3. CATARACT
• 50% of people over 75 suffer from cataract in
western world
• Developing world much higher
• 90% of cataract vision impairment and
blindness are found in developing countries
4.
5. RISK FACTORS
• Non-Modifiable
• Age
• Family history
• Genetics
• Modifiable
• Radiation and light exposure
• Diabetes
• Smoking
• Alcohol
• Corticosteroids
• Nutrition
6. Is Surgery the Only Option?
• YES, if the cataract is established
• Prevention
– Vitamin C
– Vitamin E
– Lutein, zeaxanthin
– Beta-carotene
– Omega-3 fats
– Protein
– Fibre
– Niacin
– Riboflavin
– Thiamine
– Folate
– Vitamin B12
7. AREDS 1 and 2
? Relationship between daily antioxidant supplementation
and cataract formation
• Group 1:
– Vitamin C
– Vitamin E
– Beta-carotene
– Zinc
– Copper
No effect compared to group with no supplements
• Group 2:
– Centrum
Some benefit in delaying cataract onset
8. AREDS 1 and 2
• Additional supplementation beneficial if
deficient diet, no significant benefit in those
with adequate diets.
• People who consume less than 3.5 servings of
fruit and/or vegetables daily have at least 5
times the risk of developing cataract as those
who do consume these amounts.
9. Cataract Summary
• UV-blocking sunglasses
• Stop smoking and avoid excessive alcohol
consumption
• Balanced diet with a predominantly plant-
based diet.
• Control BSL
• Minimise corticosteroids
10. MACULAR DEGENERATION
• Age-Related Macular Degeneration (AMD)
• Most common cause of irreversible blindness
and visual impairment in developed countries
• 50% of people >50 years have AMD
• 2/3 of 90 year olds have AMD
11. RISK FACTORS
• Multifactorial
• Family History
– AMD-affected first degree relative have a 50% risk of
experiencing advanced MD and vision loss in their lifetime
• Smoking
• UV light exposure
• Nutritional factors
• Obesity
• Hypertension
• High cholesterol
• Cardiovascular disease
12. AREDS 1
Nutrient Daily Dose
Vitamin C 500 mg
Vitamin E 400 IU
Beta-carotene 15 mg
Zinc 80 mg
Copper 2 mg
Can AMD be treated or prevented through use
of antioxidant supplements?
13. EYE NUTRITION
• No disease, no benefit
• 7 years of treatment
• ? Follow-up time too short
“At risk” MD can lower their risk of
progression to advanced MD by 25%
by taking antioxidant supplements
14. AREDS 2
• 2013 follow-up study
• All patients given original AREDS vitamin formulation but with
one of four variations:
Variation Change to original AREDS formulation
1 Add Lutein + Zeaxanthin
2 Add Omega-3 fatty acids
3 Eliminate Beta-carotene
4 Lower zinc dose
15. AREDS 2
• No difference in the progression to advanced
MD when any of these four variations were
made when compared to the original formula.
• Beta-carotene may increase the risk of lung
cancer in smokers, the authors suggested
replacing this carotenoid with lutein and
zeaxanthin.
16. Which Supplement is Best?
• Many supplements on the market
• No comparative studies
• Based on AREDS 1 and 2:
Nutrient Daily Dose
Vitamin C 500 mg
Vitamin E 400 IU
Lutein 10 mg
Zeaxanthin 2 mg
Zinc 25-80 mg
Copper 2 mg
17. Should Everyone Take
Supplements?
• Well-balanced diet is best
• Supplement ‘insurance policy’ if:
– Poor diet (common in elderly)
– Known high risk (smokers, family history)
• NO benefit shown in those with normal eyes
(7 year follow-up)
• 75% of adults take a nutritional supplement!
18. Potential Side-Effects
• Vitamin E - increased rates of death.
• Zinc - stomach irritation and anaemia (especially when used without
copper).
• Vitamin A - damage the liver, predispose to hip fractures and birth
defects.
• Beta-carotene - increase the risk of lung cancer in smokers and ex-
smokers.
• Bilberry - blood thinning effect and promote bleeding.
• Omega 3 supplements can interact with a number of medications
including blood-thinning drugs such as warfarin.
• Most supplements at high doses cause gastrointestinal upset.
• COST
19. What You Should Know
• Zinc: may make blood sugar control in diabetes more difficult.
• Vitamin E supplements and aspirin higher risk of bleeding.
• Statin efficacy reduced if also taking vitamin E supplements.
• Be aware multiple supplements for various diseases!
– Overlapping dosages with higher risk of toxicity
• Mineral supplements (e.g. zinc) should be taken at least two hours
away from any other prescribed medication
– Binding effect in gut reducing absorption and action of other drugs.
• Beware of spinach in a ‘healthy diet’ if taking warfarin (vitamin K)
20. Zinc Absorption
Absorption Enhanced By Absorption Decreased By
Protein
Adequate energy
(calories)
Lactose
Deficient protein intake
Very high fibre intake
Excessive alcohol
Excessive iron
Excessive calcium
23. AMD Summary
• Healthy balanced diet
– Fruit and vegetables (particularly green leafy vegetables)
– Nuts, Fish, Garlic
– Low in all types of fat
• If high risk, poor diet or advanced AMD consider supplements
– ? Don’t need the full dose – consider 3 days a week
• Stop smoking
• Minimise meat – particularly red meat. Fish preferentially.
• Normal homocysteine levels normal may protect against MD (maintain folate and B12 levels)
• Exercise and minimise obesity
• Optimise BP and cholesterol
• UV-protecting sunglasses and hats
• Consult an Accredited Practising Dietitian when contemplating changes to your diet.
24.
25. AMD
Studies have shown that by combining a healthy
diet with physical activity and not smoking you
can reduce your risk of MD by as much as 71%.
26. EYE NUTRITION
• Living a healthy lifestyle should be enjoyable!
• Food should be enjoyed, not endured.
• Foods are not inherently “good” or “bad”.
– Habits we form around foods more important.
– Eating food is one of the greatest pleasures in life!
– If the majority of our diet is based on simple and
healthy foods (our “staple diet”), there is no
reason why we can’t enjoy the occasional treat in
our diet.
27.
28. COOKING
• Eat at least half of your fruit and vegetables raw.
• Store food in a cool, dark and dry place.
• Eat food within a few days of purchase, even if this means more
frequent shopping.
• Frozen is fine!
– Freezing helps to maintain nutrient levels if food is to be stored.
• Try to leave the skin on vegetables and fruit when possible.
• Cook only for a short amount of time in a small amount of water.
• Eat food as soon as possible once it is cooked.
• Stir-fry, steaming and microwave are best
– Boiling leaches out water-soluble vitamins
• Adding a small amount of olive oil may help absorption of fat-
soluble vitamins
Editor's Notes
Not for profit
Mothers have been warning their children for years to make sure that their “Eyes are not bigger than their stomachs”! There is much irony in this statement, for there is a building body of evidence to suggest that the type and quantity of food that we put into our stomachs throughout our lives can play a significant part in determining the health of our eyes and our body in general.
Hippocrates once said, “Let food be my medicine and medicine be my food.”
These compounds have all been found to be helpful in some, but not all, studies.
Our book goes through all this stuff!
The stability of various vitamins and minerals can vary; however, minerals are generally more stable than vitamins.
Of all the vitamins, vitamin C is the most sensitive to the heat of cooking.
Other factors that influence the nutrient content of food are light, storage time, repeated heating and bruising.
