Taurine - diabetic retinopathy
Diabetes increases the retina’s requirements for taurine. Glucose rapidly and specifically decreases taurine content in retinal pigment epithelial cells. (10) Uptake of taurine is increased in the retina and retinal pigment epithelium with higher levels of insulin and glucose concentrations.

Taurine also appears to protect the lens against the development of “sugar cataracts” by an antioxidant effect. (12) 10. Stevens et al, Am J Physiol 1999 Oct;277(4 Pt 1):E760-E771. 12. Malone JI, Benford SA, Malone J Jr, Diabetes Complications

17. Vitamin B12 - diabetic retinopathy
Seven of fifteen patients with Type I diabetic retinopathy who were given vitamin B12 along with their daily insulin injections were found to have complete regression of retinal signs after 12 months. Kornerup T, Strom L. Acta Paediatr 1958.

18. Vitamin C, E, Beta Carotene and Selenium
In a clinical trial 60% of the subjects with macular degeneration or diabetic macular edema receiving 500 mg of vitamin C, 400 IU of vitamin E, 15,000 IU of beta carotene and selenium supplements showed either improvement or no further progression of the disease. South Med J; 1987

19. Vitamin E - Diabetic Retinopathy
Vitamin E significantly improved glucose tolerance in non-insulin dependent diabetics, which should result in fewer diabetic complications. Paolisso, G, et al. Am J Clin Nutr 1993; 57:650-56

Dry Eyes

1. A Comparison of Vitamin A and Cyclosporine A 0.05% Eye Drops for Treatment of Dry Eye Syndrome

Study shows using eyedrops containing Vitamin A Palmitate can improve symptoms of blurred vision and tear film after just 4 weeks of usage (see below).

Purpose:
To compare the efficacy of vitamin A (retinyl palmitate) and cyclosporine A 0.05% eye drops in treating patients with dry eye disease.

Design:
Prospective, randomized, controlled, parallel group study.

Methods:
A total of 150 patients with defined dry eye disease participated (50 in each treatment group). In 3 identical clinical trials, patients were treated twice daily with cyclosporine A 0.05%, or four times daily with retinyl palmitate 0.05%, or with neither cyclosporine or retinyl palmitate. Adjunctive treatment with preservative-free artificial tears was undertaken four times daily in all 3 groups. Corneal fluorescein staining results, Schirmer tear test (without anesthesia) results, tear film break-up time (BUT), dry eye symptom score, and impression cytologic analysis results were obtained before treatment and at the first, second, and third months after initiation of treatment.

Results:
Both vitamin A eye drops and topical cyclosporine A 0.05% treatments led to significant improvement in blurred vision, tear film BUT, Schirmer I score results, and impression cytologic findings in patients with dry eye syndrome (P < .05) compared to the control group treated with preservative-free artificial tears alone.

Conclusions:
Both vitamin A eye drops and topical cyclosporine A 0.05% treatments are effective for the treatment of dry eye disorder.

Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea

Accepted 11 August 2008. published online 09 October 2008. Inquiries to Choun-Ki Joo, Department of Ophthalmology, KangNam St Mary's Hospital, #505 Ban-Po Dong, Seocho-Ku, Seoul 137-040, Korea

2. Essential Fatty Acids (1981) - dry eyes
A controlled study evaluated immune-enhancing effects of Black Current Seed oil (BCSO), a significant source of omega-3 and omega-6 fatty acids.

The study and previous research suggests that the combination of omega-3 and omega-6 fatty acids in black current seed of both results in increased PGE1, which both stimulates acqueous tear secretion and reduces the production of PGE2, which acts as an inflammatory agent.

References:

• Horrobin DF, Campbell A, McEwan CG. Treatment of the Sicca Syndrome and the Sjogren's Syndrome with E.F.A. Pyridoxine and Vitamin C. Prog Lipid Res 8(4) 253-4 1981
• Oxholm P. Manthorpe R, Prause JU, Horrobin D. Patients with Sjogren's Syndrome Treated For 2 Months with Evening Primrose Oil. Scand J Rheumotology 1986. 15 103-106.
• Wu D, Maydani M, Leka L. Effect of dietary supplementation with black current seed oil on immune response of healthy elderly subjects. Amer J Clin Nutr 1999,70 536-543.

3. Essential Fatty Acids, Vitamins B6 and C - Dry Eyes
D.F. Horrobin and colleagues have carried out some preliminary studies using the supplemental intake of essential fatty acids, vitamin B6 and vitamin C to treat dry eyes. The rationale for this treatment was based on the biosynthesis of prostaglandin E1 (PGE1), which is necessary for acqueous tear secretion by the lacrimal glands. Patients received 2 x 500 mg capsules of Evening Primrose Oil, 50 mg of vitamin B6 and 1 gram of Vitamin C three times daily.

The results showed that 10 of the 17 patients had substantial improvement of symptoms and Schirmer Test in 2-6 weeks, 3 patients reported improved symptoms though without improved Schirmer testing. The authors conclusion was that this treatment approach is effective in many cases.References: 1) Horrobin DF, Campbell A. McEwen CG. Treatment of the Sicca Syndrome and the Sjogren's Syndrome with E.F.A. Pyroxidine and Vitamin C. Prog Lipid Res 8(4). 263-4, 1981. 2)Horrobin DF Campbell A. Srogren's Syndrome and the Sicca Syndrome: The Role of Essential Fatty Acids and Vitamin C. Medical Hypothesis. 6: 225-232 1980.

4. Evening primrose oil - dry eyes
In a pilot study, 17 patients were selected based on failure of tear secretion, objectively demonstrated (Schirmer Test), clinical exam, and the chronic need/use of lubricant drops. Patients received X500 mg capsules of evening Primrose oil (Efamol-73% linoleic acid and 10% gamma-linolenic acid), 50 mg vitamin B6 (pyroxidine) and 1 g vitamin C three times a day.

The result was that ten of the 17 patients showed substantial improvement of both symptoms and Schirmer test in 2-6 weeks. 3 additional patients reported improved symptoms though without demonstrating improved. Schirmer. Tha authors conclude that this treatment is effective in many cases. 1 Horrobin DF, Campbell A. McEwen CG: Treatment of the Sicca Syndrome with E.F.A., Pyroxidine and Vitamin C. Prog Lipid Res 8(4):253-4, 1981. 2Horrobin DR Campbell A. Sjogren’s Syndrome and the Sicca Syndrome: the Role of Prostaglandin E1 Deficiency. Treatment with Essential Fatty Acids and Vitamin C. Medical Hypothesis. 6:225-232 1980.

5. Eye drops without preservatives
Eye drops used without preservatives have been shown to enhance corneal healing and improve dry eye problems. Laflamme, M.Y., and Swieca, R. A comparative study of two preservative-free tear substitutes in the management of severe dry eye. Canadian Journal of Ophthalmology 23 (1988): 174-76.
Editor’s Notes: Preservatives in many products can aggravate dry eye symptoms, and even kill corneal cells. Eye drops that promise to “get the red out” will reduce circulation in the eye, decrease production of the tear film, and worse, eventually make your eyes even drier.

6. Fish Oil and Dry Eye Syndrome
In the third study, by K. A. Trivedi and colleagues from Harvard Medical School in Boston, Massachusetts, women with a higher dietary intake of omega-3 fatty acids were at decreased risk of developing dry eye syndrome (DES).

Of 39,876 women participating in the Women's Health Study, 32,470 female health professionals aged between 45 and 84 years provided information on diet and DES. The highest versus the lowest dietary intake of omega-3 fatty acids was associated with decreased risk of DES (OR, 0.83; 95% CI, 0.70 - 0.98; P for trend = 0.04), after adjustments for age, other demographic factors, postmenopausal hormone therapy, and total fat intake. Tuna fish consumption also had a protective effect against DES, and results were similar in other models after adjustments for diabetes, hypertension, and connective tissue diseases.

"Although this is the first study that has evaluated this relationship, and confirmation from other studies is needed, the findings are consistent with clinical observations and postulated biological mechanisms," the authors write. "Thus, further research on the role of omega-3 fatty acids in the prevention and/or treatment of DES would be of interest."

Advanced Vision Research, Inc., supported this study and has financial arrangements with its authors.

ARVO 2003 Annual Meeting: Abstract 811/B786, presented May 4, 2003; abstracts 2111 and 2112, presented May 6, 2003.

7. Hormone Replacement Therapy and Dry Eyes
Dry-Eye Syndrome: An Overlooked Side Effect of HRT

WESTPORT, CT (Reuters Health) Nov 07 - Women on hormone replacement therapy (HRT), particularly estrogen-only regimens, are at increased risk of keratoconjunctivitis sicca, also known as dry-eye syndrome, researchers report in the November 7th issue of The Journal of the American Medical Association.

"Dry-eye syndrome is a very common condition affecting millions of middle-aged and older women, and physicians should recognize the possibility that HRT may have ocular side effects," Dr. Debra A. Schaumberg, of Brigham and Women's Hospital in Boston, told Reuters Health. Dr. Schaumberg and colleagues used the Women's Health Study cohort, which included 25,665 postmenopausal women, to study the relationship between HRT and dry-eye syndrome. Participants provided information on the use of HRT at baseline, 12 and 36 months, along with data on dry-eye syndrome at 4 years.

The prevalence of dry-eye syndrome was significantly related to HRT use.

Women who used estrogen alone had the highest prevalence at 9.1%, while women who never used HRT had the lowest prevalence at 5.9%. The prevalence of dry-eye syndrome in women who used estrogen plus progesterone/progestin regimens was 6.7%.

In multivariate analyses, the adjusted odds ratio for dry-eye syndrome was 1.69 and 1.29 for estrogen use alone and estrogen plus progesterone/progestin use, respectively, compared with no HRT use. The risk of dry-eye syndrome appears to increase with longer duration of HRT, according to the data. "Each 3-year increase in the duration of HRT use was associated with a significant 15% elevation in risk of clinically diagnosed dry-eye syndrome or severe symptoms," the investigators report in JAMA.

Dry-eye syndrome is an under-recognized side effect of HRT, Dr. Schaumberg said, "with the caveat that, until our study, there were no epidemiological data available to link the two." Dry-eye syndrome can have "a significant impact on quality of life and can increase risk of ocular infection," the researcher added. JAMA 2001;286:2114-2119.

8. Omega-6 Fatty Acid Helps Relieve Dry Eyes For Contact Lens Users Study 2008

The purpose of this study was to evaluate the effects of oral treatment with omega-6 fatty acids in the form of evening primrose oil (EPO) on subjective symptoms, ocular surface signs and tear film characteristic in patients with contact lens-associated dry eye.

A total of 76 female soft contact lens wearers were treated for six months either with EPO or placebo (olive oil). Subjects underwent three examinations (baseline, three and six months). At each examination, subjects were given a questionnaire relating to lens comfort and dry eye symptoms, and they underwent a series of tests of tear film characteristics (tear meniscus height, break-up time), meibomian gland function (lipid layer thickness and quality) and ocular surface parameters (hyperemia and staining).

The EPO group showed a significant improvement in the specific symptom of "dryness" at three and six months and also a significant improvement in overall lens comfort at six months. Tear meniscus height was increased in the EPO group at six months relative to baseline, although all other objective signs were unchanged. This study provides evidence for a beneficial effect of particular orally administered omega-6 fatty acids in alleviating dry eye symptoms and improving overall lens comfort in patients suffering from contact lens-associated dry eye.

SOURCE: Kokke KH, Morris JA, Lawrenson JG. Oral omega-6 essential fatty acid treatment in contact lens associated dry eye. Cont Lens Anterior Eye 2008;31(3):141-6.

Enlarged Prostrate

1. Enlarged Prostate (Benign Prosatic Hyperplasia )
Also see discussion

1. Lees AM, Mok HYI, Lee RS, et al. Plant sterols as cholesterol-lowering agents: clinical trials in patients with hypercholesterolemia and studies of sterol balance. Atherosclerosis 1977;28:325–38.
2. Pelletier X, Belbraouet S, Mirabel D, et al. A diet moderately enriched in phytosterols lowers plasma cholesterol concentrations in normocholesterolemic humans. Ann Nutr Metab 1995;39:291–5.
3. Jones PJ, Raeini-Sarjaz M, Ntanios FY, et al. Modulation of plasma lipid levels and cholesterol kinetics by phytosterol versus phytostanol esters. J Lipid Res 2000;41:697–705.
4. Grundy SM, Ahrens EH Jr, Davignon J. The interaction of cholesterol absorption and cholesterol synthesis in man. J Lipid Res 1969;10:304–15 [review].
5. Berges RR, Windeler J, Trampisch HJ, et al. Randomised, placebo-controlled, double-blind clinical trial of beta-sitosterol in patients with benign prostatic hyperplasia. Lancet 1995;345:1529–32.
6. Kiriakdis S, Stathi S, Jha HC, et al. Fatty acid esters of sitosterol 3ß-glucoside from soybeans and tempeh (fermented soybeans) as antiproliferative substances. J Clin Biochem Nutr 1997;22:139–47.
7. Awad AB, Chan KC, Downie AC, Fink CS. Peanuts as a source of ß-sitosterol, a sterol with anticancer properties. Nutr Cancer 2000;36:238–41.
8. Berges RR, Windeler J, Trampisch HJ, et al. Randomised, placebo-controlled, double-blind clinical trial of beta-sitosterol in patients with benign prostatic hyperplasia. Lancet 1995;345:1529–32.
9. Klippel KF, Hiltl DM, Schipp B. A multicentric, placebo-controlled, double-blind clinical trial of ß-sitosterol (phytosterol) for the treatment of benign prostatic hyperplasia. Br J Urol 1997;80:427–32.

Glaucoma

1. A Sick Eye in a Sick Body
Despite intense research, the pathogenesis of primary open-angle glaucoma (POAG) is still not completely understood. There is ample evidence for a pathophysiological role of elevated intraocular pressure; however, several systemic factors may influence onset and progression of the disease.

Systemic peculiarities found in POAG include alterations of the cardiovascular system, autonomic nervous system and immune system, as well as endocrinological, psychological and sleep disturbances. An association between POAG and other neurodegenerative diseases, such as Alzheimer disease and Parkinson disease, has also been described. Furthermore, the diagnosis of glaucoma can affect the patient's quality of life.

SOURCE: Pache M, Flammer J. A sick eye in a sick body? systemic findings in patients with primary open-angle glaucoma. Surv Ophthalmol 2006;51(3):179-212.

2. Alpha lipoic acid (1995) & glaucoma
Pretreatment with alpha lipoic acid has been found to reduce neuronal damage from excitotoxic damage from cyanide, glutamate and iron ions, demonstrating a strong neuroprotective effect for neural tissue. J Cereb Blood Flow Metab 1995 Jul;15(4):624-30

3. Alpha lipoic acid (1995) & glaucoma
In a study of open angle glaucoma patients who received 150mg of Alpha Lipoic Acid each day, 45-47% of the eyes had enhancement of color visual fields and visual sensitivity when compared to controls using only topical medical therapy. More advanced cases had an even better response compared to their controls. Filina, et al., Vestn Oftalmol 1995 Oct-Dec;111(4):6-8

4. Bilberry and pine bark combo wards off glaucoma: study

In a study performed by researchers from the University of Chieti-Pescara in San Valentino, Italy, thirty-eight subjects with IOP were either given bilberry and French maritime pine bark (20 subjects) or were not treated (18 subjects)1. The visual acuity, IOP, and ocular blood flow were measured at two, three, and six months. After two months of supplementation the mean IOP decreased. No side effects were observed and ocular blood flow improved.

An improved ocular blood flow may contribute to the prevention of glaucoma. The results of this study indicate that bilberry and pine bark may represent a safe preventative intervention for lowering the risk for developing symptomatic glaucoma by controlling IOP and improving ocular blood flow. This helps to support research for other preventative nutritional approaches to major eye health, such as cataract, age-related macular degeneration, and retinopathy.

IOP was also seen to be lowered in 19 of the 20 intervention patients, from an average of 25.2mmHg to 22.0mmHG. Only one of the control patients saw a drop in IOP.

The researchers also looked at the eyes' arteries using color Doppler imaging. They saw better flood flow in the intervention group, which was taken as an indication that fluids in the eye were being restored.

"Our study is the first demonstration showing that dietary intervention can help to control IOP and increase ocular blood flow in asymptomatic subjects and if taken in time, may prevent an evolution to higher pressure and symptomatic glaucoma," wrote Steigerwalt.

Molecular Vision 2008; 14:1288-1292 "Effects of Mirtogenol on ocular blood flow and intraocular hypertension in asymptomatic subjects" Reference: Authors: Robert Steigerwalt Jr, Belcaro Gianni, Morazzoni Paolo, Ezio Bombardelli,2 Carolina Burki, Frank Schönlau

5. Carotenoids (1994) and green leafy vegetables
Besides beta carotene, other carotenoids found in dark green leafy vegetables appear to be much more essential to the health of the eye. Several studies have shown that lutein and zeaxanthin supplements may slow vision loss in glaucoma, and in some cases improve eyesight.Science News, Volume 146, 1994.

6. Depth Perception Deficits in Glaucoma Suspects
This study investigated depth perception in glaucoma suspects compared to glaucoma patients and controls. Glaucoma suspects (n=16), patients (n=18), and normal age-matched controls (n=19) aged 40- 65 years were prospectively evaluated for depth perception deficits using the Frisby Test. Stereocuity was measured by stereothreshold in seconds of arc for each group.

Glaucoma suspects showed significantly increased mean stereothreshold compared to age-matched normals (144.1 +/- 35.2 vs. 26.6 +/- 3.7 seconds of arc). The mean stereothreshold in glaucoma patients was also increased compared to age-matched normals (148.1 +/- 33.8 vs. 26.6 +/- 3.7 seconds of arc).

Glaucoma suspects show depth perception deficits. Evidence of impaired stereovision in glaucoma suspects suggests that binocular interactions are disrupted in the absence of visual field defects using standard automated perimetry.

7. East Baltimore Eye Survey (The)
This survey examined 5,308 individuals in East Baltimore. They found that approximately 40 percent of people with glaucoma have normal, not elevated, internal eye pressure. It is also confirmed that many people with elevated IOP never develop the optic nerve damage consistent with glaucoma (Beaver Dam Study had the same conclusion).

8. Effect of Topical Ginkgo biloba Extract on Steroid-Induced Changes in the Trabecular Meshwork and Intraocular Pressure

Rabbits aged 7 weeks received topical TobraDEX and/or 5 µg of Ginkgo biloba extract (GBE) four times daily for 14 days and intraocular pressure (IOP) was recorded every 3 days to study the effects of GBE on dexamethasone (DEX)-induced ocular hypertension. After enucleation, trabecular meshwork (TM) cellularity and extracellular matrix deposition were graded. The effect of GBE on apoptosis and expression of myocilin and cell stress-related genes in DEX-treated human TM cells were studied by immunofluorescence, Western blotting, and quantitative polymerase chain reaction.

Ginkgo biloba extract suppressed DEX-induced IOP elevation in rabbits. It reduced the DEX-associated accumulation of extracellular materials within the cribiform layers of the TM and achieved better TM cellularity. In cultured human TM cells, GBE substantially attenuated anti-Fas ligand-induced apoptosis and reduced DEX-induced myocilin expression. Ginkgo biloba extract modulated the expression of alphaB-crystallin and heat-shock proteins 70 and 90alpha but not other stress-related genes. Furthermore, changes associated with DEX were found less in GBE-treated or GBE-primed TM cells.

Ginkgo biloba extract, a nontoxic, anti-apoptotic, herbal compound significantly suppressed steroid-induced IOP elevation in rabbits, and it seems to prevent the adverse effects of DEX on TM cells. Clinical Relevance Ginkgo biloba extract could be a therapeutic agent or dietary supplement to prevent steroid-induced ocular hypertension.

SOURCE: Jia LY, Sun L, Fan DS, et al. Effect of Topical Ginkgo biloba Extract on Steroid-Induced Changes in the Trabecular Meshwork and Intraocular Pressure. Arch Ophthalmol 2008;126(12):1700-1706.

9. Elevated homocysteine levels in aqueous humor of patients with pseudoexfoliation glaucoma.
Elevated homocysteine levels in aqueous humor of patients with pseudoexfoliation glaucoma.

Bleich S, Roedl J, Von Ahsen N, Schlotzer-Schrehardt U, Reulbach U, Beck G, Kruse FE, Naumann GO, Kornhuber J, Junemann AG.

Dept. of Psychiatry and Psychotherapy, Friedrich-Alexander-University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany. stefan.bleich@psych.imed.uni-erlangen.de

PURPOSE: To determine total homocysteine levels in aqueous humor of pseudoexfoliation open-angle glaucoma patients. DESIGN: Case-control study. METHODS: Total homocysteine levels were measured by enzyme-linked immunosorbent assay in aqueous humor and plasma of 29 patients with pseudoexfoliation glaucoma and 31 control patients with cataract. Patients with factors affecting homocysteine levels were excluded. RESULTS: We observed significantly elevated (twofold) homocysteine levels in the aqueous humor of the glaucoma patients (Z = -5.11, P <.0001). Additionally, the calculated ratio (plasma:aqueous humor) was significantly lower in these patients (Z = -3.57, P <.001), and aqueous homocysteine was significantly correlated with their respective elevated plasma levels (r =.42, P =.02). CONCLUSIONS: Because homocysteine induces vascular injury and alterations of extracellular matrix, high aqueous homocysteine may trigger the abnormal matrix accumulation characteristic. It may reflect the proposed impairment of the blood-aqueous barrier of pseudoexfoliation open-angle glaucoma and be involved in its pathogenesis.

PMID: 15234308 [PubMed - indexed for MEDLINE]

10. Exercise - glaucoma
Research has shown that glaucoma patients who take a brisk, 40-minute walk five days a week for three months can reduce the pressure in their eyes by approximately 2.5 millimeters – similar to the reduction seen when using beta-blockers. Passo, M.S. et. al. Regular exercise lowers intraocular pressure in glaucoma patients. Investigative Ophthalmology 35. In ARVO Abstracts, March 15, 1994.

