focus on low vision

A New Outlook for Omnivores

by Erinn Morgan

A movement is afoot in the low vision realm to extol the virtues of nutrition as a means to slow diminishing eyesight. While macular degeneration is largely hereditary, it also can be affected by environmental factors.

"Macular degeneration results from a lack of nutrients and oxygen getting to the eye," says Marc Jay Gannon, OD, FAAO, director of the Low Vision Institute in Fort Lauderdale, which boasts eight offices treating over 80,000 patients in the region. "The cells become fragile and eventually die."

This situation can be made worse by a diet high in fats and triglycerides, which Gannon pinpoints as "bad for macular progress." Conversely, a diet high in nutrient-rich foods, such a dark, leafy greens and omega-3-rich fish, can actually slow this process down.

This claim is not merely speculation—its roots are grounded in research. "The AREDS study was done with the idea that diet and nutrients could help improve vision, and it did show that," says Gannon.

In fact, the Age-Related Eye Disease Study (AREDS) from the National Eye Institute, which was released about five years ago, showed that high levels of antioxidants and zinc significantly reduce the risk of advanced age-related macular degeneration and its associated vision loss.

"This was the start of linking nutrition, antioxidants, and eye disease," says Regina Strand, OD, a low vision practitioner with Total Vision Eye Health Center in Uncasville and Newington, Conn. A deeper look into the topic is currently underway; the AREDS2 study will research the effects of other nutrients like lutein on macular degeneration.

While a nutritious diet can slow the progress of macular degeneration, it will not reverse the damage that has already been done. "You can't regrow the retina and you can't repair scar tissue, so the main thing is to stabilize it from further progression. The earlier you do these things, the better," says Strand.

As a result, more and more low vision practitioners are encouraging patients (and their children who have a higher risk for developing this issue) to become partners in their own healthcare by choosing and maintaining the right diet.

"I work with every patient I have on nutrition and make suggestions based on their health," says Eleanor Faye, MD, the medical director of the Lighthouse International and a private low vision practitioner in New York City. "It's really quite a process and, as an ophthalmologist, it's time-consuming; but the patients really get into it and it's worth it—patients should be involved in their own health care."

SLOWING THE PROCESS

The recommended diet to slow macular degeneration is also one commonly prescribed for overall physical health. "We recommend eating lots of brightly colored fruits and vegetables plus dark green, leafy vegetables like spinach, kale, and collard greens," says Strand. "These are packed with antioxidants, which is why we also like whole food supplements like Juice Plus—and juicing is a great way to go, too."

Strand also recommends reducing the intake of meat and dairy products, particularly because they are high in fat. "Dairy products are not necessarily advantageous and they are linked to heart disease and high cholesterol," she explains.

The focus, says Faye, is more toward a Mediterranean and vegetarian diet. "But not total vegetarian. We're advocating the well-known, so-called balanced diet where you get a variety of fruits, vegetables, fish, and lean meats," she notes.

Gannon recommends eating eggs, which are packed with the nutrient lutein that is believed to be a key ingredient in slowing macular degeneration. He also delivers good news for oenophiles. "We recently found that the rutin in red wine stabilizes and strengthens the vascular walls," he says. "The downside is this change takes time. If you know your genetics early on, you can benefit from drinking four to eight ounces a day, but if you're 80, this is not helpful."

When choosing fish, Gannon suggests omega-3-rich, cold-water varieties like salmon and tuna. With newly publicized concerns about mercury content in fish, patients may also want to be sure they're choosing safer options—see the website www.epa.gov/waterscience/fish/ for tips on safe fish selection.

In lieu of—or in addition to—eating a diet rich in fish, practitioners are also recommending patients take an omega-3 supplement. "It's great for general nutrition, but it also enhances the ability of the gland in the eye to secrete better tears," says Strand. "Having an intact optical surface is good whether you have low vision or not."

CUTTING IT OFF AT THE PASS

Some practitioners are also reaching out to their patients' families to get them started on a prevention plan (via nutrition and supplements) early.

"If there is a history of macular degeneration in the family, at least we can help them push the odds in their favor," says Faye. "There is a definite improvement in the younger generation in terms of health and awareness."

A newly developed test called Macula Predict can even help gauge a person's risk for developing this vision impairment, says Gannon. "It's the first test that will indicate if a patient will get macular degeneration—and how severely they will get it," explains Gannon, who says he still puts the onus on educating patients' families for prevention.

Practitioners agree that future outcomes can often lie in the hands of the individual. Says Strand: "People have to take responsibility for what they do or don't do to their bodies. You need the right fuel and that is linked to everything, including vision." EB