Treating Macular Degeneration

A variety of treatments exist for macular degeneration. Retina specialists usually treat wet macular degeneration by injecting the eye with anti-VEGF (anti-vascular endothelial growth factor) drugs to stop leaking or bleeding from small blood vessels in or under the macula. Currently, the two most commonly used drugs are LucentisTM (ranibizumab) and AvastinTM (bevacizumab). AvastinTM was developed to treat colon cancer and is used off-label for macular degeneration. Therefore, it is much less expensive than other anti-VEGF drugs. The oldest drug, MacugenTM (Pegaptanib sodium), is rarely used because it is less effective than LucentisTM and AvastinTM.1 Newer drugs include EyleaTM (aflibercept) and OptheaTM (opt-302).

Anti-VEGF drugs do stop bleeding but because they do not prevent the growth of new abnormal blood vessels, patients need repeated injections. Blood vessels that have been clotted by the drug remain and may form scar tissue. When enough scar tissue forms, it can create a dark spot in the center of visual field.2 Other treatments for wet macular degeneration include photocoagulation and laser surgery.3

There are no conventional treatments for dry macular degeneration. The advice conventional eye doctors give to patients with the dry form is to eat kale or other dark green leafy vegetables, salmon and eggs and take an AREDSTM (Age-Related Eye Disease Study) supplement for eye health. This supplement is favored because large clinical trials were performed with it. Conventional eye doctors seem to consider all other eye supplements inferior because their makers could not afford to sponsor large trials.

The AREDS and AREDS2 clinical trials showed that about 25% of subjects with intermediate stage dry macular degeneration had slower progression of their disease to the advanced stage. The AREDSTM and AREDS2TM supplements did not prevent macular degeneration, slow progression from the early to the intermediate stage, or slow the progression of the advanced stage of the disease to legal blindness.4 When the results from the first AREDS study were analyzed by genotype, two genotypes comprising 31% of the study participants had a greater chance of progression than those taking the placebo.5 There was no benefit as a result of taking AREDSTM in these patients and the trend was towards harm.

In the AREDS2 study, the amount of zinc in the formula was reduced to 25 mg. The AREDS2 formula slowed the progression of intermediate stage macular degeneration to the advanced state in about 25% of patients (like the original AREDSTM supplement) but also lacked positive results for prevention of progression at other stages. In spite of the equal results with the lower amount of zinc, the amount of zinc in the formula was kept at 80 mg. Dr. Jeffery Anshel, OD, and Laura Stevens, MSci, co-authors of What You Must Know About Age-Related Macular Degeneration, feel that the lower dose of zinc is appropriate.6

The original AREDSTM supplement (Bausch & Lomb's PreservsionTM AREDS Eye Vitamin and Mineral Supplement which is still sold) contains 500 mg of vitamin C, 400 IU of vitamin E, 15 mg of beta-carotene, 80 mg of zinc, and 2 mg of copper. For the AREDS2 study, the beta-carotene was removed from the supplement and lutein and zeathanthin were added. The AREDS2TM supplement (Bausch & Lomb's PreservsionTM AREDS2 Eye Vitamin and Mineral Supplement) contains 500 mg of vitamin C, 400 IU of vitamin E, 80 mg of zinc, 2 mg of copper, 10 mg of lutein and 2 mg of zeaxanthin.7

In The Right Dose: How to Take Vitamins and Minerals Safely, Patricia Hausman, MS, discusses a study which measured the HDL "good" cholesterol levels of men who took 80 mg of zinc per day for five weeks. This higher-than-usual dose of zinc reduced their HDL levels by 25%. For individuals with macular degeneration, the goal is to protect small blood vessels in the eyes. Since HDL helps remove deposits from blood vessel walls, lowering the blood level of HDL would seem counterproductive for health of the blood vessels in the eyes.8

In The Eye Care Revolution, ophthalmologist Robert Abel, MD says that the high level of zinc in AREDSTM inhibits the absorption of calcium, magnesium, selenium, chromium, vanadium and other minerals needed by macular degeneration patients. He also states that the copper which is added to AREDSTM to balance the high level of zinc reduces the clearance of Alzheimer's disease-associated beta-amyloid in the brains of mice. The mice also exhibited a four-fold increase in abnormal capillaries in the brains. This indicates that excess copper may increase the risk of Alzheimer's disease.

At Mark's appointment with the retina specialist six month's after his diagnosis, the doctor told us about and gave him a sample of a new AREDS2 supplement, Systane I-CapsTM Chewable Eye Vitamin and Mineral Supplement AREDS2, which is made by Alcon/Novartis Pharmaceuticals. This supplement contains the reduced amount of zinc used in the AREDS2 study, 25 mg. It also contains 500 mg of vitamin C, 400 IU of vitamin E, 2 mg of copper, 10 mg of lutein and 2 mg of zeaxanthin.