11. Gingko Biloba and Glaucoma

The botanical Ginkgo biloba has been extensively examined for its cognitive effects in patients with dementia. Recently, a six-month double blind trial conducted at UCLA found significant improvement in verbal recall among subjects with age-associated memory impairment (1). Using positron-emission tomography, the researchers reported that improved recall correlated with better function in key brain memory centers of those taking ginkgo supplements. The effects of ginkgo are attributed to its ability to enhance cerebral blood flow and provide antioxidant activity.

Over the past decade, research has identified non-pressure dependent risk factors for glaucoma, including cerebral and ocular ischemia. There is increasing awareness that the prevalence of normal-tension glaucoma (NTG) is greater than previously realized, and that progressive damage can occur even with IOP-lowering intervention. Since Ginkgo has been shown to increase ocular blood flow (2), the effects of a ginkgo extract on pre-existing visual field damage in normal tension glaucoma was evaluated in a prospective, randomized, double-blind crossover trial (3).

Twenty seven patients with bilateral visual field damage resulting from NTG received 120 mg of ginkgo extract (40 mg, 3x daily) for 4 weeks, followed by a wash-out period of 8 weeks, then 4 weeks of placebo treatment. Other patients underwent the same regimen, but took the placebo first and ginkgo last. Visual field tests, performed at baseline and at the end of each phase of the study, were evaluated for changes in visual field and any ocular or systemic complications.

After ginkgo treatment, a significant improvement in visual field indices was observed.

No significant changes were found in intraocular pressure, blood pressure, or heart rate after placebo or ginkgo treatment. The investigators concluded that Ginkgo biloba is a useful therapy for some patients with NTG. An accompanying editorial in Ophthalmology points out that the mechanisms of ginkgo are plausible, and that the beneficial effects were not maintained in this study after discontinuation of ginkgo treatment. Both of these observations lend credence to the findings.

References:

1) Ercoli L et al. Society for Neuroscience Meeting, New Orleans, November, 2003
2) Chung HS et al. Ginkgo biloba extract increases ocular blood flow velocity. J Ocul Pharmacol Ther 15:233-40, 1999.
3) Quaranta L et al. Effect of Ginkgo biloba extract on preexisting visual field damage in normal tension glaucoma. Opthalmol 110:359-62 (discussion 362-4), 2003.

12. Ginkgo and glaucoma
While the alkaloid pilocarpine from the herb Pilocarpus jaborandi has established itself as an effective topical treatment for glaucoma, there is to date little evidence that the oral use of any herbs can help this condition. In this context, the publication of a recent clinical trial on the effect of

Ginkgo biloba extract on pre-existing visual field damage in normal tension glaucoma is noteworthy. (1) Normal tension glaucoma is a form of primary open-angle glaucoma in which damage to the optic nerve and visual field are present despite intraocular pressure measurements being within statistically normal ranges. The exact mechanisms behind the anatomic and functional damage in this disease are unknown, but there are two main theories: reduced blood flow to the optic nerve versus relatively high intraocular pressure. Because some patients with normal tension glaucoma can continue to experience a loss of visual field despite conventional medical treatment, the value of other treatments is worthy of investigation. Since Ginkgo biloba has been shown to improve blood flow at a tissue level, it was an obvious candidate for selection in such investigations.

In a randomized, double-blind, placebo-controlled, crossover trial, 27 patients with bilateral visual field damage resulting from normal tension glaucoma received either 120 mg of Ginkgo biloba extract (equivalent to 6 g herb) or placebo. Since it was a crossover trial, patients acted as their own placebo controls. Visual field tests were performed at baseline and at the end of each 4-week treatment phase. The main outcome measured was any change in the visual field and the development of any ocular or systemic complications. After Ginkgo biloba treatment, a significant improvement in visual field indices was recorded, but there were no significant changes found in intraocular pressure, blood pressure or heart rate. No ocular or systemic side effects were noted in any patient during the trial. The authors concluded that their results suggest that Ginkgo biloba extract can improve pre-existing visual field damage in some individuals with normal tension glaucoma. However, they observed that the exact explanation for this effect is not currently understood.

Sourced from http://findarticles.com/p/articles/mi_m0ISW/is_255/ai_n6211955

13. Glaucoma (2004) linked to Heavy Computer Use
Spending too much time looking at a computer screen may raise your risk of the vision-robbing eye disease glaucoma, particularly if you're nearsighted, according to a new Japanese study. Glaucoma is a group of eye diseases that ultimately cause damage to the optic nerve. It can lead to blindness if not treated. Heavy computer users who were farsighted or nearsighted seemed to have a higher risk for visual field abnormalities, say the researchers. Source: Journal of Epidemiology and Community Health, December 2004; vol 58: pp 1021-1027

14. Glaucoma Risk Reduction through Nutrition 2008

Anne L. Coleman, MD, PhD, professor of ophthalmology in the Jules Stein Eye Institute of the David Geffen School of Medicine at the University of California Los Angeles and professor of epidemiology in the UCLA School of Public Health, was lead author of one study that was recently published in the American Journal of Ophthalmology. The object of her study was to see whether specific nutrients might account for an apparent association between glaucoma risk and fruit and vegetable consumption, and to investigate potential links between glaucoma risk and antioxidants, calories, fat, protein, and carbohydrates obtained from natural food sources.

Study 1 Summary (Coleman AL, Stone KL, Kodjebacheva G, Yu F, Pedula KL, Ensrud KE, Cauley JA, Hochberg MC, Topouzis F, Badala F, Mangione C ; Study of Osteoporotic Fractures Research Group):

• Glaucoma risk was decreased 69 percent in women who consumed at least one serving per month of green collards and kale compared with those who consumed fewer than one serving per month.
• Glaucoma risk was decreased 64 percent in women who consumed more than two servings per week of carrots compared with those who consumed fewer than one serving per week.
• Glaucoma risk was decreased 47 percent in women who consumed at least one serving per week of canned or dried peaches compared with those who consumed fewer than one serving per month.

A second nutrition-related study that also drew data from the Study of Osteoporotic Fractures was conducted by JoAnn A. Giaconi, MD, assistant clinical professor of ophthalmology at the Jules Stein Eye Institute at UCLA.

Study 2 Summary: This study futher analyzed the results of the first study above regarding the effects of nutrition on the African-American community who have a higher percentage of glaucoma.

Dr. Giaconi’s data included 584 black women; 13 percent (77 women) had glaucoma in at least one eye. [Giaconi JA, et al. IOVS 2008;49; ARVO E-abstract 5453].

Dr. Giaconi who headed this study notes that it’s dangerous to draw too many conclusions from the nutrition-related data that has been found so far. “My study was an exploratory study,” she says. “The data clearly show associations, but we can’t say for sure that the difference in diet caused the difference in glaucoma risk. Did eating more collard greens reduce the likelihood of developing glaucoma, or is there something else about the individuals who eat more collard greens that makes them less likely to develop glaucoma? Maybe those individuals exercise more. Maybe they grew up in a different environment. Maybe they metabolize nutrients differently. We can’t claim that the association is causal, but I believe the association is worth pursuing."

For more details, go to http://www.revophth.com/index.asp?page=1_14082.htm

15. Hypnosis Can Help Lower Intraocular Pressure
The research study below shows that hypnosis can lower intraocular pressure for those with open-angle glaucoma.

For more information, go to Psychosomaticmedicine.org.

16. Hypnosis on Intraocular Pressure Glaucoma
Reseach study show hypnosis can help lower eye pressure (intracular pressure) for those with glaucoma. For full study, go to Psychosomaticmedicine.org.

17. Increased Homocysteine Levels in Tear Fluid of Glaucoma Patients

Homocysteine (Hcy) levels in tear fluid and plasma of patients with primary open-angle glaucoma (POAG) were assessed to determined the association between Hcy levels, dry eye syndrome and B vitamin status in glaucoma patients. This prospective case-control study included 36 patients with POAG and 36 controls. Hcy concentrations were measured by high-performance liquid chromatography.

Patients with POAG had significantly higher mean Hcy levels both in tear fluid (205 +/- 84 nmol/l) and in plasma (13.43 +/- 3.53 micromol/l) than control subjects (130 +/- 53 nmol/l and 10.50 +/- 3.33 micromol/l, respectively). Hcy in tear fluid was significantly correlated with plasma Hcy in POAG patients, but not in controls. POAG patients with dry eye disease had significantly higher Hcy levels both in tear fluid and plasma than POAG patients without dry eye disease. There was no association between Hcy levels and B vitamin status in subjects with POAG.

The study suggests increased Hcy levels in tear fluid and plasma of patients with POAG. Elevated Hcy levels might be a risk factor for POAG and dry eye syndrome in subjects with glaucoma.

SOURCE: Roedl JB, Bleich S, Schlotzer-Schrehardt U, et al. Increased homocysteine levels in tear fluid of patients with primary open-angle glaucoma. Ophthalmic Res 2008;40(5):249-56

18. Lipoic acid - Glaucoma
Lipoic acid may be useful in the treatment of glaucoma and may prevent ischemic optic nerve damage. Altern Med Rev 1998 Aug;3(4):308-11

19. Lipoic acid - Glaucoma
The literature data permit recommending lipoic acid in complex with vitamins B1, B2, B5, B6 (pyridoxal phosphate), and vitamin C to glaucoma patients. Filina, AA & Sporova, NA. Vestn Oftalmol 1991 May-Jun;107(3):19-21

20. Magnesium - glaucoma
Patients suffering from open angle glaucoma and normal-tension glaucoma who were given magnesium twice daily showed improvement of the visual field and reduced peripheral vasospasms (which can cause glaucoma, stroke and heart attack) after four weeks of treatment. Gasper, et al; Ophthalmologica 1995;209(1):11-3

21. Mini-Strokes May Cause Vision Loss for Those with Normal Tension Glaucoma
A study of people who suffer the mini-strokes called silent cerebral infarcts could help explain the medical mystery of normal-tension glaucoma, Hong Kong ophthalmologists report. The Hong Kong study of 286 people with normal-tension glaucoma found a high incidence of silent cerebral infarcts among those whose loss of vision progressed more rapidly. The finding is in the July issue of Ophthalmology.

22. Natural Occurring Growth Factor May Regenerate Retinal Nerve Fiber
Oncomodulin, a naturally occurring growth factor, stimulates the regeneration of injured retinal nerve fibers, according to researchers at Boston’s Children’s Hospital and Harvard Medical School. Although the optic nerve, like most mature central nervous system pathways, doesn’t regenerate after injury; however, through unknown mechanisms, macrophage activation in the eye stimulates retinal ganglion cells (RGCs) to regenerate long axons beyond the site of the injury.

Investigators in this animal study identified a calcium-binding protein called oncomodulin as a powerful macrophage-derived growth factor for RGCs and other neurons. In vivo, the oncomodulin promoted regeneration in the mature rat optic nerve; it also stimulated outgrowth from peripheral sensory neurons. The authors of the study believe that oncomodulin could some day prove useful in reversing optic nerve damage caused by glaucoma, tumors, or traumatic injury to the eye.

23. Neuroprotection by Vitamin E in Glaucoma

Vitamin E: More Than an Antioxidant

Vitamin E is best known as the body's major fat-soluble antioxidant. Its main function is to intercept free radicals and prevent chain reactions of lipid destruction. However the discovery of complex molecules that control vitamin E metabolism such as tocopherol transfer protein, alpha tocopherol membrane receptors, and intracellular transfer proteins, triggered the idea that the activity of vitamin E extends beyond its antioxidant capacity.

Vitamin E is now known to affect the expression and activity of immune and inflammatory cells, to enhance vasodilation, and to inhibit the activity of the important cell signaling molecule protein kinase C (PKC).

Modulating the PKC pathway may be relevant in glaucoma. For instance, PKC inhibitors have been shown to relax the trabecular meshwork, and to affect matrix metalloproteinase and PGF2 alpha.

Vitamin E and PKC could also have a vaso-regulatory effect in the retina. In different experimental models, retinal vascular dysfunction due to hyperglycemia was reportedly prevented by vitamin E via the diacylglycerol-PKC pathway (1,2).

These findings prompted researchers at Istanbul University to evaluate the clinical potential of vitamin E in glaucoma patients. They report prevention of visual field loss in this preliminary study, and conclude that vitamin E deserves further attention in preventing glaucomatous damage (3).

Study Design and Methods
Thirty glaucomatous patients (60 eyes) with controlled IOP, were randomly divided into three groups. Group (A) received no vitamin E, while groups (B) and (C) were given a daily dose of 300 and 600 mg of vitamin E respectively, as d-alpha tocopheryl acetate for 12 months. Blood levels of vitamin E were measured via HPLC.

Disease progression for each subject was monitored via visual field measurements and color Doppler imaging of ophthalmic and posterior ciliary arteries at baseline, and at 6 and 12 months. Retinal blood flow of ophthalmic and posterior ciliary arteries was evaluated, and resistivity and pulsatility indexes were obtained. Mean deviation values for Fastpac visual fields were recorded at all time points, and the difference in mean deviation values calculated. The change in mean deviations of Groups (B) and (C) were compared with Group (A), and the Mann-Whitney U-test was employed for statistical analysis.

Results
There were no significant differences between the groups in mean ages, IOP, best corrected visual acuities of 10/10 ratios and disease etiologies. The average differences between the pulsatility indexes (PI) and resistivity indexes (RI) of both ophthalmic arteries and posterior ciliary arteries of both supplemented groups were significantly lower than those of the non-supplemented groups at 6 months and 1 year. RI decreases observed in posterior ciliary arteries at both time points, and PI decreases observed in ophthalmic arteries at the 6th month were statistically significant.

Compared with those receiving vitamin E, non-treated subjects showed a statistically significant reduction in visual field (change in mean deviation) at 6 and 12 months (Tables, below).

Kunisaki M et al. Vitamin E prevents diabetes-induced abnormal retinal blood flow via the diacylglycerol-protein kinase C pathway. Am J Physiol 269:239-46, 1995.

Lee IK et al. d-alpha tocopherol prevents hyperglycemia induced activation of the diacylglycerol (DAG)-protein kinase C pathwayin vascular smooth muscle cells by an increase in DAG kinase activity. Diabetes Res Clin Pract 45:183-90, 1999.

Engin KN et al. Clinical evaluation of the neuroprotective effect of alpha tocopherol in glaucomatous damage. Eur J Ophthalmol 17:528-33, 2007.

24. Omega-3 - glaucoma
Studies have shown that Eskimos, who have a high intake of omega-3, have a very low incidence of open angle glaucoma. Albrick, P.H., Angle closure surveys in Greenland Eskimos, Canadian Journal of Ophthalmology 8 (1973): 260-64.

25. Physical Activity and Glaucoma Incidence Reduction

This study assessed the dose-response relationship of vigorous physical activity (running distance, km x d[-1]) or cardiorespiratory fitness (meters-per-second pace during a 10-km footrace) to the risk for incident glaucoma. Participant-reported, physician-diagnosed incident glaucoma was compared with distance run per week and 10-km footrace performance in a cohort of 29,854 male runners without diabetes followed prospectively for 7.7 years. The survival analyses were adjusted for age, hypertension, current and past cigarette use and intakes of meat, fish, fruit and alcohol.

Two hundred incident glaucoma cases were reported during follow up. The risk for reported glaucoma decreased 37% per meter per second increment in a 10-km race performance. Relative to the least fit men (i.e., slowest, < or = 3.5 m x s[-1]), the risk for incident-reported glaucoma declined 29% in those who ran 3.6-4.0 m x s(-1), 54% for those who ran 4.1-4.5 m x s(-1), 51% for those who ran 4.6-5.0 m x s(-1), and glaucoma was nonexistent among the 781 men who exceeded 5.0 m x s(-1). The risk for incident, reported glaucoma decreased 5% per kilometer per day run at baseline, which remained significant when adjusted for the 10-km race performance (5% reduction per kilometer per day), and both body mass index and race performance. Baseline hypertension was unrelated to the incident glaucoma.

These data provide preliminary evidence that vigorous physical activity may reduce glaucoma risk, which, in the absence of medical record validation, could represent ocular hypertension in addition to frank glaucoma. Additional follow up with validation is needed to identify the type of glaucoma affected.

SOURCE: Williams PT. Relationship of incident glaucoma versus physical activity and fitness in male runners. Med Sci Sports Exerc 2009;41(8):1566-1572

26. Replacing Immune Cells May Impede Onset of Glaucoma
A study in the Journal of Experimental Medicine (2003;197[10]:1335-1344) found that inflammatory immune response, which is suppressed in the normal eye, might be an early step in the onset of pigment dispersion glaucoma. Pigment dispersion glaucoma occurs when the iris begins to shed melanin into the front part of the eye. This is followed by increasing pressure within the eye, which strangles the optic nerve and kills the retinal cells attached to it.

The researchers examined the eyes of model mice with pigment dispersion glaucoma before the visible onset of the disease and found that the diseased eyes failed to successfully suppress T-cells--white blood cells that cause the iris to shed pigment. This failure preceded clinical evidence of pigment dispersion. They also found that the eyes contained bone marrow-derived white blood cells that were programmed to cause inflammatory responses. Jun Song Mo, M.D., the study's lead author, told the press, "It is relevant that one of the two genes known to be responsible for pigment dispersion glaucoma in mice is active in these same white blood cells."

The research team concluded that the eyes of the genetically predisposed mice lost immune privilege before the pigment dispersion began.

"What this suggested to us," said J. Wayne Streilein, M.D., senior author of the study, "is that maybe the first thing that the genes for pigment dispersion glaucoma do is break down immune privilege and leave the eyes vulnerable to inflammation."

The researchers tested their theory of inappropriate immune response even further by replacing the bone marrow of mice predetermined to develop pigment dispersion glaucoma with bone marrow from normal mice. Following the procedure, the team found that the immune-privileged status was maintained in the eyes, inflammation never developed and pigment dispersion failed to occur.

"These results are very exciting and encouraging. We feel that this is a major breakthrough in understanding how this disease is triggered and may be cured," said Streilein. "We are eager to understand more completely the interrelationship between loss of immune privilege and development of glaucoma. Moreover, we are also interested to know whether a similar immune dependency might occur in other blinding eye diseases, such as macular degeneration and retinitis pigmentosa"--AR

27. Stress
Above average stress has been shown to increase the risk for high eye pressure by almost three times. Grignolo, F.M. et. al. Variations of intraocular pressure induced by psychological stress. Klinische Monatsblaten Augenheilkd 170 (1977): 562-69.

28. Studies Show Relationship of Blood Pressure and Glaucoma
Glaucoma may continue to progress after the reduction of IOP to targeted levels. Research is providing increasing support for the idea that vascular risk factors may be the cause. Several population-based studies have suggested that low diastolic perfusion pressure is associated with an increased incidence of open-angle glaucoma (OAG). Perfusion pressure is defined as the difference between arterial and venous pressure, which, in the eye, by convention equals IOP. Blood pressure and IOP are therefore the principal components of ocular perfusion pressure (perfusion pressure = blood pressure – IOP). • Choi J, Kim KH, Jeong J, et al. Circadian fluctuation of mean ocular perfusion pressure is a consistent risk factor for normal-tension glaucoma. Invest Ophthalmol Vis Sci. 2007;48:104-111. • Tielsch JM, Katz J, Sommer A, et al. Hypertension, perfusion pressure, and primary open-angle glaucoma. A population-based assessment. Arch Ophthalmol. 1995;113:216-221. • Leske MC, Connell AM, Wu SY, et al. Risk factors for open-angle glaucoma. The Barbados Eye Study. Arch Ophthalmol. 1995;113:918-924. • Hulsman CA, Vingerling JR, Hofman A, et al. Blood pressure, arterial stiffness, and open-angle glaucoma: the Rotterdam study. Arch Ophthalmol. 2007;125:805-812. Perfusion pressure can be affected by IOP and blood pressure, but which is really the most important? In a given patient, it could be IOP alone, blood pressure alone, or a combination of the two. For more related studies, go to www.glaucomatoday.com/articles/0409/GT0409_06.php

29. Study: Glaucoma (2004) linked to Heavy Computer Use
Spending too much time looking at a computer screen may raise your risk of the vision-robbing eye disease glaucoma, particularly if you're nearsighted, according to a new Japanese study. Glaucoma is a group of eye diseases that ultimately cause damage to the optic nerve. It can lead to blindness if not treated. Heavy computer users who were farsighted or nearsighted seemed to have a higher risk for visual field abnormalities, say the researchers. Source: Journal of Epidemiology and Community Health, December 2004; vol 58: pp 1021-1027

30. Thiamine blood level and chronic open angle glaucoma
Chronic open angle glaucoma patients had a statistically significant lower thiamine blood level than controls along with poor absorption of that nutrient. Asregadoo, Ann Ophthalmol 1979 Jul;11(7):1095-1100

31. Thyroid Problems Linked to Glaucoma 2002 Study

Researchers at the University of Alabama at Birmingham believe that thyroid disorders may increase the risk of glaucoma. Their study, published in the British Journal of Ophthalmology, reviewed data from the 2002 National Health Interview Survey to quantify the association between a self-reported diagnosis of glaucoma and a self-reported history of thyroid problems.

Of the 12,376 survey participants, 4.6% reported glaucoma, and 11.9% reported a history of thyroid problems. The prevalence of glaucoma among those who reported thyroid problems was 6.5% compared with 4.4% among those who did not report thyroid problems. This association between glaucoma and thyroid problems remained after adjusting for differences in age, gender, race and smoking status.

The results of this study lend support to the hypothesis that thyroid disorders may increase the risk of glaucoma. Although further research on the topic is expected, study authors suspect that hypothyroidism may diminish outflow in the eye.

SOURCE: The association between thyroid problems and glaucoma, Cross, et al, British Journal of Ophthalmology 2008;92:1503-1505.

