Dr. Michael Tolentino is an Orlando, Florida retina specialist and early inventor of anti-VEGF injectable medications. In the September 2015 Primary Eyecare Optometry News article, he reported that several patients with wet AMD in his practice given Macuhealth twice daily to delay or defer injections resulted in improved acuity and resolution of subretinal/intraretinal fluid on OCT. He stated in the article, “While the results are presented as a case series, the response of these patients was equivalent to the typical response obtained after a course of anti-VEGF injections. Furthermore, Macuhealth worked synergistically with injections in patients previously unresponsive to injections.” He further states in the article, “I speculate that the potent antioxidative properties of these three carotenoids diminished the stimulus for VEGF upregulation. This supplement shows promise as a method for diminishing initiation and frequency of injections in patients with exudative AMD.”
Disclosures: Dr. Tolentino has no financial involvement in MacuHealth, Dr. David Nelson is a consultant for MacuHealth and authored the article in PCON covering the Carotenoid Conference. Click here to read the full article.
Summer is coming to an end, but there’s still ample time left to do some barbequing! You already know that when it comes to eye health, proper nutrition is imperative. Maintaining a balanced diet and consuming sufficient carotenoids (namely lutein, zeaxanthin and meso-zeaxanthin) can help to ensure that eye sight stays sharp and can even aid in warding off age-related macular degeneration. Said carotenoids are found primarily in leafy green vegetables and certain seafood. So, without further adieu, let’s get down to the details of how to prepare this eye-friendly grill out winner!!
(Ingredients and measurements to the side in blue)
• Rinse and gently pat dry kale fronds, garlic scape and Orange pepper
• Shred Kale fronds roughly ( I like the stalk too)
• With a sharp knife finely dice garlic scape and orange pepper
• Heat 2 tbs of California olive oil in a sauté pan on med-low and toss in finely diced aromatics (garlic scape and orange pepper)
• Sauté for 3 or 4 minutes before adding roughly shredded kale
• Sauté for 5-7 more minutes adding a small splash of purified water if moisture is needed.
• Toss with 1 tsp of pink crystal sea salt and fresh cracked pepper to taste!
• Take one large 16-20oz raw wild salmon filet (with the skin still on!) and rub it with 2 tbs of California olive oil, 1 tsp of pink crystal sea salt and fresh cracked pepper to taste.
• Grab one of your delicious Meyer lemons and slice it thinly into rounds. Place rounds on top of salmon filet.
• Let the salmon marinate on a covered plate for 15 minutes
• During this time, prepare grill. Also begin preparing braised kale
• Slice the other two lemons into halves
• Once grill is ready (coals are mostly white, or if fancy gas grill is up to temp)…
• Place salmon directly on grill skin side down
• Place halved Meyer lemons face down on grill
• Cover for 8-10 minutes
…Once salmon is grilled to a perfect medium rare, remove from grill with a metal spatula (and an assistant). Serve along side of your perfectly braised kale and grilled Meyer lemons! Enjoy.
About the author: Kirsten Stone hails from Portland, Oregon and grew up growing her own food on a farm. She has a lasting passion for nutrition as well as personal and global eye health.
Lloyd Snider, O.D. shares lecture topics and key takeaways from the Macular Carotenoids Conference held in Cambridge, UK July 8th-10, 2015.
I’m just back and over my jet lag from the Macular Carotenoids Conference 2015, held at Downing College, University of Cambridge, UK. It was an amazing three-day event where the world’s best researchers gathered for a spirited discussion on macular carotenoids. There were 24 lectures, each followed by questions from the attendees. Additionally, there were thirty-four posters presented which also had question and answer sessions. Poster Abstracts and Speaker Abstracts were published in the European Journal of Ophthalmology Supplement. (You can find the abstracts, here.)
Some of the topics covered:
Modifying sweet corn to increase carotenoid content
Childhood vegetable intake predicting adult MPOD
Macular pigment and cognitive function
A case of spontaneous MacTel 2 macular hole closure with carotenoid supplementation
L, Z, and MZ content in eggs from supplemented chickens
The impact of carotenoids and B vitamin supplements in Alzheimer patients
Serum response in humans to MZ enriched chicken eggs
Macular carotenoids in pre-and post-natal development
Macular carotenoids in breast milk
Clinical experience with macular carotenoids replacing injections in exudative AMD
Structural and functional response in glaucoma to carotenoid supplementation
Oxidative stress, carotenoids and dementia
Macular carotenoids, psychological stress, and general health status in young adults
Some of the things I learned:
There are differing xanthophyll contents in regions of the elderly brain
Macular pigment is important in cognition
Drusen have a high concentration of zinc.
