EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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18 EW NEWS & OPINION October 2012 Pharmaceutical focus From A to zeaxanthin by Maxine Lipner Senior EyeWorld Contributing Writer The latest on supplements to forestall AMD S ince the days of the origi- nal AREDS, which showed that risk of advanced age-related macular degeneration (AMD) was significantly reduced by consump- tion of antioxidant vitamins and zinc, eyes have been on supplements to help stave off this sight-threaten- ing condition. The thinking here centers on maintaining good blood flow and proper nutrition to the highly reactive cells of the retina, according to Jeffrey Anshel, O.D., president, Ocular Nutrition Society, Encinitas, Calif. "These cells need to regenerate themselves, and if this process does- n't work properly, the system breaks down," Dr. Anshel said. "The way I term it to patients is that the trash builds up in the retina, and it does not get proper nutrition through the blood supply, so the tissues break down." Full spectrum connection Dr. Anshel finds that most patients need supplementation to forestall AMD because they don't have the perfect diet. While there is a lot of talk about nutrients such as lutein and zeaxanthin, which do accumu- late in the retina, Dr. Anshel stressed that nutrients are designed to work together. "We don't eat spinach and kale just because they have lutein in them," he said. "They have calcium, vitamins, and other minerals." Nutrient rich foods are meant to be consumed in combination with each other, he emphasized. "So if you're going to give [patients] a sup- plement, you need to give them a full-spectrum multivitamin that has the right balance of all of these nutrients, and doctors need to do their homework," Dr. Anshel said. It isn't good enough to simply pick a supplement that others are touting or that practitioners have seen advertised. "You need to look at the science behind it," he said. It was with this in mind that Dr. Anshel founded the Ocular Nutri- tion Society. Before a company can become an Ocular Nutrition Society sponsor, the Society vets products to make sure that there is good science behind them. Some of the AMD vi- tamin-related sponsors listed on the Ocular Nutrition Society website in- clude Macula Complete (Biosyntrx, Colorado Springs, Colo.), i-Defense formulas for macular health (VisiVite, Huntington, N.Y.), PreserVision (Bausch + Lomb, Rochester, N.Y.), and EyePromise for- mulas (ZeaVision, Chesterfield, Mo.). The closer a supplement is to whole food, the better, finds Steven G. Pratt, M.D., assistant clinical pro- fessor, University of California, San Diego. "Even the very best supple- ments don't have all of the things in them that food has," said Dr. Pratt, who is board-certified by the Ameri- can Board of Integrated Holistic Medicine. He pointed out phytonu- trients such as polyphenols play a major role in eye health. "There are over 9,000 polyphenols identified in the food so far, and you're not going to get all 9,000 in any one supple- ment," Dr. Pratt said. One product with a wide variety To view full supplement, click on image of nutrients that he recommends is MaxiVision whole body formula (MedOp Inc., Oldsmar, Fla.). "There are a lot of phytonutrients in that product, not just three or four vita- mins or minerals," Dr. Pratt said. He also finds whole body products such as this one preferable to randomly mixing supplements. "You may get way too much zinc or way too much of a lot of things," he said. "Even the carotenoids in high doses can be harmful." Since most patients don't have the perfect diet, supplementation can be important to forestall AMD Source: Jeffrey Anshel, O.D. Considering additional supplements That said, Dr. Pratt does find that there are some additional supple- ments that patients may need to take in conjunction with a whole body formula. He pointed to vita- min D3, which helps to decrease the risk of angiogenesis. "MaxiVision has about 1,200 IU of vitamin D3, but I check hundreds of patients in my office and for many people that's not enough," he said. It oftentimes takes 2,000-4,000 IU per day to get the vitamin D3 levels up to where he would like them to be. He aims for a vitamin D level of between 50 and 80 nomograms per ml. He also recommended that pa- tients take a fish oil capsule twice a day in addition to consuming cold water fish such as sockeye salmon four times a week and eating ample nuts and seeds every day. Walnuts and pistachios in particular are high in lutein. Meanwhile, the best food source of zeaxanthin is orange bell peppers. These will lower C-reactive proteins, one of the risk factors for AMD, Dr. Pratt finds. In addition, he suggested taking 500 mg of vitamin C with bioflavonoid as well as choline and CoQ10 every day. While a whole body formula such as MaxiVision may have some of these nutrients, the amount may be limited. "You can't put all of this stuff into one supplement," Dr. Pratt said. He pointed out that, for example, CoQ10 is a good antioxidant for the back of the eye and the amount diminishes as we get older, making boosting this a good idea. Another supplement to consider for staving off AMD is TruNature Grape Seed & Resveratrol (Costco, Issaquah, Wash.), Dr. Pratt thinks. "What I like about this is it has grape seed extract, grape skin extract, grape pulp extract, and resveratrol," he said. "That's about as close as you're going to get to a food source for resveratrol." He rec- ommended limiting the amount to about 30 mg in divided doses. "If you use too much then the supple- ment is like a drug because nobody on the planet ever consumed 100 mg of resveratrol a day from food," Dr. Pratt said. Likewise, bilberry extract supplements, which come from a European blueberry, may prove helpful. Dr. Pratt thinks that the polyphenols in this may work in synergy with all of the other antioxi- dants. As far as the often-mentioned lutein and zeaxanthin, he recom-