Age-related Macular Degeneration (AMD)

What is Age-related Macular Degeneration (AMD or ARMD) and how do you recognise it?

AMD is a major cause of severe visual impairment and can occur as early as age 50. It affects the eye and is the result of damage to the macula, the central, highly-sensitive portion of the retina which provides clear vision. Those affected notice a central blurred spot and visual distortion e.g. straight lines suddenly appear bent or
wavy.

There are two forms of AMD

Dry AMD
The more common form of AMD affects 85 % of patients. Small deposits, so-called drusen, appear on the retina and can beidentified on the back of the eye by an ophthalmologist examiningthrough the dilated pupil.
In its early stages, the condition generally goes unnoticed by thepatient. It develops slowly and, over the course of years, leads to areduction in the function of photoreceptors which the patient notices as an increasing deterioration of their vision.

Currently, there is no medication to treat dry AMD. To prevent occurrence of the condition, doctors recommend a healthy, balanced diet and possibly intake of food supplements containing particular nutrients and vitamins.

Wet AMD

This less common form of macular degeneration occurs when abnormal blood vessels with fragile walls grow into the retina. Liquid and blood leak from these abnormal vessels leading to a generally rapid deterioration in vision. Patients see their environment, for example faces, as blurred and distorted. Straight lines are bent, numbers and letters look like strange symbols. When reading, patients often do not see individual letters or words.

Wet AMD is treated with modern medication including injections directly into the vitreous body of the eye, carried out at intervals of several weeks. These quickly stop development of the condition and generally lead to an improvement in the impaired vision.

Dry AMD develops slowly and presents as increasing loss of vision. This can change into the wet form of AMD which can lead to blindness.

Since AMD does not cause pain, it is often only detected at an advanced stage. As a result, from the age of 50 you should have regular examinations by an ophthalmologist.

What are the known risk factors for developing AMD?
• Smoking
• Exposure to strong sunlight
• Age
• Family history
• Eye-colour: blue eyes
• High blood pressure
• Unbalanced diet and overweight / obesity
• Gender: female 
• Elevated level of homocysteine

How can you lower the risk?
Extensive long-term studies with thousands of patients in the USA (AREDS 1&2) evidenced the positive effect of minerals such as zinc and copper, vitamins C and E as well as Lutein and Zeaxanthin. Additionally, the benefits of B vitamins (B1, B2, B6, B12) and Vitamin D were also established in large-scale studies.
Experts receommend this lack of nutrients should be addressed and a normal nutrient level maintained by augmentation with a combination of the right nutrients.

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Diabetic Retinopathy (DR)

What is Diabetic Retinopathy (DR) and how do you recognise it?

DR is an eye-disease caused by diabetes (type 1 and 2) and characterised by damage of the vessel (non-proliferative retinopathy) and by the growth of abnormal vessels in the retina and vitreous (proliferative retinopathy). These vessels have fragile vascular walls which results in bleeding. Blood leaking into the vitreous cause a sudden and drastic deterioration of vision and can progress to total loss of sight.

Among diabetics, the risk of developing this disease of the retina is very high. For a patient with diabetes mellitus for twenty years, the risk is approximately 90 %.

As a specific form of DR, Diabetic Maculopathy occurs when the macula, the central, highly-sensitive portion of the retina which provides clear vision is damaged. This leads to a progressive loss of visual acuity resulting in the inability to read and to drive a car. Inadequate blood supply can damage the macula during early stages of the disease. Maculopathy is the most frequent cause of severe loss of eyesight and can occur at any stage of the disease.

What are the known risk factors developing DR?

• Smoking
• Age
• High blood pressure
• Unbalanced diet and overweight / obesity
• Elevated level of homocysteine
• Hyperglycemia
• Longer diabetes duration
• Cholesterol values

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Glaucoma

What is glaucoma and how do you recognise it?

Glaucoma includes a number of eye diseases with different causes which can lead to damage to the optic nerve. Glaucoma develops slowly and displays no symptoms for a lengthy period. It can be caused by increased internal eye pressure (open-angle glaucoma), low/high blood pressure or impaired vascular function. There are also types of glaucoma without increased internal eye pressure (normal tension glaucoma). Glaucoma which remains undetected can lead to reduced visual function, long-term vision problems, visual field loss and even blindness.

The optic nerve is supplied with blood via a network of very delicate blood vessels. A number of factors can lead to reduced blood supply to the optic nerve.

Increased internal eye pressure can damage the retina as well as the optic nerve, leading to visual field impairment.

The risk of glaucoma increases with age, genetic predisposition, large fluctuations in blood pressure, diabetes, smoking and severe short-sightedness (myopia) and long-sightedness (hyperopia). Since glaucoma can remain undetected for a long time and cause irreparable damage, those aged 40 and above should undergo regular examinations by an optician.

What are the known risk factors developing a glaucoma?

• Age
• Family history
• Smoking
• Elevated inner ocular pressure
• Diabetes
• High myopia (open angle glaucoma)
• Low fluctuating blood pressure (low pressure glaucoma)
• High farsightedness (narrow angle glaucoma)

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The eye

The eye is a very important sensory organ since almost half of all sensory impressions are visual. The eye comprises the eye-ball and a number of elements which anchor or move the eye or provide moisture. The eye-ball itself consists of several layers, with the innermost, the retina, being composed of millions of photoreceptors (cones which enable colour vision and rods for black and white) which are light-sensitive “receivers”. Reflecting the high volume of sensory impressions we receive, the eye needs to perform well at all times. In order to achieve high performance levels, significant supplies of energy and oxygen are required, which is why the eye is the organ with the best supply of blood. The retina in particular can only remain healthy and maintain its function if it constantly receives a sufficient quantity of blood, which supplies micronutrients to the eye. This requires the micronutrients to pass through a barrier (the blood-retina barrier) in order to penetrate the inner part of the eye and to reach the light-sensitive receptors (photoreceptors and nerve cells) located there.

As part of the process of maintaining eyesight, the light-sensitive cells need to be continually renewed. Light triggers an oxidative process in light-sensitive cells, however. Dead eye-cells need to be removed and replaced by new ones. Factors which impact the equilibrium of the oxidative loss of cells and the supply of anti-oxidative nutrients include the process of seeing, exposure to uv light, ageing, an unbalanced diet and changes in metabolism. The result is oxidative stress.

The ageing process has particular impact of the supply of nutrients to cells in the eyes. As a result, even in cases where a balanced, healthy diet is consumed, it can make sense to supplement this with the specific micronutrients required to maintain good vision.

Eyes which are well-supplied with micronutrients stay healthy.

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