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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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]

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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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.

Focal Points of IOLs

The most commonly implanted IOLs have one major focal point. They can be chosen so that point is best at distance, or midrange, or near.  The view is blurred to some extent at any other range.

To provide two focal points, current FDA approved IOLs include multifocal IOLs that divide the incoming light into two images, and IOLs that flex in response to your effort to see near objects, resulting in a change in the focal point of the moving IOL.

There are many patients who are happy with both types of IOLs.  However, there are enough patients who are unhappy with currently available non-monofocal IOLs, with remedies that are risky, invasive, costly or otherwise inadvisable, that I steer patients away from these lenses. Read more about the voluntary reports of IOL problems at the FDA website by clicking here.

What else is there to do?

If a patient is a previously successful monovision contact lens wearer, we can reproduce that using a monofocal IOL aimed at distance in one eye and reading in the other. If they don’t mind reading glasses, then we simply aim for distance vision in both eyes.

I am carefully evaluating a lens that has been awaited on in the US market for several years, the Lenstec Tetraflex.  It is reported to give some, but not always enough, near vision to get through the day without readers. I will post more about this lens later, with appropriate references.

There are also a horde of additional IOLs coming down the road that address the issue of distance plus near focusing ability, as well as devices that might help people who already have a monofocal IOL in their eye.

Other interesting facts about IOLs that I will discuss in future blog posts will cover:

• Correction of astigmatism
• What to do if the IOL is wrong
• IOLs after refractive surgery

Thanks for reading, and please don’t hesitate to let me know what you think.

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