Macular Degeneration: Chronic Inflammation, Blue Light, Mitochondria, and Blood Sugar

Macular degeneration is the most common cause of severe vision loss in developed countries causing visual impairment in millions of individuals across the world.  It affects more than 10 million Americans, more than cataracts and glaucoma combined. Age-related macular degeneration (AMD) is considered incurable, but numerous studies highlight the essential need for nutrients to prevent and protect eyes from this life changing inflammatory disorder.

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What is Age-Related Macular Degeneration?

Age-related macular degeneration (AMD) is a breakdown in the part of the eye called the macula. The macula is small light-sensitive tissue lining the back of the eye within the retina. It is the part of the retina that is responsible for central vision. When breakdown or degeneration occurs in this tissue, it results in vision loss.  Macular degeneration starts in the center of the visual field then expands outward as the degeneration occurs. The loss of vision looks like a smudge in the center of your vision that doesn’t go away. Extensive damage may leave you with a field of vision, like the outside ring of a pizza, but the entire middle is gone. Symptoms include blurry vision, dark or distorted areas in the central vision, and loss of central vision. AMD does not affect peripheral vision.

There are two types of macular degeneration – dry and wet. Most people have dry macular degeneration. It is caused by aging and thinning of the macula. There is atrophy and loss of the retinal pigment epithelium.  Wet macular degeneration is less common and often more aggressive. It involves changes in vasculature in the eye. Both types are related with chronic inflammation.

Chronic Inflammation Causes Cumulative Damage

The current understanding of age-related macular degeneration shows that the vision loss occurs because of chronic inflammation causing cumulative damage. Chronic low grade inflammation causes damage and dysfunction to the endothelial lining, the retinal pigment epithelium, and other tissues within the eye. Researchers believe that one cause of AMD is the breakdown in this one cell thick layer (endothelial lining) inside the blood vessels that supply the eye.

Researchers have focused on ways to protect this delicate one cell thick lining in eye blood vessels to stave off the effects of macular degeneration.  Nutritional protection for the eye endothelial lining includes folate, vitamin D, melatonin, coenzyme Q 10, N-acetyl-cysteine, resveratrol, L-arginine, and curcumin.

Damage to the Retinal Lining and Mitochondria

For dry macular degeneration, the pigmented layer in the retina is another site of major damage, i.e. the retinal pigment epithelium (RPE). This pigmented layer lies over the visual cells in the retina. When it is injured by immune system inflammation, it leads to inherited and age-related macular degeneration. Immune system inflammation, i.e. abnormal complement activation, causes cholesterol to accumulate in the retinal pigment epithelium. Oxidized or damaged LDL (lipofuscin) induces this response. When lipofuscin occurs on the skin, we see it as brown age spots. In the eye, it leads to loss of vision. Lipofuscin and cholesterol accumulation changes the normal function of the tissues which creates oxidative stress and retinal pigment epithelium damage. 

The retinal pigment epithelium layer is very rich in mitochondria and has some of the most metabolically active cells in the body. The retina and optic nerve are dependent on healthy mitochondria for vision to occur.  Stress to the mitochondria there in the retina leads to dysfunction and degeneration. Researchers believe that it is chronic, cumulative damage to the retinal pigment epithelium, mitochondria and a build-up of the damaged cholesterol, i.e. lipofuscin causes macular degeneration. Several nutrients help protect and even make mitochondria. These include PQQ, astaxanthin, coenzyme Q10, and others. They may be used together with nutrients that help support healthy retinal pigment epithelium.

One incredibly important and essential fatty acid, DHA, has been found to help preserve eyesight because of lipofuscin build-up and inflammation. Best results occur when it is used long-term and before the damage is overwhelming.

Melatonin stands out by both protecting the eye mitochondria and the retinal pigment epithelium. Melatonin, the sleep hormone mainly produced by the pineal gland, is also produced in the retina. It acts a very strong antioxidant and protects the retinal pigment epithelium against damage.
It also concentrates in retinal mitochondria and helps to protect and prevent mitochondrial damage. Research supports the use of “melatonin as a preventative and therapeutic agent in the treatment of AMD”, but suggests that further research is needed. 

Curcumin is another well-known, critical antioxidant that helps protect the retinal pigment epithelium. One recent study demonstrated that curcumin caused the most significant reduction in oxidative stress to this delicate lining compared to other drugs that were being considered for treatment. In measuring damage control in this human cell study, pretreatment was the best, i.e. an ounce of prevention was worth a pound of cure.

There are other critical factors that affect health of the macula and retina. We may not readily think of them, but these factors pose a daily, often insidious challenge to eyes and the onset of age-related macular degeneration. Two ubiquitous reasons include oxidative stress from light, i.e. blue and white LED lights and blood sugar. 

Blue Light Exposure

Technology has brought a surge of blue-light devices over the last couple decades. Toxic blue light comes from light sources like indoor lighting, televisions, computers, computers, digital tablets, and smart phones that emit blue light (415-455nm) ranges from LED (Light Emitting Diodes), OLED (Organic Light Emitting Diode) or AMOLED (Active-Matrix Organic Light Emitting Diode) technology.

Research shows blue-light exposure causes a strain or oxidative stress response to the epithelial cells lining the retina, which can lead to macular degeneration. In 2002 and subsequent studies, it was pointed out that “photoreceptors” in the retina are susceptible to damage, especially by blue light. A phototoxic compound, called A2E, caused by blue light can lead to cell death and disease like age-related macular degeneration. A2E is a free radical causing blue light absorbing compound in the retina that accumulates with age. 

Researchers also caution on the use of white LED lights, as chronic exposure causes injury to the retina. This happens, but at lower levels than blue-light LED levels. Research published in the last few weeks suggests that blue component of white LED (cold-white) lights may cause toxic effect to the retina within normal work and home lighting.

