Age-related macular degeneration—AMD—is the most commonly diagnosed eye disorder in people over fifty. Well over two million Americans have been told they have AMD, and that number is expected to grow substantially. While this is a frightening statistic, over the last several years, medical researchers have shown that a number of effective treatments can slow, stop, and even reverse the progress of AMD. Now, best-selling authors Dr. Jeffrey Anshel and Laura Stevens, who herself has been diagnosed with this condition, have joined forces to produce an up-to-date guide to what you need to know to combat and even prevent AMD.
The book is divided into four parts. Part One explains how the eye works and how AMD develops, in both its wet and its dry forms. It then looks at the most common risk factors and explains how each of these factors negatively affects the structures of the eye. In Part Two, the authors look at the specific nutrients that affect the various cells of the eye. Included is a discussion of AREDS—the National Eye Institute’s study that showed which supplements help protect the eye from disease. Part Three offers an additional weapon against AMD. It explains why diet matters and offers advice on selecting foods that promote eye health while eliminating those that do the most damage. Part Four provides practical suggestions and easy-to-follow tips on how to incorporate this valuable information into your life.
If AMD runs in your family or you have been diagnosed with this potentially life-altering condition, it is important to know that there is not only hope, but a real path to a better, healthier life. Knowledge is power, and the more you know, the more likely you are to avoid the consequences of AMD. Let What You Must Know About Age-Related Macular Degeneration help you safeguard one of your most precious gifts—eyesight.
Laura J. Stevens, MSci, received her master’s degree in nutrition science from Purdue University in West Lafayette, Indiana. Since graduation, she has worked at Purdue as a researcher, investigating the relationship between diet and health disorders. Apart from her work at Purdue, Laura is the author of eight books on diet, behavior, and allergies. Laura lives with her amazing cats, Bentley and Seis, in Lafayette, Indiana.
Jeffrey Anshel, OD, FAAO, received his Bachelor of Science in Visual Science and his Doctorate of Optometry from the Illinois College of Optometry. After serving as a Navy optometrist, he worked at a clinic with other healing practitioners, where he learned about the role of nutrition in eye health. He also developed the “20-20-20” rule for easing computer-related eyestrain. Dr. Anshel is the founder and former president of the Ocular Wellness and Nutrition Society, and the current president of Corporate Vision Counseling. He is now based in Hawaii.
The Basics of Macular Degeneration
1. How Your Eyes Work
2. What Is Age-Related Macular Degeneration?
3. What Are the Risk Factors for Macular Degeneration?
4. Metabolic Syndrome
Macular Degeneration and Supplements
5. The AREDS Trials
6. Plant-Based Supplements
7. Nutrients for Eye Health
Macular Degeneration and Your Diet
8. What Not to Put on Your Plate
9. What Makes a Food Healthy?
10. Choosing Foods to Put on Your Plate
11. Putting Your Anti-AMD Diet Into Action
Living Successfully with Macular Degeneration
12. Addressing Lifestyle Risk Factors
13. Tools for Living with AMD
My first experience with age-related macular degeneration occurred when my mother struggled with the disorder. Although she never complained and tried to pretend that she wasn’t losing her sight, it eventually became apparent that she was. Once, my family and I were visiting her and my father, and we planned to watch a televised horse race together. Before she joined us in the living room, we watched the end of a TV medical drama. When my mother walked into the room, she stared at the four doctors in white uniforms on the screen and said, “Oh, there are the horses!” It was then we realized the severity of her vision issues. When she couldn’t read menus in restaurants, she just ordered whatever my father ordered. AMD was greatly affecting her life.
Years later, I began to regularly visit a lady in a nursing home as part of my church’s outreach ministry. When I first met the lady, I asked her how she was, and she grimly replied, “I sit, I eat, I sleep!” My friend had advanced AMD and could see only my shoes and socks with any clarity. She was in the nursing facility because her impaired vision prevented her from caring for herself, and now, because of her disability, she could not participate in most of the facility’s activities. For both my mother and my friend, AMD was a game changer.
