About Macular Degeneration

Macular degeneration is a progressive disease in which the center part of the retina, called the macula, gradually dies, initially a few cells at a time. In a chapter title of his book, one ophthalmologist author called macular degeneration "Starvation of the Retina." Nutrition is the key answer to macular degeneration because the disease really is starvation of this small part of the eye in a body that may seem well nourished but actually is not. This disease is often called age-related macular degeneration (AMD or ARMD) because its incidence increases with age.1

All macular degeneration starts as dry macular degeneration and may become wet (neovascular) macular degeneration if abnormal blood vessels which leak and/or bleed grow under, in, or over the macula. Wet macular degeneration may cause sudden severe changes in vision. Dry macular degeneration usually progresses more slowly but can be just as destructive if geographic atrophy (GA) develops. With geographic atrophy, regions of the retina waste away (atrophy) and die.2

Macular degeneration affects central vision but not peripheral vision, so it does not cause "total blindness," which means that no stimulus from light reaches the brain. However, it often causes "legal blindness" which is vision (with corrective lenses) of 20/200 or worse.3 Macular degeneration can make reading, driving, watching TV, recognizing faces, many kinds of work, and living independently difficult or impossible.4 AMD may cause the pleasures one intended to enjoy in later years to become only a dream.

A number of risk factors exist for developing macular degeneration. Age of over 60 years is a major risk factor, and the risk rises with increasing age. Family history of macular degeneration also increases risk, as do light colored eyes and Caucasian race. Other factors that are possibly more controllable are exposure to ultraviolet (UV) or high-energy blue light, cardiovascular disease, obesity, smoking, exposure to toxins and environmental pollution, and low blood levels of minerals and antioxidant vitamins such as vitamins A, D and E.5

The macula is the center part of the retina and is packed with light sensing structures called rods and cones. (For more detail about how rods and cones turn light into vision, scroll about half way down this page). Beneath the rods and cones is the retinal pigment epithelium (RPE), a membrane containing protective pigments derived from the diet. Beneath the RPE is the choroid, a layer that contains blood vessels. With age, the RPE deteriorates and thins, thus lessening both the transport of nutrients to the macula and waste products out of the macula. The drusen seen in the eyes with macular degeneration are deposits of waste products. Dry macular degeneration is diagnosed based on the appearance of drusen. Furthermore, the thinning and deterioration of the RPE gives the retina a mottled look rather than a uniformly red appearance. In the final stages of advanced dry macular degeneration, the RPE may deteriorate to the point of no longer supplying the macula with nutrients or supporting its function in other ways, thus resulting in complete loss of central vision.6

Wet macular degeneration occurs in only 10 to 15% of cases but causes 90% of the incidents of severe vision loss. Macular degeneration becomes "wet" when new blood vessels grow from the choroid. These vessels leak fluid or blood and can cause sudden legal blindness. Patients are instructed to look at an Amsler grid daily to see if the lines become wavy or a dark spot develops, which means they are experiencing bleeding or leaking of blood vessels under the macula. Injections of anti-VEGF (anti-vascular endothelial growth factor) drugs into the vitreous humor of the eye may stop current bleeding but do not prevent the growth of new abnormal blood vessels.7 Also, although the drug-treated blood vessels no longer leak or bleed, they are not functional. They become scar tissue which replaces normal tissue.8

What is the underlying cause of the eye's problem with disposing of waste products that initiates macular degeneration?9 Lack of antioxidants in the diet10 leads to oxidation in the eye that causes blockage of small blood vessels, resulting in decreased nutrient transport and waste removal.11 When the lack of blood flow becomes severe enough, the body attempts to correct the problem by growing new blood vessels. However, the new vessels are very fragile and leak, bleed, or grow out of the choroid and over the macula.12

As with many chronic diseases, the most effective treatment is prevention or nutritional and other natural intervention early in the disease process. For advanced wet macular degeneration with actively bleeding or leaking blood vessels, conventional treatment with anti-VEGF drugs can help temporarily by stopping the bleeding. However, the drugs do not prevent new abnormal blood vessels from growing and leaking or bleeding nor do they prevent the formation of scar tissue. Thus, progressive destruction of the macula continues, although more slowly. In my opinion, individuals with macular degeneration can best improve their odds against blindness with excellent eye nutrition, ideally started before their macular degeneration has had much time to advance.

