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Alternate or Complimentary Therapies for Macular Degeneration

Conditions:

Macular Degeneration

Related Terms

  • Maculopathy

Principal Proposed Natural Treatments

Other Proposed Natural Treatments

Not Effective Treatments

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   Principal Proposed Natural Treatments
   Other Proposed Natural Treatments
   References


The lens of the eye focuses an image of the world on a portion of the retina called the macula, the area of finest visual perception. After cataracts, damage to the macula is the second most common cause of visual impairment in those over 65. Smoking, high blood pressure, and atherosclerosis are associated with macular degeneration. Bright light also appears to play a role by creating damaging natural substances in the eye, called free radicals. Gradual deterioration of the macula is called macular degeneration.


In the most common form of macular degeneration (dry macular degeneration), a substance known as lipofuscin accumulates in the lining of the retina. A much less common form of macular degeneration involves the abnormal growth of blood vessels (wet macular degeneration). This can be treated very successfully, if attended to soon enough, but may lead to irreversible blindness if left untreated. For this reason, medical consultation in all cases of macular degeneration (or any other type of vision loss) is essential.


Principal Proposed Natural Treatments

Note: The treatments described in this section are intended as supports to standard ophthalmalogical care, not as a substitute for it. All studies refer primarily to the more common type of macular degeneration, dry macular degeneration.

Zinc and Antioxidants

Growing evidence suggests that a mixture of zinc and antioxidants can prevent or slow the progression of early macular degeneration of the most common type.


A
double-blind, placebo-controlled trial evaluated the effects of zinc with or without antioxidants on macular degeneration in 3,640 individuals in the early stage of the disease.1 Participants were randomly assigned to receive one of the following treatments: antioxidants (vitamin C at 500 mg, vitamin E at 400 IU, and beta-carotene at 15 mg), zinc (80 mg) and copper (2 mg), antioxidants plus zinc, or placebo. The results indicate that zinc alone or, even better, zinc plus antioxidants, significantly slowed the progression of the disease.


Note: Zinc at doses of 80 mg and higher daily can be harmful. One of the problems is that high-dose zinc supplementation impairs copper absorption. That's why extra copper was provided in the study described above. However, there may be other risks as well. Physician supervision is advised. For other dosage and safety issues, see the full Zinc article.


Smaller studies of zinc for macular degeneration have found mixed results.3,4


Note that it's not clear how much the antioxidants in the mixture contributed to the benefits. A 4-year, double-blind, placebo-controlled trial of 1,193 people with macular degeneration failed to find vitamin E alone helpful for preventing or treating macular degeneration.16

Lutein and Other Carotenoids

Observational studies suggest that higher intake of dietary carotenoids is associated with a lower incidence of macular degeneration.5,6 Carotenoids are a group of substances that are found in many fruits and vegetables, especially yellow-orange and dark green ones. Beta-carotene is the most famous carotenoid. However, observational studies prove little about cause and effect. To determine whether carotenoids can actually prevent or treat macular degeneration, double-blind, placebo-controlled studies are necessary. (For information on why this is the case, see Why Does the Natural Pharmacist Rely on Double-blind Studies?) One such study failed to find any benefit with beta-carotene (taken along with vitamin E and vitamin C).15


The less well-known carotenoids lutein and zeaxanthin have also been investigated for a possible role in preventing macular degeneration (as well as cataracts). 7,8 These carotenoids, principally found in corn and dark green leafy vegetables, are found in high concentrations in the eye. It has been suggested that they may protect the macula from light-induced damage by dyeing it yellow, thereby acting as a kind of natural sunglasses. They also act in the usual antioxidant fashion by neutralizing free radicals.9 Hopes were somewhat dampened by one observational study that failed to find much association between the extent of macular degeneration and the intake of either lutein or zeathanthin.10 However, they rose again after the completion of a preliminary double-blind, placebo-controlled trial of lutein.18 This study enrolled 90 people with dry ARMD and followed them for 12 months. The participants received either lutein (10 mg), lutein plus antioxidants and a multivitamin/mineral suppplement, or placebo. At the end of the study period, participants who had taken lutein alone or lutein plus the other nutrients showed improvements in vision, while no change in vision was seen in the placebo group.


While these are promising findings, further study is needed to establish the apparent benefit of lutein for ARMD. For more information, see the full Lutein article.


