What is my risk of eye disease?

The more questions are answered with “yes”, the greater the individual risk of eye diseases could be and the more important preventive measures are.

• Do you smoke or does someone in your environment smoke regularly (daily)?
• Are you frequently exposed to the sun or bright light (tanning bed, work)?
• Do you spend a lot of time in front of the computer or smartphone (blue light exposure)?
• Do you have light eyes?
• Are you short-sighted?
• Are you regularly exposed to mental or physical stress?
• Do you or a blood relative suffer from type 1 or type 2 diabetes?
• Do you have arteriosclerosis or circulatory disorders in your heart, brain or legs?
• Are there any cases of glaucoma in your family?
• Are you overweight (BMI >25)?

What are common eye diseases?

• Senile cataract
• Age-related macular degeneration (AMD)
• Glaucoma (“green cataract”)
• Mitochondrial eye diseases
• Diabetic retinopathy
• Myopia (nearsightedness)

The specific treatment of eye diseases naturally belongs primarily in the hands of ophthalmologists. But Micronutrients can be very useful in prevention and basic therapy.

A central cause of many age-related eye diseases is oxidative stress

• The rod outer elements (with photoreceptors) of our eyes consist of 65% unsaturated fatty acids (highest proportion of all body tissues!)
• Unsaturated fatty acids are easily peroxidized by free radicals, d.h. are damaged by free radicals
• The formation of free radicals generally occurs through
  • oxidative stress (oxidation of O2), but in the eye v.a. through
  • photo-oxidative stress (UV light activates oxygen radicals very quickly)
• Antioxidants defuse these free radicals
  • Antioxidant enzymes (formed in the body): Peroxidases (z.B. glutathione peroxidase, phospholipid hydroperoxide glutathione peroxidase), catalases, superoxide dismutases (SOD)
  • Non-enzymatic antioxidants (essential = must be obtained through food): z.B. Vitamins C and E, alpha-lipoic acid, secondary plant substances such as quercetin, OPC, beta-carotene, etc.
• If there is an imbalance at the expense of antioxidants, damage to the eyes occurs through free radicals.
• If this is the case, supplementing with a synergistic antioxidant complex may be beneficial.
• In addition, the formation of free radicals can already be prevented by a type of “inner sunglasses” can be prevented: Carotenoids such as lutein or beta-carotene as well as vitamins E and C protect against (blue) light

A) Cataract

• Causes
  • Change in lens protein structure
  • Conversion of water-soluble into turbid, water-insoluble proteins
  • Eye damage caused by UV radiation (especially oxidation by UV-B)
  • Inflammations and infections (z.B.caused by cytomegalovirus)
• Symptoms
  • Lens clouding, loss of lens transparency
  • Impairment of vision (“foggy vision”)
  • Can lead to blindness
• Risk factors
  • Diabetes (diabetes Increases cataract risk 3-5 times! Osmotic stress/osmotic overpressure (by diffusion of glucose + galactose in lens) à conversion into sugar alcohols sorbitol + galactitol
  • Age & predisposition (genetics)
  • Smoke
  • Arteriosclerosis (including lipid peroxidation and inflammation)
  • Bright eyes
  • Light exposure
    • Photo-oxidative stress (z.B. solariums)
    • Blue light (especially computers and smartphones)
  • stress
• Conventional therapy
  • Surgery: Implantation of an artificial, flexible lens (z.B. Intraocular lens IOL “Tecnis”)
  • Risk reduction
    • diabetes
    • Obesity
    • Smoke
    • Light & radiation exposure
    • Inflammations