In addition to the problems with the AREDSTM supplements mentioned above, there are a large number of nutrients that promote eye health but are not included in the AREDSTM supplements.9 Scroll down this page for the list of nutrients which ophthalmologists Marc and Michael Rose, MD recommend that their patients take. They say, "We're going to give you very detailed nutritional guidelines that we have seen prevent, halt, and sometimes even reverse the progress of macular degeneration… If you can commit to our Ten Steps to Restoring Vision and Vitality and the nutritional protocol for eye disease for at least nine months, you can almost certainly improve your vision. At the very least, you can keep it from getting worse."10

Nutritional treatments which are more complete than AREDSTM effectively address the causes of macular degeneration. Medical professionals such as naturopaths, who are specifically educated and trained to use nutritional methods, have much to offer for the treatment of macular degeneration – dietary advice, complete supplementation protocols and intravenous nutritional therapy. Since lack of nutrients reaching the retina is linked to the development of macular degeneration, comprehensive nutritional treatment actually addresses the underlying root problem rather than putting a temporary Band-AidTM on symptoms as the anti-VEGF drug injections do.

Two of the pioneers of nutritional therapy for macular degeneration were Jonathan Wright, MD, and Alan Gaby, MD. They developed the Occydyne and Occudyne IITM eye supplements based on their experiences treating patients and they also gave more advanced macular degeneration patients nutritional IVs. Dr. Wright's Tahoma Clinic claims 70% effectiveness for stabilizing vision and reducing further loss in those with dry macular degeneration. In some cases even gains in vision are made.11

In Save Your Sight!, ophthalmologists Marc and Michael Rose recommend that macular degeneration patients take daily oral supplements containing:

  • Vitamin C – 2000 mg
  • Vitamin A – 10,000 IU
  • Lutein – 6 to 10 mg12
  • Zeaxanthin – 0.3 to 1 mg12
  • Magnesium – 300 to 500 mg at bedtime
  • Fish oil – 1 teaspoon, should contain rosemary, etc. to prevent rancidity
  • Vitamin E – 800 IU
  • Selenium – 200 mg
  • N-acetyl cysteine – 500 mg, on an empty stomach 2 to 3 times per day
  • Taurine13 – 500 to 2000 mg between meals
  • Zinc – 15 to 30 mg
  • CoQ 10 – 30 to 200 mg

Additionally, macular degeneration patients should have a blood test for vitamin D levels. If the result is low, supplement with enough vitamin D3 to bring the blood level to 50 to 60 ng/ml and maintain it there.

Two other nutrients that have benefited eye health in recent years since the publication of Save Your Sight! are bilberry and astaxanthin. Bilberry contains anthocyanins, improves capillary fragility, is anti-inflammatory, is a powerful antioxidant, and improves insulin resistance in diabetics. The recommended dosage is 50 to 125 mg taken twice a day.14 For more about how the anthocyanins in bilberry and blueberries help insulin resistance, see the article cited below which is available online.15

Astaxanthin is the pigment that gives salmon its color. It is made by a species of algae called Haematococcus pluvialis which is consumed by krill, a microscopic crustacean, which is consumed by salmon. When choosing an astaxanthin supplement, look for one made from H. pluvialis because natural astaxanthin has significantly greater antioxidant capacity than if it is made in a laboratory from petrochemicals.16

Natural astaxanthin is the most powerful carotenoid antioxidant, is potently anti-inflammatory, crosses the blood-brain barrier and blood-retina barrier (making it especially helpful for macular degeneration), absorbs ultraviolet-B light (thus protecting the eyes from damage), and helps stabilize blood sugar, among other beneficial effects.17 Recommended dosages range from 2 to 12 mg/day.

The Occudyne IITM eye supplement that Mark takes contains most of the nutrients listed above and also includes B vitamins and trace minerals including boron, chromium, manganese, selenium and vanadium. Mark's naturopath said Occudyne IITM was a good eye supplement and all the nutrients were at safe levels but that it was not a substitute for a highly nutritious diet, so it should be taken in addition to making dietary changes. "Food is best," she says.

