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Eating Fish and Omega-3's Lower ARMD Risk in Women

Omega 3 Fatty Acids and Fish Reduce Eye Disease


Eating fish and other sources of omega-3 fatty acids may lower the risk of developing macular degeneration in women.  A new study reports a lower incidence of AMD in those eating one serving of fish per week compared to those who did not.

Omega 3 May Reduce Eye Disease

The study was to evaluate the potential benefits of eating fish and certain fatty acids with the development of the disease in women.  The analysis was performed on the data collected from the Women’s Health Study.  This study included almost 40,000 women all of whom were health professionals.

The participants all completed a questionnaire regarding dietary habits and then followed for about 10 years looking to see who might develop the disease.  The initial screening involved self-reporting.

One Serving of Fish Per Week May Reduce Eye Disease

The results indicate that eating just one serving of fish per week decreases the chances of developing ARMD compared to those who do not.  There was a bias to those eating canned tuna fish and dark-meat fish.

What Does This Mean? This is great circumstantial evidence that omega-3 fatty acids  may prevent macular degeneration…at least in women.  While not proven, it does support other similar studies indicating a possible association omega-3 FA’s and fish consumption.

Foods containing these fatty acids include “cold water” fish and nuts.

AREDS 2 is presently underway and should conclusively answer if omega-3 FA’s prevent macular degeneration.  The study concludes in a few years.  This is a prospective and randomized study.  The study is also specifically designed to examine the benefits of omega-3’s.

In contrast, this study reported in the Archives of Ophthalmology is really more the result of a questionnaire, was not truly random (all participants were women and also health professionals) and was retrospective.  While there is some value to these sorts of studies, the strongest evidence is taken from studies designed like AREDS2.


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Who Gets Macular Degeneration?

Risk Factors for Macular Degeneration, Retina Eye Doctor

Macular degeneration, also known as ARMD, is a retinal disease that typically affects both eyes.  It is not a disease that has typical inheritance patterns, yet there is a racial bias for developing the disease.   Also, certain habits, such as smoking, seem to increase the risk.

Are you at risk for developing the disease?

Northern European Ancestry

Typically, patients of northern European heritage, aka Caucasians, develop more macular degeneration compared to blacks or Asians.  Most of my patients with dry macular degeneration are usually Caucasian.  The blacks and Asians that I diagnose with ARMD usually have the wet form.  Again, this is in my practice.

Patients with Blue Eyes

Originally, patients with blue eyes were deemed at higher risk.  While there may be a statistical association, I think it’s also possible that those individuals with the lightest complexion have blue eyes, too.

Smoking Must be Bad for Your Eyes

There is definitely an association with the wet form of macular degeneration and smoking, especially in Caucasian patients.  We don’t know; however, the exact cause (i.e. how does smoking cause the disease?).

Younger Patients Don’t Get the Disease

I hesitate to make the diagnosis of ARMD in patients younger than 55.  Patients younger than 55 can get macular disease, but it may behave differently than typical ARMD.

Patients with Drusen

I get questions all the time about drusen and the risk for developing eye disease.  Drusen can be normal.  Not all drusen constitute the diagnosis of macular degeneration.

Twins and Siblings of Affected Patients?

More than anything, as an observer, I don’t feel that the eye disease runs in families, that is, it doesn’t follow usual inheritance patterns.  It is quite possible for you to contract the disease, but your twin does not.  Just because your mom or dad had the disease doesn’t mean you’ll get it.

What Does This Mean? Someday we’ll find that “macular degeneration” is actually a collection of diseases that look and behave similarly, but for now we are unable to distinguish between them.  Thus, it is difficult to characterize the disease.

There does seem to be certain risk factors that make us more susceptible to developing ARMD.  Certainly if smoking were the only risk factor, the disease would be more evenly dispersed amoung races, that is, the disease would be similar to the prevalence of smoking in a particular race.  Clearly, this is not the case, so there must be a risk factor for developing the disease if we smoke.