Other Proposed Natural Treatments

Flavonoids are another group of naturally occurring chemicals, found in many plants, that may offer a variety of beneficial effects. Weak but interesting evidence suggests that bilberry and OPCs, both rich in flavonoids, may prevent or treat macular degeneration.11-13


The herb ginkgo biloba also contains many flavonoids, and is additionally thought to increase circulation. In a 6-month, double-blind, placebo-controlled study of 20 people with macular degeneration, use of ginkgo at a dose of 160 mg daily resulted in improved visual acuity.12 Furthermore, positive results were seen in a 24-week, double-blind study of 99 people with macular degeneration that compared ginkgo extract at a dose of 240 mg per day against ginkgo at a dose of 60 mg per day.17 Vision improved in both groups, but to a greater extent with the higher dose. This study would have been more meaningful if it had included a placebo group, but nonetheless, "dose-related" effects of this type are good indications that a treatment really works.


Moderate wine consumption might also help prevent macular degeneration.14 Like these herbs, wine contains high levels of flavonoids.


References

1. Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS Report no.8. Arch Ophthalmol. 2001;119:1417-1436.


3. Newsome DA, Swartz M, Leone NC, et al. Oral zinc in macular degeneration. Arch Ophthalmol. 1988;106:192-198.


4. Stur M, Tittl M, Reitner A, et al. Oral zinc and the second eye in age-related macular degeneration. Invest Ophthalmol Vis Sci. 1996;37:1225-1235.


5. Seddon JM, Ajani UA, Sperduto RD, et al. Dietary carotenoids, vitamins A, C, and E, and advanced age-related macular degeneration. Eye Disease Case-Control Study Group. JAMA. 1994;272:1413-1420.


6. Mares-Perlman JA, Brady WE, Klein R, et al. Serum antioxidants and age-related macular degeneration in a population-based case-control study. Arch Ophthalmol. 1995;113:1518-1523.


7. Landrum JT, Bone RA, Kilburn MD. The macular pigment: a possible role in protection from age-related macular degeneration. Adv Pharmacol. 1997;38:537-556.


8. Hammond BR Jr, Wooten BR, Snodderly DM. Density of the human crystalline lens is related to the macular pigment carotenoids, lutein and zeaxanthin. Optom Vis Sci. 1997;74:499-504.


9. Snodderly DM. Evidence for protection against age-related macular degeneration by carotenoids and antioxidant vitamins. Am J Clin Nutr. 1995;62:1448S-1461S.


10. Mares-Perlman JA, Fisher AI, Klein R, et al. Lutein and zeaxanthin in the diet and serum and their relation to age-related maculopathy in the Third National Health and Nutrition Examination Survey. Am J Epidemiol. 2001;153:424-432.


11. Scharrer A, Ober M. Anthocyanosides in the treatment of retinopathies [translated from German]. Klin Monatsbl Augenheilkd. 1981;178:386-389.


12. Lebuisson DA, Leroy L, Rigal G. Treatment of senile macular degeneration with Ginkgo biloba extract. A preliminary double-blind, drug versus placebo study [translated from French]. Presse Med. 1986;15:1556-1558.


13. Caselli L. Clinical and electroretinographic study on activity of anthocyanosides [in Italian; English abstract]. Arch Med Intern (Parma). 1985;37:29-35.


14. Watson V. Wine consumption decreases risk of age-related blindness. Medical Tribune, June 5, 1997.


15. Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled clinical trial of high-dose supplementation with vitamins C and E and beta carotene for age-related cataract and vision loss: AREDS report no. 9. Arch Ophthalmol. 2001;119:1439-1452.


16. Taylor HR, Tikellis G, Robman LD, et al. Vitamin E supplementation and macular degeneration: randomised controlled trial. BMJ. 2002;325:11.


17. Fies P, Dienel A. Ginkgo extract in impaired vision-treatment with special extract EGb 761 of impaired vision due to dry senile macular degeneration. Wien Med Wochenschr. 2002;152:423-426.


18. Richer S, Stiles W, Statkute L, et al. Double-masked, placebo-controlled, randomized trial of lutein and antioxidant supplementation in the intervention of atrophic age-related macular degeneration: the Veterans LAST study (Lutein Antioxidant Supplementation Trial). Optometry. 2004;75:216-30.



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