Four years ago, I was diagnosed with AMD by an ophthalmologist in Lafayette, Indiana. He said that other than taking the AREDS2 formula—the over-the-counter vitamin supplement carried in all drugstores—I should use UV- and blue light-resistant sunglasses outdoors and follow a “nutritious diet,” which he did not explain further. There was nothing else I could do.
I’m a fighter, and I couldn’t sit around and wait for my vision to decline as I had watched my mother’s and friend’s vision worsen over time. Instead, I saw an expert, an internationally known ophthalmologist in Indianapolis. He diagnosed “familial drusen” in my left eye—the right eye was not affected—and said that the condition might not progress at all. However, a year later, I noticed that my vision was worsening and I went to see him again. This time, he diagnosed AMD in both eyes. Although he worked part-time for a pharmaceutical company, where he hoped to develop treatments for AMD, he was very discouraging about the available options. All I could do was take AREDS, eat a nutritious diet, and wear sunglasses—which I was already doing. I asked about other nutrients and any future drugs in the pipeline. He said, “No other nutrients have been found to be helpful. There are no promising drugs on the immediate horizon. I’m sorry!”
Needless to say, I was scared. I was not, however, ready to accept an inevitable decline in function. In the middle 1990s, I had received my master’s degree in Nutrition Science from Purdue University, and since that time, I had worked as a research associate there. I knew how to search medical literature, and because of my education in biochemistry and nutrition, I could read and understand the articles I found. So I turned my attention to learning if any nutrients other than those used in the AREDS study showed promise. Surprisingly, I found quite a few studies in which additional nutrients had not only slowed the development of AMD, but actually improved vision. I was excited!
At about the same time, my doctor in New York City, whom I had seen since 1986 for chronic fatigue syndrome, urged me to consult an herbalist. Soon, I began to learn more about herbal supplements for both my fatigue and my vision. We started to try various preparations, and I was thrilled when the vision in my left eye began to function better. I bought an eye chart so that I could track my vision and note improvements or setbacks. Every day, I also checked my Amsler Grid (see page 23) as instructed by my doctor. Maybe the scientist in me led me to document my progress.
I was hoping that my regimen of supplements would at least allow me to maintain my vision, but it did even more. When I started, I could read the top two lines of the eye chart with my left eye wearing my glasses. Over a period of several months, I began to read more and more letters. I was so excited by the articles I had read and my own personal experience that I decided to write this book. I wanted others to know that there are many things they can do to save their vision. I hope that the lifestyle changes I share in these pages—including my supplement regimen and the Anti-AMD Diet—will help my readers just as they have helped me.
As a third-year optometry school student in the 1970s, I recall sitting in a class on eye disease. This particular class dealt with the retina and its problems, and the current topic was “drusen,” which we see as yellowish-white spots scattered around the retina. The professor’s comment was that these were “thickening of the membrane behind the retina.” He also concluded that they were common in older patients and that there was no harm in seeing them occasionally.
Fast-forward a few years to my time in the Navy. When examining retired military personnel, I saw patients lose vision associated with the development of drusen in the center of the retina. While we knew about “age-related macular degeneration,” we had no idea about the development or course of the disease. All we knew is that it was more common as people aged and it resulted in functional blindness.
Following my Navy service, I started a practice in a holistic healing center near San Diego. It was there that I was exposed to the fields of chiropractic, acupuncture, colonic hydrotherapy, meditation, massage, and a number of other alternative medical therapies. The one thing that all of these practitioners had in common was their inclusion of nutrition as part of treatment. They all valued nutrition—everyone except me, that is.
I felt that I had received a well-rounded education in optometry school—mine was considered one of the oldest and best schools in the country—but there had been no mention of nutrition at any level. Thus, influenced by other practitioners, I began an independent study of nutrition and eye health. In the beginning, I would tell people that I emphasized nutrition for vision, and their response was, “What, just eat carrots, right?” Apparently, I had a lot of work to do to educate the public about the importance of a good diet.
