Supplements for macular degeneration

Executive Summary
Here are the supplements that are advisable to prevent or manage macular degeneration.

Necessary:
Lutein (20 mg a day);
Zeaxanthin (2 mg a day);
Omega-3 fish oils (3000 mg a day);
Vitamin C (1,500 mg a day);
Vitamin E (400 IU a day);
Beta-carotenes (15 mg a day); and
Multi-mineral tablets derived from natural sources.

Optional:
B-Vitamins complex;
Bilberry extract (400 mg a day); and
Green Tea extract (400 mg a day).

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You are probably reading this article because:

1. You are diagnosed with macular degeneration and you want to prevent or slow down further degradation; or
2. You have a family history of the same and want to know how to prevent or delay the onset of it.

So you and I are in the same boat (point 2 for me). In this article, I will cover what you need to know to manage it better with the help of supplements.

Introduction

Macular Degeneration (MD) is an eye disease that damages cells in your eye retina. A part of your retina, called the macula, is responsible for the central or middle part of your vision. MD causes blurring in the central part of the vision. Sometimes, it can even cause blind spots in your vision. Obviously, it can hamper your daily activities such as reading or walking.

In general, this problem starts as you get older. So it is often called Age-related Macular Degeneration (AMD).

Of course, one can get MD even at a young age. But if one develops MD till the age of 40, it is usually due to genetic or inherited causes. Some people develop MD if they have severe nearsightedness, which can cause retinal tears and bleeding due to elongation of the eyeball. Thus, AMD is a version of MD that is caused by age-related damage to the retinal—more specifically, macular— cells.

There are two types of AMD: the common one (85%) is called Dry AMD and the rare and acute one is called Wet AMD. Now, I can explain everything about dry AMD and wet AMD, along with their symptoms and causes. But then this article will become unnecessarily too long. I suggest you read about them from the links that I have given at the end of this writeup. Let me stick to my core knitting: supplementation strategy for AMD.

Causes of AMD

In the following section, I will briefly explain how macular degeneration develops. The insight is meant to help you understand the prevailing thinking behind where, when, and why to intervene with supplements. However, if you prefer to skip this part, you can go to the section on Principles of Supplementation in Macular Degeneration.

In simplest terms, your retina has cells that are sensitive to light and help you see. A region underneath these cells, called Choroid, brings oxygen and blood to the retinal cells. In between the retinal cells and the choroid is a thin layer of cells called the Retinal Pigment Epithelium (RPE). This RPE layer allows the crossover of nutrients from and waste products to the choroid from the retinal cells. Multiple things can go wrong in this system, leading to AMD:

1. With age, small yellow deposits, called Drusen, form below the retinal cells and above the RPE cells. They are made up of proteins and fats. These can damage the vision.
2. Extensive exposure to blue and bright lights can damage the retinal cells, leading to the release of some toxic chemicals, which can trigger AMD.
3. With age, the RPE cell layer can wear out. That prevents an effective transfer of nutrients from the choroid to the retinal cells. Also, the waste products from the retinal cells keep accumulating.
4. Sometimes, new blood vessels grow underneath the retina. They may leak fluid or blood. While we don’t yet know what causes this growth of new blood vessels, scientists feel that it is due to the nutrient blockage at the RPE layer. Our body has a mechanism that if blood supply to a region is hampered, the cells there secrete some chemical called Vascular Endothelial Growth Factor (VEGF). VEGF is known to trigger something called neoangiogenesis—new blood vessel growth.
5. Finally—and this may have a significant preventive value for us—oxidative stress and inflammation can lead to reduced RPE function, degradation, and RPE cell death.

Risk Factors

Out of the many risk factors for AMD, let me specify some that will give you some preventive hints:

• Smoking (stop it);
• Heart disease (control it);
• Obesity (get rid of it);
• High levels of blood cholesterol (lower them);
• Low levels of antioxidants in the blood (raise them);
• Regular use of antacids (reduce it); and
• Long-term exposure to blue lights (reduce it).