32. Vascular changes
Vascular changes which hinder the blood flow and impair nutrition of neuronal tissue might be the primary cause of glaucoma. Acta Ophthalmol (Copenh) 1993 Aug;71(4):433-44

33. Vascular obstruction
Vascular obstruction and hindrance of the blood flow and impaired nutrition of neuronal tissue might be the primary cause of glaucoma. Sonnsjo & Krakau, Acta Ophthalmol (Copenh) 1993 Aug;71(4):433-44

34. Vitamin B12 - glaucoma
Glaucoma patients treated with vitamin B12 for over 5 years demonstrated better visual acuity and better overall control of their disease. Glacome, 1992; ; Oftalmol Zh. 1965; 20(6); Klin Oczna 1974 Nov;44(11):1183-7

35. Vitamin B12 - glaucoma
Japanese researchers found that a significant number of glaucoma patients who took 1,500 mcg of vitamin B12 for five years actually regained some sight while others showed no deterioration – even though eye pressure did not reduce. Sakai, T. Murata, M., and Amemiya, T. Effect of long-term treatment of glaucoma with vitamin B12. Glaucoma 14 (1992): 167-70.

36. Vitamin C - Glaucoma
Large doses of Vitamin C have been shown in several studies to lower intraocular pressure through several mechanisms, including increased blood osmolarity, decreased aqueous production, improved outflow and collagen support. Acta Ophthalmology Scand, 1969.

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2. High Cholesterol (2005): Beneficial Effects of Olive Oil

The beneficial health effects of olive oil are due to both its high content of monounsaturated fatty acids and its high content of antioxidative substances. Studies have shown that people who consumed 25 milliliters (mL) -- about 2 tablespoons - of virgin olive oil daily for 1 week showed less oxidation of LDL cholesterol and higher levels of antioxidant compounds, particularly phenols, in the blood.

The International Olive Oil Council (IOOC) sets standards of quality used by the major olive oil producing countries. The United States is not a member of the IOOC, and the U.S. Department of Agriculture does not legally recognize its classifications. California has set high standards for its olive oil through the California Olive Oil Council (COOC). The COOC has adopted the standards set by the International Olive Oil Council, but went one step further. The international standard for free acidity content is less than 0.8% and the COOC standard for free acidity content is less than 0.5%. If olive oil makers from California meet these standards, they can put the COOC seal of quality on their bottles.

For more information go to http://www.mercola.com/forms/oil_vinegar.htm

3. Omega-3 fatty acids protect bypass patients (2005)
A report published in the May 17 2005 issue of the Journal of the American College of Cardiology summarized the findings of Italian researchers that giving omega-3 fatty acids to patients before and after coronary artery bypass graft surgery helps protect them from atrial fibrillation, a type of heart arrhythmia that is often associated with the procedure.

Hypertension

1. Hypertension
Also see discussion.

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Indigestion

1. Indigestion
Also see discussion

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27. Reed PI, Davies WA. Controlled trial of a carbenoxolone/alginate antacid combination in reflux oesophagitis. Curr Med Res Opin 1978;5:637–44.

2. Indigestion (2005): Heartburn Remedies That Kill

The Journal of the American Medical Association now reports that the use of antacid preparations (Prilosec, Prevacid, Nexium, Pepcid, Zantac) also inhibit stomach acidity (production of hydrochloric acid) and makes people more prone to deadly Clostridium difficile infections and diarrhea. More alarming, the Centers for Disease Control reports that more and more cases of Clostridium difficile are being reported by non-hospitalized healthy adults. Could this rise in C. difficile infection rates be among the users of heartburn remedies? It seems likely.

For the complete report, go to http://www.knowledgeofhealth.com/report.asp?story=The%20Heartburn%20Remedy%2 0That%20Kills

Editor's Note: Try digestive enzymes during meals.

Light Sensitivity

1. Improve Night Vision with Herbal Extract
By Kimberly Beauchamp, ND

Healthnotes Newswire (November 10, 2005)—Supplementing with a highly concentrated extract of bilberry fruit (Vaccinium myrtillus) may help improve night vision in nearsighted people, reports the British Journal of Nutrition (2005;93:895–9).

The new study was conducted to determine the effect of a bilberry extract on night vision and other symptoms related to nearsightedness in 60 people with mild to moderate myopia. People received either 100 mg of a bilberry extract (containing 85% anthocyanosides) two times per day or a placebo for four weeks.

The bilberry-supplemented group showed significantly greater improvement in eye symptoms than the placebo group. Contrast sensitivity was also significantly improved in the bilberry group, suggesting an improvement in night vision. No improvement in night vision was seen in the placebo group.

No side effects were associated with use of the bilberry supplement.

Bilberry, a relative of the blueberry, is a small shrub that grows in northern Europe and North America. Historically the berries have been used to treat diarrhea, hemorrhoids, and urinary tract infections. The active components of bilberry, called anthocyanosides, are potent antioxidants, which help repair tissue and strengthen blood vessels. Preliminary studies have shown that bilberry may prevent cataracts and help treat age-related macular degeneration and the eye damage that occurs in some people with diabetes (diabetic retinopathy). Anthocyanosides also enhance the function of a compound in the eye that is responsible for night vision. British World War II pilots reported improved night vision after eating bilberries.

Not all studies, however, have concluded that bilberry has vision-enhancing effects.

Editor's Note: For an excellent organic liquid form of bilberry, go to http://www.naturaleyecare.com/store/detail.aspx?ID=1539

2. Lutein, Zeaxanthin and Light Sensitivity 2008

The February 2008 issue of Optometry & Vision Science published a study about lutein and zeaxanthin which found that many visual performance issues (including contrast sensitivity) are compromised under glaring light conditions. The human macular pigments (MPs), lutein and zeaxanthin, were found to be strongly related to improvements in glare disability and photostress recovery of those people with “normal eyesight”.1 This includes dealing with bright sunlight outdoors, light from your computer monitors, bright car headlights, etc.

The study included forty healthy individuals (mean age of 23.9) who were followed for 6 months measuring their MP. After six months of lutein and zeaxanthin supplementation, average MP improved and had shown to significantly reduce the harmful effects of glare.

Macular Degeneration

1. 2005 Study Shows Benefits of Nutrients for Macular Degeneration
This randomized, double-blind, placebo-controlled study enrolled 106 patients with bilateral macular degeneration. The subjects received either a nutrient combination (consisting of 200 mg of acetyl-L-carnitine, 780 mg of omega-3 fatty acids, and 20 mg of coenzyme Q10) or a placebo daily for 12 months, and underwent visual testing every three months. Treatment improved visual field defects in both eyes. Only one of 102 eyes treated deteriorated during the 12-month study, compared to 14 of 110 placebo-treated eyes. Moreover, the area of the eye’s fundus covered by drusen (degenerated retinal pigment cells that are a precursor to macular degeneration) in the treated group decreased by 15% to 23%, while increasing by more than 10% in the placebo group.

The nutrients were selected based on their biological activities. Specifically, acetyl-L-carnitine facilitates fatty acid oxidation, omega-3 fatty acids regulate neural and sensory development in the retina, and coenzyme Q10 is critical to the generation of energy in the mitochondria. The results suggest that supporting mitochondrial health may be useful in preventing and managing macular degeneration.

Reference

* Feher J, Kovasc B, Kovacs I, Schvoller M, Papale A, Balacco Gabrieli C. Improvement of visual functions and fundus alterations in early age-related macular degeneration treated with a combination of acetyl-L-carnitine, n-3 fatty acids, and coenzyme Q10. Ophthalmologica. 2005 May-Jun;219(3):154-66.

2. acetyl-L-carnitine, omega-3 fatty acids, coenzyme Q10 may help reduce drusen
Improvement of visual functions and fundus alterations in early age-related macular degeneration treated with a combination of acetyl-L-carnitine, n-3 fatty acids, and coenzyme Q10. Ophthalmologica. 2005 May-Jun;219(3):154-66.

The aim of this randomized, double-blind, placebo-controlled clinical trial was to determine the efficacy of a combination of acetyl-L-carnitine, n-3 fatty acids, and coenzyme Q10 (Phototrop) on the visual functions and fundus alterations in early age-related macular degeneration (AMD). One hundred and six patients with a clinical diagnosis of early AMD were randomized to the treated or contro l groups. The primary efficacy variable was the change in the visual field mean defect (VFMD) from baseline to 12 months of treatment, with secondary efficacy parameters: visual acuity (Snellen chart and ETDRS chart), foveal sensitivity as measured by perimetry, and fundus alterations as evaluated according to the criteria of the International Classification and Grading System for AMD.

The mean change in all four parameters of visual functions showed significant improvement in the treated group by the end of the study period. In addition, in the treated group only 1 out of 48 cases (2%) while in the placebo group 9 out of 53 (17%) showed clinically significant worsening in VFMD.

Decrease in drusen-covered area of treated eyes was also statistically significant as compared to placebo when either the most affected eyes or the less affected eyes were considered. These findings strongly suggested that an appropriate combination of compounds which affect mitochondrial lipid metabolism, may improve and subsequently stabilize visual functions, and it may also improve fundus alterations in patients affected by early AMD.

3. Age related macular degeneration and micronutrient antioxidants.
Curr Eye Res. 2004 Dec;29(6):387-401. Hogg R, Chakravarthy U. Ophthalmology & Vision Science, Institute of Clinical Science, The Royal Victoria Hospital, Belfast, Northern Ireland.
Age-related macular degeneration is a common clinical entity. The late-stage manifestations of age-related macular degeneration have devastating consequences for vision. Various risk factors have been identified in the development of the condition, which are consistent with the premise that oxidative stress plays an important role in its pathogenesis. Thus, the possibility that antioxidant balance can be manipulated through diet or supplementation has created much interest. Associations between diet and nutrition and the clinical features of macular degeneration have been described. Scrutiny of the literature shows consistency in the report of notable reductions in serum micronutrients in wet Age related macular degeneration, however, the evidence for causation is still circumstantial. In this comprehensive review of the clinical literature, we have assessed the evidence for a link between diet and nutrition as risk factors for the development of macular degeneration. All published case control, population-based, and interventional studies on macular degeneration were examined. Although initial support appeared to be moderate and somewhat contradictory, the evidence that lifetime oxidative stress plays an important role in the development of ARM is now compelling. The positive outcomes in the Age-Related Eye Diseases Study, a major controlled clinical trial, have given hope that modulation of the antioxidant balance through supplementation can help prevent progression to Age related macular degeneration.

4. Age-related Macular Degeneration and DHEA
Study suggests correlation between reduced blood serum levels of DHEA and increased severity of macular degeneration.

Am J Ophthalmol. 2006 Nov 13;

Serum Dehydroepiandrosterone Sulphate Level in Age-related Macular Degeneration

Tamer C, Oksuz H, Sogut S.
Ophthalmology Department.

PURPOSE: To evaluate plasma dehydroepiandrosterone sulphate (DHEAS) levels in patients diagnosed with age-related macular degeneration (AMD) and controls. DESIGN: Case-controlled, prospective, comparative noninterventional study. METHODS: This study involved 32 men and 35 women with exudative AMD, 37 men and 38 women with nonexudative AMD, and 32 men and 32 women of an age-matched control group. The Wisconsin Age-Related Maculopathy Grading System was used to asses the severity of AMD lesions. DHEAS levels were measured and compared according to a gender based subdivision. Analysis of variance was used to assess the association between DHEAS and AMD. Linear regression model was used to examine the relation among DHEAS level and AMD severity scale. RESULTS: Mean +/- SD of DHEAS levels in exudative AMD, nonexudative AMD, and controls in men was 2.67 +/- 0.68 mumol/l, 2.89 +/- 0.95 mumol/l, and 4.43 +/- 1.44 mumol/l, respectively (P = .001), and in women was 1.64 +/- 0.72 mumol/l, 1.85 +/- 0.73 mumol/l, and 2.78 +/- 0.91 mumol/l, respectively (P = .001). Post hoc Tukey analyses revealed a significant reduction in serum DHEAS level in both AMD groups, compared with controls for men and women (P = .001), while no difference was found between AMD groups in both men and women (P = .668 and 0.49, respectively). Regression analyses revealed an inverse correlation among serum DHEAS level and AMD severity scale both in men and women (P = .006 and .007, respectively).

CONCLUSIONS: This study suggests an inverse correlation between serum DHEAS level and AMD severity scale with a considerably reduced DHEAS level in AMD.

5. Antioxidants (1991) - macular degeneration
After 18 months, subjects with macular degeneration who took antioxidants on a consistent basis were 2.5X more likely to improve on visual acuity testing, and four times less likely to deteriorate in their worst eye, compared to those who took them less consistently. J. Cat Refr Surg, Mar 1991.

6. Antioxidants (1996) & macular degeneration
The ARMD population manifested decreased intake of vitamin E, magnesium, zinc, vitamin B6 and folic acid. Patients with advanced ARMD taking antioxidants twice daily maintained vision in their better functioning eyes significantly better than those taking a placebo. Richer, J Am Optom Assoc 1996 Jan;67(1):12-29 J Am Optom Assoc 1996 Jan;67(1):30-49

7. Antioxidants (1997) and angiogenetic factor associated with age-related macular degeneration (exudative type)
Ishihara N, Yuzawa M, Tamakoshi A Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan. Nippon Ganka Gakkai Zasshi 1997 Mar;101(3):248-51

To confirm the hypothesis that antioxidants and angiogenetic factors may be associated with the development of age-related macular degeneration (exudative type), we compared serum levels of vitamins A, C, and E and carotinoid, zinc, selenium and b-FGF (basic-fibroblast growth factor) in 35 patients with age-related macular degeneration (exudative type) with the levels in 66 controls. The average serum zinc level was significantly lower in the patient group than in the control group. Serum vitamin E-alpha levels also tended to be lower. Most serum b-FGF levels were below the standard value in each group. Based on the above results, we conclude that subnormal levels of zinc and vitamin E may be associated with the development of age- related macular degeneration.

8. Antioxidants (2001) and Zinc - AREDS Study
Clinical Trial Finds Antioxidants and Zinc Beneficial in Reducing Risk of Severe AMD.

Patients with advanced cases of dry age-related macular degeneration (AMD) can moderately lower the risk of developing the more severe wet form of the disease and preserve vision by taking a daily dose of antioxidant vitamins and zinc. This finding is the result of the Age-Related Eye Disease Study (AREDS), a randomized, placebo-controlled clinical trial funded by the National Eye Institute. AREDS evaluated over 3600 men and women between the ages of 55 and 80 for an average of 6.3 years. Published in the October, 2001 issue of the Archives of Ophthalmology, AREDS also evaluated whether antioxidants and zinc might reduce cataract development but found no beneficial effect.

Dr. Paul Sieving, Director of the National Eye Institute, stated, "Now that we know antioxidants and zinc are helpful in reducing the risk of severe disease, it is even more important for older-age Americans to have regular eye exams. Intervening in at-risk individuals could help reduce severe disease and vision loss in millions of Americans." Specifically, the AREDS study found that AMD patients with advanced cases of dry AMD or vision loss due to wet AMD in one eye, who took daily supplements containing vitamin C, vitamin E, beta carotene, and zinc, had a 20% chance of developing wet macular degeneration over a five-year period. By comparison, the control group taking a placebo pill lacking any nutrients had a 28% chance of developing wet macular degeneration over a five-year period. This finding is important because delaying the onset of wet AMD and its accompanying vision loss by several years can prolong the independence and mobility of seniors and preserve their quality of life.

Dosages Used in the Study:

The daily therapeutic dosages of each of the nutrients used in the AREDS study are as follows: vitamin C, 500 mg; vitamin E, 400 IU; beta carotene, 15 mg; and zinc, 80 mg Cancer prevention studies have found that high doses of beta carotene increase the risk of developing lung cancer in cigarette smokers. These studies strongly suggest that cigarette smokers, or those with smoking histories, should avoid taking beta carotene to prevent advanced macular degeneration.

9. Antioxidants (2008) and Macular Degeneration Prevention Study

A new study reveals part of the magic behind a diet rich in antioxidants, showing how artichokes, blueberries and pecans can hold at bay the leading cause of age-related blindness in developed countries.

Researchers at Brigham Young University and Weill Medical College of Cornell University discovered a link between two processes in the retina that, in combination, contribute to a disease called macular degeneration. They found antioxidants disrupt the link and extend the lifetime of irreplaceable photoreceptors and other retinal cells.

“The implication is that people at risk of macular degeneration could help prevent the disease by consuming antioxidants,” said Heidi Vollmer-Snarr, a BYU chemist who earned a doctorate from Oxford and began work on this disease as a postdoctoral researcher at Columbia.

The new study finds a destructive synergy between the buildup of a compound called A2E and damage to cellular “power plants” called mitochondria. A2E is a natural byproduct of cellular activity that, unlike other compounds, won’t break down or be disposed by the body.

A problem occurs when A2E encounters oxidative stress created by light exposure. In these circumstances, A2E disrupts energy production in mitochondria. The resulting energy shortage pulls the plug on daily cleaning and maintenance of photoreceptors and another type of retinal cell.

The result is more A2E buildup, and the cycle of destruction hastens the death of these vital visual cells, which are not replaced when they die. The experiments performed with visual cells from rats, cows and humans showed that antioxidants could completely counter the damage.

Again, researches found that antioxidants disrupt the above link and extend the lifetime of irreplaceable photoreceptors and other retinal cells.

This study will be published in the upcoming issue of the Journal of Biological Chemistry.

10. Antioxidants, Lutein, Zeaxanthin and Macular Degeneration Study
A study by Dr. Paul Bernstein from the University of Utah indicated that low eye levels of antioxidants, lutein and zeaxanthin, could contribute to Aged-Related Macular Degeneration. The study compaged carotenoid levels in 63 patients with Aged-Related Macular Degeneration to 138 patients with this disease. The study also showed that supplementing with just 4 mg per day of lutein could return lutein levels back to normal.

Ophthalmology, 2002;109:1780-1878

11. AREDS Study (2001)
NATIONAL INSTITUTES OF HEALTH
National Eye Institute
October 12, 2001

Antioxidant Vitamins and Zinc Reduce Risk of Vision Loss from Age-Related Macular Degeneration

Same Nutrients Have No Effect on the Development of Cataract

High levels of antioxidants and zinc significantly reduce the risk of advanced age-related macular degeneration (AMD) and its associated vision loss. These same nutrients had no significant effect on the development or progression of cataract. These findings from a nationwide clinical trial are reported in the October 2001 issue of Archives of Ophthalmology.

Scientists found that people at high risk of developing advanced stages of AMD, a leading cause of vision loss, lowered their risk by about 25 percent when treated with a high-dose combination of vitamin C, vitamin E, beta-carotene, and zinc. In the same high risk group -- which includes people with intermediate AMD, or advanced AMD in one eye but not the other eye -- the nutrients reduced the risk of vision loss caused by advanced AMD by about 19 percent. For those study participants who had either no AMD or early AMD, the nutrients did not provide an apparent benefit. The clinical trial -- called the Age-Related Eye Disease Study (AREDS) -- was sponsored by the National Eye Institute (NEI), one of the Federal government's National Institutes of Health.

"This is an exciting discovery because, for people at high risk for developing advanced AMD, these nutrients are the first effective treatment to slow the progression of the disease," said Paul A. Sieving, M.D., Ph.D., director of the NEI. "AMD is a leading cause of visual impairment and blindness in Americans 65 years of age and older. Currently, treatment for advanced AMD is quite limited. These nutrients will delay the progression to advanced AMD in people who are at high risk -- those with intermediate AMD in one or both eyes, or those with advanced AMD in one eye already.

"The nutrients are not a cure for AMD, nor will they restore vision already lost from the disease," Dr. Sieving said. "But they will play a key role in helping people at high risk for developing advanced AMD keep their vision."

A common feature of AMD is the presence of drusen, which are yellow deposits under the retina. Often found in people over age 60, drusen can be seen by an eye care professional during an eye exam in which the pupils are dilated. Drusen by themselves do not usually cause vision loss, but an increase in their size and/or number increases a person's risk of developing advanced AMD, which can cause serious vision loss.

The three stages of AMD analyzed in this study are:

• Early AMD. People with early AMD have, in one or both eyes, either several small drusen or a few medium-sized drusen; these people do not have vision loss from AMD.
• Intermediate AMD. People with intermediate AMD have, in one or both eyes, either many medium-sized drusen or one or more large drusen; in these people, there is usually little or no vision loss.
• Advanced AMD. In addition to drusen, people with advanced AMD have, in one or both eyes, either:
  
  - A breakdown of light-sensitive cells and supporting tissue in the central retinal area (advanced dry form); or
  
  - Abnormal and fragile blood vessels under the retina that can leak fluid or bleed (wet form).

12. Associations Between Intermediate Age-Related Macular Degeneration and Lutein and Zeaxanthin in the Carotenoids in Age-Related Eye Disease Study (CAREDS)
Ancillary Study of the Women's Health Initiative

Suzen M. Moeller, PhD; Niyati Parekh, PhD; Lesley Tinker, PhD; Cheryl Ritenbaugh, PhD, MPH; Barbara Blodi, MD; Robert B. Wallace, MD; Julie A. Mares, PhD; for the CAREDS Research Study Group

Arch Ophthalmol. 2006;124:1151-1162.

Objective To evaluate the relationship between dietary lutein plus zeaxanthin and intermediate age-related macular degeneration (AMD).

Design Women aged 50 to 79 years in Iowa, Wisconsin, and Oregon with intake of lutein plus zeaxanthin above the 78th (high) and below the 28th (low) percentiles at baseline in the Women's Health Initiative Observational Study were recruited 4 to 7 years later into the Carotenoids in Age-Related Eye Disease Study (CAREDS), when the presence of AMD was determined by fundus photographs. Logistic regression analyses examined the prevalence of AMD in 1787 CAREDS participants, after accounting for potential covariates.