Avocado helps with lutein uptake
Ganglion cell loss in glaucoma causes glare and dark adaptation problems
Glaucoma patients have lower macular pigment
With foveal involvement, more damage means slower photo stress recovery
There is a possible link between glaucoma and cognitive decline
After the lectures, expert guides gave us an historical tour of Cambridge and many of its colleges. Sampling some of the many pub offerings was delightful. We also had a great banquet with best poster awards for PhD candidates, as well as surprise entertainment from an opera-singing chef and maitre’d. They had the entire group singing and dancing around the hall.
The lectures should be available in the near future on video. We will let you know as soon as they are ready. The next Macular Carotenoids Conference meeting in Cambridge is slated for 2018. I hope to see you there. It is truly a unique experience and a worthwhile, intriguing meeting. Please plan ahead!
‘Could your eye vitamins be making macular degeneration worse?’ The alarming (yet intriguing) notion was recently discussed by Canadian optometrist, Richard Maharaj via his blog, Eyes on Eyes. In the article, Dr. Maharaj reviews some of the recent findings surrounding the important role of genetics in prescribing nutritional eye supplements.
Maharaj refers to the recent scientific research of Dr. Carl Awh et al. which has shown that up to 65% of AMD patients using an AREDS formulation may be on the wrong path due to their individual genetics. Dr. Awh, a vitreoretinal surgeon and leading author/researcher on genetically guided therapy for AMD claims that a subgroup of patients might actually be increasing the progression of AMD by supplementing with an AREDS formula.
It is no secret that the latest AREDS formula has, in some respects, become a standard treatment for dry AMD in recent years – and millions of patients have been prescribed the lutein, zeaxanthin, C, E, zinc and copper formula since AREDS2 was published. However, over the last few years, Awh et al. have discovered that patients experience geno-type dependent responses to AREDS’ antioxidant combination. In particular, Awh found that certain patients had unfavorable reactions to either zinc, anti-oxidants (C, E), or a combination of the two.
Maharaj describes Awh’s findings as ‘compelling enough’ for him to mark a change in the direction of care he delivers. He also voices his concern regarding AREDS’ inclusion of zinc, since zinc has been found to exacerbate certain retinal conditions. Plus, the upper daily limit of zinc by nutrition standards is a meager 40 mg, yet the AREDS formula somehow recommends a whopping 80 mg, causing Dr. Maharaj to further ponder the notion of blanketing all patients with the formula.
Though more research is necessary and some remain beholden to the AREDS formula, Dr. Maharaj notes that he is now, more so than ever, consciously considering the complexity of genetics when prescribing treatment for AMD. Indeed, the notion of personalized medicine is becoming more prominent — and an ‘AREDS for all’ approach is simply no longer appropriate.
If you’re interested in learning more about the role genetics may play in nutritional supplementation for eye disease, click here to view a presentation by Dr. Jerome Sherman on the subject.
A recent National Health and Nutrition Examination Survey has established a link between over consumption of calcium and a significantly increased risk of developing macular degeneration in the older population.
Researchers from the University of California evaluated 3,191 people aged 40 and over who participated in a national health survey. The group consisted of 248 people who were previously diagnosed with macular degeneration. Participants answered multiple questions regarding their use of dietary supplements and antacids, specifically. The survey also accounted for factors including age, sex, ethnicity, obesity smoking, alcohol consumption, cataract surgery, osteoporosis history, glaucoma and heart disease.
The results, published in the April 2015 issue of JAMA Ophthalmology, reported that individuals (aged 68 and older) supplementing with 800 mg of calcium per day were 85% more likely to be diagnosed with macular degeneration than those who do not supplement with calcium. The association between calcium supplementation and AMD was found to be more prominent in older individuals, likely due to the longer duration of calcium supplementation.
Indeed, some calcium is necessary for good health. However, studies like this one show that an over consumption of the mineral mixed with a lack of awareness may be serious concerns; especially considering that calcium supplementation is tremendously common among the older population, often due to concerns about osteoporosis and bone health. In fact, about 43% of the U.S. population (including approximately 70% of older women) say they take calcium supplements.
Researchers acknowledge the study’s limitations noting the possibility that some of the participant’s did not accurately report their use of calcium as well as the lack of research into the role that calcium from food and drink may play. Although the researchers have declined to make any new recommendations regarding calcium supplementation until further studies are conducted, individuals worried about developing AMD should continue to avoid smoking, wear protective eyewear when exposed to UV or blue light, eat a diet rich in leafy green vegetables and limit simple carbohydrates.
