Eye Health

Synopsis:
Background
Risk Factors
Nutritional Support for Eyes
Suggested Supplementation
References

 

 

Loss of vision is one of the most feared consequences of aging (Rosenberg 2008; AFB 2007). Adults with poor vision are at a significantly higher risk for many social and health problems including depression, social withdrawal, accidents, and self-administered medication errors (Casten 2013; Rosenberg 2008; Rowe 2004; Campbell 2005; Field 2007). Common causes of blindness in adults include macular degeneration, cataracts, glaucoma, and diabetic retinopathy (NEI 2014; Congdon 2004).

Fortunately, nutrient interventions such as omega-3 fatty acids, carotenoids, and B-complex vitamins have been shown to support eye health during aging (Christen 2009; Weikel 2012; Ma 2013; Nolan 2013; Hammond 1997).

Types of Eye Problems

• Macular degeneration. Macular degeneration is characterized by loss of function in the central portion of the retina (called the macula) (AMDF 2014). People with macular degeneration experience a gradual loss of vision, especially in the central visual field.
• Cataracts. Cataracts are caused when protein fibers in the lens undergo harmful changes that cause them to become cloudy and impair vision.
• Glaucoma. Glaucoma may be caused by a gradual increase in eye pressure which causes damage to the optic nerve (Chiang 2013). People with glaucoma experience reduced vision, especially in the outer (peripheral) field of view.
• Diabetic retinopathy. Diabetic retinopathy damages vision in persons with long-term type 1 or type 2 diabetes. It involves damage to tiny blood vessels, formation of advanced glycation end products, oxidative damage to cells, and inflammation (Bandello 2013).
• Inherited eye conditions. These genetic conditions include retinitis pigmentosa and others. Retinitis pigmentosa first causes night blindness, then progressive loss of the outer field of view during daytime, and may lead eventually to total blindness (Hamel 2006).

Other Common Eye and Vision Concerns

• Double vision. Double vision or diplopia is the perception of a single object as two duplicate objects. Diplopia can be caused by many problems including lens cataracts, corneal infections or scars, hormone problems (eg, Grave’s disease), diabetes, autoimmune diseases (eg, multiple sclerosis), stroke, brain tumors, brain trauma, and migraine headaches.

• Night blindness. Night blindness involves a greatly impaired visual ability in low-light conditions. Night blindness has many causes including cataracts, use of certain drugs, vitamin A deficiency, and genetic problems (eg, retinitis pigmentosa) (Loeffler 2013).

• Eye floaters. Eye floaters are small spots that appear in the field of vision. Floaters are relatively common and the majority are caused by age-related changes to the vitreous humor. However, floaters require immediate medical attention if there is sudden onset of new floaters. Immediate medical attention is especially important if they are accompanied by flashes of light or losses of peripheral vision, as these conditions may be due to retinal detachment. Most cases of floaters do not require treatment.

• Dry eyes. Tear production often declines with age (Furukawa 1978). Eyes can also often become dry in windy or arid conditions. Dry eyes can lead to itching and blurred vision. Artificial tears can often provide short-term relief for dry eyes (Yanoff 2011).

• Eye fatigue. Eye fatigue commonly occurs after spending long hours looking at small objects; straining to see in dim light; or when driving or using a computer screen for long periods. Eye fatigue can be minimized by placing computer screens at the proper location (about 20-26 inches away from and just below eyes) and taking breaks from long-term computer screen viewing (AAO 2011; Agarwal 2013).

• Infection. A number of bacteria, fungi, and viruses can infect the eye or related structures like the eyelid. Prompt medical attention with antibiotics and sometimes surgery are often required to successfully treat eye infections (Yanoff 2011).

Refractive Errors

Refractive errors are common and are due to problems in the structure and function of the cornea, lens, and shape of the eye. The 3 main types of refractive errors include (Resnikoff 2008; Merck 2013; NEI 2010):

• Myopia (near-sightedness): difficulty seeing objects far away. In 2010, about 34.1 million US adults over age 40 had myopia (NEI 2014).

• Hyperopia (far-sightedness): difficulty seeing objects close-up. In 2010, about 14.2 million US adults over age 40 had hyperopia (NEI 2014).