Results The prevalence of intermediate AMD was not statistically different between the high and low lutein plus zeaxanthin intake recruitment groups after adjusting for age (odds ratio, 0.96; 95% confidence interval, 0.75-1.23). Limiting analyses to women younger than 75 years with stable intake of lutein plus zeaxanthin, without a history of chronic diseases that are often associated with diet changes, substantially lowered odds ratios (0.57; 95% confidence interval, 0.34-0.95). Exploratory analyses of advanced AMD in 34 participants resulted in protective, but statistically nonsignificant, associations in the overall sample and in women younger than 75 years.

Conclusion Diets rich in lutein plus zeaxanthin may protect against intermediate AMD in healthy women younger than 75 years.

Author Affiliations: Departments of Ophthalmology and Visual Sciences (Drs Moeller, Parekh, Blodi, and Mares) and Nutritional Sciences (Drs Moeller and Parekh), University of Wisconsin, Madison; Fred Hutchinson Cancer Research Center, Seattle, Wash (Dr Tinker); Department of Family and Community Medicine, University of Arizona, Tucson (Dr Ritenbaugh); and Department of Epidemiology, University of Iowa, Iowa City (Dr Wallace).

13. Bacterium, Gene Play Roles in Elderly Vision Loss
Researchers at the Massachusetts Eye and Ear Infirmary found C. pneumoniae in the diseased eye tissue of five of nine people with wet AMD but not in the eyes of 20 people without AMD. The findings offer more evidence that AMD may be caused by inflammation, the researchers said.

The study appears in the November issue of the journal Graefe's Archive for Clinical and Experimental Ophthalmology.

"We found that C. pneumoniae infection led to increased production of vascular endothelial growth factor (VEGF), the key protein involved in wet AMD. That C. pneumoniae infection of human eye cell types increases VEGF production is therefore significant and could explain in part why VEGF levels are increased in many people with wet AMD," Kalayoglu said.

"Our hypothesis is that C. pneumoniae may be the key link between CFH and AMD. That is, patients with CFH variations may be particularly susceptible to the damaging effects of chronic infection, and an infectious organism like C. pneumoniae may be particularly effective in accelerating inflammation and driving progression of AMD in these patients," Kalayoglu said.

14. Cardiovascular Risk Factors and AMD

This study assessed the association of cardiovascular risk factors and ocular perfusion pressure with early and advanced age-related macular degeneration (AMD) in Latinos. Data were collected from a population-based sample of self-identified adult Latinos using standardized protocols for assessing blood pressure and intraocular pressure (IOP) measurement and stereoscopic macular photography. Hypertension was defined as either a history of hypertension or systolic blood pressure (SBP) higher than 140 mmHg +/- diastolic blood pressure (DBP) 85 mmHg or higher. Ocular perfusion pressure (OPP) was defined as the difference between mean arterial blood pressure and IOP. AMD was diagnosed from photographic grading by masked trained graders.

Gradable retinal photographs were available in 5,875 participants. After adjusting for age, gender and cigarette smoking, higher DBP and uncontrolled diastolic hypertension were associated with exudative AMD. Higher OPP was associated with a decreased risk of geographic atrophy (GA). Low pulse pressure was associated with a lower risk of exudative AMD. Obesity was associated with increased retinal pigment.

These data suggest that in Latinos, cardiovascular risk factors may play a role in advanced AMD. Given that Latinos have a high prevalence of cardiovascular risk factors, an intervention aimed at reducing these risk factors may also have a beneficial impact on the risk of having early and advanced AMD.

SOURCE: Fraser-Bell S, Wu J, Klein R, et al. Cardiovascular risk factors and age-related macular

15. Carotenoids (1995) and antioxidants
Laboratory data shows that carotenoid and antioxidant vitamins help to protect the retina from oxidative damage initiated in part by absorption of light. When the dietary intake of different carotenoids as analyzed, the sum of lutein and zeaxanthin , the retinal carotenoids forming macular pigment, had the strongest protective effects against neovascular AMD. DM Snodderly, Am J Clin Nutr 1995 Dec;62(6 Suppl):1448S-1461S

16. Collard greens and spinach (1988)
Eating collard greens and spinach at a frequency of two to four times a week was enough to lower the risk of macular degeneration by 46 percent, and was even greater at five to six times per week. Goldberg, J. et al. Factors associated with age-related macular degeneration: An analysis of data from the First National Health and Nutrition Examination Survey. American Journal of Epidemiology 128 (1988): 700-20.
Editor’s Note: Lutein and Zeaxanthin are the two carotenoids found in collard greens and spinach. When taken as supplements, they are best taken separately from beta-carotene because they compete for absorption.

17. Combined Supplements Improve Visual Acuity in Subjects with Dry Macular 2007
Combined Supplements Improve Visual Acuity in Subjects with Dry Macular Degeneration

Author: Steve Austin, N.D.

Reference: Cangemi FE. TOZAL study: an open case control study of an oral antioxidant and omega-3 supplement for dry AMD. BMC Ophthalmol 2007;7:3-12.

Design: Despite the article title (see above), this was a controlled, double blind (though not randomized) intervention trial.

Participants: Subjects included 37 adults with age-related macular degeneration (AMD). The control was a constructed cohort of similar patients from a previous report matched for both inclusion and exclusion criteria.

Study Medication and Dosage: Study subjects received retinol (10,000 IU/d), beta-carotene (28,640 IU/d), vitamin C (452 mg/d), vitamin E (200 IU/d), zinc (56 mg/d), copper (1.6 mg/d), taurine (400 mg), EPA (180 mg/d), DHA (120 mg/d), lutein (8 mg/d), and zeaxanthin 400 mcg/d). The control subjects had also received vitamin C (400 mg/d), vitamin E (200 IU), zinc (40 mg), and beta-carotene (300 IU/d), but none of the other supplements.

Primary Outcome Measures: Changes from baseline in visual function were measured using a variety of standard research tools (e.g., Best-Corrected Visual Acuity (BCVA) via the Early Treatment Diabetic Retinopathy Study (ETDRS) chart, contrast sensitivity, and retinal imaging).

Key Findings: 77% of subjects receiving the full complement of supplements demonstrated stabilization or improvement of BCVA at 6-months. These same subjects saw small improvements in visual acuity that achieved statistical significance (p<0.05). As expected, mean visual acuity declined in the control group.

Practice Implications: Conventional medicine has little to offer many patients with this all too common disease (incidence: >15,000,000 Americans >60 years of age), now the leading cause of irreversible blindness in the elderly. Progressive deterioration is the norm, though the rate of deterioration can vary significantly. Dry AMD is the most common form. Previous research has suggested the possibility that a wide variety of nutritional supplements help patients with AMD, such as lutein, fish oil, zinc, antioxidants, or some combination thereof. This trial combines most of these supplements at easily attainable dose levels. The outcome--a halting of progression and the beginnings of a reversal--give healthcare practitioners a potential treatment plan from which to get started.

Interestingly, a standard control group was not part of the trial design not due to the cost, but rather because the independent review board determined that evidence supporting nutritional supplementation is now so strong that the standard of care demands some nutritional supplementation.

18. CoQ10 Intake (2003) May Improve Retinal Function in Those with Macular Degeneration
In the journal Ophthalmologica, Dr. Janos Feher, a researcher at the University of Rome, Italy, reported that CoQ10 may improve retinal function in patients with age-related macular degeneration by improving the performance of mitochondria in the retinal pigment epithelium. Feher J, Papale A, Mannino G, Gualdi L, Balacco Gabrielli C. Mitotropic compounds for the treatment of age-related macular degeneration. The metabolic approach and a pilot study. Ophthalmol. 2003 Sept- Oct:217(5):351-7.

Dr. Feher and associates treated 14 patients diagnosed with early age-related macular degeneration using a preparation that included CoQ10, acetyl-L-carnitine, polyunsaturated fatty acids, and vitamin E. A matched control group received vitamin E alone. A number of tests were then performed at 3, 6, 9, 12, and 24 months.

In patients receiving the CoQ10 mixture, all functions were slightly improved after three months and remained level throughout the two-year study period, while degeneration and visual function among participants in the control group continued to slowly decline.

19. Deficiency of Taurine (1998)
Deficiency of taurine, an amino acid, has been shown to lead to retinal degeneration and supplementing it has been used with some success to prevent, treat and stabilize retinal changes. Altern Med Rev 1998 Apr;3(2):128-36. Oftalmol Zh 1989;(8):463-5 Brain Res Brain Res Rev 1991 May-Aug;16(2):151-69 J Neurosci Res 1987;18(4):602-14
Editors’s Note: Taurine should be taken on an empty stomach.

20. Diet High In Refined Carbohydrates, Cataracts and Macular Degeneration
For the past decade epidemiologic studies and clinical trials have been suggesting that diets high in the full-spectrum of vitamins, minerals and antioxidant nutrients lower the risk of degenerative eye diseases. New studies published in the 2006 April and May issues of The American Journal of Clinical Nutrition now suggest an association between consumption of high glycemic carbohydrate foods and both cortical and nuclear lens opacities and macular degeneration.

April 2006 Journal of Clinical Nutrition Study Design

1036 eyes from 526 Boston-area participants without a previous ARMD diagnosis were included in this study. Long-term dietary information was based on data from an average of 4 food-frequency questionnaires collected over a 10-year period before the assessment of ARMD.

Results and Conclusion

After multivariate adjustment, dietary glycemic index (GI), a measure of carbohydrate intake quality, was related to ARMD (specifically to retinal pigmentary abnormalities), whereas total carbohydrate intake was not.

May 2006 Journal of Clinical Nutrition Study Design

A food-frequency questionnaire was used to obtain dietary information from 3377 participants in the Age-Related Eye Disease Study (AREDS). The aim was to test whether glycemic index (GI) was associated with the presence of cortical or nuclear opacities.

Results and Conclusion

The participants with the highest dietary intake of high glycemic foods had the highest prevalence of nuclear and cortical opacities, respectively. This study is one of a few studies reporting the association between carbohydrate nutrition in non-diabetic persons and lens opacities, and it is the first study that has indicated a solid relationship between dietary GI and the risk of nuclear cataract.

References:

Dietary glycemic index and carbohydrate in relation to early age-related macular degeneration. Chiu J, Hubbard L, Armstrong J, et al. American Journal of Clinical Nutrition. 2006 Apr;83(4):880-6 [abstract]

Dietary carbohydrate intake and glycemic index in relation to cortical and nuclear lens opacities in the Age-Related Eye Disease Study Chiu J, Milton R, et al. American Journal of Clinical Nutrition. 2006 May;83(5):1177-84.abstract]

21. Dietary carotenoids, vitamins A, C, and E (1994)
Dietary carotenoids, vitamins A, C, and E, and advanced age-related macular degeneration. Johanna M. Seddon, Umed A. Ajani, Robert D. Sperduto, Rita Hiller, Norman Blair, Thomas C. Burton, Marilyn D. Farber, Evangelos S. Gragoudas, Julia Haller, Dayton T. Miller, Lawrence A. Yannuzzi, Walter Willet: for the Eye Disease Case-Control Study Group. JAMA (The Journal of the American Medical Association) 272: 1413-1420 (1994).

22. Dietary Glycemic Index and AMD Association
Age-related macular degeneration (AMD) appears to share several carbohydrate-related mechanisms and risk factors with diabetes-related diseases, including retinopathy and cardiovascular disease (CVD). The objective of this study was to test the hypothesis that dietary glycemic index (dGI), which has been related to the risk of diabetes and CVD, is associated with the risk and severity of AMD in non-diabetic elderly populations. Dietary information was obtained from 4,099 participants aged 55 to 80 years (56 percent women) who participated in the Age-Related Eye Disease Study (AREDS). A total of 8,125 eligible eyes at baseline were classified into one of five AMD groups according to the size and extent of drusen, the presence of geographic atrophy and neovascular changes.

Compared with eyes in the first quintile of dGI, eyes in the fourth and fifth quintiles had a significantly or suggestively higher risk of large drusen, geographic atrophy and neovascularization. A significant positive relation between dGI and severity of AMD was noted. There was a 49 percent increase in the risk of advanced AMD (geographic atrophy plus neovascularization) for participants who had a dGI higher than the sex median (women, 77.9 or greater; men, 79.3 or greater). This result indicated that 20 percent of prevalent cases of AMD would have been eliminated if the AREDS participants consumed diets with a dGI below the median.

The association between dGI and AMD from the AREDS cross-sectional analysis at baseline suggests that a reduction in the dGI, a modifiable risk factor, may provide a means of diminishing the risk of AMD.

SOURCE: Chiu CJ, Milton RC, Gensler G, Taylor A. Association between dietary glycemic index and age-related macular degeneration in nondiabetic participants in the Age-Related Eye Disease Study. Am J Clin Nutr 2007;86(1):180-8.

23. Dietary modification with lutein rich food (1999)
26. Richter Press Release

(PRESS RELEASE Reprinted from AOL News) DIETARY MODIFICATION WITH A LUTEIN-RICH FOOD REVERSES ARMD VISION LOSS, ACCORDING TO OPTOMETRIC RESEARCHER DR. STUART RICHER
ATLANTA, Feb. 25 /PRNewswire/ - Dietary modification with a lutein-rich food can reverse the damaging effects of age-related macular degeneration (ARMD), the leading cause of blindness in people over age 65 in the United States, according to a report presented today by Stuart Richer, O.D. at the Southern Council of Optometrists 1999 annual meeting. Until this point, research only indicated that diet plays an important role in reducing disease risk.
“Patients demonstrated positive effects in visual function in one or both eyes with the simple addition of lutein-rich foods,” reported Richer, chief of the Optometry Section, DVA Medical Center, North Chicago, IL. “This research supports the hypothesis that lutein is associated with building macular pigment, a key indicator of ARMD risk and pathology.”
Richer supplemented the diets of 15 atrophic (dry) ARMD patients with an additional portion of five ounces of sautéed spinach four to seven times per week. Study subjects were given a battery of tests to establish baseline measurements of contrast sensitivity, low-luminance, low-contrast visual acuity and glare recovery in each eye. Subsequent measurements were made at intervals ranging from two months to 12 months. Richer observed improvements in visual function in as little as three months. Often striking improvements in vision were detected through follow-up tests, even when the patient did not report subjective vision changes. Partial or complete resolution of metamorphopsia (distorted vision) and scotomas (blind spots) was reported in seven of eight applicable cases.
Dietary treatment of ARMD should receive more attention, due to its simplicity, low cost and potential application in a broad range of ARMD cases, according to Richer. “There is a preoccupation by clinicians and researchers with exudative (wet) ARMD and a continuing commercial and professional interest in higher-technology, expensive treatment approaches,” said Richer. “Such therapies are applicable to a small percentage of ARMD patients and the disease must be detected early for treatment to be effective.” Prevent Blindness America, the nation’s leading eye health organization, estimates 13 million people in the U.S. have symptoms of ARMD, and the disease causes visual impairment in 1.2 million. Richer said this is particularly alarming as the population over the age of 65 is projected to double by the year 2050.
Lutein and zeaxanthin, related carotenoids found in leafy green vegetables like spinach and kale, are concentrated in retinal macular pigment and accumulation is dependent on dietary intake.
Macular pigment may filter blue light that damages photoreceptors and the retinal pigment epithelium. In addition, carotenoids may limit oxidant stress resulting from metabolism and light, acting as antioxidants.
. “There is hope for people who suffer from ARMD as well as those at risk for the disease. This disease is preventable, and now may even be treatable with the right dietary modifications or intake of lutein supplements,” said Richer.

24. Dietary Omega-3 Fatty Acids (2003) May Reduce Risk of Age-Related Macular Degeneration
May 6, 2003 — Dietary omega-3 fatty acids but not beta-carotene supplementation is associated with a reduced risk of age-related macular degeneration (AMD), according to two presentations May 4-6 at the Association for Research in Vision and Ophthalmology annual meeting in Fort Lauderdale, Florida. A third presentation suggests that omega-3 fatty acids may also reduce the risk of dry eye syndrome in women.

"Higher intake of omega n-3 long-chain polyunsaturated fatty acid (LCPUFA) and fish was associated with decreased risk of having neovascular AMD after adjusting for nutrient- and nonnutrient-based predictors and correlates of AMD," write J. P. SanGiovanni, from the National Eye Institute in Bethesda, Maryland, and colleagues.

The Age-Related Eye Disease Study (AREDS) was a case-control study of 4,513 participants aged 60 to 80 years at enrollment. Best-corrected visual acuity was 20/32 or better in at least one eye in all subjects.

Compared with the lowest quintile of total n-3 LCPUFA intake, the risk for neovascular AMD was significantly decreased for the highest quintile (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.40 - 0.88), after statistical adjustment for all nutrient- and nonnutrient-based variables. Docosahexaenoic acid, an n-3 LCPUFA that is selectively accreted and retained in the photoreceptor outer segments, also had a protective effect (OR for highest vs. lowest quintile, 0.53; 95% CI, 0.35 - 0.79).

Total fish consumption of more than two servings per week was associated with a decreased risk for neovascular AMD compared with no fish in the diet (OR, 0.49; 95% CI, 0.28 - 0.84). Having more than one four-ounce weekly serving of broiled or baked fish (OR, 0.64; 95% CI, 0.44 - 0.94) or tuna (OR, 0.66; 95% CI, 0.45 - 0.98) also protected against neovascular AMD.

Bausch & Lomb, Inc. helped support this study.

25. Dietary supplementation with bilberry extract prevents macular degeneration and cataracts in senesce-accelerated OXYS rats.
Cataracts and macular degeneration remain the major cause of blindness and acuity of vision deterioration in the elderly. Both pathology have been attributed to damage by free radicals, there has been a great deal of interest in antioxidants. Bilberry's flavonoids are known as potent antioxidants, scavenging free radicals and used for multiple age-releted ocular disorders. There are no experimental studies, devoted to estimation of bilberry effect. To explore this one the senescence-accelerated OXYS rats with early senile cataract and macular degeneration were used. From 1.5 to 3 month OXYS rats were given control diets or those supplemented with 25% bilberry extract (BE, 20 mg on kg of body weight including 4.5 mg of antocianidin) or vitamin E (40 mg/kg) as drag for comparison. The testing at 3 month have showed that more then 70% of control OXYS rats had cataract and macular degeneration while the supplementation of BE completely prevented impairments in the lenses and retina. The VE had no significant effects but both antioxidants decreased lipid peroxides in the retina and serum of OXYS rats. The results suggest that the OXYS rat strain is the useful model for macular degeneration and senile cataract and long-term supplementation with bilberry extract is effective in prevention of macular degeneration and cataract.

26. Early Age-Related Maculopathy in Eyes After Cataract Surgery
Early Age-Related Maculopathy in Eyes After Cataract Surgery

Patients aged 60 years and older who had undergone cataract surgery at Westmead Hospital, Sydney, Australia, during 2001 to 2003 were examined for age-related maculopathy (ARM). Interviews using standardized questionnaires and stereo retinal photography were performed. Retinal photographs were graded using the Wisconsin ARM grading system. The proportions with ARM were compared between surgical and non-surgical eyes, and between this surgical cohort and the Blue Mountains Eye Study population.

27. Eggs for Eyes
In a new study, published in the Journal of Nutrition, 33 people age 60 or older were divided into two groups. During the first five weeks, one group ate one egg per day while the other group ate no eggs; both groups stopped eating eggs for a period of time and then the groups were reversed for another five weeks. In the egg-eating groups, blood levels of lutein and zeaxanthin rose 26% in the first phase of the study and 38% in the second phase. Neither group experienced any significant change in their cholesterol levels. One regular egg per day, despite having relatively little lutein and zeaxanthin, was enough to raise these antioxidant levels in seniors without raising their cholesterol levels. This finding suggests that eggs—and possibly eggs from chickens that eat grass and other fresh vegetation in particular—could be a part of a healthy diet for older people trying to prevent macular degeneration. (J Nutr 2006;136:2519–24)

28. Elevated Homocysteine Levels and Eye Disease Including Macular Degeneration
Cataracts and Bioflavenoids

In clinical studies elevated homocysteine is associated with the following:

- degenerative eye diseases including macular degeneration, glaucoma, diabetic retinopathy, optic neuropathy and ocular complications from behcet disease. - accelerating the progression of the aging process. - being a major cause or contributing factor to heart disease, abnormal clotting, dementia, depression , multiple sclerosis, Parkinsons Disease, miscarriage and psoriasis.

The following also affect homocysteine levels in the blood: aging, excessive stress, deficiencies in choline, taurine, n-acetyl-cysteine.

Eye Related References:

1. Elevated homocysteine levels in aqueous humor of patients with pseudoexfoliation glaucoma. Bleich S, Roedl J, et al. Am J Ophthalmol. 2004 Jul; 138(1):162-4 [abstract]
2. Plasma homocysteine and total thiol content in patients with exudative age-related macular degeneration. Coral K, Raman R, et al. Eye. 2005 Apr 1 [abstract]
Editor's Note: For our recommended nutrients for different eye conditions, please go to http://www.naturaleyecare.com/diseaselist.asp

29. Essential Fatty Acids and AMD Prevention (2001)
Fish Protect Against Macular Degeneration

Eating fish, especially tuna fish, may protect against age-related macular degeneration (AMD), which is a currently untreatable disease that causes fuzziness, shadows or other distortions in the center of vision.

Over several years, investigators questioned study participants about their diets and calculated the types of fat and total fat they ate.

Those who ate more fat overall increased their risk of AMD, while those who ate fish reduced their risk of developing the eye disease.

Diets containing saturated fats from animals and unsaturated fats from vegetables were associated with modest increases in the risk of developing AMD, although long-chain fats from fish, especially tuna fish, actually reduced the risk.

A specific fish fat, called docosahexaenoic acid (DHA), may help protect and promote healthy retinal function.

It is also concentrated in the retina of the eye. DHA was modestly inversely related to AMD. The intake of fish, the food source of DHA, was also inversely related.