Unfortunately, at that time, there had not been much research into eye nutrition. People did not realize that the eyes are an integral part of the body—especially, the brain. My work centered on the connection of nutrition to basic human physiology. In other words, if something was good for a particular body function, it was likely good for the eyes, as well. While I tried to convey these concepts to local practitioners and my patients, there was still no national exposure to these concepts.
That changed in 2001, when a study from the National Eye Institute showed that a few nutrients (specifically, antioxidants and zinc) slowed the progression of macular degeneration. This began the public’s acceptance of nutrition as a potential treatment for eye disorders. At the time, I became acquainted with the CEO of an eye supplement company, who dedicated her life to teaching eye-care professionals about various eye conditions and how they could be resolved through nutritional means. I soon realized that although the treatment of eye disorders through supplements was important, eye-care professionals were now receiving information that was filtered through supplement manufacturers and was typically skewed to support their particular products. I discussed this concern with a few colleagues, and we decided to form the Ocular Nutrition Society (ONS). The mission of the ONS was to provide leadership, education, advice, and guidance to eye-care and other health care professionals and consumers regarding the role of nutritional support in vision and eye health. The ONS supported evidence-based analysis concerning nutritional influences on eyes and systemic disease.
For six years, I devoted my time to the ONS and saw the eye-care field—including both ophthalmology and, to a larger degree, optometry—begin to learn about the use of nutrition and nutritional supplements to support both eye health and general well-being. I then decided to get back to my roots as a practitioner. Relocating my practice to my home town, I directed my energy toward treating patients on a personal level. My focus remains on nutrition, and I have been rewarded by seeing the difference I can make in the lives (and eyesight) of my patients. It is my hope that my coauthor, Laura Stevens, and I can offer our readers insight, guidance, and encouragement as they work to maintain their eyesight through proven dietary and lifestyle modifications.
As far back as Hippocrates, who advised “Let food be thy medicine,” health experts have known that diet can have a great influence on physical well-being. But for a long time, most people—doctors included—did not view nutrition as being a critical element in the maintenance of good vision. That changed in 2001, when results of the Age-Related Eye Disease Study (AREDS) were published, clearly demonstrating that selected nutrients can slow the progression of age-related macular degeneration (AMD), the leading cause of vision loss in people age fifty and over. This research and the follow-up study, known as AREDS2, convinced a great many eye-care providers and their patients that supplements can improve eye health.
Although the AREDS2 formula was found to slow the progression of age-related macular degeneration, it was not found to prevent, stop, or reverse AMD, nor did it help people in the earliest stages of the disease. So when author Laura Stevens was diagnosed with this disorder, she was told by her doctor that other than taking the AREDS formula and wearing eye-protective sunglasses, there was nothing she could do to change AMD’s course. Fortunately, Laura, a medical researcher at Purdue University, refused to stand by helplessly as her vision declined. Instead, she searched medical literature for studies that explored the relationship between nutrition and macular degeneration. She soon found that additional nutrients could not only slow the development of this disorder but actually improve vision. The idea for this book was born when Laura’s nutritional supplement regimen, enhanced diet, and other lifestyle changes began to bear fruit, and Laura realized that she was experiencing better vision and greater eye health.
Written by Laura Stevens and Jeffrey Anshel, a doctor of optometry, What You Must Know About Age-Related Macular Degeneration guides you in using nutritional supplements, diet, and lifestyle modifications such as exercise to help prevent, halt, or even reverse the progression of AMD. The book is based on the most recent scientific research and is supported by Laura’s real-life endeavor to treat her own AMD and Jeffrey’s years of experience helping patients manage eye disorders through both conventional and alternative means.
Part One of this book focuses on understanding the basics of vision and macular degeneration. Chapter 1 begins by explaining the anatomy of the eye and how the different structures work together to allow you to see an image. Included is a look at the eye structures that are specifically affected by macular degeneration.
Chapter 2 takes a close look at AMD—what it is, how it can start, and how it can progress. The chapter also discusses how AMD is diagnosed, monitored, and treated by both conventional and alternative medicine, providing the knowledge you need to better communicate with your doctor and make informed decisions about treatment.
