As people age their vision also becomes compromised and I am seeing complaints of glaucoma and cataracts more often along with a few retinal detachments and macular degeneration. Preventive medicine is surely the best way to prevent age related visual changes and the following discussion is meant to have you consider improving the anti-oxidant portion of your “Health Insurance” program.

The most common complaint is cataracts and poor vision from cataracts affects 80% of people 75 years or older. In Canada, by the year 2015, it is predicted that one out of two Canadians will need cataract surgery on both eyes! Although considered to be simple surgery, it is in fact very delicate and complex surgery associated with some complications including: secondary glaucoma, detached retinas, corneal edema and other corneal damage, internal eye infections that can cause the complete loss of the eye. Twenty to thirty percent of people who have cataracts removed and replaced with artificial lenses develop clouding of the lens capsule which requires laser surgery to restore vision. The cells of the lens of the eye do not regenerate or turn over, but they do grow and as they grow they become less transparent to light creating the opacity of cataracts. Doctors don’t tell their patients about small changes to the lens that they can diagnose until the vision is no longer correctable using glasses.

The biggest cause of cataracts is ultraviolet radiation and thus the wide spread recommendation that sunglasses and wide brimmed hats be used to prevent this exposure. There is also a link between poor nutrition and cataracts. Diabetics are at the highest risk because high blood sugar levels increase oxidative stress and the process of glycation which is the binding of sugar molecules to a protein causing cross links that are inflexible and inhibit normal physiologic function. Glycation produces 50 times more free radicals that non glycated proteins and affects many other tissues in the body aside from the eyes including the brain. Glycation can occur in non diabetics who have insulin resistance ie high levels of blood sugars and triglycerides(TG) and a low level of HDL(good) cholesterol. Nutrients that protect against cataract formation include quercitin (found to slow cataract development in diabetics), N-acetyl-L-carnosine eye drops, glutathione (NAC and alpha lipoic acid increase glutathione in the eye), taurine, cysteine, vitamin C, A, E and riboflavin.

Vitamin C naturally exists in high concentrations in the aqueous humor of the eye ball and research indicates that those who consume high dosages of vitamin C orally will have more protection for their eyes.

B complex and riboflavin help to quench free radicals and regenerate glutathione and protect against common degenerative ocular disorders.

Vitamin A and Vitamin E decrease cataract risk and are required along with Vitamin C and E to regenerate glutathione. Consuming a low glycemic diet will lower the level glycation in the body preventing visual impairment.

Age-related Macular degeneration (AMD) is the leading cause of blindness in both men and women over the age of 55 and affects more people than glaucoma and cataracts combined.  The macula is the central part of the retina responsible for focusing central vision that is needed for fine detail, reading, driving and recognizing facial features. In this condition the macula deteriorates and although total blindness does not occur nor is color vision affected, functional vision is very often lost. There is little that can be done in conventional medicine to restore lost eyesight, but leading researchers are determining that lifestyle and nutritional changes can make a difference. These include exercise, improved nutrition by reducing saturated fats, improving glutathione status, taking lutein and zeaxanthin (the primary carotenoids concentrated in the macula), abstaining from smoking and protecting the eyes from sunlight. Eating dark leafy vegetables is associated with a 43% lower risk of macular degeneration. Other studies found that alpha-tocopherol or tocopherol combined with carotene and ascorbate are protective against AMD. Low levels of zinc increase risk of developing AMD. Carotenoids will reduce risk of AMD by 43% in those consuming the most.

Diabetic retinopathy is the most common form of diabetes eye condition and is caused by the oxidative damage of the retinal blood vessels and glycation. Insulin resistance can be detected long before the diagnosis of diabetes is made so it is imperative that people know their blood levels of glucose as well as the ratio of TG to HDL’s so that it can be treated before heart disease or diabetes develop. The above antioxidants are crucial for treatment along with gingko, acetyl-L- carnitine, bilberry, magnesium, P5P and proanthocyanidines (OPC’s including those bioflavinoids found in red wines, blueberries and grapes) which lower insulin resistance. Elevated homocysteine in the blood might be a risk factor for developing diabetic retinopathy. This is routinely checked on most of my patients over the age of 50. Quericitin is another bioflavinoid that reduces the incidence of diabetic cataracts.

Glaucoma results from a build up of pressure in the acqeous humor of the eye that pinches the blood vessels that feed the optic nerve, causing the nerve to die over time, leading to decreased peripheral vision, tunnel vision and finally blindess. Pressure build up may also cause optic nerve damage which can continue once the pressure has normalized so be sure that your optic nerve is checked as well. One out of 25 North Americans (mostly over the age of 40) have glaucoma which can lead to blindness. Causes include age related losses of anti-oxidants, increase physical stress on the eye and oxidative damage. Anti-oxidant therapy over a five year period can stabilize visual functions.

General Retinal Health: Anti-oxidants such as Vitamin C, E, carotenoids lutein and zeaxanthin are found in high concentrations in the retina. The highest food sources of lutein and zeaxanthin are egg yolk, corn, (lutein) orange peppers (zeaxanthin), dark green leafy vegetables (lutein). Selenium is a mineral that when combined with other anti-oxidants such as vitamin C and E will improve visual acuity. It is found in large amounts in the retina and lens of the eye. Night vision is improved with vitamin A and OPC supplementation.