American Journal of Clinical Nutrition 2001;73:209-218

30. Exercise and Macular Degeneration Prevention
M D Knudtson, R Klein and B E K Klein
Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA

Correspondence to:
M D Knudtson
University of Wisconsin-Madison, School of Medicine and Public Health, Department of Ophthalmology and Visual Sciences, 610 North Walnut Street, 4th Floor WARF, Madison, WI 53726-2336, USA; knudtson@epi.ophth.wisc.edu

ABSTRACT
Background: Cardiovascular disease and age-related macular degeneration (AMD) may share common risk factors. Physical activity improves the cardiovascular risk profile; however, there have been few studies investigating a relationship between physical activity and the long-term incidence of AMD.

Methods: The 15-year cumulative incidence of AMD was determined through four examination phases at 5-year intervals of a population-based study conducted in Beaver Dam, Wisconsin, USA, initiated in 1988–90 (n = 3874 men and women between ages 43 and 86 years). Early AMD (pigment abnormalities or soft indistinct drusen), exudative AMD and geographic atrophy were determined by grading stereoscopic colour fundus photographs. Measures of physical activity were obtained through a questionnaire administered at the baseline examination.

Results: After controlling for age, sex, history of arthritis, systolic blood pressure, body mass index, smoking and education, people with an active lifestyle (defined as regular activity 3 times/week) at baseline were less likely to develop exudative AMD (odds ratio (OR) 0.3, 95% confidence interval (CI) 0.1 to 0.7) compared with people without an active lifestyle. After multivariate adjustment, increased categories of number of blocks walked per day decreased the risk of exudative AMD (OR 0.7, 95% CI 0.6 to 0.97). Physical activity was not related to the incidence of early AMD or pure geographic atrophy.

Conclusions: These data show a protective effect of physical activity for incident exudative AMD, independent of body mass index and other confounders. They also suggest a possible modifiable behaviour that might be protective against developing AMD.

31. Fish Consumption, Cholesterol and Incidence of AMD (2000)
Those consuming fish more than once per week were only half as likely to develop macular degeneration than those consuming it less than once per month. Those consuming the highest amount of cholesterol in their diet were 2.7 times more likely to develop advanced macular degeneration. Smith, et al. Arch Ophthalmol 2000, Mar;118(3):401-4

32. Fish Oil (Essential Fatty Acids) (2000)
According to a study in the March Archives of Ophthalmology Eating fish as seldom as one to three times a month may cut the risk of developing age-related (AMD). In research being done by Australian researchers, they have been studying more than 3,600 people aged 49 and older. They found that those who ate the most fish cut their risk of late-stage AMD by half compared to people who ate fish less than once a month. However, a fish-rich diet didn't seem to reduce the risk of early-stage AMD. They also found that people eating greater amounts of saturated fat and cholesterol appeared to increase the risk of AMD.

Researchers speculate that the omega-3 fatty acids found in fish may provide a protective effect. Similar fatty acids exist and are used in the eye's retina.

33. Gingko Biloba (1986)
One double blind study found that Gingko Biloba could help people with macular degeneration, possibly due to its benefit of improving blood circulation to the brain.Lebuisson DA, Leroy L, Rigal G. Treatment of senile macular degeneration with Ginkgo biloba extract. A preliminary double-blind, drug versus placebo study. Presse Med 1986;15:1556–58 [in French].

34. Glutathione - (1993) - Macular Degeneration
Glutathione and its related enzyme precursor amino acids (N-Acetyl-Cysteine, L-glycine, and glutamine and selenium are protective against damage to human retinal pigment epithelium cells. Sternberg, Davidson, Jones, et al. Invest Ophthalmol Vis Sci 1993 Dec;34(13):3661-8

35. Glutathione and Macular Degeneration (2002)
In the early stages of macular degeneration, glutathione has been found to protect retinal pigment epithelial cells from dying. Ayalasomayajula SP, et al. Induction of vascular endothelial growth factor by 4-hydroxynonenal and its prevention by glutathione precursors in retinal pigment epithelial cells. Eur J Pharmacol 2002 Aug 9;449(3):213-20.

36. Good Fats and Bad Fats and Macular Degeneration

In a recent study called the POLANUT study, the results showed a 60% decrease in the occurence of macular degeneration for those that included fatty fish in their diets more than once a month versus less than one time per month.

Saturated and monounsaturated fat intake were associated with increased risk for age-related macular degeneration. Total polyunsaturated fatty acid was not significantly associated with age-related macular degeneration. Total and white fish intake was not significantly associated with age-related macular degeneration.

Eur J Clin Nutr. 2007 Feb 14; Inserm, Research Unit U593 for Epidemiology, Public Health and Development, Bordeaux, France, Universite Victor Segalen Bordeaux 2, Bordeaux, France.

37. Higher Omega-3 Intake Reduces Risk of Developing Macular Degeneration (Study Oct. 2009)

A new study has investigated whether higher omega-3 intake is associated with a reduced likelihood of developing AMD. This study shows the progression to advanced AMD in 1837 people at moderate to high risk of the condition. Baseline data was on Omega-3 intake with a validated food-frequency questionnaire.

Participants who reported the highest omega-3 consumption were 20% less likely than their peers to develop AMD. The 12-year incidence of AMD in participants at moderate to high risk of these outcomes was lowest for those reporting the highest consumption of Omega-3. Assuming these results are generalizable, they may guide the development of low-cost and easily implemented preventive interventions for progression to advanced AMD.

Ref: http://www.ajcn.org/cgi/content/abstract/ajcn.2009.27594v1

38. Improvement of visual functions and fundus alterations in early age-related macular degeneration treated with a combination of acetyl-L-carnitine, n-3 fatty acids, and coenzyme Q10.
Ophthalmologica. 2005 May-Jun;219(3):154-66.
The aim of this randomized, double-blind, placebo-controlled clinical trial was to determine the efficacy of a combination of acetyl-L-carnitine, n-3 fatty acids, and coenzyme Q10 on the visual functions and fundus alterations in early age-related macular degeneration. One hundred and six patients with a clinical diagnosis of early macular degeneration were randomized to the treated or control groups. The primary efficacy variable was the change in the visual field mean defect (VFMD) from baseline to 12 months of treatment, with secondary efficacy parameters: visual acuity (Snellen chart and ETDRS chart), foveal sensitivity as measured by perimetry, and fundus alterations as evaluated according to the criteria of the International Classification and Grading System for macular degeneration. The mean change in all four parameters of visual functions showed significant improvement in the treated group by the end of the study period. In addition, in the treated group only 1 out of 48 cases (2%) while in the placebo group 9 out of 53 (17%) showed clinically significant worsening in VFMD. Decrease in drusen-covered area of treated eyes was also statistically significant as compared to placebo when either the most affected eyes or the less affected eyes were considered. These findings strongly suggested that an appropriate combination of compounds which affect mitochondrial lipid metabolism, may improve and subsequently stabilize visual functions, and it may also improve fundus alterations in patients affected by early macular degeneration.

39. Inflammation and Macular Degeneration
Recent study published in the June 2005 Archives of Ophthalmology reports a positive association between the systemic inflammatory markers CRP and Il-6 and the rate of progression to advanced AMD. Smoking and obesity were significantly related to elevated levels of both CRP and Il-6. This study also suggests that anti-inflammatory agents may play an important role in preventing AMD.

40. Inflammation and Risk of Developing Age-related Macular Degeneration
Recent study published in the June 2005 Archives of Ophthalmology reports a positive association between the systemic inflammatory markers CRP and Il-6 and the rate of progression to advanced AMD. Smoking and obesity were significantly related to elevated levels of both CRP and Il-6.

This study also suggests that anti-inflammatory agents may play an important role in preventing AMD.

41. Inflammation and Risk of Developing Age-related Macular Degeneration (2005)
A recent study published in the June 2005 Archives of Ophthalmology reports a positive association between the systemic inflammatory markers CRP and Il-6 and the rate of progression to advanced AMD. Smoking and obesity were significantly related to elevated levels of both CRP and Il-6. This study also suggests that anti-inflammatory agents may play an important role in preventing AMD.

42. Intake of carotenoids and reduced risk of macular degeneration
Study shows: (a) A higher dietary intake of carotenoids was associated with a lower risk for AMD. The specific carotenoids, lutein and zeaxanthin, which are primarily obtained from dark green leafy vegetables, were most strongly associated with a reduced risk for AMD. Individuals consuming the highest levels of carotenoids had a statistically significant 43% lower risk for AMD. A significant trend was seen for a lower risk for AMD with increasing amounts of carotenoids in the diet. The combination of lutein and zeaxanthin was most strongly associated with AMD, (b) The dominant pigments in the macula are lutein and zeaxanthin, which are selectively accumulated in the retina from plasma. Lutein and zeaxanthin can filter out visible blue light ... and might serve to protect the retina from photic damage or other oxidative insults. Seddon, etal. JAMA 1994 Nov 9;272(18):1413-20

43. Laser therapy improves vision in patients with Age-related Macular Degeneration
Laser therapy improves vision in patients with Age-related Macular Degeneration Low-level laser therapy improves vision in patients with Age-related Macular Degeneration Researchers at University of Heidelberg, Germany have conducted a clinical trial on 203 patients with AMD (age-related macular degeneration) and improved visual acuity for between 3 and 36 months. The prevalence of metamorphopsia, scotoma, and dyschromatopsia was reduced. In patients with wet AMD, edema and bleeding improved. The improved vision was maintained for 3-36 mo after treatment. Visual acuity in the control group remained unchanged. No adverse effects were observed in those undergoing therapy. Conclusion: In patients with AMD, LLLT significantly improved visual acuity without adverse side effects and may thus help to prevent loss of vision. Photomed Laser Surg 2008 Jun 26(3) 241-5

44. Lifestyle, Supplement May Improve Outcomes in AMD
New research indicates changes in lifestyle, including having a lower body mass index, exercising and taking a dietary supplement, may reduce the risk and/or the severity of age-related macular degeneration (AMD), which affects 30% of people 75 years or older. A study of 261 patients age 60 or older with signs of non-advanced AMD was_recently published in the Archives of Ophthalmology (2003;121[6]:785-792).

Patients were followed for an average of 4.6 years, and their height, weight and blood pressure were measured annually. The data indicated that study participants with a high body mass index (BMI >25) were more than twice as likely to have their AMD worsen than were those with lower weight. Patients who exercised vigorously at least three times a week had a 25% reduction in the risk that the severity of the disease would increase.

45. Limiting Refined Carbohydrates May Stall Macular Degeneration

Limiting carbohydrates in the diet may help slow the progression of age-related macular degeneration (AMD), according to a recent study by researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. The study builds on a recent analysis that found that men and women older than 55 years who consumed diets with higher-than-average dietary glycemic index foods appeared to have an increased risk for early and later stages of AMD. Dietary glycemic index determines how quickly carbohydrates are broken down into glucose: Foods with a high glycemic index are associated with a faster rise and subsequent drop in blood sugar than those with a low glycemic index.

In the study, investigators analyzed diet questionnaires completed by 4,757 non-diabetic men and women participating in the nationwide Age-Related Eye Disease Study (AREDS), an eight-year study that included participants ages 55 to 80 with varying stages of AMD. They examined the participants' carbohydrate intake over one year and used the data to calculate the participants' dietary glycemic index. Results showed that those who consumed the greatest amount of refined carbohydrates were 17 percent more likely to develop blinding AMD than the group that consumed the least. Based on this data, the investigators believe that limiting dietary refined carbohydrates in at-risk elderly people could reduce the number of advanced AMD cases by 8 percent in five years. The authors note, however, that their findings warrant randomized controlled clinical trials.

SOURCE: Chiu CJ, Milton RC, Klein R, et al. Dietary carbohydrate and the progression of age-related macular degeneration: A prospective study from the Age-Related Eye Disease Study. Am J Clin Nutr 2007;86(4):1210-8.

46. Low fat diet and omega-3 oils
In general, a very low-fat diet (10 percent of calories from fat) that excludes red meat and dairy products has been shown to reduce the risk of macular degeneration. Anderson, R.E., Rapp, L.M., and Wiegard, R.D.. Lipid peroxidation and retinal degeneration. Current Eye Research 3 (1984): 223-27.

However, the lack of omega-3 fatty acids, in the form of omega-3 oils, is also a risk factor. When treated with omega-3 fatty acids for four weeks, 85 percent of macular degeneration patients over age 70 experienced improved vision. Conner, W.E., Neuringer, M., and Reisbick, S. Essential fatty acids: The importance of n-2 fatty acids in the retina and the brain. Nutrition Reviews 50 (1992): 21-29.
Editor’s Note: The best sources of omega-3 EFA’s are the flesh of cold water marine fish as well as black currant oil, flaxseed oil and hemp seed.

47. Low selenium levels and smoking
There is a borderline association between age-related macular degeneration and both low serum selenium levels and current smoking status. Doc Ophthalmol 1992;81(4):387-400 Mayer, et al. Acta Ophthalmol Scand 1998 Feb;76(1):62-7

48. Lutein (1992) macular degeneration and cataracts
Lutein Research- 1992- Cataracts & Macular Degeneration Prevention (a) Decreased risk of neovascular AMD was associated with higher levels of carotenoids in the serum samples ... (pg. 1704), (b) Increased risk of neovascular AMD was associated with cigarette smoking, higher levels of serum cholesterol ... (pg. 1704) Persons with higher carotenoid levels (sum of serum lutein/zeaxanthin, b-carotene, a-carotene, cryptoxanthin, and lycopene levels) had markedly reduced risks of neovascular AMD. This finding is of special interest because of suggestions that AMD occurs after cumulative oxidative insults and that higher levels of micronutrients with antioxidant capability may decrease the risk of AMD. The Eye Disease Case-Control Study Group, "Risk Factors for Neovascular Age-Related Macular Degeneration," Archives of Ophthalmology, December, 1992, Volume 110, Pages 1701-1708.

49. Lutein (1997) AMD blue light
Study showed 2 test subjects consuming 30 mg free lutein per day for 140 days all had increased Macular Pigmentation in both eyes, which protects our eyes from blue light, and may be responsible for protecting us against macular degeneration. Supplementation caused a 10-fold increase in serum levels of lutein in both subjects within 10-20 days of treatment. Landrum, et al. Exp Eye Res 1997 Jul;65(1):57-62

50. Lutein (1999) from Spinach and Supplements
A preliminary study showed those consuming lutein from either spinach or supplements demonstrated some improvement of some of the early vision loss from "dry" macular degeneration. Richer, J. Amer Optom Assoc; Jan 1999

51. Lutein (1999), Xeaxanthin & the Retina - Macular Degeneration (AMD)
The macular pigment is highly organized within the retina of the human eye. Studies show that the retina contains two carotenoids, lutein and zeaxanthin, with the greatest concentration at the center. Within the central macula, zeaxanthin is the dominant component, up to 75% of the total, whereas in the peripheral retina, lutein predominates, usually being 67% or greater. Typical carotenoid concentrations within other human tissues are much lower. Data show that the macular pigment increases through dietary supplements. Evidence points to a correlation between macular pigment density and a reduction in the risk for age-related macular degeneration (AMD). [“Analysis of Zeaxanthin Distribution within Individual Human Retinas” by John T. Landrum, Richard A. Bone, Linda L. Moore, and Christina M. Gomez, Methods In Enzymology (1999, 299: 457-467).]

52. Lutein (2004) and AMD
Another lutein study was reported last month in the July, 2004 issue of The Journal Experimental Eye Research. And although this small, brief study didn't exactly fit the scope of what the Chicago team called for in the conclusion to their research, it still serves to confirm the effectiveness of lutein for patients with AMD.

Singapore Polytechnic researchers tested a group of seven older subjects with early stage AMD, and six subjects of the same age with healthy eyesight. Each subject received 10 mg of lutein supplements daily for 18 to 20 weeks.

Macular pigment optical density (MPOD) and plasma concentrations of lutein were measured before and after the study. The MPOD average increased significantly in both groups as lutein levels rose. Researchers concluded that even a diseased macula may accumulate and synthesize lutein effectively, while people with healthy macula reap benefits from lutein as well.

53. Lutein (2004) and dry AMD
Researchers at the Department of Veterans' Affairs, Medical Center Eye Clinic in Chicago, recruited 90 subjects with dry AMD. (There are two varieties of the disorder: dry AMD, and the more debilitating wet AMD in which blood vessels begin to grow in the macula.)

As reported in the April 2004 issue of the journal Optometry, the subjects were divided into three groups and randomly assigned to receive 10 mg of lutein daily, or 10 mg of lutein combined with other nutrients that are known to enhance vision health (such as bilberry, zinc, quercetin, N-acetylcysteine, and others), or a placebo.

Over a one-year test period, several measurements were taken. Changes in macular pigment optical density (MPOD) were recorded (low density of macular pigment is considered a risk factor for AMD); contrast sensitivity was evaluated; and visual perception was assessed with eye chart exams.

At the end of the trial, the Chicago team found clear improvements in both the lutein and the lutein-plus-nutrients group, but no noteworthy changes in the placebo group. Most significantly, even subjects with advanced AMD showed improvement with the additional lutein intake. The researchers stress that larger and longer studies are needed to confirm their findings.

54. Lutein and Prevention of Macular Degeneration
1994 Study; Dr. Johanna Seddon of Harvard University published a study in the Journal of the American Medical Association that examined the effect of consumption of specific carotenoids on AMD prevention. The results of the study found that the highest correlation of disease prevention was associated with an intake of 6 mg per day of lutein, which led to a 57% decrease in the risk of contracting AMD. Therefore, lutein is the key carotenoid for providing the proper amount of lutein and zeaxanthin.

Seddon, J.M., U.A. Ajani, et al. (1994). “Dietary carotenoid, vitamins A, C, E, and advanced age-related macular degeneration. Eye Disease Case-Control Study Group Jama 272(18):1413-20

55. Lutein and Zeaxanthin (2003) & Age-Related Macular Degeneration
Catharine R. Gale, Nigel F. Hall, David I. W. Phillips, and Christopher N. Martyn

From the Medical Research Council Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom.

PURPOSE. To investigate the relation between plasma concentrations of lutein and zeaxanthin and age-related macular degeneration in a group of elderly men and women.

METHODS. The Wisconsin Age-Related Maculopathy Grading System was used to grade features of early and late macular degeneration in 380 men and women, aged 66 to 75 years, from Sheffield, United Kingdom. Fasting blood samples were taken to assess plasma concentrations of lutein and zeaxanthin.

RESULTS. Risk of age-related macular degeneration (early or late) was significantly higher in people with lower plasma concentrations of zeaxanthin. Compared with those whose plasma concentrations of zeaxanthin were in the highest third of the distribution, people whose plasma concentration was in the lowest third had an odds ratio for risk of age-related macular degeneration of 2.0 (95% confidence interval [CI] 1.0–4.1), after adjustment for age and other risk factors. Risk of age-related macular degeneration was increased in people with the lowest plasma concentrations of lutein plus zeaxanthin (odds ratio [OR] 1.9, 95% CI 0.9–3.5) and in those with the lowest concentrations of lutein (OR 1.7, 95% CI 0.9–3.3), but neither of these relations was statistically significant.

CONCLUSIONS. These findings provide support for the view that zeaxanthin may protect against age-related macular degeneration.

(Investigative Ophthalmology and Visual Science. 2003;44:2461-2465.)© 2003 by The Association for Research in Vision and Ophthalmology, Inc. DOI: 10.1167/iovs.02-0929

56. Lutein research -1993
Lutein Research - 1993 - Macular Degeneration Prevention .(a) AMD, the leading cause of new cases of blindness in persons age 65 years and older... (pg. 104), (b) Persons with carotenoid levels in the medium and high groups, compared with those in the low group, had markedly reduced risks of neovascular AMD, with levels of risk reduced to one half and one third. (pg. 104) Higher levels of the individual carotenoids (except for lycopene ...) were associated with statistically significant reductions in risk. The two variables found to be significantly associated with risk of AMD [are} carotenoid levels and the antioxidant index. There was a progressive decrease in risk of AMD with increasing levels of carotenoids and increasing level of the antioxidant index. (pg. 107) These results suggest that higher blood levels of micronutrients with antioxidant potential, in particular, carotenoids, may be associated with a decreased risk of the most visually disabling form of AMD. (pg. 104)
(c) Data ... suggest a protective role in AMD for carotenoids, compounds that have potent antioxidant capabilities. Levels of total and individual carotenoids were significantly lower in persons with neovascular AMD than in controls. When we compared the patients with AMD with patients with macular holes, the findings were in the same direction as those in the primary analyses; persons with higher levels of carotenoids were at reduced risk of AMD... Data from the Eye Disease Case-Control Study are consistent with hypotheses suggesting a reduced risk of neovascular AMD in persons with higher levels of circulating micronutrients with antioxidant capabilities, in particular carotenoids. (pg. 108), (d) The highly significant finding for serum carotenoids is of particular interest because it provides some indirect support for hypotheses suggesting that sunlight exposure is a risk factor for AMD. Singlet oxygen, a potentially damaging chemical species produced when biological systems are exposed to sunlight, has been proposed as the mediator of light damage in the retina. Carotenoids, notably lutein and zeaxanthin, are known to be present in the retina and are known to be highly effective protective agents against singlet oxygen .... Carotenoids may protect the retina from light damage. (pg. 108). The Eye Disease Case-Control Study Group, "Antioxidant Status and Neovascular Age-Related Macular Degeneration," published Archives of Ophthalmology, January, 1993, Volume 111, Pages 104-109

57. Lutein Research-1997
Lutein Research - 1997 - AMD risks. Pigment protective w/active & passive role, rebuildable (a) AMD ...occurs in 19.7% of the population above the age of 65. It is the leading cause of visual impairment in the United States... Factors with an apparent positive correlation with AMD include light skin color, light iris color, high exposure to ambient light, low levels of dietary xanthophylls, and low level of serum xanthophylls. Data indicate that lower than normal amounts, of macular pigment are found in persons with AMD .... The macular pigment may play a protective role in the eye. (pg. 538) Cigarette smoking is correlated with reduced amounts of macular pigment. (pg. 541)
(b) Because both of the pigmented layers are anterior to the light-sensitive photoreceptor outer segments, the macular pigment represents a color filter through which light must pass before detection. Our own interest in the macular pigment in the early 1980's led us to show ... that it consisted-of the xanthophyll isomers, lutein and zeaxanthin. (pg. 538) (c) ...The pigment probably acts in a protective capacity against the damaging effects of blue light. This essential role of carotenoids to protect against photo-oxidation in photosynthetic plants by blue light has been long established. Blue light can induce the formation of reactive radicals, triplet excited states, superoxide, and singlet oxygen within the retina, specifically the choriocapillaris, Bruch's membrane, and the retinal pigment epithelium. The formation of such species may be greatly, reduced in individuals having a high level of macular pigmentation. The xanthophylls which comprise the macular pigment are effective quenchers of excited triplet states and are reactive toward singlet oxygen and radicals. They may serve actively to protect the nerve tissue of the macula in which they are incorporated from the degradative effects of these species. They may also serve passively by shielding those tissues posterior to the outer plexiform layer from excessive blue light. These include those tissues which are most adversely affected in AMD: the photoreceptors, Bruch's membrane, and the RPE (pg. 542) Our data and those of others suggest that macular pigmentation does. function to protect the retina. An increased rate of photo-oxidation that might accompany lower macular pigment levels in some individuals could contribute to a more rapid buildup of the drusen characteristics of the atrophic regions of the macula and associated with AMD. (pg. 552) Long-term lutein supplementation of individuals having low levels of macular pigmentation could result in a significant increase in the level of pigmentation within the macula. (pg. 553) (d) Tissue Samples [were taken from] human donor eyes, both controls and those diagnosed with AMD... (pg. 542) AMD eyes had on average approximately 70% {30% less]of the total carotenoid found in controls... (pg. 547) This difference is not restricted to the macular region as would be expected if atrophy of the macula was the cause .... Lowered levels of macular pigmentation are a causative factor in the development of macular degeneration and not necessarily a result of the degeneration process. (pg. 552) (e) The equivalent of 30mg of lutein per day was ingested in the form of lutein esters (source: marigold flowers) ... (pg. 544) Concentration of[serum]lutein...increased by a factor of about 10 times within the first week and remained high thereafter. Macular pigmentation increase appears to-be a slow process--this amounted to a 15%.increase in the pigment level after 72-days of lutein supplementation. (pg. 551) A relationship has- been established between serum levels of lutein and corresponding increases in the concentration of lutein in the macular of the human eye. (pg. 553). . J T Landrum et al, "The Macular Pigment: A Possible Role in Protection from Age-Related Macular Degeneration," Advances in Pharmacology, 1997, Volume 38, Pages 537-556.