• Astigmatism (blurry outer vision): Astigmatism is usually caused by an irregularly-shaped lens or cornea. In 2008 a study of 12 010 US adults reported that 36.2% of all adults over age 20 years have significant astigmatism in one or both eyes (Vitale 2008).

Most common refractive eye problems can be corrected by the use of eyeglasses or contact lenses.

 

 

• Routine eye examinations, since many eye problems may not have symptoms until the condition has reached an advanced state (Pelletier 2009)
• Regular exercise may be useful in preventing or slowing the progression of macular degeneration, cataracts, and diabetic retinopathy (Munch 2013; Williams 2013; Janevic 2013).
• Avoid smoking as it has been associated with a significantly higher risk of macular degeneration (Coleman 2010; Velilla 2013) and cataracts (Lindblad 2005). Higher alcohol consumption is also linked to a higher risk of macular degeneration (Coleman 2010).
• Wearing UV-blocking sunglasses can significantly reduce the risk of macular degeneration or cataract formation (Delcourt 2001; Neale 2003; Sui 2012).
• Controlling blood sugar, blood pressure, and cholesterol can significantly decrease the risk for diabetic retinopathy, cataracts, and macular degeneration.
• Eat a healthy plant-based diet that provides nutrients for the eyes since many nutrients are involved in eye health. E.g. fruits, vegetables, fish, beans.

B-complex vitamins

In one study, women aged ≥40 years at baseline were treated with either a daily supplement containing folic acid, vitamins B6 and B12, or placebo. After an average 7.3-year follow-up period, risk of developing macular degeneration was 33% lower in the supplement group (Christen 2009). Also, benfotiamine, a fat-soluble form of thiamine, has been shown to prevent diabetic retinopathy in animal research (Hammes 2003).

 

Omega-3 fatty acids

Studies have revealed higher consumption of omega-3 fatty acids is associated with significantly lower rates of macular degeneration (Weikel 2012). A combination of vitamin A and omega-3 fatty acids may be helpful for individuals with retinitis pigmentosa; one study found rates of yearly vision decline were slower among subjects supplementing with vitamin A and consuming greater than 200 mg of omega-3’s than among those supplementing with vitamin A and consuming lower amounts of omega-3’s (Berson 2012).

Several studies have also reported that omega-3 fatty acids or fish oil can significantly reduce the symptoms of dry eye syndrome. A large double-blind study treated 325 patients with dry eyes with either an omega-3 supplement containing 325 mg EPA and 175 mg DHA or placebo twice daily for 3 months. After 3 months, 65% of the subjects who received omega-3 supplements reported significant improvement in dry eye symptoms compared to 33% of the placebo subjects (Bhargava 2013).

 

Carotenoids

Carotenoids are phytochemicals found in a wide range of fruits and vegetables - especially those of dark green or yellow color. Higher carotenoid consumption has been linked to better eye health, including a lower risk of macular degeneration and cataracts. Lutein, zeaxanthin, and meso-zeaxanthin are considered to be especially helpful since they are the most common carotenoids found in the eye lens and retina (Ma 2013; Nolan 2013; Hammond 1997).  Lutein, zeaxanthin, and meso-zeaxanthin absorb low wavelength light and minimize oxidative damage to the retina and other parts of the eye (Krinsky 2003).

A comprehensive review of 6 studies involving close to 42 000 aging adults reported that higher dietary levels of lutein and zeaxanthin were associated with significantly lower rates of cataract formation (Ma 2013).

 

Astaxanthin

Astaxanthin, another carotenoid, is a red-colored pigment produced by algae, bacteria, and fungi. It is present in algae-eating fish and shellfish and is found in especially high levels in red-colored seafood such as crab, lobster, krill, salmon, and shrimp. Astaxanthin has strong anti-inflammatory and anti-oxidative properties. Several Japanese studies reported that supplemental astaxanthin was associated with better visual acuity and significantly less visual fatigue (Kidd 2011).

