Posterior Segment Age-related Macular Degeneration
Nutritional Supplements and Age-related Macular Degeneration – Focus on Omega-3 Fatty Acids
Eric H Souied President, Age-related Macular Degeneration Association and Head of Department, Ophthalmology Service, Créteil Intercommunal Hospital
Abstract
Age-related macular degeneration (AMD) is a leading cause of vision loss for which treatment options are limited. The socioeconomic benefits of prevention of AMD are enormous. While considerable observational evidence supports an association between dietary fats and AMD, the relation between specific types of fat and AMD has been unclear. Recent research has focused on the ω-3 polyunsaturated acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). The diets of industrialised nations contain higher levels of saturated fats, trans fatty acids and ω-6 fatty acids and less ω-3 fatty acids than they did in the past. This imbalance may have important implications for retinal health. Several observational studies have found that consumption of oily fish and high dietary intakes of DHA and EPA are associated with a reduced risk of developing AMD. Recent studies evaluating nutritional supplements containing ω-3 fatty acids for the treatment of AMD suggest a potential beneficial effect but further research in this area is warranted.
Keywords
Age-related macular degeneration, docosahexaenoic acid, eicosapentaenoic acid, omega-3, omega-6, polyunsaturated fatty acid (PUFA)
Disclosure: The author has no conflicts of interest to declare. Acknowledgement: Writing support was provided by Touch Briefings. Received: 28 November 2011 Accepted: 19 January 2012 Citation: European Ophthalmic Review, 2012;6(1):43–7 Correspondence: Eric H Souied, Service d'ophtalmologie, Hôpital Intercommunal de Créteil, Université Paris Est Créteil, 40 avenue de Verdun, 94000 Créteil, France. E:
eric.souied@
chicreteil.fr
Support: The publication of this article was funded by Bausch & Lomb Swiss AG. The views and opinions expressed are those of the author and not necessarily those of Bausch & Lomb Swiss AG.
Age-related macular degeneration (AMD) is the major cause of irreversible vision loss in adults in developed countries.1–3
Data from
the European eye study (EUREYE) indicate that the prevalence of AMD in Europeans aged 65 years and over is 3.3 %.4
Approximately
30 % of individuals aged 75 or older have the mild or intermediate stage of the disease (age-related maculopathy [ARM]).5
The
socioeconomic burden of AMD will only increase as global life expectancy rises.6–8
The pathogenesis of AMD is unknown but it is a multifactorial disorder, involving genetic and environmental factors. These include age, sex, diet, smoking, hypertension, genetic markers and nutritional status.9–14
Psychosocial and physiological changes set the stage for inadequate nutrition as the body ages.15
Older adults who are hospitalised due to
an acute illness may be at greater risk of experiencing malnutrition due to low dietary intake and/or underlying illness. Malnutrition may be present upon admission or develop during hospitalisation.16
Among
all hospitalised adult patients, prevalence of malnutrition at admission ranges between 20 and 70 % and for older patients between 12 and 72 %,17–21
and the population studied.19,21–23
depending on the definitions used for nutritional status Greater age in the patient population
is frequently related to an increased prevalence of malnutrition, observed in trials such as those cited above.
© TOUCH BRIEFINGS 2012
Medical treatments for AMD are limited to neovascular AMD. Anti-vascular endothelial growth factor (VEGF) agents and other options, such as verteporfin and laser treatment, are beneficial for neovascular AMD and research in this area is active,24–26 exists to treat non-exudative or dry AMD.27 treatment exists for prevention or treatment of AMD.
but no medical intervention No pharmacological
In 2001, the Age-related eye disease study (AREDS), a large-scale randomised controlled trial, found that high doses of vitamins C and E, β-carotene and zinc significantly reduced the odds of developing advanced AMD in a high-risk group.32
A second study
(AREDS2) on the effects of additional supplements on the development of AMD is on-going.
43
Nutritional supplements are of particular interest since the nutritional quality of the diet is decreasing. Several vitamins and minerals are known to be important in eye health, with particular interest in their antioxidant efficacy, since it has been suggested that retinal damage due to oxidation may contribute towards AMD pathogenesis.30,31
The identification of risk factors is of major importance for understanding the origins of AMD and for establishing strategies of prevention. Current therapeutic strategies focus on delaying or halting disease progression by modifying risk factors, such as lifestyle changes, e.g. cessation of smoking, or nutritional supplements.28,29
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