58. Lutein Research-1997
Lutein Research - 1997 - Dietary increase in macular pigment density (a) Macular pigment density is positively correlated with lutein and zeaxanthin in the blood. (pg. 1795) ...Our subjects were expected to receive about 4 times as much lutein and two to three times as much zeaxanthin as in a normal healthy diet. Most subjects [77%] responded to increases in dietary intake of lutein and zeaxanthin [spinach and corn] with increases of macular, pigment density. (pp. 1796-7) An analysis of the dietary records ... for whom we had complete data indicated that modification of their diets increased their average intake of lutein and zeaxanthin by a mean factor of 6.7. This increase in dietary intake was sufficient to raise .... mean macularpigmenLdensity 29%. (pg. 1799), (b) Harmful side effects from surgical light exposures have been documented for patients and for surgeons as well. (pg. 1800), (c) Elevation of macular pigment density in patients [and the] probability that the patient will progress to neovascular complications could be reduced .... There is a substantial body of evidence that macular pigment protects the retina and retinal pigment epithelium against light damage. (pg. 1800). B. R. Hammond et al, "Dietary Modification of Human Macular Pigment Density," Investigative Ophthalmology & Visual Science, August 1997, Volume 38, No. 9, Pages 1795-1801.

59. Lutein research-1998
Lutein / Zeaxanthin Research - 1998 -Macular pigment density, prevent loss, recover vision. Vision loss associated with aging may-be preventable – even reversible—through improved nutrition. Macular pigment or dietary factors associated with it appear to protect the retina from loss of sensitivity, when the eye is adapted for light as well as for dark. (a) Macular pigment is composed of...lutein and zeaxanthin... The retina does not take up beta carotene.
© The researchers measured macular pigment and visual sensitivity of 27 healthy older subjects, ages 60-84, and compared them with 10 younger healthy subjects, ages 24-36. Macular-pigment was a clear determinant of visual sensitivity: Subjects over age 60 with high macular pigment density had the same visual sensitivity as the younger subjects. The results show that high macular pigment density was associated with the. Retention of youthful visual sensitivity, which suggested that macular pigment might retard age-related declines in visual function. (pg. 2), (b) Smoking, female gender and blue irises are all risk factors for the disease, and people with those risk factors also have lower macular pigment density. (pg. 2). People with higher macular pigment density are associated with factors that decrease risk, such as high blood concentrations of carotenoids, high dietary intake of lutein and zeaxanthin and dark irises. (pg. 3), (c) Macular pigment density may be useful as a predictor for overall ocular health, because macular pigment density correlates with preservation of clarity of the lens as well. As. Sensitivity-of the retina, (d) It is possible that by improving protection, retinal or retinal pigment epithelial cells that may be damaged but still viable could recover.

It appears that people lose visual sensitivity before the worst stages of disease. But with the right nutritional program, you might prevent the low macular pigment group from getting worse, and in the best cases even recover some of the lost function. Schepens Eye Research Institute , An Affiliate of Harvard Medical School, “Improved Nutrition Could Prevent Vision Loss, Schepens Study Finds,” February 1998.

60. Lutein, Omega-3 & Macular Degeneration Study May 2008

A recent study published in the May 2008 issue of American Journal of Clinical Nutrition, studied the effects of lutein and docosahexaenic acid (DHA – omega-3) on macular degeneration. This four-month study researched 59 women, 60 to 80 years old. The women were randomly assigned a placebo, lutein, DHA, or lutein plus DHA supplement.

Lutein is found in the healthy macula. DHA is found in the retina. Researchers wanted to study the effects lutein (12 mg/day) and DHA (800 mg/day) had on their serum concentrations and macular pigment optical density (MPOD).

Both supplements alone helped to increase their concentration levels in the eye, however, both lutein and DHA together had the greatest difference on serum concentrations and MPOD when combined. The study concluded that “lutein and DHA may aid in prevention of age-related macular degeneration.”

Ref: Elizabeth J Johnson, Hae-Yun Chung, Susan M Caldarella and D Max Snodderly. “The influence of supplemental lutein and docosahexaenoic acid on serum, lipoproteins, and macular pigmentation.” American Journal of Clinical Nutrition. Vol. 87, No. 5, 1521-1529, May 2008.

61. Lutein, Zeaxanthin and AMD 2007 Study
Lutein and zeaxanthin has again been linked to lowering the risk of neovascular AMD. Researchers studied 4,519 Age-Related Eye Disease Study (AREDS) participants between 60 and 80 years of age. They found that carotenoids, lutein and zeaxanthin, absorb blue light that could damage the macula, by preventing free radicals from damaging eye cells and by strengthening eye cell membranes.1 This study, published in Archives of Ophthalmology, concluded that a higher intake of Lutein and zeaxanthin may help lower the risk for AMD.

62. Lutein, Zeaxanthin and AMD 2008

The Centre for Vision Research at the University of Sydney, Australia, studied the dietary and supplement intakes of antioxidants and the long-term risk of incident age-related macular degeneration (AMD). Over 10 years, 2454 participants were examined and reexamined. Those participants that had higher amounts of lutein and zeaxanthin intake had a reduced risk of incident neovascular AMD and those with above median intake had a reduced risk of soft or reticular drusen. The study concluded that the higher dietary lutein and zeaxanthin intake reduced the risk of long-term incident AMD. It also confirmed finding protective influences from zinc and beta-carotene to help lower the risk of AMD, as did the 10 year study by the US National Institute of Health’s Age-Related Eye Disease Study (AREDS).

Ref: J.S.L. Tan, J.J. Wang, V. Flood, E. Rochtchina, W. Smith, P. Mitchell. "Dietary Antioxidants and the Long-term Incidence of Age-Related Macular Degeneration: The Blue Mountains Eye Study." Ophthalmology (Elsevier). February 2008, Volume 115, Issue 2, Pages 334-341.

63. Lutein, Zeaxanthin and Macular Degeneration 2008 Study
Macular degeneration- In people with the highest level of consumption of lutein and xeoxanthin (from leafy greens), risk of AMD was 35% of the risk in people who ate less greens. Zinc was also protective. This in a study by J.S. Tan, et al. in Opthalmology, February 2008.

64. Lutein/Zeaxanthin and AMD Risk Reduction Age-Related Eye Disease 2008 Study (CAREDS)

Lutein and zeaxanthin are the only carotenoids that concentrate in the macula. There is evidence of three mechanisms by which lutein and zeaxanthin may afford protection against AMD: by absorbing blue light, by quenching free radicals and by increasing membrane stability.

Many previously published studies which have examined the relationship between AMD and these carotenoids have reported an inverse association between the disease and intake of lutein plus zeaxanthin. These carotenoids are commonly obtained from leafy green vegetables, corn, egg yolks, broccoli, peas, squash - as well as from supplements.

The authors of the Carotenoids in Age-Related Eye Disease Study (CAREDS) now report that a stable intake of these carotenoids over time could reduce the risk of AMD by about 43% in healthy women under 75.

Design and Methods

CAREDS is an ancillary study of the Women's Health Initiative (WHI), a prospective cohort study. CAREDS was designed, in part, to evaluate the relationship between lutein/zeaxanthin and the prevalence of intermediate AMD. Over 1780 women aged 50-79 who had high or low intake of lutein plus zeaxanthin at WHI enrollment were recruited into CAREDS 4-7 years later, when the presence of AMD was determined by fundus photographs.

To maximize extremes in intake of these carotenoids in the study sample, women with intakes of lutein plus zeaxanthin above the 78th (high) and below the 28th (low) percentiles at baseline in the WHI were recruited. Dietary assessments were performed by means of food frequency questionnaires administered at the study's start and over the previous 15 years. Logistic regression analyses examined the prevalence of AMD, after accounting for potential covariates.

Results

While an association between dietary intake of these carotenoids and AMD was not observed in the overall study population, secondary analyses disclosed a statistically significant protective effect in women younger than 75 with stable intakes of lutein and zeaxanthin.

Higher intakes of lutein/zeaxanthin (2, 868 mcg or more daily) compared to lower consumption (792 mcg daily) in women with stable intakes resulted in a substantial 43% lower risk of intermediate AMD (odds ratios [0.57; 95% confidence interval, 0.34-0.95]). The younger women (< 75 years) did not have a history of chronic diseases such as cardiovascular disease and diabetes that are often associated with diet changes and instable intakes of lutein/zeaxanthin rich foods.

Similar protective associations were observed for large drusen. While not statistically significant, associations in this sub-sample were in the protective direction for the more advanced lesions of pigmentary abnormalities, as well as for the exploratory outcome, advanced AMD.

The researchers observed the strongest inverse associations between intermediate AMD and high intake of vegetables in general, as well as of green vegetables. Blood levels of the carotenoids were not associated with risk of AMD.

Comments

According to lead author Dr. Suzen Moeller of the University of Wisconsin, the findings are consistent with a broad body of evidence from observational and experimental studies suggesting that these carotenoids may protect against AMD. There was evidence that diet instability may have biased the associations and, together with the possibility of selective mortality bias, may explain our inability to detect the hypothesized association in the full study population, wrote Dr Moeller.

Reference:
Moeller SM et al. Age-Related Macular Degeneration and Lutein and Zeaxanthin in the Carotenoids in Age-Related Eye Disease Study (CAREDS). Archives of Ophthalmology 124:1151-1162, 2006.

65. Lycopene and Macular Degeneration
Persons who had the lowest serum levels of lycopene, the most abundant carotenoid in the serum, were twice as likely to have macular degeneration when compared to those with the highest levels. Mares-Perlman, et al. Arch Ophthalmol 1995 Dec;113(12):1518-23 (Ed. Note: Consumption of high levels of lutein and lycopene (a carotenoid found in tomatoes) has also been associated with dramatically lower cancer rates for lung and prostate cancer!)

66. Macular carotenoids: lutein and zeaxanthin.
Dev Ophthalmol. 2005;38:70-88. The yellow color of the macula lutea is due to the presence of the carotenoid pigments lutein and zeaxanthin. In contrast to human blood and tissues, no other major carotenoids including beta-carotene or lycopene are found in this tissue. The macular carotenoids are suggested to play a role in the protection of the retina against light-induced damage. Epidemiological studies provide some evidence that an increased consumption of lutein and zeaxanthin is associated with a lowered risk for age-related macular degeneration, a disease with increasing incidence in the elderly. Protecting ocular tissue against photooxidative damage carotenoids may act in two ways: first as filters for damaging blue light, and second as antioxidants quenching excited triplet state molecules or singlet molecular oxygen and scavenge further reactive oxygen species like lipid peroxides or the superoxide radical anion.

67. Macular degeneration & leafy greens
Eating collard greens and spinach at a frequency of two to four times a week was enough to lower the risk of macular degeneration by 46 percent, and was even greater at five to six times per week. Goldberg, J. et al. Factors associated with age-related macular degeneration: An analysis of data from the First National Health and Nutrition Examination Survey. American Journal of Epidemiology 128 (1988): 700-20.
Editor’s Note: Lutein and Zeaxanthin are the two carotenoids found in collard greens and spinach. When taken as supplements, they are best taken separately from beta-carotene because they compete for absorption.

68. Macular Degeneration (2005): Heavy Cigarette Smoking Increases Risk

CAMBRIDGE, England, Dec. 20, 2005 - Smoking can contribute to age-related macular degeneration, according to investigators here. Long-term heavy smokers have a sharply increased risk -- between 2.5- and 3.5-fold -- of losing vision from age-related macular degeneration, according to medical geneticist John R.W. Yates, Ph.D., of the University of Cambridge.

The study "provides strong support for a causal relation between smoking and age-related macular degeneration," Dr. Yates and colleagues concluded in a study published in the January issue of the British Journal of Ophthalmology. For full article, go to http://www.medpagetoday.com/PublicHealthPolicy/PublicHealth/tb/2359

Editor's Note2: Some research suggests that smokers should not supplement with betacarotene as it may increase chances for lung cancer.

69. Macular Degeneration (2005): Omega-3 Fatty Acid Study

The Lewin Group was commissioned in early 2005 by the Dietary Supplement Education Alliance (DSEA) to critically review the research literature concerning Omega-3 fatty acids, lutein and zeaxanthin. Visual impairment is one of the top four reasons for loss of independence. Age-related diseases of the eye are common and costly (35% of individuals aged 75 and older have AMD).

For example, eighteen percent of all hip fractures among seniors are attributed to age-related vision loss (hip fracture patients have a substantially increased risk of death for at least 6 years post-fracture). The Lewin Report addresses several hundred studies on the benefits of Omega-3 fatty acids dating back nearly thirty years, including several comprehensive reviews.

In addition, in 2004, the FDA issued a qualified health claim for reduced risk of coronary heart disease (CHD) associated with foods containing Omega-3 fatty acids. Earlier, in 2000 the FDA announced a similar qualified health claim for reduced risk of CHD for dietary supplements containing EPA and DHA Omega-3 fatty acids.

Key findings of the Lewin report support the supplementation of omega-3 fatty acids, lutein, and zeaxanthin in helping preserve vision and supporting people to be able to maintain independent living.

For full article, go to http://www.nowfoods.com/?action=itemdetail&item_id=41654

70. Macular Degeneration (2005): Secondhand Smoking

There is mounting evidence indicating that cigarettes are not only bad for smokers but those around them. Now a new study from Cambridge University says secondhand smoke can cause vision problems. Secondhand smoke nearly doubles the risk of developing age related macular degeneration and the risk is much higher for smokers. Researchers found smoking a pack a day for 40 years tripled their risk of vision loss.

Macular Degeneration Disease is the leading cause of partial blindness in the United States.

71. Macular degeneration (AMD) (2001) and Fat Intake
Dr. Joanna Seddon of the Massachusetts Eye and Ear Infirmary. Harvard Medical School and colleagues have discovered that a diet high in fat may be associated with an increased risk of developing wet macular degeneration (AMD). According to the study published in the August 2001 issue of Archives of Ophthalmology, researchers analyzed the dietary habits and physical condition of over 800 patients with and without wet AMD.

The results of the study indicated that high intake of vegetable, monosaturated and polyunsaturated fats were associated with a twofold-increased risk of developing wet AMD. These fats are all commonly found in snack foods such as potato chips, french fries, cakes and commercially prepared pies. HIgh intake of linoleic acid, a fat also found in many snack foods, was associated with the greatest risk of developing wet AMD.

Conversely, Dr. Seddon and colleagues found that individuals who consumed little food containing linoleic acid and who ate two or more servings of fish per week showed a lower risk of developing AMD. Fish are high in a fat called docosahexanoic acid, or DHA, for short. Heart disease studies have shown a beneficial link between DHA and cardiovascular disease. DHA may also have a healthful effect on blood vessels leading to the retina. Furthermore, DHA is also highly enriched in the retina. Diets rich in DHA may have a positive effect on retinal function and could possibly lesson the risk of developing the disease.

Previous studies have found that a diet high in fatty foods increases the formation of fatty deposits in blood vessels, a condition called atherosclerosis. These fatty deposits may also affect blood vessels leading to the retina, thereby interfering with the ability to provide the retina with oxygen and nutrients. In AMD, blood vessel growth may be spurred to overcome the adverse affects of atherosclerosis. Unfortunately, the body responds by producing abnormal blood vessels that leak fluid and blood into the macula, thus causing central vision loss.

Earlier studies have found that cigarette smoking and hypertension increase the risk of developing AMD. This recent finding regarding dietary fat adds another important clue in the development of AMD. Because these same risk factors also increase the risk of cardiovascular disease, it may be that both diseases can result from similar environmental causes. These studies provide valuable information for reducing the environmental risks associated with the disease, especially for people with a family history of AMD.

Excerpted from “Fighting Blindness News” Fall 2001.

72. Macular Degeneration and the Oils We Eat
Regular high consumption of vegetable fat more than doubles the risk of macular degeneration as compared to those with a low vegetable fat diet. Higher intake of omega-3 fatty acids tended to reduce the risk of age-related macular degeneration. There was no association found between aged-related macular degeneration and cholesterol.

Arch. Ophthalmol., August 2001;119:1191-1199

Editor's Note: The high consumption of vegetable oils and grains, along with meats and eggs eaten from animals fed grains has dramatically thrown our omega-3 to omega-6 ratio out of balance, resulting too much omega-6 fatty acids which tend to be inflammatory. We believe it will eventually be proven that the high levels of omega-6 fatty acids in our diet with high levels of refined carbohydrates eaten are the main causes besides genetics of heart disease, stroke and autoimmune diseases.

73. Macular Degeneration and Vitamin E and Zinc Deficiency
Subnormal zinc and vitamin E serum levels may be associated with the development of age-related macular degeneration. Ishihara, et al. Nippon Ganka Gakkai Zasshi 1997 Mar;101(3):248-51

In a study of adults over 60 there was found to be a significant link between risk of macular degeneration and low blood levels of vitamin E as well as increased sun exposure. Belda, et al Mech Ageing Dev 1999 Mar 1;107(2):159-64

Subnormal zinc and vitamin E serum levels may be associated with the development of age-related macular degeneration. Ishihara, et al. Nippon Ganka Gakkai Zasshi 1997 Mar;101(3):248-51

In a study of adults over 60 there was found to be a significant link between risk of macular degeneration and low blood levels of vitamin E as well as increased sun exposure. Belda, et al Mech Ageing Dev 1999 Mar 1;107(2):159-64

74. Meso-Zeaxanthin Aids Eyes 2007 Study

A supplement of meso-zeaxanthin may bolster macular pigment optical density (MPOD), according to researchers from Florida International University (Nutr Metab. 2007;4:12) (DOI:10.1186/1743-7075-4-12). Lutein and zeaxanthin have been the primary focus of research trials exploring how the xanthophyll carotenoids can support macular pigment and possibly prevent onset of age-related macular degeneration (AMD). Meso-zeaxanthin is the third major carotenoid found in macular pigment.

In this 120-day supplementation study, 10 subjects received gelcaps containing 20 mg/d of predominantly meso-zeaxanthin, with smaller amounts of lutein and zeaxanthin; 9 additional subjects formed a control group taking a placebo. Supplementation increased blood serum levels of all three carotenoids during the supplementation period. In addition, MPOD, measured at 460 nm, rose at an average rate of 0.59 ± 0.79 milli-absorbance unit/day in the 10 supplemented subjects; no such change was seen in the placebo group. These trial results showed meso-zeaxanthin was absorbed into the serum following supplementation and was effective at raising MPOD.

Patients with macular degeneration have been shown to have 30% less meso-zeaxanthin in their macula compared to healthy eyes. Vrabec T, Tantri A et al. Autosomal dominant Stargardt-like macular dystrophy: identification of a new family with a mutation in the ELOVL4 gene. Am J Ophthalmol. 2003;136(3):542-5

One reason for this deficiency of meso-zeaxanthin is lack of ingested lutein. Another explanation for the missing meso-zeaxanthin observed in macular degeneration may be the inability to adequately convert lutein to meso-zeaxanthin in the retina.

76. Mesozeaxanthin Supplementation Effective in Raising Macular Pigment Density 2007 Study

Methods
A 120 day supplementation study was conducted in which 10 subjects were given gel-caps that provided 20 mg/day of predominantly meso-zeaxanthin, with smaller amounts of lutein and zeaxanthin. A second group of 9 subjects were given gel caps containing a placebo for the same 120 day period. Prior to and during the supplementation period, blood serum samples were analyzed by high performance liquid chromatography for carotenoid content. Similarly, macular pigment optical density was measured by heterochromatic flicker photometry. Differences in response between the supplementation and placebo groups were tested for significance using a student's t-test.