B) Macular degeneration

• Symptoms
  • Disturbing spot in the center of the visual field
  • Colors become paler
• Cause: Degenerative processes (exact causes are still unknown); central role:
  • Photoreceptors of the retina (especially in the macula area) with high metabolic activity and high O2 consumption à increased radical formation
  • Retinal pigment epithelium (RPE) behind the retina: RPE cells dispose of oxidized (unusable) photoreceptor parts by phagocytosis and removal à disturbances of the process (oxygen deficiency, metabolic disorders, arteriosclerosis are discussed) lead to deposits (“drusen”),
    which accelerate the degeneration of RPE cells and promote macular degeneration
• Risk factors
  • Age & predisposition (genetics)
  • Smoke
  • Arteriosclerosis (including lipid peroxidation and inflammation)
  • Bright eyes
  • Light exposure
    • Photo-oxidative stress (z.B. solariums)
    • Blue light (especially computers and smartphones)
  • stress
• Senile cataracts and micronutrients
• • Secondary plant substances with strong antioxidant potential (antioxidant enzymes such as glutathione peroxidase, SOD and catalase are reduced in cataracts!), such as
    • Quercetin
    • Grape seed extract with high OPC content
    • Green tea (cf. Kumar, V. et al. (2017): Effect of Green Tea Polyphenol Epigallocatechin-3-gallate on the Aggregation of αA(66-80) Peptide, a Major Fragment of αA-crystallin Involved in Cataract Development.Curr Eye Res. 2017 Oct;42(10):1368-1377, https://www.ncbi.nlm.nih.gov/pubmed/28628342 )
    • Triphala
    • Carotenoids (beta-carotene, lutein etc)

  See Schalch, W. and Chylack, L.T. (2003): Antioxidant micronutrients and cataracts. The Ophthalmologist. 2003; 100:181–189, https://link.springer.com/article/10.1007/s00347-003-0788-0

  • Vitamin E
    • Prevents lens clouding
    • Vitamin E deficiency increases risk by 1.8 to 3.7 times (9 studies with 10,355 subjects)
    • Zhang, Y. et al. (2015): Vitamin E and risk of age-related cataract: a meta-analysis. Public Health Nutr. 2015 Oct;18(15):2804-14. https://www.ncbi.nlm.nih.gov/pubmed/25591715
  • Riboflavin (vitamin B2)
    • Important for lens metabolism
    • Studies suggest a 40% reduction in the incidence of senile cataracts
  • Vitamin C
    • Prevents lens clouding
    • Reduces risk by approximately 40% (9 intervention studies with 80,675 subjects)
  • zinc (regulates hormone levels)
  • selenium (has an antioxidant effect)
  • Omega 3 fatty acids with a high EPA content (have an anti-inflammatory effect)

How do wet and dry macular degeneration differ?

• Wet macular degeneration
  • 10% of all cases of macular degeneration
  • Fluid accumulation under the macula (“macula edema”)
  • Retina swells & lifts out
  • Loss of central visual acuity and distortion of lines and edges
  • Established forms of therapy available
• Dry macular degeneration
  • 90% of all cases of macular degeneration
  • Formation of “drusen”: Drusen are an accumulation of waste products (crystalline-looking fatty dots/deposits) under the macula lutea, z.B. as a result of genetics and/or oxidative stress: Many of the proteins found in drusen are the result of chronic inflammatory processes
  • Initially limited to outer regions of the macula with little effect on photoreceptors
  • Later increasing deterioration of vision, in some cases loss of vision due to cell death
  • Currently not reliably treatable