Science has found that carotenoid compounds, lutein and zeaxanthin, help filter blue-light in the retina. Negatively charged phospholipids, i.e. phosphatidylserine and phosphatidylcholine prevent the cell death induced by A2E.  In addition, resveratrol has been shown protect the retina against the A2E oxidative stress that leads to permanent damage and causes macular degeneration.

Blood Sugar – Low and High Blood Sugar Affects Eye Health

The subject of blood sugar on eye health and macular degeneration risk is fascinating and readily ties in with oxidative stress and mitochondria.  It is well known that diabetes and elevated blood sugar gravely impacts eye health. Macular degeneration is just one of the eye diseases associated with diabetes. This occurs in large part to the advanced glycation end-products, which cause stiff blood vessels and connective tissue and high levels of inflammation.

On the other hand, low blood sugar or hypoglycemia is very stressful to the retina. The retina has been described as one of the most metabolically active tissues in the body. This requires a constant supply of blood sugar for the retina to perform. Vision depends on glucose availability. Scientists have described retinal function and visual acuity correlating directly with the degree of hypoglycemia. Symptoms like eye floaters and clouding of vision related with hypoglycemia reflect eye stress. 

A recent study involved adults with type 1 diabetes and those with normal blood sugar. Scientists evaluated the impact of low blood sugar on retina and central vision in the two groups. All participants were subjected to low blood sugar states. Both groups had measurable loss of central vision, which originated in the retina. Once blood sugar levels were restored, the stressed central vision returned to normal. The scientists emphasized the importance of promptly treating hypoglycemia, as it is a metabolic stress and adds to risk and burden of macular degeneration.

Much of the research on hypoglycemia and eye stress is on diabetics for blood sugar control, but I suggest that this information is vital for those who struggle with low blood sugar for other reasons. Individuals who have significant adrenal stress or insufficiency, pituitary problems, mitochondria, poor diets, reactive hypoglycemia/insulin resistance or food coma responses need to act to protect their eyes from the low blood sugar. Leptin hormone management and The Leptin Diet can help support healthy blood sugar management.

Nutrition to the Rescue!

It is repeatedly noted in these and other studies, like the famous AREDs2 study, that the antioxidant levels are diminished in age-related macular degeneration and that healthy nutrition is fundamental. Damage is cumulative from chronic inflammation and vision loss is permanent with AMD.  Medicine has failed to find a way to cure this disease with Big Pharma or surgery. Researchers and medicine though has focused on nutritional support for the eye as the preferred method of treatment.  Even the American Family Physician journal stated that “vitamin supplements can delay the progression of age-related macular degeneration”.

It is evident that different types of nutrients are essential to protecting the eye. A diet void in choline rich foods and abundantly colored fruits and vegetables is a prescription to unhealthy eyes, macular degeneration and vision loss. Curcumin was described as an “ideal drug that can effectively restore the nerve function in AMD… and render this drug an effective option for macular degeneration therapy and an agent against aging-associated oxidative stress”. Nutrients like lutein, zeaxanthin, vitamin A, C, D, E, zinc, copper, carnosine, coenzyme Q, curcumin, fish oils, resveratrol, melatonin, B vitamins, tocotrienols, chromium, N-acetyl cysteine, choline and phosphatidylserine may all play a role in managing eye health. These nutrients are needed to manage antioxidant levels, endothelial lining protection, mitochondria and blood sugar support, nutrients that filter blue-light and other oxidative stressors.

Age-related macular degeneration is a destructive process that occurs from inflammation and aging. You may have caught one of the opening statements – it is a disorder found most commonly in developed countries, not third world countries. My concern exists for not only today’s adults at risk but also for our children and young adults. Many in this age group have diets that are woefully lacking in antioxidants and good protective fats that we described for eye health. Blood sugar imbalances with hypoglycemia and diabetes often plague our youth with over-training in athletes, social pressure with being thin/anorexia, obesity, and failing to eat quality meals. This same age group is growing up with blue-light technology more so than any other generation. It is critical now more than ever to ensure that we and our future generations protect our eyes. Besides reducing LED blue-light technology stress, using soft white lighting, nutrition is the only way. Once vision is lost, it is gone.

Nutritional Options

Lutein and zeaxanthin – Lutein and zeaxanthin are two antioxidants found in the carotene family critical for eye health. Zeaxanthin is the dominant carotenoid found in the macula. They are essential to block blue-light from damaging the retina. At least 20 mg of lutein per day is recommended for eye health. One serving of carrots provides 0.038 mg of lutein and zeaxanthin.  One serving of spinach provides 6.5 mg of lutein and zeaxanthin. Diets often lack these essential antioxidants especially in children and busy adults.

Astaxanthin – This fat and water soluble antioxidant is well known for its versatility and power. It protects mitochondria from damage. It provides UV-light protection and protects eyes from eye strain. It also helps support cholesterol, reduce inflammation, healthier metabolism and blood sugar. Consider astaxanthin essential for eye health and support.

Phosphatidylserine – Phosphatidylserine (PS) is used for memory and cognitive function. Include it now in the arsenal to protect the eye from damaging blue-light compounds. It is an essential, unique type of phospholipid or fat that is essential for nerve function and cell membranes. 

Melatonin – Melatonin is far more than a sleep hormone. It provides potent antioxidant protection to mitochondria within the retina, nervous system, and protects the retinal pigment epithelium from damage.

Curcumin – This prized antioxidant is well-known for its anti-inflammatory effects throughout the body. Researchers suggest that curcumin which is the active ingredient of the spice turmeric is better at protecting the retinal pigment epithelium from oxidative stress than any drug. Consider using a standardized, highly absorbable form of curcumin.

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