The lens of the eye focuses an image of the world on a portion of the retina called the macula , the area of finest visual perception. Gradual deterioration of the macula is called macular degeneration. After cataracts , damage to the macula is the second most common cause of visual impairment in those over 65. Smoking , high blood pressure , and atherosclerosis are associated with progressive damage to the macula. Ultraviolet light may also play a role by creating harmful free radicals in the eye.
In the most common form of macular degeneration (dry macular degeneration), a substance known as lipofuscin accumulates in the lining of the retina. A much less common form of macular degeneration involves the abnormal growth of blood vessels (wet macular degeneration). This can be treated very successfully, if attended to soon enough, but may lead to irreversible blindness if left untreated. For this reason, medical consultation in all cases of macular degeneration (or any other type of vision loss) is essential.
Note : The treatments described in this section are intended as support to standard ophthalmalogical care, not as a substitute for it. In addition, all studies refer primarily to the more common type of macular degeneration, dry macular degeneration.
A single solid study suggests that zinc, or a mixture of zinc and antioxidants can prevent or slow the progression of early macular degeneration. However it is not clear whether the antioxidant portion of this mixture added any additional benefit.
This double-blind, placebo-controlled trial evaluated the effects of zinc with or without antioxidants on macular degeneration in 3,640 individuals in the early stage of the disease. 1 Participants were randomly assigned to receive one of the following treatments: antioxidants ( vitamin C at 500 mg, vitamin E at 400 IU, and beta-carotene at 15 mg), zinc (80 mg) and copper (2 mg), antioxidants plus zinc, or placebo. The results indicate that zinc alone or zinc plus antioxidants, significantly slowed the progression of the disease.
Note : Zinc at doses of 80 mg and higher daily can be harmful. One of the problems is that high-dose zinc supplementation impairs copper absorption. That's why extra copper was provided in the study described above. However, there may be other risks as well. Physician supervision is advised. For other dosage and safety issues, see the full Zinc article.
Smaller studies of zinc for macular degeneration have found mixed results. 3,4
Note that it’s not clear how much the antioxidants in the mixture contributed to the benefits. In fact, there is no convincing evidence that antioxidants alone are effective for preventing or delaying the onset of macular degeneration. A 4-year, double-blind, placebo-controlled trial of 1,193 people with macular degeneration failed to find vitamin E alone helpful for preventing or treating macular degeneration. 16 An even larger and longer study, following over 20,000 people for over 10 years, failed to find that beta-carotene alone reduced the incidence of macular degeneration. 23 A mixture of beta-carotene, vitamin E, and vitamin C has also failed to prove beneficial. 15 And, a review of 3 randomized controlled trials involving a total of 23,099 subjects found no evidence of benefit for vitamin E and beta-carotene. 24
Carotenoids are a group of substances that are found in many fruits and vegetables, especially yellow-orange and dark green ones. ( Beta-carotene is the most famous carotenoid). Observational studies suggest that higher intake of dietary carotenoids is associated with a lower incidence of macular degeneration. 5,6 However, observational studies prove little about cause and effect. To determine whether carotenoids can actually prevent or treat macular degeneration, double-blind, placebo-controlled studies are necessary. (For information on why this is the case, see Why Does This Database Rely on Double-blind Studies? )
As noted above, in one very large study, beta-carotene failed to prove effective for preventing macular degeneration. However, the less well-known carotenoids lutein and zeaxanthin might be more promising. 7,8 These carotenoids, principally found in corn and dark green leafy vegetables, are found in high concentrations in the eye. It has been suggested that they may protect the macula from light-induced damage by dyeing it yellow, thereby acting as a kind of natural sunglasses. They also act in the usual antioxidant fashion by neutralizing free radicals. 9
These hopes received support from a double-blind, placebo-controlled trial. 18 This study enrolled 90 people with dry macular degeneration and followed them for 12 months. The participants received either lutein (10 mg), lutein plus antioxidants and a multivitamin/mineral supplement, or placebo. At the end of the study period, participants who had taken lutein alone or lutein plus the other nutrients showed improvements in vision, while no change in vision was seen in the placebo group. A subsequent study failed to find benefit with lutein, but it used a lower dose (6 mg daily) and involved fewer people. 21 Ultimately, further study will be needed to establish whether lutein is actually helpful for macular degeneration. For more information, see the full Lutein article.