There must also be, but yet to be proven, a protective effect of diet.  We’ll see with AREDS II.

For now, we think we’ve identified those attributes that increase our risk for macular degeneration.  Until we can predict who will develop the disease, get regular dilated eye exams if you are concerned.

The disease may not be truly inherited, but the risk factors might be.

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Benefits of Omega 3 to Our Vision

(Today’s post is contributed by Leslie Degner, RN, BSN.  Her website is focused on Macular Degeneration.  Thank you Leslie for sharing this information on Fatty Acids.)

Fatty acids may improve macular degeneration.  The importance of omega-3 fatty acids for a healthy brain are well known. But you may not know that these essential fatty acids (EFAs) may benefit our vision as well. These fats are called essential fatty acids because without them we die and if we are deficient in them we suffer from inflammatory and degenerative diseases.

Because the human body does not have the ability to make these fatty acids, we must get these healthy fats from our diet or fish oil tablets or supplements. The three main types of omega-3 fatty acids are :

√ docosahexaenoic acid (DHA)

√ eicosapentaenoic acid (EPA)

√ alpha-linolenic acid (ALA)

Docosahexaenoic Acid (DHA) is an essential nutrient and a type of omega-3 fatty acid that has been studied for its role in brain, heart and eye health. Although it is found in most tissues throughout the body, the highest concentrations of DHA are in:

1) the brain,

2) the nervous system and

3) the retina.

Both DHA and EPA are long-chain fatty acids that protect against oxidative, inflammatory and age-related degenerative changes. These three damaging processes result in the development of age related macular degeneration..

Several studies have shown the correlation between omega 3 fatty acid consumption and the risk of macular degeneration. Increasing the amount of oily fish, such as salmon and mackerel, consumption to just 2 servings per week can reduce the risk of macular degeneration.

Researchers from Australia and Singapore published a study entitled, “Dietary Omega-3 Fatty Acid and Fish Intake in the Primary Prevention of Age-Related Macular Degeneration: A Systematic Review and Meta-analysis.” This meta-analysis consisted of a mathematical evaluation of the results from nine previous studies of nearly 89,000 people, of which more than 3000 developed macular degeneration.

The authors found that high dietary intake of fish oils was associated with a 38% reduction in the risk of late macular degeneration. Furthermore, people who ate fish twice weekly not only reduced their risk of late AMD, but also early AMD (soft drusen or retinal pigmentary changes).

Because of their apparent benefits, the National Eye Institute is currently performing the Age Related Eye Disease Study 2, which is looking at the benefit of supplementing with fish oil, and with the antioxidants lutein and zeaxanthin.

In the next article we will look at how to include fish oil in your diet through food and/or supplements.

Leslie Degner, RN, BSN

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Prevent Vision Loss from Macular Degeneration

Vision loss from macular degeneration increases as we age.  This means that more and more people may lose vision as the population (baby boomers) get older due to ARMD (Age Related Macular Degeneration).  There are lots of recommendations on the Internet that just don’t make sense.  Here are a few practical recommendations and tips about ARMD, prevent vision loss and preserve your retina.

There are Two Types of ARMD

There are two classifications of macular degeneration, so-called “dry” and “wet.”.  They have many similarities, yet differ, principally, in two ways.  First, the “wet” ARMD is defined by the presence of leaky, abnormal blood vessels.  The presence of “neovascularization” (aka choroidal neovascularization) causes a more rapid change, or decrease, in vision.

Most cases of macular degeneration affect both eyes and are of the “dry” type.  The dry form changes vision loss much more slowly than the more aggressive “wet” form and accounts for about 90% of patients.

Both types can cause blurring of the central vision, formation of dark/grey areas in the vision and distortion.  Neither affects the peripheral, or side, vision.

There is No Cure for Macular Degeneration

Unfortunately, despite what you read, there is no cure for either type of ARMD (Age Related Macular Degeneration).  Intraocular injections are a treatment only for the “wet” form of the disease.  It is only a treatment and not a cure.

