Scheie Eye Institute, University of Pennsylvania
Since age-related macular degeneration (AMD) is a leading cause of vision loss in Americans 60 years of age and older, it’s important to take steps that may prevent this eye disease. Certain measures have been shown in large clinical trials to clearly decrease the risk of AMD, and other actions, based on smaller trials or theoretical considerations, may also decrease risk.
Smoking is a definite risk factor for AMD, as well as other serious diseases. Anyone who smokes should try their hardest to stop, especially if they already have signs of AMD. It will help save your vision.
The age-related eye disease study (AREDS2) showed that supplementation with certain micronutrients reduces the risk of progression from the intermediate to the late stage of AMD by 25 percent. AREDS2 showed that a formula containing 10 milligrams (mg) of lutein, 2 mg of zeaxanthin, 500 mg of vitamin C, 400 International Units (IU) of vitamin E, 80 mg of zinc oxide, and 2 mg of cupric oxide can reduce the risk of disease progression by 25 percent. Lutein and zeaxanthin are carotenoids like vitamin A. There are many vitamins marketed for the eye or AMD sold over-the-counter. If recommend by your ophthalmologist, be sure to purchase those that specify “AREDS2 formula.” The vitamins are helpful for people who have a certain number of spots called drusen on the retina, which can be seen by an eye doctor during a dilated eye exam. The supplements are not recommended, however, for people who do not have drusen or have only a few drusen because they have a low risk of developing AMD, at least during the next 5 years.
Family members of people with macular degeneration often ask whether they should take AREDS2 vitamins or lutein and zeaxanthin supplements. While these are safe to take over a period of at least 5 years (the duration of the AREDS2 study), it is not known whether it would be safe to take them for a number of decades. Therefore, it is recommended that family members eat foods containing high levels of lutein and zeaxanthin rather than take the supplements. These foods also contain hundreds of other phytochemicals that are likely to be helpful. Foods such as egg yolk (go easy due to cholesterol), yellow corn, orange or yellow peppers, kale, broccoli, spinach, kiwi, grapes, zucchini, and squash have high levels of lutein and/or zeaxanthin and are thought to be protective.
People who eat a diet rich in fruits and vegetables, as well as twice-weekly meals of fat-rich fish like salmon, sardines, tuna or mackerel have a lower risk of AMD. Conversely, people who eat red meat every day have an increased risk of AMD. It is possible (although not proven) that this results from too much iron getting into the retina.
High blood pressure is a risk factor for developing wet AMD. High blood pressure, like smoking, leads to a constriction, or narrowing, of the blood vessels that nourish the retina, negatively affecting its health.
Long-term bright light exposure may be a risk factor for AMD. The Chesapeake Bay Waterman Study suggested that fisherman exposed to daily bright sunlight may have an increased risk. Certainly, staring at bright light such as the sun, for even a few minutes, can cause permanent damage to the retina. Many ophthalmologists recommend the use of sunglasses and a hat to protect against potentially harmful bright sunlight.
It is very important to have regular eye examinations, particularly as you age, or if you have any of the risk factors associated with age-related macular degeneration. If only one eye is affected by macular degeneration, there may be no noticeable symptoms, but a doctor can still make an accurate diagnosis. Early diagnosis and treatment may help control progression of the disease, and stabilize or even restore some vision.
While doctors do not yet know how to completely prevent AMD, a healthy lifestyle consisting of not smoking; a diet rich in fruits and vegetables, but limited in red meat; use of sunglasses when outside; regular eye examinations; and AREDS2 vitamins when they are indicated, will increase the chance of maintaining healthy vision for a lifetime.
Joshua Dunaief, MD, received his BA magna cum laude in Biology from Harvard (1987), MD/PhD from Columbia College of Physicians and Surgeons (1996), completed ophthalmology residency at the Wilmer Eye Institute, Johns Hopkins in 2000, and medical retina fellowship at Scheie Eye Institute, University of Pennsylvania in 2004.
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