As usual, talk to your doctor before starting or discontinuing use of any supplement.
“An ounce of prevention is worth a pound of cure.” The classic proverb was coined by Benjamin Franklin, who was obviously referencing the concept that it is easier to stop something from happening in the first place than to repair the damage after it has already been done. The notion rings true for many instances, particularly where eye disease is concerned. From smoking to light exposure to diet, there are a variety of known modifiable (and non-modifiable) risk factors that contribute to the onset of macular degeneration. However, with some knowledge and preventative measures, mitigating your AMD risk level is possible. The following are excellent ways to help protect your eye sight:
Talk to Your Family: Having a genetic predisposition to AMD is one of the biggest risk factors for the disease. Ask your immediate relatives about their eye health and make note of it. Be sure to also inquire as to whether they are aware if a grandparent, aunt or sibling developed any eye related diseases or issues in their lifetime. Being armed with your family medical history is a key component in protecting your vision from eye disease. The earlier you are aware and inform your doctor that AMD may be hereditary for you, the more likely treatment can be implemented and vision can be salvaged.
Supplement with Macular Carotenoids: Since the human body does not naturally manufacture ocular carotenoids, it is vital to supplement with all three of them. Lutein, Zeaxanthin and Meso-Zeaxanthin need to work in a synergistic manner to help improve the macular protective pigment at the back of the eye. When this pigment density is increased, the macula (which is responsible for central vision) is more protected from free radicals and harmful blue light spectrums. A supplement like MacuHealth contains all three of the macular carotenoids in the appropriate amounts to help build upon macular pigment, improve visual function and stave off AMD. Check with your doctor whether a nutraceutical like MacuHealth is right for you
Educate Yourself (and Consider Meso-Zeaxanthin!): One of the keys to controlling risk factors for any disease is efficient patient education. If you are at risk for AMD, make it a priority to learn as much as you can about the condition, its symptoms and treatment methods by conducting your own research and asking your doctor important questions. For example, research has concluded that lesser-known carotenoid Meso-Zeaxanthin is the most potent antioxidant of the three macular carotenoids. Since Meso-Zeaxanthin is not found in large amounts in a typical Western diet (it is found in small doses in rainbow trout, shrimp etc.), it is important to ensure that your daily vitamin and/or supplement contains this pigment.
Watch out for Blue Light: With the increasing prevalence of smart phones, tablets and other handy electronics, eyes are exposed to harmful light spectrums now more than ever. In fact, harmful blue light is emitted from fluorescent, CFL and LED bulbs. Exposure to blue light causes a gradual oxidation and deterioration of the macular pigment and macula, leaving eyes more susceptible to glare issues, decreased contrast sensitivity and macular degeneration. Look into purchasing some quality, protective eyewear to lessen your exposure.
Quit Smoking: While today it is common knowledge that smoking causes respiratory illnesses like emphysema and lung cancer; it seems society is somewhat under informed about the clear link between smoking and macular degeneration. Studies have shown that smoking (and even being exposed to secondhand smoke) can enhance free radical generation and reduce macular pigment density. If you’re a smoker, it’s time to quit the single most controllable risk factor for AMD once and for all!
Eat More Greens: Proper nutrition is critical to eye health. As previously mentioned, it is very difficult to obtain an adequate dose of Meso-Zeaxanthin in the Western diet. However, Lutein and Zeaxanthin are readily found in leafy green and brightly coloured vegetables like kale, bell peppers and spinach, for example.
Exercise Regularly and Stay a Healthy Weight: What’s good for the heart is generally good for the eyes. Aim to reach your target heart rate range at least three times per week. Recumbent bike, yoga, brisk walks and light weight lifting are all low vision or beginner friendly ways to exercise.
Reduce Simple Carbohydrates: Limiting refined sugar in your diet can potentially slow the progression of AMD or even help to protect against the development of the blinding disease. A study from Tufts University showed a correlation between eating food high in glycemic index (such as white pasta, bread, cake or muffins) and an increased risk or worsening of AMD. (Ditch the breakfast bagel and opt for eggs!)
The 3rd International Macular Carotenoids Conference will take place at Downing College in Cambridge, UK from July 8th to 10th, 2015. The annual meeting is primarily attended by macular carotenoid researchers who are exploring up-to-date, evidence based hypotheses and the supporting research data into the role of carotenoids in AMD, vision and cognitive function.