At present, there is nothing to do for dry ARMD, although you will hear the contrary with regard to vitamins and other supplements.

Only one NIH study has confirmed evidence that vitamins have a role in macular degeneration.  That role, is NOT curative, but may prevent patients with high and intermediate risk factors from experiencing severe vision loss from macular degeneration. The AREDS 1 study was completed over ten years ago.  AREDS 2 is underway.

There is no other indication, or reason, to take vitamins or other supplements.

Most ARMD is NOT Inherited

The term macular degeneration is probably a huge “waste basket” of terms, that is, we will probably learn that ARMD is a collection of different diseases that have similar characteristics and behaviors.   While there are cases of disease that have been found to run in certain areas or families, for the most part, macular degeneration is not passed on.

Regular Examination Prevents Vision Loss

The best way to look for macular degeneration is to have your pupils dilated by your doctor.  This will allow direct examination of the retina.  He or she does not have to be a retina specialist, but you should be referred to one if your exam raises any concerns or suspicions.

A retina specialist, with the aid of a fluorescein angiogram and OCT, may be able to confirm the diagnosis.  Remember, there can be several causes for whatever symptoms that concern you.

Monitor Your Own Vision

Self-monitoring of your vision is probably the best thing you can do for yourself.  Once diagnosed with ARMD, daily use of an Amsler grid or similar device, can help identify any changes that may need to be treated early.

The idea of self-monitoring is to catch any sudden, sustained, change in vision, including distortion, as early as possible.  You should alert your doctor of any changes.

What Does This Mean? There is a lot of “misinformation” regarding macular degeneration.  There are many ways that patients can help themselves including early examination and understanding that there are few, if any, supplements to help with the disease.

Don’t get hung up on seeing a retina specialist off the bat.  If there are concerns regarding your vision, see your eye doctor for a complete examination of your retina for macular degeneration.  There are many reasons you may have changes in your vision.

Just because a family member does have macular degeneration does not mean that you, too, have the disease.  Get examined and have your eye doctor, or retina specialist, confirm the presence, or absence, of the disease.

Lastly, sustained changes in your vision usually don’t go away by themselves.  Get tested!

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What Vitamins Prevent Macular Degeneration?

We’ve talked about this many times. Most people with macular degeneration do not need to be taking vitamins for macular degeneration. Whether the vitamins contain β-carotene, zeaxanthin or lutein, most people just don’t need to be taking them.

There is lots of anecdotal evidence that certain elements, such as β-carotene, zeaxanthin and lutein may be helpful, and indeed these specific questions are under study.  Read more about AREDS 1 and AREDS 2.  According to the AREDS1 study, very few people need to be taking these supplements.

Who DOES Need Vitamins? The only group of patients that “require” vitamins are those with “high or intermediate risk” wet macular degeneration.

  • Intermediate Risk – patients with either “intermediate” macaular degeneration in either eye.
  • High Risk – patients with advanced dry (geographic atrophy) or known “wet” macular degeneration in either eye.

Which Vitamins? The only vitamins “proven” to be effective are the vitamins containing the “AREDS Formulation.”  It is usually printed on the side of the bottle.  The AREDS formula contains;  Vitamins C and E, Beta-carotene, zinc and copper.  Examples of vitamins include;  Preservision® (Bausch and Lomb) and ICAPS® (Alcon).

What Will the Vitamins Do? The vitamins will reduce the chance of the “wet” form developing in either eye.  For example, if a patient has the “wet” form in the right eye, the vitamins reduce the risk of developing the “wet” form in the other eye by 25%.

What does this mean? This emphasizes the need for a regular eye examination.  Only your doctor can tell you if you have intermediate or high risk characteristics.

There are too many people randomly taking vitamins for the “eyes.”  It is important that you know the basis for which vitamins are suggested for you.


Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist

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Spinach and Carrots – Good for Your Eyes?

There is a lot of confusing information regarding what you should eat for the health of your eyes.  There is still a lot of confusion about proven supplements that may affect the rate of progression of macular degeneration.

