RAY D. STRAND, M.D.

Specialist in Nutritional Medicine

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Macular Degeneration
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In the United States, age-related macular degeneration is the leading cause of blindness in people over 60 years of age. Macular degeneration presents itself in two different forms: dry and wet, which both affect the macula of the eye. This is the area of the retina responsible for our central vision.

The dry form is characterized by a gradual reduction in central vision, and may progress to the wet form in approximately 10% of the cases. There is no proven treatment currently for the dry form of macular degeneration.

The wet form causes a more rapid reduction in central vision, development of new vessels, and possible vessel leakage. This form of macular degeneration is potentially treatable via laser photocoagulation. However, treatment does not prevent blindness.

Several clinical studies reveal that the underlying cause of age-related macular degeneration is free radical damage or oxidative stress to the macula. Within the eye, high-energy ultraviolet light and the visible blue light creates excessive free radicals. As a person ages, one's ability to offset these free radicals in order to limit oxidative stress, decreases.

The Journal of the American Medical Association reported in its November 9, 1994 issue that individuals who have the highest intake of beta-carotene have a 43% lower risk of developing macular degeneration than those with the lowest levels. Other epidemiological studies have shown that people with macular degeneration also had low levels of zinc, selenium, vitamin C, carotenoids, and vitamin E when compared to control groups that did not have macular degeneration.

A two-pronged approach has been proposed to limit this damage created by free radicals with the hope of preventing or at least managing macular degeneration. First, one should always shield the eye against high-energy rays from sunlight by using high quality sunglasses. Secondly, the patient with macular degeneration needs to start an aggressive nutritional supplement program in order to improve the eye's antioxidant defense system.

In one particular study, 192 patients with macular degeneration were given antioxidants and 61 control patients went untreated. After six months, 87.5% of the supplemented patients had visual acuity equal to or better than at the beginning of the study. In comparison, only 59% of the untreated group had visual acuity that was equal to or better than they were at the beginning of the study.

Clinical studies have identified particular nutrients that appear to be beneficial in macular degeneration. Mixed carotenoids containing lutein and zeaxanthin have been found to improve the pigment density in the macula. In fact, supplementing with lutein showed about a 50% increase in concentration of this nutrient within the macula of the eye. This offers the macula increased protection against high-energy light and free radical damage. It is like having an internal pair of sunglasses, since lutein gives this area an amber color that is able to filter the light before it hits the retina.

These carotenoids are also antioxidants and help bring the oxidative stress back into balance. Selenium and zinc supplements have been found to improve our own natural antioxidant defense system (glutathione perioxidase, superoxide dismutase, and catalase). Don't worry about these big names; just remember that these antioxidant systems need zinc and selenium to do their job. If they are not present in adequate amounts, our defense against free radicals is decreased. Bioflavanoid antioxidants, vitamin C, and vitamin E have also been found to help protect the eye against the development of macular degeneration.

Many clinical trials are in progress for the research of this particular disease. The National Eye Institute is currently sponsoring a 10-year study involving 4,600 patients. Though study results will not be available for several years, there is great hope that results from this longitudinal study, called the Age-Related Eye Disease Study, and will bring much –needed clarity and medical solutions.

In the mean time, there is very little for physicians to offer their patients who have macular degeneration. Still, most ophthalmologists discourage their patients from trying any alternative therapy. They merely keep asking to see the patients at periodic intervals to document the progression of the disease, and in the case of the wet form of macular degeneration, possible laser treatment.

I take a more proactive approach. I place my patients with macular degeneration on cellular nutrition while adding some of the most potent optimizers. I am using a much more aggressive approach than those taken in medical studies. There are two main objectives in beginning this aggressive supplementation program. The first is to stabilize the degenerative process. The second objective is to actually regain some visual acuity. Since macular degeneration is caused by oxidative stress, doesn't it make sense to optimize the antioxidant defense system of the eye as much as possible?

I have had several patients with documented improvement of their vision on this program. I have also had several patients who have not experienced any improvement but feel confident we have slowed the progression of the disease. Like any disease, it is best if a patient starts their nutritional program as soon as possible after their diagnosis. If the disease has progressed too far, the results are definitely not as good.

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