Amongst the over 20 experts, scientists and doctors speaking at the conference are Professors John Nolan and Stephen Beatty. Nolan and Beatty are colleagues within the Macular Pigment Research Group at the Waterford Institute of Technology. The pair and their team have dedicated most of their professional lives to researching macular pigment in relation to carotenoids and have published over 30 peer-reviewed papers on the subject. More recently, Nolan and Beatty have been focusing their research on the fascinating correlation between carotenoid levels, visual function and cognitive performance, in particular.
Nolan describes the Macular Carotenoids Conference, to which he is head chairman, as a unique opportunity for young scientists in particular to share their new ideas with more seasoned researchers. Click on the video below to view Professor Nolan’s official address regarding this year’s conference:
Interested in attending the 2015 Macular Carotenoids Conference in Cambridge, UK? For more information and to register, click here.
MacuHealth would like to extend a sincere thank you to everyone who shared content, used the campaign hashtags and discussed age-related macular degeneration in any way, shape or form during February. (AMD Awareness month)
An additional special thank you goes to all of the doctors, technicians and receptionists who displayed and promoted AMD educational materials within their practices. It is so important for patients to realize that the key to successful AMD treatment is early intervention!
As a result of the incredible amount of social sharing, engagement and AMD discussion that took place last month, MacuHealth is delighted to announce that they will be donating $1,000.00 to Optometry Giving Sight and another $1,000.00 to the Center for Vision Rehabilitation at Henry Ford Health System. There is no doubt that these donations will aide in supporting research, awareness and charitable endeavors in the space of eye disease!
Your willingness to help make the world a little more eye health conscious is deeply appreciated.
Again, thank you for your participation during Age-related Macular Degeneration month.. Let’s vow to keep the conversation surrounding AMD going!
AMD is the leading cause of vision loss in the U. S. and in the entire western world. The macula is the tiny center of the retina that gives us our precise, detailed vision. AMD causes the macula to gradually thin and lose its ability to see, which creates a small blind spot in the center of vision. There are two forms of AMD, commonly referred to as wet, because of abnormal blood vessels that leak and damage the macula, and dry, which does not have the abnormal blood vessels.
The cause is understood to be a combination of a predisposition, and exposures to toxins including smoke, air pollution, herbicides and pesticides, and sunlight. The predisposition may include having a gene variant that controls inflammation or just having fair coloring, both of which runs in families and indeed those with a parent or sibling with AMD are at higher risk.
The current most effective treatment for wet macular degeneration is injections into the eye of one of three drugs that eliminate the abnormal blood vessels and turn off the signal for them to develop, but only for a while. Those with wet AMD usually receive repeated injections at various time intervals. There are several drugs being tested for dry macular degeneration but none are yet approved and available, so supplements are currently the only treatment for dry AMD. These are the AREDS-2 supplements, marketed by several companies and available over the counter. “AREDS-2” stands for the second Age-Related Eye Disease Study.
There is also research to show that Zeaxanthin and Meso-Zeaxanthin, cousins of Lutein, are more effective than Lutein in protecting the macula. This combination in supplement form is available through www.MacuHealth.com. Because I am at high risk, with a father and sister with AMD, I am taking MacuHealth.
Four Important Things You Need to Know
First, both types of macular degeneration affects only the very center of your vision, sparing all the vision just off center to the far edges of vision. This means that it never causes total blindness. You will always have usable vision.
Second, because there is always remaining usable vision use, the training in strategies, devices and adaptations that vision rehabilitation provides helps you use your remaining vision efficiently for reading, writing and doing daily activities. See the section below about vision rehabilitation at Henry Ford.
Third, depression is common with vision loss but the depression doesn’t correlate to level of vision loss; rather, it correlates to difficulty reading and doing daily activities. Learning strategies for reading and accomplishing your daily activities, through vision rehabilitation, goes a long way in combating depression. This is important because you can learn to live well with vision loss from macular degeneration but you cannot live well with depression.
Fourth, about 30% of people with vision loss experience Charles Bonnet Syndrome for a year or two, in which they see clear, colorful images of people, animals, flowers or buildings, for example, that aren’t really there. The person seeing these is usually aware that the images are not real, as they may be superimposed on their living room wall or appear in the sky. It’s important to know that these are not pathological hallucinations; they are just your eyes playing tricks on you, similar to phantom pain, for example, when someone feels like an amputated finger is itching but it can’t be because it’s not there.