• Macular degeneration and micronutrients
  • Against the dry form of AMD So far there is only the prophylaxis: "Since dead photoreceptors cannot be replaced, one must hope for inhibiting cell death." (Source: Gerste RD; Modulation of the visual cycle; Deutsches Ärzteblatt 20.1.2012; 82-83)
    • AntioxidantsAntioxidant vitamin and mineral supplements slow the progression of AMD (see Evans, JR and JG Lawrenson, "Antioxidant vitamin and mineral supplements for slowing the progression of age-related macular degeneration. The Cochrane Database of systematic reviews, 2012)
    • Secondary plant substances such as Beta-carotene, lutein, zeaxanthin, ginkgo, green tea; see Willett W et al., "Dietary carotenoids, vitamins A, C, and E, and advanced age-related macular degeneration." Jama 272.18 (1994): 1413-1420; see Age-Related Eye Disease Study 2 Research Group, "Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration: the Age-Related Eye Disease Study 2 (AREDS2) randomized clinical trial, JAMA, May 2013
    • CurcumaExtract: Curcumin protects retinal pigment epithelial cells against oxidative stress via the induction of heme oxygenase-1 expression and reduction of reactive oxygen (see Chung HT et al., "Curcumin protects retinal pigment epithelial cells against oxidative stress via induction of heme oxygenase-1 expression and reduction of reactive oxygen," Molecular Vision, April 2012)
    • ginkgo: Ginkgo extract in impaired vision - treatment of dry AMD (cf. Fies, P., and A. Dienel. "[Ginkgo extract in impaired vision - treatment with special extract EGb 761 of impaired vision due to dry senile macular degeneration]." Wiener Medizinische Wochenschrift (1946) 152.15-16 (2001): 423-426)
    • Zinc: Reduces oxidative stress (a component of SOD); reduced zinc and copper levels in the retinal pigment epithelium and choroid in AMD (cf. Pulido JS et al., "Reduced zinc and copper in the retinal pigment epithelium and choroid in age-related macular degeneration," American Journal of Ophthalmology, February 2009)
    • Unsaturated omega-3 fatty acids (anti-inflammatory): "Administration of 5 g/day of EPA/DHA resulted in an improvement in visual acuity of more than one line on the eye test within 4.5 months. The greatest improvement of 15 letters on the eye test was achieved by patients with an AA/EPA < 2. Even patients with severe AMD were able to achieve significant improvement within a few months. (Source: Georgiou T, Prokopiou E: The New Era of Omega-3 Fatty Acids Supplementation: Therapeutic Effects on Dry Age-Related Macular Degeneration. J Stem Cells. 2015;10(3):205-15.)
    • L-Arginine: has a vaso-relaxing and blood circulation-promoting effect
    • Alpha-lipoic acid: Antioxidant, improves glutathione supply
  • "In ARED-1, a positive effect of high-dose micronutrients is found Vitamins C and E, beta-carotene and zinc in intermediate AMD stages (OR 0.72). In ARED-2, Lutein/zeaxanthin and omega-3 fatty acids in intermediate and advanced stages (OR 0.89)” (Source: Stahl A; Macular degeneration; Deutsches Ärzteblatt 8/2020, 371)

C) Glaucoma (“green cataract”)

What are the specific causes and symptoms of glaucoma?

• Symptoms
  • Restriction of the field of vision
  • Blindness
• Causes
  • Disturbed aqueous humor outflow
    • Increase in intraocular pressure (normal: 14-18 mm Hg)
    • Damage and destruction of optic nerve fibers
  • Autoimmune processes with the formation of auto-IgG antibodies are discussed (Source: Deutsches Ärzteblatt, 3/04)

• Risk factors
  • Vascular processes (z.B. Arteriosclerosis)
  • Age (> 40 years)
  • Family history of glaucoma
  • Myopia (from -5 diopters)
  • Neurodegenerative processes
  • Diabetes (see Bonovas et al.; Diabet Med 2004/21, 609-614)
• Conventional therapy
  • Reduce eye pressure to 16-18 mm Hg
  • Medications: z.B. Beta-blocker Timolol
  • Prostaglandin analogues (Latanaprost/Xalatan)
  • Alpha-2 agonists
  • Laser therapy/surgery
• Glaucoma and micronutrients: This is about v.a.to correct deficiencies in antioxidants and omega 3 fatty acids that often occur in glaucoma
  • Vitamins C and E: reduce oxidative stress and eye pressure
  • Secondary plant substances such as Quercetin, OPC, carotenoids etc: improve blood circulation, reduce oxidative stress and eye pressure
  • L-Arginine: has a vaso-relaxing and blood circulation-promoting effect
  • zinc: acts as an antagonist of copper to counteract glaucoma
  • chrome: lower chromium levels in the body are associated with high eye pressure
  • Omega 3 fatty acids with high EPA content: reduce inflammation, improve blood circulation; see: Tourtas T et al., Preventive effects of omega-3 and omega-6 fatty acids on peroxide mediated oxidative stress responses in primary human trabecular meshwork cells. 2012, PloS one
  • magnesium: promotes spasmolysis and ocular blood circulation
  • Vitamin D: Low vitamin D levels are associated with the presence but not the severity of primary open-angle glaucoma; see Goncalves A et al., Serum vitamin D status is associated with the presence but not the severity of primary open-angle glaucoma. August 2015, Maturitas
  • Green tea: cf. Chu et al. Green Tea Catechins and Their Oxidative Protection in the Rat Eye.Journal of Agricultural and Food Chemistry, 2010