Extensive studies have revealed the risk factors—including environmental, genetic, and lifestyle-related elements—that play a role in the development of AMD. Although some of these variables, such as age and gender, cannot be changed, you’ll find that a number can (and should) be modified, enabling you to take steps to safeguard and even improve your vision. Chapter 3 explores these risk factors, while Chapter 4 focuses on one of the most common of these factors, metabolic syndrome.
As you know, the AREDS study proved that nutritional supplements are effective in the treatment of AMD. Just as important, research has shown that additional supplements can have an impact on eye health. Part Two focuses on the important topic of AMD and supplementation.
Chapter 5 looks at the AREDS trials, which provided the clinical evidence that specific supplements help protect the eyes from AMD. The nutritional approach based on the AREDS formula is now the most widely accepted means of combating this disorder.
Chapter 6 focuses on supplements that are derived from plants. Included are botanical preparations that have been specifically shown to prevent, slow, or reverse AMD, as well as plant-based supplements that have properties which can improve eye health. In addition to the discussions of specific supplements, this chapter provides basic information about the different forms in which herbal preparations can be found and guides you in using them wisely and effectively.
Chapter 7, which concludes Part Two, provides a comprehensive examination of the many vitamins, minerals, essential fatty acids, and other nutrients that you need to protect your eyes, and especially your retina. A handy table details recommended dosage as well as important considerations for usage.
Research conducted all over the world has indicated that, in addition to key nutritional supplements, a good diet is essential to eye health, just as it is essential to good health in general. The important topic of macular degeneration and your diet is explored in Part Three.
The standard Western diet is packed with foods that promote hardening of the arteries, heart disease, diabetes, and other conditions that contribute to age-related macular degeneration. Clearly, it is important to avoid the foods that are known to damage the human body. With a focus on macular degeneration and the conditions associated with it, Chapter 8 begins the discussion of diet by clearly explaining what you should not put on your plate. Here, you’ll learn about the foods that can compromise your health so that you can either avoid them or greatly limit their use as a means of protecting your vision.
What makes a food healthy? That is the subject of Chapter 9, which begins our exploration of healthier foods by looking at the dietary components—fiber, protein, and more—that play a crucial role in maintaining vision.
Once you have learned about the nutritional components that are important for eye health, you’re ready to learn about the delicious foods that contain these nutrients. Chapter 10 provides informative discussions about the many foods that should have an important place in your Anti-AMD Diet.
By the end of Chapter 10, you will know all the basics of an eye-healthy diet, but you still may wonder how you can put these dietary principles into practice. Chapter 11 shows the way by first reviewing the fundamentals of an eye-healthy diet, and then offering a number of sample menus that take the guesswork out of creating wholesome meals and snacks. Included are invaluable tips for dining out so that you can enjoy nourishing, health-promoting meals even when you’re away from home.
Although diet and nutritional supplements are essential to fighting macular degeneration, there are other steps you can take to lower your risk of AMD. That’s why Part Four begins with a chapter that explores the simple lifestyle modifications—such as quitting smoking, getting regular exercise, and protecting your eyes from damaging blue light—that can help you avoid or slow AMD. Finally, for those readers who are already affected by macular degeneration, the last chapter of the book is a guide to the many tools that can help you make the most of the vision that remains. Armed with the right devices and techniques, even people with advanced AMD can often participate in those activities that they need to perform as well as those that provide enjoyment.
Everyone has the ability to lead a healthier life, and this book looks at the simple steps you can take to safeguard your eye health, halt or reverse the progression of age-related macular degeneration, and maybe even improve your overall well-being. Just remember that Rome wasn’t built in a day, and neither is an eye-protective lifestyle. Over time, the small changes that you begin to implement today will pay off. There is no more important investment than the investment you make in your health.
"Very professionally written, yet the science is well within the scope of the generally knowledgeable reader . . . a medical book packed with sound and readable advice about an important topic. Your eyes age along with all other body parts and it is possible to reduce the pace of that process, something that you will learn how to do from this book."