Omega-3 Fatty Acids and Macular Degeneration in Women

The evidence continues to grow for the macular-protective effect of the omega 3 fatty acids found most abundantly in fish. Consider an excellent quality fish oil supplement to your diet, especially if you have signs of macular degeneration or a family history. Due to the anticoagulative effect of the oil, you should check with your primary doctor if you are on “blood thinners” of any type, especially warfarin (Coumadin). Up to 3 grams a day of fish oil is the dose generally recognized as safe by the FDA.

Take a look at the following study, published in the Archives of Ophthalmology (archopht). You can also read the full article by clicking here.

Dietary -3 Fatty Acid and Fish Intake and Incident Age-Related Macular Degeneration in Women

William G. Christen, ScD; Debra A. Schaumberg, ScD; Robert J. Glynn, ScD; Julie E. Buring, ScD
Arch Ophthalmol. 2011;129(7):921-929. doi:10.1001/archophthalmol.2011.34

Objective: To examine whether intake of -3 fatty acids and fish affects incidence of age-related macular degeneration (AMD) in women.

Design A detailed food-frequency questionnaire was administered at baseline among 39 876 female health professionals (mean [SD] age: 54.6 [7.0] years). A total of 38 022 women completed the questionnaire and were free of a diagnosis of AMD. The main outcome measure was incident AMD responsible for a reduction in best-corrected visual acuity to 20/30 or worse based on self-report confirmed by medical record review.

Results: A total of 235 cases of AMD, most characterized by some combination of drusen and retinal pigment epithelial changes, were confirmed during an average of 10 years of follow-up. Women in the highest tertile of intake for docosahexaenoic acid, compared with those in the lowest, had a multivariate-adjusted relative risk of AMD of 0.62 (95% confidence interval, 0.44-0.87). For eicosapentaenoic acid, women in the highest tertile of intake had a relative risk of 0.66 (95% confidence interval, 0.48-0.92). Consistent with the findings for docosahexaenoic acid and eicosapentaenoic acid, women who consumed 1 or more servings of fish per week, compared with those who consumed less than 1 serving per month,had a relative risk of AMD of 0.58 (95% confidence interval, 0.38-0.87).

Conclusion: These prospective data from a large cohort of female health professionals without a diagnosis of AMD at baseline indicate that regular consumption of docosahexaenoic acid and eicosapentaenoic acid and fish was associated with a significantly decreased risk of incident AMD and may be of benefit in primary prevention of AMD.

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CATT findings: Lucentis, Avastin Equal

The cancer drug, Avastin (bevacizumab, Genentech, San Francisco), is as efficacious as Lucentis (ranibizumab, Genentech) in treating neovascular age-related macular degeneration (AMD), according to initial results from the Comparison of AMD Treatments Trials (CATT), the National Eye Institute (NEI, Bethesda, Md.) said in a press release.

NEI reported results from the first year of the 2-year study. In the multicenter, single-masked trial, researchers randomly assigned 1,208 patients with Neovascaular AMD to receive intravitreal injections of Lucentis or Avastin on either a monthly schedule or as needed.

The primary outcome was the mean change in visual acuity at 1 year. In the study, both drugs provided beneficial outcomes to patients with between 25% and 34% of affected eyes improving substantially and more than 90% of affected eyes avoiding any further loss of vision. According to Paul A. Sieving, M.D., director of the NEI:

Over 250,000 patients are treated each year for AMD, and a substantial number of them receive Avastin. Given the lack of efficacy data regarding Avastin for AMD treatment, the NEI had an obligation to patients and clinicians to conduct this study…[source]

Given monthly, Avastin used off-label helped patients gain 8.0 letters, while Lucentis helped them gain 8.5 letters. When dosed on a PRN schedule, Avastin showed a 5.9 letter gain and Lucentis a 6.8 letter gain.  According to David W. Parke II, M.D., chief executive officer of AAO,

The initial results of the CATT study affirm the position of the American Academy of Ophthalmology (AAO) that both Lucentis and Avastin should be available for the treatment of AMD… [source]

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Omega 3 Essential Fatty Acids-Not Just a Supplement Fad

I’ve been telling people to use EFAs for several years to help boost their eyelids’ meibomian gland production, to help with symptoms of dry eye.

Initially, I recommended the use of flax oil due to its low cost and palatability.  However, I now tell people that fish oil gives them more of the active ingredients they need without the extra metabolic step that plant sources require; and that truly pure fish oils (like Carlson’s and Nordic Naturals) do not taste fishy.

I think that 1-2 teaspoons of a really good fish oil are probably as cost effective as flax oil capsules.  Besides the other metabolic benefits touted for the EFAs (anticoagulation, antiinflammation, cholesterol amelioration, etc.) there is evidence that EFAs play a role in protecting against macular degeneration.

There are excellent ongoing studies of this at the National Eye Institute (NEI), headed up by Emily Chew, M.D., that should delineate the role of EFAs in macular health; but for a quick fix, here you go:

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Intraocular Lenses

I have just finished reviewing a number of sites with postings by patients on intraocular lenses (IOLs).

IOLs are integral to the cataract eye surgery.  If one removes 1/3 of the focusing power of the eye (the cataractous lens), then it has to be replaced.  As wary as I am about believing web postings, I was struck by the number of people who felt that the IOLs they received did not live up to their promises, especially those who seemed to have done their homework.

What lens should be put in your eye when the cataract comes out?

In my practice, it’s the lens I would have in my own eye, if your eye were mine.  How boring. Not cutting edge. Old fashioned. Not profitable.  The right thing.

Notice I said, “if your eye were mine,” since you are the one having the surgery. Each person is different, with preoperative factors that go into the equation.

So, what lens should be put in your eye?

First, your ophthalmologist should address issues that might need optimizing before you undergo an elective eye procedure:

• How is the ocular surface?
• Correct dryness, irregular surface, rosacea.
• Do you have glaucoma, and if so, is it well controlled and has it damaged your vision?
• Are there other issues that might affect your outcome, like corneal disease (eg. corneal guttatae with Fuchs’ dystrophy); macular pucker; macular edema; peripheral retinal disease; amblyopia.
• What are your visual needs?  What is practical?
• What is realistic about your goals?

Once you and your eye doctor have decided that cataract surgery will help you, and that the risks of eye surgery are worth its potential benefits, discuss the IOL.

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