Dr. Grossman’s Blog

Patients with age-related macular degeneration (AMD) experience a deterioration of their central vision. Two thirds of AMD patients have problems with visuomotor and balance skills resulting in clumsiness and increased risk of falls.

A new study investigates the link between balance training and improved visual, vestibular and somatosensory functions involved in balance control. The investigation, published in the Journal of Vestibular Research, measured the impact of balance training on several visuomotor functions and reading speed.

Balance status statistics of 54 AMD patients were compared to 55 normal controls. Sixteen of these patients and 14 controls subsequently received balance training sessions on a postural platform. Researchers assessed postural sway, pointing accuracy, reading performance and, for the AMD patients, the effect of low vision training and balance training on the shift from several spontaneous Preferred Retinal Loci (PRLs) to one or more Trained Retinal Loci (TRL).

Even after a limited number of sessions of cross-modal balance training, the results show a significant improvement for the vestibular input and fixation stability, leading to the conclusion that more training sessions may help AMD patients gain more significant improvement of visuo-motor functions.

Learn more about AMD, including diet, nutrition, self-help and alternative treatment information at the Natural Eye Care website

Read other studies on AMD prevention and treatment options

SOURCE: Balance training and visual rehabilitation of age-related macular degeneration patients, Radvay, et al, Journal of Vestibular Research, Volume 17, Number 4, 2007, pages 183 – 193.

A miniature telescope mounted into a spectacle lens can now help people with vision loss from macular degeneration. The device, which is about the size of a pencil eraser, can improve vision by about three and a half lines on an eye chart.

A telescope surgically implanted directly into the eye is expected to be approved by the FDA later this year, however the “spectacle” mounted telescope is available now without the safety concerns associated with a surgical procedure.

Additional information on telescopic glasses and Dr. Paul’s research is available at http://www.LowVisionDoctor.com

In the first study, Jennifer S.L. Tan, MBBS, BE at the University of Sydney, Australia and her colleagues evaluated data from 2,454 participants in the Blue Mountains Eye Study of men and women aged 49 and older. Those who consumed one serving of fish per week were shown to have a 31 percent lower adjusted risk of developing early AMD compared with those who consumed less.

In the second article, Elaine W. T. Chong, MD, PhD, of the Centre for Eye Research Australia and her associates evaluated data from 6,734 men and women aged 58 to 69 who participated in the Melbourne Collaborative Cohort Study. Dietary questionnaires completed between 1990 and 1994 were analyzed for the intake of various foods and individual fatty acids. Follow up examinations conducted between 2003 and 2006 detected 2,872 cases of early age-related macular degeneration and 88 cases of late disease.

A high intake of trans-unsaturated fats was associated with a significant increase in late macular degeneration, with those whose intake was categorized as among the top 25 percent of participants having a 76 percent greater risk than those whose intake was among the lowest fourth.

Olive oil emerged as protective against late disease. When those who reported consuming at least 100 milliliters per week olive oil were compared with those who consumed less than 1 milliliter per week, they were found to have a 52 percent lower risk of late AMD.

For early AMD, those whose omega-3 fatty acid intake was among the top 25 percent had a 15 percent lower risk compared with those whose intake was among the lowest quarter.

For more information on nutrition and macular degeneration and related research studies, see NaturalEyeCare’s Section on Macular Degeneration.

Seniors who perform poorly on tests of language, memory and concentration are more likely to be suffering from the early stages of age-related macular degeneration (AMD). 

A new study published in the Archives of Ophthalmology reviews the association between cognitive function decline and the onset of AMD.

“We found that those who have memory impairment were more likely to have early stages of macular degeneration independent of the effects of age, education and vascular risk factors,” said study co-author Dr. Tien Yin Wong, a professor in the department of ophthalmology with the Centre for Eye Research Australia at the University of Melbourne.

2088 participants aged 69 to 97 years who participated in the Cardiovascular Health Study were assessed for AMD.  Cognitive function was evaluated using the Digit Symbol Substitution Test (DSST) and the Modified Mini-Mental State Examination. Participants were also evaluated for dementia using detailed neuropsychological testing.

After controlling for age, sex, race, and study center, participants with low DSST scores were more likely to have early AMD than were participants with higher DSST scores.   In analysis that also controlled for education, systolic blood pressure, total cholesterol level, diabetes mellitus, smoking status, and apolipoprotein E genotype, the association was even stronger.

There was no association of dementia or Alzheimer disease with early AMD.

