Age-Related Macular Degeneration: Nutritional Considerations

Dietary factors appear to play an important role in ARMD. In epidemiologic studies, the following factors are associated with reduced risk of onset or progression of the disease:

Maintenance of ideal weight. Studies have found a higher risk for ARMD in association with measures of adiposity, including body mass index (BMI) and waist/hip ratio.^9-11 Regular exercise is associated with lower risk for ARMD.^9,12

Low fat intake. Studies have found associations between high intakes of saturated fat and cholesterol and ARMD.^13,14 Other studies have implicated vegetable fat and total fat intake in ARMD.^15-17 Regular consumption of processed baked goods increased risk for ARMD twofold compared with those who did not regularly consume these foods, possibly through adverse effects on blood lipids or inflammation.¹⁵ In contrast, fish intake is associated with reduced prevalence of ARMD, at least among certain populations.^{13, 15-17}

High consumption of fruits and vegetables. Lutein and zeaxanthin are the principal carotenoids in the macular region of the retina. They are abundant in dark-green, leafy vegetables and appear to play an important role in prevention of macular degeneration.¹⁸ Several studies have found that people with high intake of fruits and vegetables had a significantly lower risk for ARMD compared with those who have low intakes.^19,20 The Eye Disease Case Control Study found that individuals in the highest quintile of carotenoid intake had a 43% lower risk for ARMD compared with those in the lowest quintile. Intakes of collard greens and spinach, both rich in lutein, were found to be the most protective. The Health Professionals Follow-Up Study and Nurses' Health Study found inverse associations between higher fruit intakes (3 or more servings per day) and lower risk for neovascular age-related maculopathy.²¹

Antioxidant supplements. In the Age-Related Eye Disease Study, individuals with moderate or advanced ARMD who received 500 mg of vitamin C, 400 IU of vitamin E, 15 mg of beta carotene, and 80 mg of zinc oxide (and 2 mg cupric oxide to prevent copper deficiency ) had significantly reduced progression of their disease, compared with subjects receiving a placebo.²² Caution is advised, however, given evidence that beta-carotene supplementation may increase lung cancer risk among smokers, and that daily doses of vitamin E 400 IU and greater may increase cardiovascular and all-cause mortality.²³

In the lutein antioxidant supplementation trial (LAST), a 10-mg supplement of lutein taken daily, alone or with an antioxidant vitamin combination, increased macular pigment density and improved visual function when compared with a placebo.²⁴ Lutein supplementation also improved visual performance (visual acuity and glare sensitivity) in other controlled trials.²⁵ Patient-specific recommendations should be made by an ophthalmologist, because the age of the patient, disease severity, duration of treatment, and potential inhibitory effect of lutein supplementation on other carotenoids should be taken into account.

Orders

See Basic Diet Orders.

Emphasize fresh fruits and vegetables, collard or turnip greens, kale, spinach.

Consider the following supplements in consultation with an ophthalmologist:

• Vitamin C 500 mg, vitamin E 400 IU, beta-carotene 15 mg, zinc oxide 80 mg, and cupric oxide 2 mg daily.
• Lutein, dosed as per ophthalmologist recommendations.

Smoking cessation.

What to Tell the Family

Appropriate medical care and self-care can slow the loss of vision due to ARMD. It is helpful to encourage smoking cessation and a diet that is low in fat and cholesterol and high in fruits and vegetables. That means including at least 1 serving daily of a dark leafy green vegetable, such as spinach, kale, collards, or turnip greens, along with 3 servings of fresh fruit. This diet is also beneficial to family members, who may have a higher risk of ARMD. Supplemental lutein and certain vitamins and minerals (C, E, beta-carotene, and zinc/copper oxide) may be beneficial, but their use should be supervised by an ophthalmologist. Low-vision aids (such as special lighting and magnifiers) are available through eye clinics.