Since 2006, eye doctors have been recommending a high dose of antioxidants and zinc for AMD patients to reduce their risk of getting advanced AMD (bleeding at the macula). The doses of Vitamin C, E, beta carotene and Zinc recommended are much higher than our daily recommended intake and supplements have to be taken daily to get such high doses. This is based on the landmark AREDS study done in the USA which was conducted on almost 5000 patients who were randomized to receive either the high dose supplements or placebo. They were then followed up for 5 years and the patients taking the supplements were found to have almost 25% lower risk of getting advanced AMD.
Happy new year! I hope you have had a good break over the Christmas and New Year holidays and are ready to face 2013. I am quite excited as there will be a couple of new medicines for retinal diseases that will soon be available in Malaysia for my patients. Both drugs have to be injected into the eyeball as an intravitreal injection.
Eyelea (Aflibercept) blocks VEGF
Eyelea is a new type of Anti-VEGF drug that binds to VEGF molecules in the eye. VEGF is one of the factors involved in common eyes diseases like AMD, diabetic retinopathy, and retinal vein occlusion. Drugs that can reduce VEGF in the eye like Avastin and Lucentis are now widely used to treat these retinal diseases. The main problem is that we have to inject the current drugs into the eyeball every month as current medicines only last about one month in the eye and the disease recurs. Eyelea is unique in that it can stay in the eye for more than two months. This means that patients will need less frequent injections. I am looking forward to Eyelea being approved in Malaysia as I have many patients that require monthly injections and it becomes a big burden for them to come to clinic every month for their injection. So, rather then needing an injection every month for your retina disease, you will probably only need an injection every 2 months if you choose to have Eyelea.
Jetrea (Ocriplasmin) is an enzyme that helps the vitreous to detach from the retina
In our eyes, the vitreous jelly is attached to the retina inside the eye. Sometimes if the vitreous is too tightly attached to the macula, this can lead to conditions like macula hole which is normally treated with vitrectomy surgery. During vitrectomy surgery, retina surgeons aim to release the vitreous from the retina and this can be sometimes very difficult. Studies have shown that Jetrea can help release the vitreous from the retina if injected before vitrectomy surgery. In some cases, the macula hole was actually closed with the injection of Jetrea alone and the patient did not require surgery! This is very exciting. This new drug may also be used for cases of diabetic retinopathy requiring vitrectomy surgery as detaching the vitreous from the retina is often required for such cases. Children with retina diseases like retinopathy of prematurity (ROP) or retina detachment, may also benefit from having an injection of Jetrea prior to vitrectomy surgery. In children, the vitreous jelly is very stuck to the retina and it is extremely difficult to separate the vitreous from the retina with surgery. This new drug is a breakthrough and earned a publication in the prestigious New England Journal of Medicine for the discovery.
Have a happy and healthy year ahead!
Kuala Lumpur, Malaysia
A question I am often asked is whether changes in your diet or taking supplement can prevent AMD (Age Related Macular Degeneration). There have been many studies looking at this issue but probably the most important research in this area is from the Age-Related Eye Diseases Study (AREDS).
AREDS was started more than 10 years ago to see if high dose anti-oxidants supplements were useful in preventing progression to advanced macular degeneration in patients with early dry macular degeneration. This study did show some benefit for moderate to advanced dry AMD patients.
So, eye doctors are now recommending that dry AMD patients take supplements daily to prevent their eye from developing wet AMD. Wet macular degeneration is bleeding at the macula which can cause severe visual loss.
It is important to see your eye doctor before you take any such supplements as you may not actually need to take them. Also, supplements can interact with your medications and cause side effects.
Vegetables May Improve Vision
We have always been told to eat our vegetables and our mothers were right! Colourful vegetables like carrots, beetroot, green lettuce, and tomatoes, contain carotenoids. Carotenoids are the natural pigments that give colour to egg yolks, tomatoes, green leaves, fruits, and flowers. They cannot be made internally in the body, and therefore, must be obtained from the diet.
Beta-carotene, lutein and zeaxanthin are members of the carotenoid family. Carotenoids are light-gathering pigments and protect against the toxic effects of ultra-violet radiation and oxygen.
Lutein and zeaxanthin are found in the macula, and are protect our retina from UV light damage. UV light exposure is thought to be one of the causes of AMD. Carotenoids also have antioxidant properties.
Omega-3 Fish Oils Might Slow AMD
Omega-3 fish oils are also popular food supplements for a variety of conditions. They have anti-inflammatory properties and may be helpful in AMD patients.
In AREDS, they found that patients with early AMD are were eating more two portions of oily fish a week had a lower rate of progressing to wet AMD than patients who ate less oily fish. Again, it seems like our mothers were right to nag us to eat more fish!
A new study called AREDS2 has been started and will look at whether taking lutein, zeaxathin, and fish oil supplements can help prevent or delay progression of AMD. As a retinal specialist, I look forward to the results of this study.
For further information about how diet and supplements can help in AMD, please check out my article in my regular medical column in the Star newspaper, “Food and Your Macula.”