Previous posts included information about the results of AREDS 1, Omega 3 Fatty Acids and their ability to slow down ARMD and the prospects for AREDS 2.  Remember that AREDS stands for Age Related Eye Disease Study.  The AREDS 1 study has been published and the AREDS 2 is presently underway.

What about Spinach? There are two potential advantages to eating spinach.  Spinach is a rich source of beta-carotene.  Beta-carotene is an antioxidant (protects cells against the damaging effects of oxygen at the microscopic cellular level).  It may be beneficial in slowing down macular degeneration, but we don’t yet know.  This is specifically being addressed by AREDS 2.  In AREDS 1, beta-carotene was linked to a beneficial effect in macular degeneration patients, but it also increased the rate of lung cancer in smokers taking the supplement.  AREDS 2 will directly study whether beta-carotene is even needed.

Spinach also is a rich source of macular xanthophylls (pigment related compounds).  Two of these xanthophylls are lutein and zeaxanthin.  Lutein has become very famous/popular for the treatment of macular degeneration.  Many “eye vitamins” tout the inclusion of lutein.  Lutein has yet to be absolutely proven to be effective against macular degeneration.  This question, too, will be answered in the upcoming AREDS 2 study.

And now, Carrots. Carrots are a great source of vitamin A.  Certain meats are also great sources.  Vitamin A is needed in the retina to help with the chemical reaction that allows us to see light.  Vitamin A leads to the function of rhodopsin, a protein/enzyme that allows us to see in the dark.  Vitamin A deficiency can lead to decreased rhodopsin and night blindness.  (Vitamin A  is also vital to the cornea and mucous membranes.)  Vitamin A deficiency is very rare/non-existent in the United States.

Carrots, like spinach, are also a great source of beta-carotene.  For the same reasons listed above (under the spinach heading), we may need to eat more carrots, not for the vitamin A, but for the beta-carotene.

Other sources of beta-carotene included; carrots, pumpkin and sweet potatoes, as well as, cabbage, kale, spinach, beet greens and collard greens.

What does this mean? There are advantages to spinach and carrots; good sources of beta-carotene that may be proven to retard or improve macular degeneration.  At present, no additional supplements, diet or vitamins, have been proven to improve vision or eye health.


Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist

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Does Your Diet Reduce Risk for Macular Degeneration? Part 1

Good Morning!  I am going to review, over the next 2-3 days, the dietary and vitamin recommendations for patients that have been diagnosed with Macular Degeneration.

Today’s Post:  What has been proven and not proven to work.  Focusing on the AREDS study and the supplements.

Next:  Part II:  What looks promising from a dietary standpoint, i.e. what things to eat that may help AMD, but not proven.  Read Part II.

Last:  The AREDS 2 study, what questions it hopes to answer.


A few years ago in 2001, the Age Related Eye Disease Study (AREDS or AREDS 1) study results were published. You can read the actual press release here…Click To Read AREDS Press Release.  It was a huge study that analyzed the risk of developing macular degeneration and cataract when given certain supplements.  The AREDS study has been the only study testing the effects of supplements on your eyes.  The AREDS 2 study is underway.

The Direct and Honest Answer.

1.  No diet has been proven to alter the chances of developing macular degeneration so far.  NOTHING!

2.  The only supplement/vitamin proven to be effective is the so-called AREDS formula (containing vitamin C, vitamin E, beta-carotene, and zinc) and this supplement/vitamin was only effective in patients with moderate to high-risk characteristics of macular degeneration (i.e. those with diagnosed macular degeneration).  Patients with low or no risk characteristics of macular degeneration did not benefit from the AREDS formula.

3.  Lutein and zeaxanthin have also not been studied directly (they will be in AREDS 2), that is, they have yet to be proven to work.

The Translation.

1.  Patients that have so-called high risk characteristics of macular degeneration had a 25% decrease in the likelihood of developing the ‘wet’ form of macular degeneration in one eye.  The chance of developing the wet form decreased from 28% to 21% while taking the supplements.  Patients at “intermediate risk” showed a 19% decrease in developing the wet form.