 

Vitamins A, C, E, and D

Some studies have reported that higher consumption of the antioxidant vitamins A, C, and E (in diet or supplements) is associated with a significantly lower risk of many eye problems, especially cataracts. Vitamin C is an important antioxidant found in the lens and aqueous humor of the eye at concentrations at least 50-fold greater than in the blood plasma (Weikel 2013). In one review, eight of 15 published studies reported that higher vitamin C intake, supplement use, or blood levels were associated with significantly lower rates of nuclear cataracts (Chiu, Taylor 2007). Researchers noted that consuming ≥135 mg of vitamin C daily (food and supplements) was associated with an approximately 40% decreased risk of cataracts (Weikel 2013). Studies also report that higher consumption of vitamin E is associated with a significantly lower risk of cataracts (Chiu, Taylor 2007).

Several studies have reported that higher intake or higher blood levels of retinol or vitamin A are associated with a significantly lower risk of cataracts (Weikel 2013). One study reported that risk of cataracts was 58% lower in people who used vitamin A supplements and 46% lower in those who used vitamin D supplements compared to supplement nonusers (Klein 2008).

 

Lipoic Acid

Lipoic acid, a powerful antioxidant, is involved in many energy-producing reactions and may help control blood sugar in diabetics. Supplemental lipoic acid significantly reduced both blood sugar levels and risk of cataracts in diabetic rats. The authors conclude, “Light-scattering measurements indicated that dietary LA [lipoic acid] is effective in delaying not only cataract development but also its progression. LA may be able to do this by preventing protein glycation and reducing oxidative stress…” (Kojima 2007). In a preclinical study, supplemental lipoic acid significantly increased tear production in a dry eye model (Andrade 2014). Human clinical trials involving lipoic acid supplementation and eye health are eagerly awaited.

 

Zinc

Concentrations of zinc are high in the retina (Weikel 2012). Zinc is involved in many processes involving immunity, reproduction, and nerve development. Several studies found that higher zinc intake was associated with a lower risk of macular degeneration or vision loss (Weikel 2012; Mares-Perlman 1996; van Leeuwen 2005; VandenLangenberg 1998; Tan 2008). A large study of 4170 adults reported that higher zinc and vitamin E intake was associated with a lower rate of early macular degeneration. This study also found an above-median intake of β-carotene, vitamins C and E, and zinc was associated with a 35% reduced risk of AMD (van Leeuwen 2005). One study of 80 macular degeneration subjects reported that supplementation with 25 mg zinc twice daily was associated with significantly better vision (Newsome 2008).

 

Anthocyanins and C3G

Anthocyanins are water-soluble plant pigments found in dark-colored fruits and vegetables. Some of the richest sources of anthocyanins include chokecherries, black currants, wild blueberries, bilberries, blackberries, and red or purple grapes (Hosseinian 2007; Anisimoviene 2013; Flamini 2013; Wu 2006; Nile 2014; Mazza 2007; Jaakola 2010). During World War II, British pilots ate bilberry jam several hours before night missions to improve their night vision. Research findings on the night vision effects of bilberry or bilberry extracts have been mostly positive. Subjects in these studies generally received bilberry or bilberry extracts containing 12-40 mg of anthocyanins daily (Canter 2004).

An anthocyanin of particular interest is cyanidin-3-glucoside (C3G). C3G has a wide range of health benefits including antioxidant, anti-inflammatory, and DNA-protecting effects (Ding 2006). C3G has been shown to selectively upregulate expression of genes that protect aging tissue, while downregulating genes that cause damage (such as pro-inflammatory cytokines) (Tsuda 2006; Sasaki 2007; Tsuda 2005). C3G helps protect the retina by several mechanisms and stimulates production of a retinal pigment called rhodopsin (Liu 2012; Matsumoto 2003; Tirupula 2009). Rhodopsin is a critical pigment for seeing in dim light. C3G also serves to protect retinal cells from harmful oxidation and free radical protection in the light (Jang 2005).