Mark's macular degeneration was diagnosed at the intermediate stage and his father went from diagnosis to being legally blind in a few months. Thus, in addition to excellent nutrition from food and supplements, he chose to have more assertive treatment with nutritional IVs. All potential problems with absorption are bypassed by the IVs and higher levels of nutrients than can be achieved by oral supplementation bathe the eyes with what they need effectively. The IV protocol he took is the most comprehensive of any I've seen. (Admittedly, I've only see descriptions of a few on the internet). It contains vitamin C, a multi-B vitamin complex, additional B-6 and B-12, magnesium, selenium, zinc, boron, copper, molybdenum, chromium, manganese, vanadium, lithium, strontium, and taurine.

Mark and I first heard about astaxanthin after he had completed treatment with nutritional IVs. He was very impressed with what he read, and I told him I could easily add it to his smoothies if he didn't want yet another supplement to swallow. Then I added it without mentioning it. On the fourth day after he consumed the first astaxanthin-containing smoothie, he saw something he had never before seen in the Magic EyeTM 3D image books he received as gifts several months previously. He discovered that the designs on the inside of the front and back covers of the books were also 3D images. He hadn't seen anything totally unexpected since the third month he took IVs so was wondering what changed. When I told him that I began adding astaxanthin to his smoothies a few days earlier, he was sure that was what made him able to see 3D much more easily. A week later, he looked at a Magic EyeTM image that is mostly shades of blue. He had never been able to make out a hidden object in this image before, but after about ten days of taking astaxanthin, an old Spanish sailing ship popped out at him. For more about all the improvements in vision he experienced, click here and here.

Nutritional treatment for macular degeneration may succeed after conventional treatment has failed. In Blind Faith18, John Crittenden tells of consecutively taking injections of three different anti-VEGF drugs monthly for a total of nineteen months with no improvement in his vision. In fact, during this time, he became legally blind. Then, with his ophthalmologist's blessing and with assistance from a naturopath, he researched and worked out a diet and supplement protocol that restored his vision from 20/400 to 20/80 in eleven weeks. Upon examining his eyes, his ophthalmologist told him that he had never seen that kind of regeneration before, and said, "Keep doing what you're doing. You may change some minds."

I realize that this book is only one man's experience, but given a choice between legal blindness if you live long enough and making nutritional changes, does it not seem that nutritional treatment is worth a try?

Click here to read more about how to implement nutritional changes and additional ways to help yourself.

1 Anshel, Jeffrey, OD and Laura Stevens, M. Sci. What You Must Know About Age-Related Macular Degeneration. (Garden City Park, NY: Square One Publishers, 2018), 25.

2 Buettner, Helmut, MD, Editor in Chief. Mayo Clinic on Vision and Eye Health. (Rochester, MN: Mayo Clinic, 2002), 142

3 Buettner, 145-146 and Anshel and Stevens, 145-146.

4 Heier, Jeffrey S., MD. 100 Questions and Answers About Macular Degeneration. (Boston, MA: Jones and Bartlett Publishers, 2011), 40-41.

5 Anshel and Stevens, 59 and "AREDS Eye Supplements: Helpful or Harmful?"

6 Anshel and Stevens, 59.

7 Anshel and Stevens, 55, 57.

8 Hausman, Patricia MS. The Right Dose: How to Take Vitamins and Minerals Safely. (New York, NY: Ballantine Books, 1987), 390.

9 Abel, Robert, Jr. MD. The Eye Care Revolution: Prevent and Reverse Common Vision Problems. (New York, NY: Kensington Publishing Corp., 1999, 2014), 187 and Anshel and Stevens, 65.

10 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), xiii.

11 and

12 Lutein and zeaxanthin are pigments that protect the macula.

13 Taurine is for blood vessel health. Take it separately from N-acetyl cysteine

14 Anshel and Stevens, 72-73 and Bornsek, SM, L ziburna, et al. "Bilberry and blueberry anthocyanins act as powerful intracellular antioxidants in mammalian cells." Food Chemistry, 2012 Oct 15;134(4):1878-84. doi: 10.1016/j.foodchem.2012.03.092. Epub 2012 Mar 30. The article may be requested here: 235739688_Bilberry_and_blueberry_anthocyanins_act_as_powerful_ intracellular_antioxidants_in_mammalian_cells

15 Stull, April J. "Blueberries' Impact on Insulin Resistance and Glucose Intolerance." Antioxidants. 2016 Dec; 5(4): 44. (full text article)

16 Shah, Mahfuzur, Yuanmel Liang, et al. "Astaxanthin-Producing Green Microalga Haematococcus pluvialis: From Single Cell to High Value Commercial Products." Frontiers in Plant Science, 2016; 7: 531.Published online 2016 Apr 28.

17 Mercola, Joseph, DO. "Astaxanthin: The Most Powerful Nutrient Ever Discovered for Eye Health." November 23, 2010.

18 Crittenden, John. Blind Faith. (2014).