2.  No other benefit was shown from taking these vitamins.

3.  These high/intermediate risk patients should take the AREDS formulation (available over the counter) as long as they don’t smoke.  There is a smoker’s formulation, too.

The Not so Direct and Honest Answer. Beware of the hype.

There are a ton of vitamins available that claim to “cure” macular degeneration.  All of this is hype with exception of the AREDS study and formula.  Many doctors recommend taking vitamins to prevent macular degeneration, but there is no data or study to support this.  The AREDS study simply says that patients taking high doses of certain anti-oxidants, with zinc, may be beneficial.  Be careful when you read advertisements or listen the TV or radio.

There are also many products touting they contain the key ingredient “lutein” for macular degeneration.  There was an association in the AREDS 1 study, but there is no proof yet.

Read Part II


Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist

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AREDS Database is Open to Public

The data, including patient records, from the largest prospective study of macular degeneration is now “open source.”  The Age Related Eye Disease Study (AREDS) was completed in 2001.  It followed over 4000 patients for at least five years looking at factors that influence the development of macular degeneration and cataract.  This study proved conclusively that certain vitamin supplements, in select patients, could reduce the effects of macular degeneration.  In November, this database (dbGaP) was has become available to the “public,” or more specifically, the research world.

Scientists will have all data available to them from the original cohort of patients including patient records, retinal photographs and DNA.  It is hoped that by opening up the database, additional analyses will find more relationships between genetic and environmental factors that influence both cataract and macular degeneration.

What does this mean? The database became unrestricted in November or last year.  Since then, there seems to be weekly “studies” finding associations between certain dietary factors and the development of macular degeneration.  I believe we are going to be overwhelmed by the number of “studies” resulting from the open source of data.  While I read these articles with interest, I have to remember that these are not concrete findings, but merely associations that may or may not be true.  For now, read the articles with interest.  Before we make firm recommendations, or changes in our diets, additional prospective/randomized studies need to be performed that test these associations.

Eat your carrots!

Randall V. Wong, M.D.
Retina Specialist/Ophthalmologist

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Cataract Surgery Does Not Cause Macular Degeneration

A recent study reports that there is no link between cataract surgery and the development of macular degeneration.  The Age Related Eye Disease Study (AREDS) was a large randomized prospective trial that examined the chance of developing macular degeneration.  This was a prospective study where patients were examined before and afer cataract surgery for the presence of macular degeneration.  This is the first study, and perhaps the largest, that finds cataract surgery is safe for patients worried about macular degeneration.  Emily Chew, M.D., and her colleagues at the National Eye Institute, examined the data of over 4500 patients who were examined every six months for up to 11 years.

What does this mean? As a retinal specialist, I commonly examine patients that do not improve after successful cataract surgery.  Many times the culprit is macular degeneration, that is, patients fail to improve after cataract surgery due to macular degeneration.  For years, there has been an unproven feeling that cataract surgery makes macular degeneration worse.  Remember, there are two eye diseases that increase with age;  cataracts (okay, maybe not a disease) and macular degeneration.  To find both in the same patient is not surprising, yet it is truly frustrating to the patient who just had cataract surgery and can not see.

I would recommend that we take the conclusions of the AREDS trial at face value.  There is no relationship between cataract surgery and macular degeneration.  From a practical side, if you are worried about macular degeneration and are anticipating cataract surgery, get a second opinion from a retinal specialist.

Read the article.

Randall V. Wong, M.D.
Retina Specialist/ Ophthalmologist


Currently, I see patients with retinal diseases; macular degeneration, retinal detachment, macular holes, macular pucker within several different's a different arrangement, but it allows more continuous care with many eye specialists. In addition, I am very accessible via the web. To schedule your own appointment, call any of the numbers below.

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Randall V. Wong, M.D.
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Randall V. Wong, M.D.
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