 

Ginkgo Biloba

A number of lab animal and cell culture studies have reported that Ginkgo biloba extracts have strong antioxidant as well as anti-inflammatory properties and provide protection against oxidative damage to retina cells and mitochondria in cells (Huynh 2013). A Korean study examined the effects of Ginkgo biloba extract in 30 adults with normal tension glaucoma (a form of glaucoma in which damage to the retina and optic nerve occur even in the presence of normal internal eye pressure). Subjects who received 80 mg of Ginkgo biloba extract twice daily for 4 weeks had significantly better retinal blood flow compared to subjects who received placebo (Park 2011). Two small human studies reported that supplementation with 80 mg twice daily or 240 mg once daily of Ginkgo biloba led to modest improvement in vision of individuals with macular degeneration (Evans 2013).

 

Curcumin

Curcumin is a major phytochemical constituent of the common Indian herb turmeric. Several studies reported that curcumin has many anti-inflammatory and anti-cancer properties (Huynh 2013). Preclinical studies have reported that curcumin supplements can slow progression of diabetic retinopathy and cataracts and help prevent formation of new blood vessels (neovascularization) in animal models of macular degeneration (Pescosolido 2013; Xie 2012). One clinical study treated adults with diabetic retinopathy with either 200 mg curcumin twice daily (39 subjects) or placebo (39 subjects). After 4 weeks of treatment, the subjects receiving curcumin had significantly less eye swelling (edema) and improved blood flow in the retina and other parts of the eye (Steigerwalt 2012).

 

Pycnogenol®

Pycnogenol®, a bark extract from the French Maritime Pine Pinus pinaster, has been shown to protect cells from oxidative damage (Bartlett 2008). In one study, subjects with diabetic or hypertensive retinopathy were treated with either 50 mg of Pycnogenol® or placebo three times daily for 60 days. Visual acuity improved significantly and retinopathy did not increase in subjects treated with Pycnogenol®. Visual acuity and retinopathy worsened in those receiving placebo. Eye blood vessel studies (fluorangiography) showed significant improvement in retinal blood vessels and reduction in eye membrane leakage in the Pycnogenol® but not the placebo group. This suggests that Pycnogenol® may support the structural integrity of delicate blood vessels in the eye (Spadea 2001). Another study of diabetic adults with moderate diabetic retinopathy reported that treatment with 50 mg Pycnogenol® three times daily (24 subjects) for 2 months showed significant improvement in visual acuity, eye blood flow, and reduced retinal edema (swelling) compared to placebo (22 subjects) (Steigerwalt 2009). Yet another study reported that treating people who had asymptomatic elevated eye pressure with 40 mg Pycnogenol® and 80 mg standard bilberry extract twice daily for 6 months significantly reduced eye pressure in 95% of subjects. A decrease in eye pressure was reported in only 5.5% of the placebo group (Steigerwalt 2008).

 

Taurine

Taurine is an amino acid that comprises almost half of the free amino acid content of the retina. Animal and tissue culture studies have reported that taurine supplements provide significant protection against retinal cell degeneration (Froger 2012). Supplemental taurine was found to be protective against retinal damage in experimental animal models with the taurine-depleting seizure medication vigabatrin (Sabril®) (Jammoul 2009).

 

Aristotelia chilensis Berry Extract

Aristoteliachilensis (A. chilensis) (Maqui or Chilean wineberry) is a berry-producing plant native to certain areas of South America, as well as parts of Asia, Australia, and the Pacific region (Schreckinger 2010; Romanucci 2016). Analysis of phytonutrients from A. chilensis has revealed high concentrations of anthocyanins including cyanidins and delphinidins, flavonol glycosides, and ellagic acids (Brauch 2016). Maqui berry is an especially rich source of delphinidins, a specific type of anthocyanin with powerful anti-inflammatory and free radical-quenching capacity, and other bioactive properties that include protection of blood vessels and protection against sun damage (Watson 2015).

Delphinidins extracted from A. chilensis have been demonstrated to protect photoreceptor cells in the retina of the eye from light-induced damage. This eye protecting effect was likely mediated by blocking the damaging effect of reactive oxygen species on sensitive retinal tissue (Tanaka, Kadekaru 2013).