Read other studies on AMD

See tips on preventing vision problems with a focus on nutrition, exercise, lifestyle changes, and a positive mental approach to life at Natural Eye Care

SOURCE:  Early Age-Related Macular Degeneration, Cognitive Function, and Dementia – The Cardiovascular Health Study, Baker, et al, Arch Ophthalmol. 2009;127(5):667-673.

Researchers have released a new study showing that regular consumption of fish, omega-3 polyunsaturated fatty acids, and nuts helps protect against age-related macular degeneration (AMD).

The study, published in the Archives of Ophthalmology, assessed the relationship between dietary fatty acids and the 10-year incident of AMD.

Scientists examined 3654 elderly Australian participants at baseline and re-examined 2454 of these participants five and/or ten years later.  Participants completed a food frequency questionnaire.

The findings confirmed many previous studies on AMD.  After adjusting for age, sex, and smoking:

• one serving of fish per week was associated with reduced risk of early AMD primarily among participants with less than the median linoleic acid consumption
• findings were similar for consumption of long-chain omega-3 polyunsaturated fatty acids:  one to two servings of nuts per week was associated with reduced risk of early AMD 
• protective associations between nut consumption and reduced risk of pigmentary abnormalities were seen among nonsmokers, participants with less than the median ratio of serum total to high-density lipoprotein cholesterol, and those with beta carotene intake greater than the median level.

This study provides evidence of protection against early AMD through:

• regular consumption of fish and nuts
• greater consumption of omega-3 polyunsaturated fatty acids
• low intakes of foods rich in linoleic acid

Read more about AMD and natural eye care

Learn which foods to eat to help maintain good eye health

SOURCE:  Dietary Fatty Acids and the 10-Year Incidence of Age-Related Macular Degeneration, The Blue Mountains Eye Study, Tan, et al, Arch Ophthalmol. 2009;127(5):656-665.

A team of scientists and surgeons from the Institute of Ophthalmology at University College London and the Moorfields Eye Hospital in London has developed a stem cell therapy to treat age-related macular degeneration (AMD), the most common cause of vision loss in the elderly.
“Under the new treatment, embryonic stem cells are transformed into replicas of the missing cells,” writes The Times of London. “They are then placed on an artificial membrane which is inserted in the back of the retina.”

Pharmaceutical giant Pfizer announced this week that it will fund the development of the therapy; UCL professor Pete Coffey, who led the research team, predicts the therapy will be available as part of a simple, one-hour procedure within six or seven years.The researchers are applying for approval to conduct a clinical trial on humans; it would be just the second-ever trial conducted on humans using embryonic stem cells. Laboratory trials completed by the British team have demonstrated that stem cells can prevent blindness in rats with a similar disease to AMD. They have also successfully tested elements of the technology in pigs.

For natural approaches to help prevent the onset of macular degeneration as well as help preserve vision for those with macular degeneration, visit the Natural Eye Care web site

Researchers from Tufts University have found that a diet rich in omega-3 fatty acids and low in starchy carbohydrates can significantly reduce the risk of age-related macular degeneration (AMD).

The study, published in the journal Ophthalmology, is the first to calculate the combined effect of specific dietary nutrients and eating habits on a person’s risk for age-related macular degeneration.

During the study of 4003 participants in the ongoing Age-Related Eye Disease Study (AREDS), each dietary factor was assigned a percentile score; these scores were accumulated to find each participant’s compound score. The compound score was then evaluated for its association with the risk of AMD.

Researchers showed that vitamins C and E, zinc, lutein, zeaxanthin and the omega-3 fatty acids known as D.H.A. and E.P.A. were linked to lower risk for AMD.

The lowest risk of AMD was found in participants who regularly consumed a combination of these nutrients as part of a low-glycemic index diet.

The glycemic index (GI) is a measure of the effects of carbohydrates on blood glucose levels. Carbohydrates that break down rapidly during digestion, such as white bread and pastries, have a higher GI, as they release glucose into the bloodstream rapidly. Foods that break down more slowly, such as vegetables and proteins, have a lower GI value.

Read more about AMD on the Natural Eye Care website

Learn more about food sources for nutrients important for good eye health, including omega-3 fatty acids

SOURCE: “Dietary Compound Score and Risk of Age-Related Macular Degeneration in the Age-Related Eye Disease Study”, Chiu, et al, Ophthalmology, Volume 116, Issue 5, Pages 939-946.

Researchers from Tufts University have created a model to better predict a person’s risk for Age-related Macular Degeneration (AMD). 