D) Mitochondrial diseases of the eyes

Mitochondria are involved in many degenerative and inflammatory diseases, v.a. of tissues with high energy consumption. But there are also Diseases in which disorders of mitochondrial energy production are the primary cause:

• Neuropathy, ataxia and retinitis pigmentosa (NARP)
• Leber's hereditary optic neuropathy (LHON)
• Chronic Progressive External Ophthalmoplegia (CPEO)

Mitochondrial eye diseases and micronutrients

• L-carnitine: serves as a carrier for fatty acids on their way into the mitochondria
• Coenzyme Q10: as a ubiquinol/ubiquinone redox system, an essential component of the electron transport chain (“respiratory chain”) in the mitochondria
• B vitamins: play a central role as cofactors of mitochondrial processes

E) Diabetic retinopathy

• Onset: 5-30 years after the onset of diabetes
• Frequency:
  • If diagnosed with diabetes: ~ 30%
  • After 20 years of diabetes: ~ 90%
• Species (according to Airlie House classification):
  • Non-proliferative form (early form)
    • with microaneurysms
    • with intraretinal microbleeds & exudates
  • Proliferative form (late form)
    • with fibrovascular neovascularization z.B.in the papilla
    • with vitreous hemorrhages & retinal detachment
  • Cause:
    • Reaction of glucose & amino acids (especially lysine & arginine) à (glycosylation) Schiff bases à AGEs (advanced glycosylation end-products)
    • AGEs are insoluble, non-reactive proteins that lead to a deterioration of oxygen supply and to thickening of the retinal capillary endothelium and ultimately to progressive capillary death
  • Conventional therapy
    • Optimized adjustment of pre-existing metabolic syndrome (diabetes, lipid metabolism disorder, obesity), accompanied by micronutrients:
      • Optimization of vitamin C and vitamin
      • Zinc: improves insulin production, storage and release
      • Chromium: Component of the glucose tolerance factor
    • In proliferative form
      • Laser coagulation (reduces the risk of vision loss by 50%)
      • Vitrectomy (in case of late complications)
    • In both forms (non-proliferative & proliferative):
      • Octreotide (somatostatin analogue)
      • Inhibits growth hormone production in the pituitary gland
    • Diabetic retinopathy and micronutrients
      • Vitamin C
        • Reduces protein glycation in the vessel wall by 50%
        • Reduces vascular fragility (capillary inner walls made of collagen!)
      • Quercetin & Grape Seed Extract (OPC)
        • Stabilizes eye capillaries
        • Reduces increased connective tissue synthesis in diabetes
      • ginkgo: see https://www.thieme-connect.com/products/ejournals/pdf/10.1055/a-0947-5712.pdf

F) Myopia (“nearsightedness”)

• Myopia rate continues to rise in the Western world
• Risk factors for myopia
  • Reduced time spent outdoors
  • Increased use of digital media (screen activity)
  • Increased close work (z.B. Read)
  • Daylight deficit
  • Smoking of parents (especially mother during pregnancy)
  • Pollution (z.B. Particulate matter, nitrogen oxides)
  • Poor vitamin D supply
  • Birth and postpartum period in seasons with high light increases risk (probably leads to increased growth of the axial
    length of the eye)
  • Firstborns have a higher risk
  • Children of pregnant women over 35 have a higher risk
• Myopia and micronutrients: Several scientific studies have shown that a higher Vitamin D-levels in the blood significantly reduce the risk of developing myopia. See, for example, https://pubmed.ncbi.nlm.nih.gov/24970253/ : "Myopic participants had significantly lower 25(OH)D₃ concentrations. The prevalence of myopia was significantly higher in individuals with vitamin D deficiency compared to the individuals with sufficient levels."