The Big 8 to Help Yourself
If you have macular degeneration of if you are at high risk for developing it, here’s the lists of do’s and don’ts to minimize the rate of progression, for those who already have it, or to minimize the risk of developing it at all.
1. Don’t smoke and avoid exposure to second hand smoke. Smoke is highly correlated with macular degeneration.
2. Wear sunglasses that block the blue wavelengths. In commercial lenses these are the amber/brown family of tints.
3. Eat lots of dark green leafy vegetables including kale, collards and spinach, for example: the darker the leaf the better. These leaves contain Lutein, which can also be taken in pill form for those who are on Coumadin and cannot eat greens.
4. Eat lots of omega-3 fatty acids, found in fish, flaxseeds and some nuts
5. Avoid packaged foods as much as possible as they are almost all packaged with vegetable oils rich in omega-6 fatty acids that undermine the omega-3s.
6. Avoid artificial fat, notably partially hydrogenated vegetable oils, which substitutes for real fat in a lot of foods but particularly those that can’t be made without fat, for example bakery goods. Bakery goods labeled no fat means that artificial fat was used. Artificial fat is a chemical made in a laboratory; it is not food. If you’re going to eat a cookie, eat a real one, not a low-fat one; just don’t eat the whole box!
7. Exercise and keep your cholesterol and blood pressure under control.
8. If you have lost vision, make an appointment for vision rehabilitation.
Stroke rehabilitation is familiar to everyone. If you can’t write because you had a stroke on that side, you go to rehab. Vision rehabilitation is less familiar because it’s newer. Medicare recognized its value and began offering it as a benefit in Michigan in 1997 and nationally in 2002. The goal of vision rehabilitation is to make you as independent as possible in reading, writing and managing your daily activities at home, on the job, and in the community.
The Henry Ford Center for Vision Rehabilitation and Research offers services in Michigan and there are several similar vision rehabilitation programs in departments of ophthalmology around the country including, among others, Harvard, U. of Nebraska, Omaha; U of Texas, Houston; U. of Tennessee, U. of Alabama, Birmingham; Regents U., Augusta, GA; California Pacific Medical Center, San Francisco; Duke U; Oregon Health Science U.. Portland, and the Medical College of S. Carolina. There are also private non-profit agencies providing vision rehabilitation services and state services for qualifying individuals.
To locate services near you at www.visionaware.org and click on “Find Services Near You” and for a comprehensive list of resources go to www.aao.org, type in “SmartSight” and click on the first item, the handout.
Have you or a loved one ever struggled with reading the small print on a medication label or even distinguishing between a navy sweater and a black one? A new app called Be My Eyes is aiming to help the blind and visually impaired ‘see’ by connecting them with sighted strangers (helpers) who have also downloaded the app. The way it works is whenever a blind user needs help identifying an object, the app launches the user’s iPhone’s rear-facing camera and connects them with a designated ‘helper’ via video chat. The helper can then describe and/or read what they see to the blind user and answer their questions.
The app’s ‘helpers’ are individuals who have agreed to be ‘on call’, so to speak. The helpers can be notified at any point during the day that a user needs assistance; often with distinguishing paper money, the location or colour of an object, for instance. However, the helpers are in no way obligated to answer the call and so the app will automatically notify alternate helpers until someone picks up the call.
The creators behind Be My Eyes have been testing the app in Denmark for quite some time. The app’s founder, Hans Wiberg explained that most tasks and questions asked by the visually impaired have to do with identifying a piece of mail, finding the right item on a shelf or in the fridge. Wiberg believes that the visually impaired who do not have a live-in caregiver or assistant will be able to make great use of the new app. He describes Be My Eyes as a new way of providing independence to people with vision loss. After all, many low vision patients are reluctant to continuously ask a neighbour or family member for help with minor chores like distinguishing apple juice from milk or reading the subject on a piece of mail. Be My Eyes allows users to ask multiple questions per day with a degree of comfort, since users can be sure the ‘helper’ on the other end is more than willing to help.
Described as a kind of ‘micro-volunteering’, Be My Eyes does not offer incentives for the helpers’ participation. However, the app does track the number of times a helper has answered question through a points system that rates their level of trustworthiness. As of February 2015, the app already has 14,000 sighted ‘helpers’ and 1,200 visually impaired users.
The free app is planning to expand to Android in the future, but is currently focused on perfecting Be My Eyes for iPhone.
What do you think? Would you use the Be My Eyes app or suggest it to a visually impaired loved one? Or do you find the idea of strangers being your eyes odd?