How Rods and Cones Produce Vision

In the discussion of rods and cones near the beginning of this page, more information about how our eyes are "fearfully and wonderfully made" was promised. Here is the amazing story of how our eyes process light to become complex images of the world around us.

We first heard about the incredible function of rods and cones one night when both of our sons were eating dinner with us, and we were discussing Mark's improvements in color vision. Our older son, Joel, an electrical engineer whose dissertation subject was image processing, told us that he had learned in graduate school about how the human eye processes images. He said that our retinas are populated with rods and some cones that serve special purposes including detecting motion, lines, edges, etc. We have three kinds of color-detecting cones: short, medium and long. The short cones detect blue light, the medium cones detect green, and the long cones detect red. Although the detection of yellow depends mostly on the short cones, the signal sent from the retina to the brain for yellow is a combination of information from all three types of cones. We see yellow when the brain compares the signals from short (yellow/blue) cones to signals from long (red) and medium (green) cones.

Each rod or cone has a nerve coming from it. These nerves work together to combine and interpret the signals from nearby rods and cones to form an image, such as "red stationary object." These "processed" signals then travel to the brain and are transformed into a visual image there. In addition to detecting light, the retina is actually also a neurological structure, like an extension of the optic nerve into the eye, when it combines signals from various rods and cones to produce part of an image.

We learned more about this from a paper Mark found online titled "Detection of Early Loss of Color Vision in Age-Related Macular Degeneration – With Emphasis on Drusen and Reticular Pseudodrusen."13 In addition to covering some of the information we heard from Joel, the paper said that the short yellow-blue (YB) cones are the fewest in number, comprising about 8% of the cones in the retina and less in the macula, ranging from a high of 5% across the outer parts of the macula to 0.5% in the center of the macula. Therefore, when macular degeneration patients are tested for color vision, as their vision worsens, they experience changes in yellow-blue color sensitivity first because the short cones are fewest in number, so the loss of just a few of them is more noticeable.

In this study, loss of yellow-blue color sensitivity preceded and was slightly greater than the loss of red-green (RG) color sensitivity. The patients with the highest loss of both yellow-blue and red-green color sensitivity were the most likely to have their disease progress rapidly to wet macular degeneration or to geographic atrophy, the advanced stage of dry macular degeneration.

In Mark's experience, as he was progressively regaining color vision with each IV he took, he noticed blue first after about three IVs. (Read about the long-owned but never noticed bright blue blouse here). His realization that yellow traffic lights, center-of-the-street lines and school busses were bright orange-ish yellow rather than pale lemon yellow came next after five IVs. Then he became able to see more subtle differences in color, such as that most car headlights emit the warm yellow-tinged light color of incandescent bulbs but than LED headlights look blue-ish white. He also began to recognize a very light beige or cream color in places which he thought were white before.

We think that his eyes may have contained some short cones that were struggling nutritionally and therefore not functioning well, but were still alive. As they received high levels of much-needed nutrients with each weekly IV, they became more functional. The body's ability to heal is amazing! His experience tells us that as long as there is life left in a cone or rod in the eye, there is hope for recovery of its function with intensive nutrition. Thus there is hope for improvement in vision.

1 Buettner, Helmut, MD, Editor in Chief. Mayo Clinic on Vision and Eye Health. (Rochester, MN: Mayo Clinic, 2002), 137.

2 https://www.brightfocus.org/macular/article/what-geographic-atrophy

3 Buettner, 139.

4 Buettner, 137.

5 Rose, Marc R., MD and Michael R. Rose, MD. Save Your Sight! Natural Ways to Prevent and Reverse Macular Degeneration. (New York, NY: Warner Books, 1998), 18; Heier, Jeffrey S., MD. 100 Questions and Answers About Macular Degeneration. (Boston, MA: Jones and Bartlett Publishers, 2011), 19; and Buettner, 142-143.

6 Buettner, 139.

7 Heier, 49, 64.

8 Buettner, 142.

9 Buettner, 141.

10 Rose and Rose, 56-57.

11 Buettner, 142 and Rose and Rose, 56-57.

12 Buettner, 142.

13 Vermala, Roopa, Sobha Sivaprasad and John L Barbur. "Detection of Early Loss of Color Vision in Age-Related Macular Degenration – With Emphasis on Drusen and Reticular Pseudodrusen." Investigative Ophthalmology & Visual Science. August 2017, Vol. 58, BIO247-BIO254.