Principles of Supplementation in Macular Degeneration

Supplementation in macular degeneration relies on 4 pillars:

1. Preventing RPE Cell Death:
   With age, RPE layer thins out with its cells dying. This happens because normally, these cells are loaded with antioxidants lutein and zeaxanthin.
   When blue light rays hit the retinal and RPE cells, they produce free radicals that can damage or destroy those cells. But lutein and zeaxanthin are able to neutralise those free radicals. With age, the levels of these antioxidants fall making the cells vulnerable to damage.
   Besides oxidative stress, even inflammation can lead to RPE cell death.
2. Preventing Drusen Deposits:
   Obesity, high blood cholesterol, and high blood pressure are associated with drusen deposits. We don’t know if they cause drusen but controlling them is a good idea even for general health. High blood pressure also restricts the amount of oxygen reaching the retina, increasing the risk of AMD.
3. Strengthening Blood Vessels in Choroid:
   If the blood vessels in the choroid rupture due to weak walls, the bleeding can lead to AMD.
4. Preventing New Blood Vessel Formation:
   New blood vessels that form in a damaged retina will block or blur vision. Nutrients that prevent such neoangiogenesis will help protect in AMD.

Supplements for Preventing RPE Cell Death

Supplements that provide antioxidant and anti-inflammatory support to the retinal and RPE cells should be considered.

1. Lutein: 20 mg a day is helpful in AMD. Read on this website: Macular degeneration: Can Lutein help?;
2. Zeaxanthin: 2 mg a day is found to help delay the progression of AMD;
3. Omega-3 fish oils: They help reduce inflammation, though their protective dose for AMD is not known. Take 3,000 mg of fish oil, which should give about 1,000 mg of omega-3 oils (DHA and EPA). For a comprehensive discussion on this nutrient, read on this website: Omega–3 oils: A complete guide;
4. Bilberry extract: Anthocyanosides in bilberry help in vision problems. They help improve blood circulation in the retina. 200 mg twice a day;
5. Vitamin C: 1,500 mg a day;
6. Vitamin E: 400 IU a day;
7. Beta-carotenes: 15 mg a day. These are precursors of vitamin A. For detailed coverage of this nutrient, read on this website: Vitamin A: A complete guide;
8. Zinc: 80 mg a day. Slows the progression of AMD from intermediate to advanced stage;
9. Copper: 2 mg a day.

Take a natural-source multi-mineral, multi-vitamin supplement to get the last five nutrients together.

Supplements for Preventing Drusen Deposits

There are no direct supplements for preventing drusen deposits. But anything that helps lower blood pressure and blood cholesterol should be considered.

1. Omega-3 fish oils: Some of the drusen deposits have pro-inflammatory coatings. Anti-inflammatory nature of fish oils will be helpful. They also help in the control of cholesterol;
2. Garlic: Helps in blood pressure as well as cholesterol control.

Supplements for Strengthening Blood Vessels in Choroid

Supplements that help with vascular strengthening should be considered. B-vitamins are great when it comes to such protection. Get a good natural-source B-vitamin complex.

1. Vitamin B₆: 50 mg a day;
2. Vitamin B₉: 2,500 µg a day;
3. Vitamin B₁₂: 1,000 µg a day.

Supplements for Preventing New Blood Vessel Formation

1. Green Tea Extract: EGCG from green tea is beneficial;
2. Curcumin (turmeric extract);
3. Ginkgo Biloba: 200 mg a day;
4. Quercetin;
5. Resveratrol (grape seed extract);
6. Ginger extract.

It is difficult to know the exact dosage of the above supplements required in AMD. However, they are all beneficial in preventing neoangiogenesis. Take the recommended daily dose mentioned on the bottle. My personal preference is for green tea extract.

Long Term Complications

Many people with AMD won’t face significant vision loss if they continue with the treatment.

However, in some people, the chronic or dry form of AMD may lead to an acute or wet form of AMD. This can cause legal blindness.

To Read More

• Cochrane.org: Antioxidant vitamin and mineral supplements to slow down the progression of age-related macular degeneration (AMD)
• VeryWellHealth: Macular Degeneration: Timeline of Vision Loss Progression
• Cleveland Clinic: Age-Related Macular Degeneration
• Healthline: Macular Degeneration
• Antioxidants: Nutrients for Prevention of Macular Degeneration and Eye-Related Diseases
• Healthline: Lutein and Zeaxanthin: Benefits, Dosage and Food Sources

First published on: 20th March 2022
Image credit: Mart Production on Pexels
Last updated on: 22nd June 2022