Results

During supplementation with the carotenoids, blood samples revealed the presence of all three carotenoids. Macular pigment optical density, measured at 460 nm, rose at an average rate of 0.59 ± 0.79 milli-absorbance unit/day in the 10 supplemented subjects. This was significantly different from the placebo group (9 subjects) for whom the average rate was -0.17 ± 0.42 milli-absorbance units/day.

Conclusion

We have shown for the first time that meso-zeaxanthin is absorbed into the serum following ingestion. The data indicate that a supplement containing predominantly meso-zeaxanthin is generally effective at raising macular pigment density, and may turn out to be a useful addition to the defenses against AMD.

Reference:
Nutrition & Metabolism 2007, 4:12doi:10.1186/1743-7075-4-12

77. More good fat, less bad, reduces age-related macular degeneration risk

Two reports published in the May, 2009 issue of the American Medical Association journal Archives of Ophthalmology reveal a protective effect for omega-3 fatty acids, fish, nuts and olive oil, and an adverse effect for trans fatty acids, on the risk of developing age-related macular degeneration (AMD), a leading cause of vision loss in older individuals.

In the first study, Jennifer S.L. Tan, MBBS, BE at the University of Sydney, Australia and her colleagues evaluated data from 2,454 participants in the Blue Mountains Eye Study of men and women aged 49 and older. Those who consumed one serving of fish per week were shown to have a 31 percent lower adjusted risk of developing early AMD compared with those who consumed less.

In the second article, Elaine W. T. Chong, MD, PhD, of the Centre for Eye Research Australia and her associates evaluated data from 6,734 men and women aged 58 to 69 who participated in the Melbourne Collaborative Cohort Study. Dietary questionnaires completed between 1990 and 1994 were analyzed for the intake of various foods and individual fatty acids. Follow up examinations conducted between 2003 and 2006 detected 2,872 cases of early age-related macular degeneration and 88 cases of late disease.

A high intake of trans-unsaturated fats was associated with a significant increase in late macular degeneration, with those whose intake was categorized as among the top 25 percent of participants having a 76 percent greater risk than those whose intake was among the lowest fourth.

Olive oil emerged as protective against late disease. When those who reported consuming at least 100 milliliters per week olive oil were compared with those who consumed less than 1 milliliter per week, they were found to have a 52 percent lower risk of late AMD.

For early AMD, those whose omega-3 fatty acid intake was among the top 25 percent had a 15 percent lower risk compared with those whose intake was among the lowest quarter.

Trans fatty acids increase cholesterol levels and inflammation, both of which affect the eyes' blood vessels, while omega-3 fatty acids may help protect the retina. Although the main fats contained in olive oil were not associated with macular degeneration risk, the oil contains antioxidants and anti-inflammatory compounds that could be protective. "A diet low in trans-unsaturated fat and rich in omega-3 fatty acids and olive oil may reduce the risk of AMD," the authors conclude.

Ref: www.lef.org/newsletter/2009/0512_Fat-and-Age-Related-Macular-Degeneration-Risk.htm?source=eNewsLetter2009Wk21-1&key=Article&l=0

78. More good fat, less bad, reduces age-related macular degeneration risk 2009 Studies

Two reports published in the May, 2009 issue of the American Medical Association journal Archives of Ophthalmology reveal a protective effect for omega-3 fatty acids, fish, nuts and olive oil, and an adverse effect for trans fatty acids, on the risk of developing age-related macular degeneration (AMD), a leading cause of vision loss in older individuals.

In the first study, Jennifer S.L. Tan, MBBS, BE at the University of Sydney, Australia and her colleagues evaluated data from 2,454 participants in the Blue Mountains Eye Study of men and women aged 49 and older. Those who consumed one serving of fish per week were shown to have a 31 percent lower adjusted risk of developing early AMD compared with those who consumed less.

In the second article, Elaine W. T. Chong, MD, PhD, of the Centre for Eye Research Australia and her associates evaluated data from 6,734 men and women aged 58 to 69 who participated in the Melbourne Collaborative Cohort Study. Dietary questionnaires completed between 1990 and 1994 were analyzed for the intake of various foods and individual fatty acids. Follow up examinations conducted between 2003 and 2006 detected 2,872 cases of early age-related macular degeneration and 88 cases of late disease.

A high intake of trans-unsaturated fats was associated with a significant increase in late macular degeneration, with those whose intake was categorized as among the top 25 percent of participants having a 76 percent greater risk than those whose intake was among the lowest fourth.

Olive oil emerged as protective against late disease. When those who reported consuming at least 100 milliliters per week olive oil were compared with those who consumed less than 1 milliliter per week, they were found to have a 52 percent lower risk of late AMD.

For early AMD, those whose omega-3 fatty acid intake was among the top 25 percent had a 15 percent lower risk compared with those whose intake was among the lowest quarter.

Trans fatty acids increase cholesterol levels and inflammation, both of which affect the eyes' blood vessels, while omega-3 fatty acids may help protect the retina. Although the main fats contained in olive oil were not associated with macular degeneration risk, the oil contains antioxidants and anti-inflammatory compounds that could be protective. "A diet low in trans-unsaturated fat and rich in omega-3 fatty acids and olive oil may reduce the risk of AMD," the authors conclude.

79. neovascular age-related macular degeneration (2004) and hyperhomocysteinemia associated
This study suggests an association between an elevated plasma level of homocysteine and exudative neovascular AMD but not dry AMD. Below is the abstract:

Axer-Siegel R, Bourla D, Ehrlich R, Dotan G, Benjamini Y, Gavendo S, Weinberger D, Sela BA.

Department of Ophthalmology, Rabin Medical Center, Petah Tiqva, Israel. seegs@netvision.net.il

PURPOSE: To assess the relationship between plasma homocysteine levels and exudative neovascular age-related macular degeneration (AMD). DESIGN: Cross-sectional study. METHODS: A prospective comparative cross-sectional study was conducted in outpatient ophthalmology clinics in a university-affiliated medical institution. The cohort consisted of 59 patients (25 male, 34 female) with a mean age of 78 years (standard deviation [SD] = 8.4) with neovascular AMD who were candidates for photodynamic treatment. Patients were compared for plasma homocysteine levels with 58 patients who had dry AMD (24 male, 34 female) with a mean age of 76.3 years (SD = 8.4) and with a control group of 56 age-matched subjects (27 male, 29 female), with a mean age of 77.3 years (SD = 8.2). A 3-ml venous blood sample was obtained from each participant after an 8-hour fast. Levels of plasma homocysteine were measured by high performance liquid chromatography. The main outcome measure was hyperhomocysteinemia, defined as a plasma homocysteine level above 15 micromol/l. RESULTS: Homocysteine levels were higher by 27.9% in the neovascular AMD than in the dry AMD group, and by 21.9% than in the control group (P <.02). Hyperhomocysteinemia was found in 44.1% of the study group, in 22.4% of the dry AMD group, and in 21.4% of the control group (P =.011). CONCLUSIONS: This study suggests an association between an elevated plasma level of homocysteine and exudative neovascular AMD but not dry AMD.

Am J Ophthalmol. 2004 Jan;137(1):84-9.

80. Omega-3 & Macular Degeneration New 2008 Study

Last month Archives of Ophthalmology published a meta analysis on omega-3 fatty acid and fish intake and its effect on the prevention of age-related macular degeneration (AMD).

This study identified 274 abstracts, 3 prospective cohort, 3 case-control, and 3 cross-sectional studies.

Using quantitative methods, a high dietary intake of omega-3 fatty acids was associated with a 38% reduction in the risk of late AMD. Fish intake (2x per week) was associated with reduced risk of early and late AMD.

More omega-3 and AMD specific studies need to be conducted to further investigate omega-3¹s effect on AMD.

Ref: Arch Ophthalmol. 2008;126(6):826-833.

81. Omega-3 and vitamin D linked to 40% reduced risk of macular degeneration (2007)

Study shows that consumption of omega-3 fatty acids and omega-3 rich fish could slash the risk of developing age-related macular degeneration (AMD) by 40 per cent.

This study adds further support for increasing the ratio of omega-3 to omega-6 fatty acids with the finding that arachidonic acid (AA, omega-6 fatty acid) is associated with an increased risk of AMD.

Ref: "Association Between Vitamin D and Age-Related Macular Degeneration in the Third National Health and Nutrition Examination Survey, 1988 Through 1994"

Authors: N. Parekh, R.J. Chappell, A.E. Millen, D.M. Albert, J.A. Mares

Archives of Ophthalmology

May 125, 2007 Volume 125, Pages 671-679

82. Omega-3 Fatty Acid Intake Reduces Risk of Macular Degeneration 2008 Studies

According to a meta-analysis(1) published in the June issue of Archives of Ophthalmology, a higher intake of the omega-3 fatty acids EPA and DHA reduced the risk of age-related macular degeneration (AMD). In analyzing 9 studies that included roughly 88,900 participants, the Australian authors report that higher intakes of EPA and DHA cut the risk of early AMD substantially and yielded a 38% risk reduction for advanced AMD.

Most recently, a study published in the August issue of the American Journal of Clinical Nutrition is the first in Europeans to show a beneficial association between neovascular AMD and the consumption of oily fish (e.g. mackerel, tuna, salmon, sardines, and herring)(2). The study, funded in part by the European Commission and the Macular Disease Society UK, is consistent with results from studies in the US and Australia.

Study Design and Methods
The EUREYE study is a cross-sectional population-based study in persons aged 65 years or older in 7 centers located from north to south Europe. Participants in the cross-sectional population-based EUREYE study underwent fundus photography and were interviewed by using a food-frequency questionnaire. Fundus images were graded by the International Classification System for Age Related Maculopathy.

Questionnaire data were converted to nutrient intakes with the use of food-composition tables. Survey logistic regression was used to calculate odds ratios (ORs) and 95% CIs of energy-adjusted quartiles of EPA or DHA with neovascular AMD, taking into account potential confounders.

Results
Dietary intake data and fundus images were available for 105 cases with neovascular AMD and for 2170 controls without any features of early or late AMD.

Eating oily fish at least once per week compared with less than once per week was associated with a halving of the odds of neovascular AMD (OR = 0.47; 95% CI: 0.33, 0.68; P = 0.002). Compared with the lowest quartile, there was a significant trend for decreased odds with increasing quartiles of either DHA or EPA. Odds ratios in the highest quartiles were 0.32 (95% CI: 0.12, 0.87; P = 0.03) for DHA and 0.29 (95% CI: 0.11, 0.73; P = 0.02) for EPA.

In short, habitual consumption of oily fish at least once a week was linked to a 50% reduction in the risk of developing wet AMD. Further, people who consumed at least 300 mg per day of DHA and EPA were 69% less likely to have wet AMD then those consuming less.

83. Omega-3 Fatty Acids and Macular Degeneration Prevention 2009 Study

A group of researchers led by Dr. Chi-Chao Chan at the National Eye Institute examined the direct effect of omega-3 fatty acids on a mouse model of age-related macular degeneration. A diet with high levels of omega-3 fatty acids resulted in slower lesion progression, with improvement in some lesions. These mice had lower levels of inflammatory molecules and higher levels of anti-inflammatory molecules, which may explain this protective effect.

The researchers suggest that “a diet enriched in EPA and DHA can reduce the progression of retinal lesions in their mouse model of age-related macular degeneration” and that “the results in these mice are in line with the epidemiological studies of age-related macular degeneration risk reduction by long chain n-3 fatty acids.” The results “further provide the scientific basis for the application of omega-3 fatty acids and their biologically active derivatives in the prevention and treatment of age-related macular degeneration.”

Journal Reference: Tuo et al. A High Omega-3 Fatty Acid Diet Reduces Retinal Lesions in a Murine Model of Macular Degeneration. American Journal Of Pathology, 2009; DOI

84. Omega-3 fatty acids protective against advanced age-related macular degeneration

Having a greater intake of omega-3 fatty acids and fish was found to be associated with a reduced risk of advanced age-related macular degeneration (AMD) in a report published in the the May, 2007 issue of the American Medical Association journal Archives of Ophthalmology. Age-related macular degeneration occurs when the macula at the back of the eyes' retina deteriorates, which can lead to central vision loss.

In a study conducted by The Age-Related Eye Disease Study Research Group, 4,519 individuals aged 60 to 80 upon enrollment completed questionnaires concerning the previous year's dietary intake and underwent retinal photography to assess the presence and stage of macular degeneration.

While 1,115 participants were free of AMD symptoms, 2,746 were classified in intermediate stages, and 658 were found to have advanced (neovascular) age-related macular degeneration. The research team determined that a greater intake of omega-3 fatty acids, as well as fish, which is a source of the omega-3s, was associated with a reduced risk of advanced disease. When fish intake was examined, consuming more than two servings per week provided the greatest protection.

"Dietary total omega-3 long-chain polyunsaturated fatty acid intake was inversely associated with neovascular AMD, as was docosahexaenoic acid," the authors write. "Higher fish consumption, both total and broiled/baked, was also inversely associated with neovascular AMD."

Omega-3 fatty acids docosahexaenoic acid and eicosapentaenoic acid may protect the retina by influencing gene expression, retinal cell differentiation, and survival. Other properties of the fatty acids may also be involved, including their ability to reduce inflammation.

The authors conclude, "These results and those from other observational analytic investigations suggest that modifying diet to include more foods rich in omega-3 long-chain polyunsaturated fatty acids could result in a reduction in the risk of having neovascular age-related macular degeneration."

85. Omega-3 linked with Protection from Macular Degeneration
Author: Steve Austin, N.D.

Design:
A. Observational prospective study -- mean follow of 5 years
B. Observational retrospective study

Participants:
A. 2895 adults > 49 years of age at baseline for whom baseline food frequency questionnaire (FFQ) data were available.
B. 681 elderly male twins of whom 222 had age-related macular degeneration (AMD) and 459 did not

Main Outcome Measures:
A. FFQ data were analyzed, looking for variables associated with the risk of AMD.
B. Subjects were grouped by smoking status and by quantity and quality of dietary fat intake.

Key Findings:
A. Subjects in the highest quintile of omega-3 fatty acid intake had a 59% lower risk for AMD compared with those in the lowest quintile of intake (95% CI, 0.22-0.75). Those eating fish ? once per week had a 42% reduction in risk compared with those with a minimal fish intake (95% CI, 0.37-0.90). Those consuming fish > three times per week had a 75% reduced risk (95% CI, 0.06-1.00).
B. After multivariate analysis, those consuming fish > twice per week had a statistically significant 37% reduction in risk compared with those consuming less than one serving per week. Those with a median intake of 350 mg of omega-3 oil (the top quartile of intake) had an adjusted 45% lower risk of AMD compared with those consuming only 60 mg/day (the lowest quintile of intake, p=0.02). The protection associated with EPA/DHA intake occurred primarily in those consuming relatively low levels of linoleic acid (adjusted odds ratio of 0.23, p<0.001). Current smokers had almost twice the risk for AMD compared with those who never smoked (p=0.06).

Practice Implications:
Allopathic treatment for AMD is relatively ineffective for most patients. Until now, most of the emphasis in prevention and treatment in the realm of natural medicine has focused on the use of lutein and zinc, though a small body of evidence suggested fish consumption might reduce the risk of AMD (Arch Ophthalmol 2000;118:401-4). Both new studies confirm a strong and consistent inverse correlation between EPA, DHA, and fish consumption and AMD.

The study by Chua and colleagues also tracked alpha-linolenic acid (ALA) intake -- the vegetarian omega-3 oil that partially bioconverts to EPA. In terms of 5-year risk for early AMD, ALA showed the same protective effect, as did EPA/DHA. However, though this difference was not statistically significant, for late AMD, those in the lowest quintile of ALA intake had a lower risk than those consuming more ALA. Until more is known, therefore, there is little reason to assume ALA has the same protective effect that EPA and DHA appear to have.

Chua's findings regarding associations between total fat, monounsaturated fatty acids, trans fatty acids, polyunsaturated fatty acids [PUFA], and saturated fatty acids, and AMD risk conflict with previously published research (Arch Ophthalmol 2003;12:1728-37). Therefore, we don't know enough about the possible effects of these variables to alter clinical practice.

Findings from the study by Seddon and colleagues, suggest that cessation from smoking combined with a modest increase in fish or omega-3 fatty acid intake would literally cut the risk for AMD in half. Implementing appropriate changes could save vision in many elderly people. But what sense do these findings make?

Experimental reports show that DHA protects against retinal oxidative damage. Also, an inflammatory component to AMD has been reported, and EPA and DHA have known antiinflammatory actions. That said, for the most part we still do not understand how EPA and DHA protect against AMD.

Despite a lack of understanding, encouraging patients to increase intake of fatty fish makes sense. After considering the favorable risk-to-benefit ratio, an argument can also be made for discussing supplementation of EPA/DHA with AMD patients. Optimal dosing remains unclear, but even a few hundred milligrams per day of EPA plus DHA would reach well into the dietary intake reported by those experiencing a protective effect.

References:
A. Chua B, Flood V, Rochtchina E, et al. Dietary fatty acids and the 5-year incidence of age-related maculopathy. Arch Ophthalmol 2006;124:981-6.
B. Seddon JM, George S, Rosner B. Cigarette smoking, fish consumption, omega-3 fatty acid intake, and associations with age-related macular degeneration. Arch Ophthalmol 2006;124:995-1001.

86. Plasma homocysteine and total thiol content in patients with exudative age-related macular degeneration.
Plasma homocysteine and total thiol content in patients with exudative age-related macular degeneration.

Coral K, Raman R, Rathi S, Rajesh M, Sulochana KN, Angayarkanni N, Paul PG, Ramakrishnan S.

1Biochemistry Research Department, Vision Research Foundation, Sankara Nethralaya, Chennai, India.

PURPOSE: Exudative age-related macular degeneration (ARMD) is one of the debilitating ocular complications, which results in permanent blindness. Elevated homocysteine (Hcys) levels have been associated in the development of several vascular diseases. Vascular and oxidative stress theories have been implicated for the development of choroidal neovascularization in exudative ARMD. The aim of the present study was to investigate the possible role of plasma Hcys and thiol content (tSH) as a risk factor for the development of exudative ARMD. METHOD: A total of 16 patients with exudative ARMD and 20 age-matched controls were recruited for the study. Plasma Hcys levels were analysed using Reverse Phase High Performance Liquid Chromatography. Plasma glutathione (GSH) content was determined using o-phthalaldehyde (OPA) derivatization and subsequent detection by fluorimeter. Plasma tSH levels were determined by using thiol-specific reagent dithionitrobenzoic acid (DTNB) spectrophotometrically. RESULTS: Plasma Hcys levels in exudative ARMD were elevated three-fold (18+/-5.0 muM) when compared to healthy controls (6.7+/-1.8 muM). There was a two-fold decrease in the GSH and tSH in exudative ARMD when compared with controls. Negative correlation was observed between diminished tSH and Hcys levels (r=-0.4837, P=0.05). Similarly plasma Hcys levels negatively correlated with GSH content (r=-0.6620, P<0.05). CONCLUSION: Results from our present study revealed that there is an elevated Hcys level and diminished thiol pool content in exudative ARMD that are significant.Eye advance online publication, 1 April 2005; doi:10.1038/sj.eye.6701853.

PMID: 15803172 [PubMed - as supplied by publisher]

87. Poor Circulation and Aged Related Macular Degeneration Study 2009
A large study found strong evidence that older people who have age-related macular degeneration (AMD) are at increased risk for coronary heart disease (CHD), although not for stroke. This result adds to mounting evidence that AMD and cardiovascular disease may share some risk factors–smoking, High Blood Pressure, inflammatory indicators such as C-reactive protein, genetic variants such as complement factor H–and disease mechanisms. The Cardiovascular Health Study (CHS) followed 1,786 white or African American participants, who were free of CHD or stroke at the study’s outset, for about seven years. The CHS received funding from the National Heart, Lung and Blood Institute, a division of the National Institutes of Health. The incidence of CHD was 25.76 percent in patients with AMD, compared with 18.9 percent in those without AMD. The association between AMD and CHD was somewhat stronger in people age 69 to 78 than age 79 and up. Data were adjusted to counter potentially confounding factors like hypertension, diabetes, and smoking.

88. Prevention and remediation of macular degeneration
General measures for prevention and remediation of macular degeneration would include a combination of supplementation with trace elements, antioxidants and other vitamins, ozone therapy, increasing physical fitness, improving nutrition (e.g. avoiding hydrogenated oils), abstaining from smoking, and protection from excessive light exposure.Eur J Med Res 1997 Oct 30:2(10):445-54

89. Pro-vitamin A and E
There was an inverse relationship between dietary pro-vitamin A carotenoid and vitamin E consumption and the incidence of large macular drusen, and between zinc and the incidence of pigmentary abnormalities. Am J Epidemiol 1998 Jul 15;148(2):204-14

90. Resveratrol reduces oxidation and proliferation of human retinal pigment epithelial cells via extracellular signal-regulated kinase inhibition.
Chem Biol Interact. 2005 Jan 15;151(2):143-9. King RE, Kent KD, Bomser JA.
Department of Food Science and Technology, Ohio State University, Columbus, OH
Epidemiological evidence suggests that moderate wine consumption and antioxidant-rich diets may protect against age-related macular degeneration, the leading cause of vision loss among the elderly. Development of age-related macular degenerationnd other retinal diseases, such as proliferative vitreoretinopathy (PVR), is associated with oxidative stress in the retinal pigment epithelium (RPE), a cell layer responsible for maintaining the health of the retina by providing structural and nutritional support. We hypothesize that resveratrol, a red wine polyphenol, may be responsible, in part, for the health benefits of moderate red wine consumption on retinal disease. To test this hypothesis, the antioxidant and antiproliferative effects of resveratrol were examined in a human RPE cell line (designated ARPE-19). These results suggest that resveratrol can reduce oxidative stress and hyperproliferation of the RPE.

