Ask an Expert about Macular Degeneration

There is no evidence to support the use of vitamins or other supplements for the resolution of a macular hole. However, macular holes have been known to resolve spontaneously in some instances.

The National Eye Institute’s Age-Related Eye Disease Study (AREDS) found that taking a specific high dose formula of antioxidants and zinc (500 milligrams of vitamin C, 400 International Units of vitamin E, 15 milligrams of beta-carotene, 80 milligrams of zinc as zinc oxide and two milligrams of copper as cupric oxide) may delay or prevent intermediate AMD from progressing to the advanced stage. There is no evidence, however, that the AREDS formula benefits people with early stage AMD. Patients with intermediate AMD in one or both eyes or advanced AMD (dry or wet) in one eye but not the other eye should consider taking the formula. Consult a physician before taking any supplements because they may be contraindicated for certain medical conditions or may react negatively with some medications.

Researchers continue to explore environmental, genetic and dietary factors that may contribute to developing AMD. New treatment strategies are also being explored, including retinal cell transplants, drugs to prevent or slow down the progress of the disease, radiation therapy, gene therapies, a computer chip implanted in the retina (may help simulate vision) and agents to prevent the growth of new blood vessels under the macula.

Yes, some people with macular degeneration also develop Charles Bonnet Syndrome (CBS) and hallucinate. Some eye diseases prevent normal nerve impulses from reaching the brain, and it is believed that spontaneous, brain-generated nerve activity may cause visual hallucinations. CBS appears to be more common in women than men and is more likely to occur if both eyes are affected by disease. The hallucinations are normally complex and can include detailed patterns or fully formed images such as animals, people, faces or scenery. Patients know that the hallucinations are not real. These images are not associated with any other sensory (e.g., sound or odor) hallucinations, nor are they delusions. The hallucinations may last for seconds or for most of the day. They tend to disappear when people close their eyes. CBS may last for days or even years, but can be managed by educating the patient and reassuring him or her that the images are a result of eye disease, not a mental disorder.

• View a video of neurologist and author, Dr. Oliver Sacks, discussing Charles Bonnet Syndrome.

Some limited studies appear to indicate that eating a diet high in carotenoids, antioxidant vitamins (such C and E), and omega-3 fatty acids may reduce the risk of developing age-related macular degeneration (AMD); however, more research is required before definitive statements can be made.

Carotenoids are compounds that are found in plants, which have been associated with protection not only from macular degeneration, but from cancer, heart disease, diabetes, and a number of other medical conditions. Dark green, yellow and orange fruits and vegetables, especially those high in the carotenoids known as lutein and zeaxanthin, appear to provide the best protection for AMD. Lutein and zeaxanthin are the primary pigments in the macula and are thought to protect the retina from ultraviolet light.

Lutein is found in spinach, collard greens, kale, broccoli, papaya, oranges, kiwi, mango, green beans, peaches, sweet potatoes, lima beans, squash, red grapes, and green bell pepper.  Yellow corn, honeydew melon, squash, oranges, mango, kale, apricots, peaches, and orange bell pepper are good sources of zeaxanthin.

Foods abundant in vitamin C include green peppers, citrus fruits, tomatoes, broccoli, strawberries, yams, leafy greens, and cantaloupe.

Vitamin E is found in eggs, fortified cereals, fruit, wheat germ, green leafy vegetables, nuts/nut oils, vegetable oils, and whole grains.

Wild salmon, sardines, walnuts, and flaxseed oil are good sources of omega-3 fatty acids.

There are two forms of AMD: dry and wet. It is possible for a person to suffer from both forms, for AMD to affect one or both eyes, and for the disease to progress slowly or rapidly. Dry AMD may advance and cause loss of vision without turning into the wet form of the disease. However, it is also possible for early-stage dry AMD to change into the wet form of the disease.

Dry macular degeneration is the most common type of AMD. This form, in which the photosensitive cells of the macula slowly break down, is diagnosed in 85-90 percent of cases. Yellow deposits called drusen (extracellular waste products from metabolism) form and accumulate under the retina between the retinal pigmented epithelium (RPE) layer and the Bruch's membrane, which supports the retina. Drusen are often found in the eyes of older people, but an increase in the size and number of these deposits is frequently the first sign of macular degeneration. Over time, drusen are associated with deterioration of the macula and the death of RPE and photoreceptor cells, resulting in a blurring or spotty loss of clear, straight-ahead vision.

Wet macular degeneration occurs when abnormal blood vessels grow behind the macula as RPE and photoreceptor cells die. The Bruch’s membrane begins to break down, usually near drusen deposits, and new blood vessels grow. This growth is called neovascularization. These vessels are very fragile and can leak fluid and blood, resulting in scarring of the macula and the potential for rapid, severe damage. Straight-ahead vision can become distorted or lost entirely in a short period of time, sometimes within days or weeks. Wet macular degeneration accounts for approximately 10 percent of the cases, but it results in 90 percent of the cases of legal blindness. All wet AMD is considered advanced.

I believe the report you are referring to speaks about a belief that the consumption of vegetable oil in the diet increases the risk of macular degeneration. There are, however, no published reports in the scientific databases, at present, in which detailed studies have been conducted to support this claim. As such, more research is needed from other independent groups before any definitive comments can be made concerning this issue.

After searching the scientific literature, I did not find any published reports specifically linking smokeless forms of tobacco to macular degeneration risk. However, it is important to point out, that the exact reason why smoking increases the risk of macular degeneration is not totally clear. Many believe the increased risk stems from the exposure of the eyes to the chemicals present in exhaled cigarette smoke, which in turn affect blood flow to the retina. Others point out that even with smokeless forms of tobacco one is still exposed to a number of toxic chemicals; however, the main difference is the route of exposure. For example, chemicals in smokeless tobacco would likely be absorbed into the bloodstream via the mouth. With this in mind, smokeless tobacco may alleviate the problem of exposure to toxins present in cigarette smoke, but it is quite possible that the toxins, once absorbed into the bloodstream, may still cause changes that contribute to increased risk of macular degeneration.