In a rodent study, a maqui berry extract rich in delphinidins protected lacrimal gland (tear-forming) tissue from damage by suppressing reactive oxygen species and preserving tear formation and secretion (Nakamura 2014). In another study, people with moderately dry eyes consumed 30 or 60 mg A. chilensis berry extract for 60 days; a substantial improvement in tear fluid amount, compared with baseline, occurred within 30 days. Those in the 60 mg group experienced a more durable improvement, with a 45% increase in tear production compared with baseline, and substantial improvement in dry eye-related quality of life score, a patient-reported measure of eye function, comfort, and symptoms (Hitoe 2014).

 

Saffron Extract

Saffron (Crocus sativus) has been used for centuries as a culinary and medicinal herb. Its therapeutic effects on macular and visual health are likely related to the actions of its carotenoids, which include crocin, crocetin, and safranal (Alavizadeh 2014; Fernandez-Sanchez 2015; Higdon 2015). In laboratory and animal research, both crocin and crocetin have been found to protect retinal cells from damage due to light exposure, oxidative stress, and loss of blood flow (Fernandez-Sanchez 2015; Chen 2015), and crocin-related compounds have been found to increase retinal blood flow (Xuan 1999). In addition, safranal was found to protect retinal cells and prevent capillary loss in an animal model of retinitis pigmentosa (Fernandez-Sanchez 2012). 

Research has found saffron may help prevent AMD, suggesting it might play a valuable role as an eye protectant and in restoring vision. In a randomized, controlled, crossover clinical trial of saffron effect on AMD, 25 subjects with early AMD received either 20 mg per day of saffron or placebo. Retinal light sensitivity, a marker of macular health, improved with saffron but not placebo (Falsini 2010). To evaluate the long-term benefits of saffron supplementation, 29 subjects with early AMD took 20 mg saffron daily for an average of 14 months. Retinal sensitivity improved after the first three months of treatment. In addition, at the three-month exam, visual acuity improved such that subjects could accurately read, on average, two more lines on the standard vision test than they could prior to treatment.

Saffron may have a general protective effect on eye health, preventing other conditions as well. In a randomized clinical trial, 34 patients with open-angle glaucoma received either 30 mg per day saffron extract or placebo, in addition to usual treatment, for one month. Saffron treatment resulted in greater reductions in intraocular pressures than placebo (Jabbarpoor Bonyadi 2014). In animal research, treatment with saffron extract prevented experimentally-induced and diabetes-related cataract formation. In a study in diabetic animals, saffron extract decreased AGEs and serum glucose levels (Makri 2013; Bahmani 2016). 

 

 

• Comprehensive multivitamin/multi-nutrient formula: Per label instructions
• Carotenoid blend: containing 10 mg lutein, 4 mg meso-zeaxanthin and zeaxanthin, 6 mg astaxanthin, 2.2 mg cyanidin-3-glucoside (C3G), and 1.24 mg alpha-carotene
• French Maritime Bark extract (Pycnogenol®): 100 – 200 mg
• Fish oil (with olive polyphenols): providing 1400 mg EPA and 1000 mg DHA
• Coenzyme Q10 (CoQ10) (as ubiquinol): 50 – 200 mg
• Folate (as L-Methylfolate): 1000 mcg
• Vitamin B12 (as methylcobalamin): 1 – 8 mg daily, sometimes up to 40 mg
• Vitamin B6 (as pyridoxal 5’-phosphate): 100 mg
• Vitamin B1 (Thiamine): 10 – 40 mg
• Benfotiamine: 250 – 1000 mg
• Vitamin B2 (Riboflavin): 50 – 100 mg
• Vitamin A (as beta-carotene): 5000 IU
• Vitamin C: 500 – 1000 mg
• Vitamin E: 400 IU with at least 200 mg gamma tocopherol
• R-lipoic acid: 240 – 480 mg
• Taurine: 1000 – 4000 mg
• Zinc: 30 – 90 mg
• Bilberry extract (std. to 36% total anthocyanins [36 mg]): 100 mg
• Ginkgo biloba extract: 120 mg
• Curcumin (as highly absorbed phospholipid blend): 630 mg
• Aristotelia chilensis (Maqui) berry extract (providing delphinidins): 60 mg
• Saffron extract: 176 mg
• UV-blocking sunglasses: should be worn during sun exposure

 

 

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