Like carotenoids, flavonoids are found in many plants and may offer a variety of beneficial effects. Weak but interesting evidence suggests that bilberry and oligomeric proanthocyanidins (OPCs), both rich in flavonoids, may prevent or treat macular degeneration. 11-13
The herb Ginkgo biloba also contains many flavonoids and is additionally thought to increase circulation. In a 6-month, double-blind, placebo-controlled study of 20 people with macular degeneration, use of ginkgo at a dose of 160 mg daily resulted in improved visual acuity. 12 Furthermore, positive results were seen in a 24-week, double-blind study of 99 people with macular degeneration that compared ginkgo extract at a dose of 240 mg per day against ginkgo at a dose of 60 mg per day. 17 Vision improved in both groups, but to a greater extent with the higher dose. This study would have been more meaningful if it had included a placebo group, but nonetheless, “dose-related” effects of this type hint that a treatment may really work. It has been suggested that ginkgo aids vision by increasing blood flow to the optic nerve. However, one study designed to evaluate this possible mechanism of action failed to document such an effect. 22
In observational studies, people who happen to consume a diet rich in omega-3 fatty acids (fish oil) seem to lower their risk of macular degeneration. However, in the absence of randomized controlled trials, it is not possible to say whether or not it is the omega-3 that produces this benefit. 25 One controlled study that unfortunately failed to use a placebo group appeared to find benefit with a combination of acetyl-L-carnitine , fish oil and coenzyme Q 10 . 20
1. Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS Report no.8. Arch Ophthalmol. 2001;119:1417-1436.
10. Mares-Perlman JA, Fisher AI, Klein R, et al. Lutein and zeaxanthin in the diet and serum and their relation to age-related maculopathy in the Third National Health and Nutrition Examination Survey. Am J Epidemiol . 2001;153:424-432.
12. Lebuisson DA, Leroy L, Rigal G. Treatment of senile macular degeneration with Ginkgo biloba extract. A preliminary double-blind, drug versus placebo study [translated from French]. Presse Med . 1986;15:1556-1558.
15. Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled clinical trial of high-dose supplementation with vitamins C and E and beta carotene for age-related cataract and vision loss: AREDS report no. 9. Arch Ophthalmol. 2001;119:1439-1452.
18. Richer S, Stiles W, Statkute L, et al. Double-masked, placebo-controlled, randomized trial of lutein and antioxidant supplementation in the intervention of atrophic age-related macular degeneration: the Veterans LAST study (Lutein Antioxidant Supplementation Trial). Optometry . 2004;75:216-230.
20. Feher J, Kovacs B, Kovacs I, et al. Improvement of Visual Functions and Fundus Alterations in Early Age-Related Macular Degeneration Treated with a Combination of Acetyl-L-Carnitine, n-3 Fatty Acids, and Coenzyme Q10. Ophthalmologica . 2005;219:154-166.
21. Bartlett HE, Eperjesi F. Effect of lutein and antioxidant dietary supplementation on contrast sensitivity in age-related macular disease: a randomized controlled trial. Eur J Clin Nutr . 2007 Jan 31. [Epub ahead of print]
25. Chong EW, Kreis AJ, Wong TY, et al. Dietary omega-3 fatty acid and fish intake in the primary prevention of age-related macular degeneration: a systematic review and meta-analysis. Arch Ophthalmol. 2008;126:826-833.
Last reviewed September 2014 by EBSCO CAM Review Board
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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