91. Serum anti-oxidants
Serum antioxidants and age-related macular degeneration in a population-based case-control study. Julie A. Mares-Perlman, William E. Brady, Ronald Klein, Barbara E. K. Klein, Phyllis Bowen, Maria Stacewicz-Sapuntzakis, and Mari Palta. Archives of Ophthalmology 113: 1518-1523 (1995).

92. Smoking and carotenoids
Smokers with early macular degeneration who consumed the lowest amounts of carotenoids were nearly 6X as likely to develop advanced macular degeneration than those consuming the highest amounts. Seddon, et al. J. Amer Med Assoc; 1994

93. Spinach and corn
Researchers Hammond, Johnson, Russel and colleagues performed a study in which they measured macular pigment in 13 patients who recieved dietary modifications for a period of up to 15 weeks. Subjects were given daily servings of spinach and corn, which added 11.2 mg lutein and 0.6 mg zeaxanthin. Relative to an average diet, this increased lutein intake 4-fold and Zeaxanthin intake 3-fold. Eight of 10 patients compliant on the spinach/corn supplement diet exhibited an average increase in macular pigment density of 19% (minimum 13%). Hammond, etal. Invest Ophthalvol Vis Sci 1997 Aug;38(9):1795-801

94. Statin Drugs and Macular Degeneration
Contrary to the expectations of some scientists, cholesterol-lowering 'statin' drugs (such as Lipitor or Zocor) do not appear to stave off age-related macular degeneration (AMD) in the eye. In fact, a review of data from the Cardiovascular Health Study suggests that taking a statin may slightly increase the risk of age-related macular degeneration. SOURCE: Archives of Ophthalmology, January 2006.

95. Statins May Increase Chances of Getting Macular Degeneration
January 13th 2006

Recent recommendations for the aggressive use of medications to lower low-density lipoprotein (LDL) cholesterol levels has contributed to a rising trend in the use of statin drugs. A study published in the January 2006 Archives of Ophthalmology evaluates the use of these drugs, specifically with regard to the risk of age-related macular degeneration (AMD).

The investigators collected data from the Cardiovascular Health Study, a population-based prospective study, to address the relationship between the use of statins and other cholesterol-lowering medications and AMD. Fundus photographs were taken in 1997 and 1998 on 4249 statin users and non-statin users in the study. 2755 of these participants were available to be classified as cases (AMD) or controls (no AMD).

The results of this study suggests no association exists between cholesterol-lowering medications and AMD progression. However, there was a suggestion that statin use might increase the risk of developing AMD. These findings are corroborated in several similar studies, including the first National Health Examination and Nutrition Survey. This evidence may seem a bit contrary to some and more than disappointing to the pharmaceutical companies who are now using the popular atherosclerotic-like theory of AMD to justify detailing statin drugs as AMD medications in ophthalmic offices.

The Doctors Klein (Beaver Dam Study) recently proposed the idea that high LDL levels and low HDL levels may actually offer protection from AMD by down-regulating LDL receptors in the Retinal Pigment Epithelium (RPE), thereby reducing the contribution of cholesterol to drusen. This line of reasoning implies that by lowering serum cholesterol levels with statins; an increased amount of cholesterol may be taken up by the RPE cells with a subsequent increased deposition in drusen and an increased risk of AMD.

References:

3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitors and the Presence of Age-Related Macular Degeneration in the Cardiovascular Health Study. McGwin G, Kayvon M, et al. Arch Ophthalmol. January 2006;124(1):33-37 [abstract not yet catalogued in the National Library of Medicine]

A case control study of age related macular degeneration and use of statins. Smeeth L, Cook C, et al. Br J Ophthalmol. 2005 Sep;89(9):1171-5 [abstract]

The association of cardiovascular disease with the long-term incidence of age-related maculopathy: the Beaver Dam eye study. Kelin R, Klein BE, et al. Ophthalmology. 2003 Apr;110(4):636-43 [abstract]

The Use of Cholesterol-lowering medications and Age-related macular degeneration McGwin Jr G, Xie A, et al. Ophthalmology 2005;112:488-494 [abstract]

Cholesterol lowering drugs and risk of age related maculopathy: prospective cohort study with cumulative exposure measurement. van Leeuwen R, Vingerling JR, Hofman A, et al. BMJ 2003;326:255-256 [abstract]

Relation of statin use to the 5-year incidence and progression of age-related maculopathy. Klein R, Klein BE, et al. Arch Ophthalmol. 2003 Aug;121(8):1151-5 [abstract]

96. Stem Cell Tranplants Show Some Success in Restoring Vision
Could an out-patient surgical procedure for cure of age-related macular degeneration (AMD) with stem cells transfer become commonplace in the next decade?

During a recent visit to discuss the possibility of conducting human trials of retinal stem cell transplants in India, Professor Pete Coffey, from University College London (UCL) Institute of Ophthalmology, London, United Kingdom; reportedly told the Times of India:

"… some cases, the transplants were so successful that the patients were able to read, cycle and use a computer. By 2011, we will make it a 45-minute out patient operation."

Professor Pete Coffey and his colleagues at the UCL Institute of Ophthalmology in London, UK, have previously written:

• "Retinal pigment epithelial (RPE) transplantation aims to restore the subretinal anatomy and re-establish the critical interaction between the RPE and the photoreceptor, which is fundamental to sight."1
• "Diseases that have been treated with RPE transplantation demonstrating partial reversal of vision loss include primary RPE dystrophies … photoreceptor dystrophies as well as complex retinal diseases such as atrophic and neovascular age-related macular degeneration (AMD).
• "Unfortunately, in the human trials the visual recovery has been limited at best and full visual recovery has not been demonstrated."
• "Autologous full-thickness transplants have been used most commonly and effectively in human disease but the search for a cell source to replace autologous RPE such as embryonic stem cells, marrow-derived stem cells, umbilical cord-derived cells as well as immortalised cell lines continues."

97. Sternberg P. Treating Age-Related Macular Degeneration
Macular degeneration patients have 58 percent less glutathione than people without the disease. Sternberg, P. Treating Age-Related Macular Degeneration . Presented at Science Writers Seminar in Ophthalmology: Research to Prevent Blindness. 1988.
Editor’s Note: Glutathione protects retinal cells from light damage caused by ultraviolet and blue light sunlight.

98. Taurine - As it affects Rhodopsin Regeneration and the Protection of the Macular Pigment Epithelium
Taurine is a sulfur-containing amino acid found naturally in egg whites, meat, fish and milk. High concentrations are found in the heart muscle, white blood cells, skeletal muscle and central nervous system.

In the retina there are two binding proteins specific to taurine. And, intracellular concentrations are higher in the retina than in any other region derived from the central nervous system (1, 2, 3, 4).

Taurine plays a role in the process of rhodopsin regeneration necessary for night vision. (5) It is essential to the retinal pigment epithelium and the photoreceptors ( cells that we see with) (6) where it is found at levels ten times higher than other free amino acids (7)! Taurine helps protect cell membranes from oxidative attack. It helps transport nutrients across cell membranes, acts as a catalyst to retinal cells that remove cellular debris (8) and assists in the elimination of potentially toxic substances. Taurine in combination with retinol protects lipids twice as much as retinol alone. Taurine protects rod outer segment lipids during exposure to cyclic light. (9) 1. Kennedy AJ et al, Journal of Neurochemistry 1974; 23:1093. 2. Orr HT et al, Journal of Neurochemistry 1976; 26:606. 3. Lopez-Colome AM et al, Journal of Neurochemistry 1980; 34:1047. 4. Lombardi JB, Society for Neuroscience 1981; 7:321. 5. Petrosian AM, Haroutounian JE, Adv Exp Med Biol 1998;442:407-13. 6. Hayes KC et al, Science 1975; 188:949. 7. Wright CE et al, Annual Review of Biochemistry 1986; 55:427. 8. American Biologics, Research Institute, Mexico; Tijuana, B.C. Mexico, 1991. 9. Keys SA, Zimmerman AWF, Exp Eye Res, 1999 Jun;68(6):693-702. Tallan HH et al, Life Sciences 1983; 33:1853.

99. Vitamin B Trio Effective Against AMD
Women's Antioxidant & Folic Acid Study

Results from the vision component of the Women's Antioxidant and Folic Acid Cardiovascular Study, also known as WACS, were presented at the ARVO 2007 Annual Meeting. Researchers from the Brigham and Women's Hospital and the National Eye Institute concluded that the data from this randomized trial indicate that supplementation with folic acid, vitamins B6 and B12 reduced the risk of AMD in women with cardiovascular disease (CVD) (1).

These three B-vitamins, particularly folic acid, have been shown to reduce high levels of the naturally occurring compound, homocysteine. Research has implicated elevated plasma levels of homocysteine in the development of vascular diseases including choroidal neovascularization in exudative AMD.

Christen WG, et al. Folic acid plus B-vitamins and age-related macular degeneration in a randomized trial in women. Invest Ophthalmol Vis Sci 48:E-abstract 1152, ARVO, 2007.

100. Vitamin B, folic acid linked to lower risk of eye disease in Harvard study
T

he Women's Antioxidant and Folic Acid Cardiovascular Study

Women who took a combination of folic acid and two B vitamins for several years had a lower chance of developing the most common cause of vision loss in older Americans, Harvard researchers report, the first rigorous trial to show a benefit from the supplements.

A team led by William G. Christen of Brigham and Women's Hospital and Harvard Medical School found that women who took a combination of folic acid and vitamins B6 and B12 had a 35 percent to 40 percent lower risk of developing age-related macular degeneration than the women who took a placebo. The results are reported in the Archives of Internal Medicine (http://archinte.ama-assn.org/cgi/content/abstract/169/4/335).

William G. Christen, ScD; Robert J. Glynn, ScD; Emily Y. Chew, MD; Christine M. Albert, MD; JoAnn E. Manson, MD
Arch Intern Med. 2009;169(4):335-341.

101. Vitamin B6 deficiency
Patients with confluent soft drusen, or "pre-wet" ARMD, were found to have evidence of vitamin B6 deficiency. B. Lane, Ann Mtg Amer Coll of Nutrition, 1991.

102. Zeaxanthin ann Lutein Can Significantly Reduce the Chances of Getting AMD (2003)
Summary

Dr. Gale reported a significant (50%) reduced risk of early or late AMD in subjects with high plasma zeaxanthin (>0.05ìM), compared with subjects with low levels (<0.03ì). The associations in this study were even stronger, perhaps because of the higher values in the highest quintile of zeaxanthin and lutein in this Mediterranean population, probably associated with higher dietary intakes of these xanthophylls.

Study Summary

Risk of Age Related macular degeneration (early or late) was significantly higher in people with lower plasma concentrations of zeaxanthin. Compared with those whose plasma concentrations of zeaxanthin were in the highest third of the distribution, people whose plasma concentration was in the lowest third had an odds ratio for risk of age related macular degeneration of 2.0 (95% confidence interval [CI] 1.0-4.1), after adjustment for age and other risk factors.

Risk of age-related macular degeneration was increased in people with the lowest concentrations of lutein plus zeaxanthin (odd ratio [OR] 1.9, 95% CI 0.9-3.5) and in those with the lowest concentrations of lutein (OR 1.7, 95%CI 0.9-3.3), but neither of these relations was statistically significant.

Invest Ophtalmol Vis Sci 2003;44:2461-2465, C. Gale, Nigel F. Hall, David Phillips and C. Martins. From the Medical Research Council Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, UK.

103. Zeaxanthin Can Reduce Chances of AMD 79% (2006 study)
A recent study conducted by the Ocular Pathologies Associated with Age group (POLA in French) was reported in an article published in the Investigative Ophthalmology and Visual Science June 2006 issue reports finding a particularly strong inverse association between plasma zeaxanthin and AMD: Subjects with high levels of plasma zeaxanthin had a 93% reduced risk of AMD. Globally, subjects with high total plasma lutein and zeaxanthin had a 79% reduced risks of AMD compared with subjects with low total plasma lutein and zeaxanthin.

IOVS, June 2006, Vol. 47, No. 6
Plasma Lutein and Zeaxanthin and Other Carotenoids as Modifiable Risk factors for Age Related Maculopathy and Cataract: the POLA study Cecile Delcourt, Isabelle Carriere, Martine Delage, Pascale Barberger-Gateau, Wolfgang Schalch and the POLA Study Group

Epidemiological data on the association of xanthophylls and the risk of Age Related Macular Degeneration (AMD) and cataract remain scarce, and are partly inconsistent. Also, until recently, most studies assessed the association of AMD or cataract with the combined plasma concentration of lutein and zeaxanthin, thereby limiting the chances of finding specific associations of lutein or zeaxanthin with these diseases. This study separately assessed these associations in a Mediterranean population study.

The researchers found that plasma lutein and zeaxanthin showed a strong inverse association with AMD, and that the association with plasma zeaxanthin was particularly strong. Compared with subjects that had low levels of zeaxanthin (<0.04 ìM), subjects with high levels of plasma zeaxanthin (>0.9ìM) had a 93% reduced risk of AMD. Globally, subjects with high total plasma lutein and zeaxanthin (>0.56ìM) had a 79% reduced risks of AMD compared with subjects with low total plasma lutein and zeaxanthin (<0.25ìM).

With respect to cataract, after adjustment for age and gender, only plasma zeaxanthin showed a strong inverse association with nuclear cataract. Compared with subjects with low plasma zeaxanthin (<0.04ì), those with high plasma zeaxanthin (>0.9ìM) had a 75% decrease risk of nuclear cataract. The other types of cataract did not show any significant association with plasma zeaxanthin. Similarly, subjects with high plasma dehydro-lutein had a significant (66%) reduced risk of nuclear cataract. By contrast plasma lutein was not significantly associated with any type of cataract.

The results of this study are consistent with those of a recent cross sectional study performed in the United Kingdom. The authors reported a significant (50%) reduced risk of early or late AMD in subjects with high plasma zeaxanthin (>0.05ìM), compared with subjects with low levels (<0.03ì). The associations in this study were even stronger, perhaps because of the higher values in the highest quintile of zeaxanthin and lutein in this Mediterranean population, probably associated with higher dietary intakes of these xanthophylls.

Previous studies may have obscured the association with cataract, if only zeaxanthin is associated with cataract, by given results for pooled lutein and zeaxanthin.

The hypothesis of a more important role of zeaxanthin in retina and lens health is supported by several lines of evidence. First, the ratio of zeaxanthin to lutein is much higher in the central retina (1:1 in the macula, 2:1 in the fovea) and in the lens (1:1) than it is in the plasma (~1-5) suggesting that the eye preferentially accumulates zeaxanthin. Moreover, although both lutein and zeaxanthin protect liposomal membranes from light inductive oxidative stress, zeaxanthin appears to be a better photoprotector during prolonged UV exposure, perhaps because there is a different orientation of lutein and zeaxanthin in the biological membranes. Zeaxanthin is also particularly effective in protecting lipid membranes against oxidation by peroxyl radicals.

104. Zinc and vitamin E
Subnormal zinc and vitamin E serum levels may be associated with the development of age-related macular degeneration. Ishihara, et al. Nippon Ganka Gakkai Zasshi 1997 Mar;101(3):248-51

105. Zinc deficiency
Zinc deficiency can lead to loss of eye function as several zinc-dependent enzymes play important roles in eye function. Levels of these enzymes decline with age. Zinc deficiency may contribute to macular degeneration of the central part of the retina. Results from the Beaver Dam Eye Study, published in 1996, suggest a link between low zinc intakes and risk of macular degeneration. Mares Perlman JA; Klein R; Klein BE; Greger JL; Brady WE; Palta M; Ritter LL. Association of zinc and antioxidant nutrients with age-related maculopathy. Arch Ophthalmol, 1996 Aug, 114:8, 991-7

106. Zinc supplements
Zinc supplements have been used to treat age-related macular degeneration, the leading cause of lack of vision in people aged over 55.In one double-blind study, researchers at Louisiana State University found that patients receiving zinc supplements had significantly less vision-loss than those not taking zinc. Newsome D A et al. Oral zinc in macular degeneration. Arch Opthalmol. 1988;106:192-198

Male Infertility

1. Male Infertility
Also see discussion

1. Goverde HJM, Dekker HS, Janssen HJG, et al. Semen quality and frequency of smoking and alcohol consumption - an explorative study. Int J Fertil 1995;40:135–8.
2. Abell A, Ernst E, Bonde JP. High sperm density among members of organic farmers’ association. Lancet 1994;343:1498.
3. Hruska KS, Furth PA, Seifer DB, et al. Environmental factors in infertility. Clin Obstet Gynecol 2000;43:821–9.
4. Wang SL, Wang XR, Chia SE, et al. A study on occupational exposure to petrochemicals and smoking on seminal quality. J Androl 2001;22:73–8.
5. Zhang JP, Meng QY, Wang Q, et al. Effect of smoking on semen quality of infertile men in Shandong, China. Asian J Androl 2000;2:143–6.
6. Fraga CG, Motchnik PA, Shigenaga MK, et al. Ascorbic acid protects against endogenous oxidative DNA damage in human sperm. Proc Natl Acad Sci 1991;88:11003–6.
7. Dawson EB, Harris WA, Teter MC, Powell LC. Effect of ascorbic acid supplementation on the sperm quality of smokers. Fertil Steril 1992;58:1034–9.
8. Dawson EB, Harris WA, McGanity WJ. Effect of ascorbic acid on sperm fertility. Fed Proc 1983;42:531 [abstr 31403].
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Myopia (nearsightedness)

1. Prevalence rate of nearsightedness in schoolchildren in rural Mongolia

Prevalence rate of nearsightedness in schoolchildren in rural Mongolia

Optom Vis Sci. 2006 Jan;83(1):53-6.

The prevalence of nearsightedness among some young Asian populations has been reported to be increasing to near epidemic proportions. Mongolia is an emerging Asian economy with limited ophthalmic resources. The purpose of this study was to define a level of nearsightedness for school-aged children in rural Mongolia. The total prevalence of nearsightedness (more than -0.5 D spherical equivalent) was 5.8%. Female students exhibited a significantly higher prevalence of nearsightedness in comparison to male students: 8% compared with 3%, respectively. The prevalence rate of nearsightedness in Mongolia is low in comparison to other Far Eastern countries.

2. Refractive status of indigenous people in the Amazon region of Brazil

Refractive status of indigenous people in the northwestern Amazon region of Brazil

Optom Vis Sci. 2005 Apr;82(4):267-72.
Thorn F, Cruz AA, Machado AJ, Carvalho RA.
New England College of Optometry, Boston, Massachusetts

The purpose of this study was to investigate the refractive status of the illiterate indigenous people of the upper Rio Negro region of the Amazon rain forest in northwestern Brazil.

METHODS: From an overall sample of 486 people, 259 indigenous people and 78 Brazilians between 12 and 59 years of age with no compromising optical opacities were refracted with cycloplegic retinoscopy. Subjects were categorized as indigenous if they had at least three generations of indigenous ancestry with no folklore suggesting other ancestors.

RESULTS: Nearsightedness was rare among the indigenous population. Only 2.7% of eyes showed Nearsightedness of -1.00 D or more and 1.6% (four people) had bilateral Nearsightedness of -1.00 D or more. Half of this small group were the only educated indigenous people examined. The prevalence of astigmatism and anisometropia equal to or >1.00 D was 15.5% and 8.2%, respectively. Most of the astigmatism in the indigenous people had an against-the-rule axis. Age was not associated with the refractive errors of the indigenous people. Brazilians from the small city in which the study was performed had higher rates of Nearsightedness (6.4% of eyes and 5.1% of subjects bilaterally). Older preeducation adults also had a very low prevalence of Nearsightedness (3.2% of eyes and 2.0% of subjects), whereas the younger, slightly educated Brazilians had a higher prevalence of Nearsightedness (11.3% of eyes and 9.7% of subjects).

CONCLUSION: The low prevalence of nearsightedness in the illiterate indigenous people is consistent with other studies and suggests that Nearsightedness is related to literacy. The generational change among the local mixed race Brazilians further supports this conclusion. The relatively high rates of astigmatism and anisometropia in the indigenous people were unusual for a predominantly emmetropic sample.

3. Sunlight can help children avoid myopia: Aussie researchers 2009

Children should spend two to three hours a day outside to prevent them becoming short-sighted, says a study by the Australian Research Council Centre of Excellence in Vision Science.

A comparison of children of Chinese origin in Australia and Singapore, which has the highest rate of myopia in the world, found the only significant difference was the time spent outdoors.

Ian Morgan from the ARC Vision Centre yesterday said exposure to daylight appeared to play a critical role in limiting the growth of the eyeball, which is responsible for myopia or short-sightedness.

Professor Morgan said it had been apparent for a couple of hundred years that more educated people were short-sighted, but the research suggested spending some hours a day outdoors could counteract the myopic effects of study.

"Video games are as ineffective as reading on vision," he said. "Computers are pretty neutral, watching television doesn't seem to affect vision. The only difference we could find is the amount of time spent outdoors.

The research says about 30 per cent of six-year-olds in Singapore are short-sighted enough to need glasses, compared with only 3 per cent of Chinese-Australians.

Both groups spend the same amount of time studying, playing video games, watching television and reading books. But Singapore children spend an average 30 minutes a day outdoors compared with two hours in Australia.

Professor Morgan said similar trends were seen in India, with 5 per cent of rural-dwelling Indians being short-sighted compared with 10 per cent of their urban cousins and 65 per cent of those living in Singapore.

Myopia is increasing in urban areas around the world, and is described as an epidemic in parts of east Asia, with Singapore the world capital.

Australia has a level of myopia more commonly found in the Third World, with only 0.8 per cent of six-year-olds of European origin being short-sighted.

They spend on average three hours a day outdoors.

Osteoarthritis

1. Osteoarthritis
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