Macular Degeneration

If you have macular degeneration, it may seem as though your eyes are playing tricks on you. Door frames, telephone poles, and the edges of buildings appear bent or wavy. Other objects seem to change in color or size when you look at them with one eye closed, then the other. And you may notice a blurry blank spot in the middle of your field of vision, as though someone erased part of the scenery.

At the back of each of your eyes is a light­sensitive, nerve-rich area called the retina. The retina translates light into visual images, which then travel to your brain via the optic nerve. At the center of the retina is the macula, a tiny but supersensitive area that enables you to see color and fine detail.

If the macula deteriorates, as it does in macular degeneration, objects at the center of your field of vision appear wavy and change from color to black and white. As the condition advances, you begin viewing the world from the corners of your eyes rather than straight ahead.

What causes the macula to deteriorate? Oxidative damage, the same process that leads to the formation of cataracts. Oxidative damage occurs as highly unstable oxygen ions, called free radicals, circulate in your blood and find their way into every bodily tissue. Just as oxygen rusts iron, the oxygen ions harm healthy cells. When the affected cells are located in the macula, macular degeneration results.

Some free radicals form naturally as a by­product of various bodily functions, explains Alan P. Brauer, M.D. But certain lifestyle factors-especially eating a high-fat diet and smoking-greatly increase the number of free radicals floating around inside your body.

Other factors help decide who gets macular degeneration and who doesn't. Age certainly plays a role. Macular degeneration is rare before age 50 but becomes more common between ages 50 and 65. One in four people between the ages of 65 and 75 has the condition; the figure jumps to one in three people over the age of 75.

Macular degeneration doesn't always develop in the same way. In fact, the condition takes two distinct forms: dry and wet. The dry form is much more common, accounting for 80 to 90 percent of all cases. The wet form is much more severe.

In dry macular degeneration, the macula becomes thin and peppered with yellow spots called drusen. This happens quite slowly and painlessly. But over time, it can seriously affect your central vision.

By comparison, wet macular degeneration can destroy central vision very quickly. This form occurs when abnormal blood vessels grow underneath the retina and displace the macula, much like tree roots buckling a sidewalk. The blood vessels often leak, leading to the formation of scar tissue. The scar tissue is what alters your eyesight.

No matter which type of macular degeneration you have, you need to be under the care of an ophthalmologist. The treatment should focus on preventing the condition from getting worse. For the wet form, this most likely means surgery. For the dry form, alternative therapies show the most promise. Here's what the experts recommend.

Best Choices

Nutrition

Make like Popeye-eat your spinach. Compounds in the vitamin A family of nutrients called lutein and zeaxanthin, as well as the other carotenoids, seem to thwart macular degeneration. They're antioxidants, which means that they have the ability to neutralize harmful free radicals. In this way, antioxidants safeguard the maculae against free-radical damage.

Spinach contains all of these compounds. But if you're not partial to spinach, don't worry. You can also get lutein and zeaxanthin by eating other vegetables.

Supplements

Take extra antioxidants. By eating lots of fruits and vegetables, you get healthy doses of carotenoids and other antioxidant nutrients. Supplements can raise your antioxidant intake even higher-and possibly boost your defense against macular degeneration.

For people with macular degeneration, Joseph Pizzorno Jr., N.D., offers the following antioxidant prescription: 1,000 milligrams of vitamin C three times a day, 600 to 800 international units (IV) of vitamin E a day, 400 micrograms of selenium a day, and 45 milligrams of zinc a day. But note that you need to check with your doctor first before trying this prescription because all of these doses are much higher than standard recommendations.

Herbal Medicine

Become acquainted with bilberries. Bilberries, sometimes called European blueberries, have an age-old reputation for improving vision. They contain high levels of potent antioxidant compounds called anthocyanosides, which have a special afftnity for the eyes, Dr. Pizzorno explains.

European herbalists have developed a standardized bilberry extract that contains 25 percent anthocyanosides. Dr. Pizzorno suggests taking 80 to 160 milligrams of the extract three times a day. It's available in many health food stores and from most naturopaths. As an alternative to the extract, James A. Duke, Ph.D., suggests eating blueberries. Like bilberries, blueberries are rich in anthocyanosides. Choose fresh berries when they're in season, frozen or canned berries at other times of the year. You can also get anthocyanosides by eating blackberries, raspberries, red or purple grapes, plums, raisins, and prunes.

Get to know ginkgo, too. Ginkgo is widely used in Europe as a treatment for stroke and Alzheimer's disease because it improves blood flow through the brain. Like bilberry, it also contains antioxidants that have a special affmity for the eyes.

Dr. Pizzorno suggests taking 40 milligrams of a standardized extract containing 24 percent ginkgo heterosides three or four times a day. You can buy this extract in health food stores.

Home Remedies

Kick butts. Smoking is a major cause of the oxidative damage that sets the stage for macular degeneration. Researchers have concluded that people who smoke a pack or more of cigarettes a day are 2.4 times more likely to develop macular degeneration than people who have never smoked. Ex-smokers are twice as likely to develop macular degeneration as lifelong nonsmokers.

Raise a glass to better eyesight. A little red wine-very little, just 2 to 12 glasses a year-can help protect against macular degeneration, judging from a study by Thomas Obisesan, M.D., chief of geriatrics at Howard University School of Medicine in Washington, D.C.

Of course, if you don't drink, don't start. But if you already drink in moderation, you should know that an occasional glass of wine might do your eyesight good.

Other Good Choices

Homeopathy

Consider Secale. Edward Kondrot, M.D., an ophthalmologist and homeopath in Pittsburgh, sometimes prescribes the homeopathic medicine Secale for people in the early stages of macular degeneration. To find out whether Secale might benefit you, consult a homeopath.

Chinese Medicine

Help your eyes with Chinese herbs. For patients with macular degeneration, Efrem Korngold, O.M.D., L.Ac., often prescribes salvia root, lycii berries, and chrysanthemum tea. "Salvia root protects the retina and discourages the growth of new blood vessels there," he notes. "Lycii berries are similar to bilberries in that both contain anthocyanosides. And chrysanthemum tea clears Heat and soothes your eyes."

Stimulate better vision. Dr. Korngold also recommends acupuncture or acupressure as a treatment for macular degeneration. For acupressure, apply steady finger pressure to each of the following points for 3 minutes.

• liver 3, situated on top of your foot in the webbing between your big toe and second toe
• Spleen 10, located on your inner thigh, four finger-widths above your kneecap and just under your thighbone

Medical Measures

For dry macular degeneration, mainstream medicine has little to offer in the way of effective treatments. But wet macular degeneration may respond to laser surgery, provided it's performed in the early stages of the disease.

If you experience any degree of vision impairment because of macular degeneration, you may want to take advantage of the support services offered by a nonprofit organization called lighthouse International. You can write to the organization at 111 East 59th Street, 12th Floor, New York, NY 10022-1202.