This study, published in the May issue of Investigative Ophthalmology and Visual Science, was based on data from the 1,446 participants in the Age-Related Eye Disease Study (AREDS).  It shows how genetic, ocular, and environmental variables were evaluated and predictive models for prevalence and incidence of AMD were assessed. 

Researchers evaluated six criteria:

• age,
• sex,
• education,
• smoking status,
• body mass index, and
• supplementation with high-dose formulation of antioxidants and zinc (to slow progression of the AMD).

Although genetics play a large part in who will get AMD, there are lifestyle choices that can greatly influence a person’s risks for AMD.  Dr. Seddon noted that among individuals with one genotype studied (homozygous C3 risk genotype), the chance of suffering from the advanced form of AMD increased from approximately three times the risk for nonsmokers to almost 10 times the risk for smokers.

Study authors hope that learning more about how to predict who is at risk for AMD will give doctors and patients better information about how to better treat and even help prevent AMD.

Learn more about AMD and AMD prevention self-help tips

SOURCE:  Prediction Model for Prevalence and Incidence of Advanced Age-Related Macular Degeneration Based on Genetic, Demographic, and Environmental Variables, Seddon, et al, Investigative Ophthalmology and Visual Science. 2009;50:2044-2053.

Antioxidant and omega-3 supplements continue to be a simple, low-cost, effective therapy for AMD

A study designed to measure changes in visual function in subjects with atrophic (dry) age-related macular degeneration (AMD) found that three-quarters of the subjects receiving a nutritional supplement demonstrated stabilization or improvement of visual acuity at 6 months.

Dry, atrophic, or non-exudative, AMD is the most common form of macular degeneration.  Risk factors for dry AMD include:

• age greater than 50
• Caucasian race
• poor nutrition
• smoking
• atherosclerotic vascular disease
• genetics 
• sunlight exposure.

Multiple studies have suggested that nutritional factors can play a significant role in slowing the onset or limiting the effects of AMD.  The Taurine, Omega-3 Fatty Acids, Zinc, Antioxidant, Lutein (TOZAL) study tried to identify the potential benefits of a new supplement designed to limit the risk of AMD and progressive vision loss.

In this study, published in BMC Ophthalmology, 37 mixed gender patients (average age 76 years) at 5 independent study sites received a nutritional supplement specifically formulated to combat AMD.   This supplement included natural beta-carotene, vitamins A and E, zinc, and copper.   Results were compared to subjects in other tests who had been given placebos.

76.7% of subjects receiving the nutritional supplement demonstrated stabilization or improvement of visual acuity at 6 months.

Read other studies about AMD

Learn more about antioxidants and food sources for nutrients important for good eye health

SOURCE:  TOZAL Study: An open case control study of an oral antioxidant and omega-3 supplement for dry AMD, Cangemi, BMC Ophthalmology 2007, 7:3doi:10.1186/1471-2415-7-3.

Researchers predict age-related macular degeneration (AMD) will increase substantially by 2050, as the U.S. population ages, but the use of new and existing therapies can mitigate the effects of the condition.

A significant preventative therapy named in this study is the use of antioxidant vitamins to slow the progression of AMD from early to late stages.  Other treatments reviewed include laser and photodynamic therapies and anti-VEGF injections.

Scientists from the Research Triangle Institute International in North Carolina simulated cases of early AMD, choroidal neovascularization (CNV), geographic atrophy (GA), and AMD-attributable visual impairment and blindness with 5 universal treatment scenarios:

1. no treatment;
2. focal laser and photodynamic therapy (PDT) for CNV; 
3. vitamin prophylaxis at early-AMD incidence with focal laser/PDT for CNV; 
4. no vitamin prophylaxis followed by focal laser treatment for extra and juxtafoveal CNV and anti-vascular endothelial growth factor treatment; and 
5. vitamin prophylaxis at early-AMD incidence followed by CNV treatment, as in scenario 4.

From the results of this analysis, the researchers predicted that cases of early AMD will increase from 9.1 million in 2010 to 17.8 million in 2050 across all scenarios, but that existing medical therapies have the potential to reduce the visual impairment and blindness attributable to AMD by as much as 35 percent, translating to 565,000 fewer cases of visual impairment and blindness in 2050.

Learn about good food sources of antioxidants

Read about antioxidant vitamins important in the treatment of macular degeneration

SOURCE:  Forecasting age-related macular degeneration through the year 2050: the potential impact of new treatments, Rein, et al,  Arch Ophthalmol. 2009 Apr;127(4):533-40.