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Eye diseases and micronutrients

from Patrick Linder

What is my risk of developing eye diseases?

The more questions are answered with "yes", the greater the individual risk of eye diseases could be. The more important preventive measures become, the more important they are..

  • Do you smoke, or is smoking a regular (daily) activity in your environment?
  • Are you frequently exposed to the sun or bright light (tanning beds, work)?
  • Do you spend a lot of time in front of the computer or smartphone (blue light exposure)?
  • Do you have light-colored eyes?
  • Are you nearsighted?
  • Are you regularly exposed to psychological or physical stress?
  • Do you or a blood relative suffer from type 1 or type 2 diabetes?
  • Do you have arteriosclerosis or circulatory disorders affecting your heart, brain, or legs?
  • Are there any cases of glaucoma ("green star") in your family?
  • Do you have an excessive body weight (BMI)? >25)?

What are some common eye diseases?

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

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

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

Freie Radikale

  • The rod-shaped 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.hare 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 neutralize these free radicals.
    • Antioxidant enzymes (produced 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.BVitamins C and E, alpha-lipoic acid, secondary plant compounds such as quercetin, OPC, beta-carotene, etc.
  • If there is an imbalance to the detriment of antioxidants, damage to the eyes from free radicals can occur..
  • If this is the case, supplementing with a synergistic antioxidant complex could be beneficial.
  • Furthermore, the formation of free radicals can already be caused by a type of "inner sunglasses" be prevented: Carotenoids such as lutein or beta-carotene, as well as vitamins E and C, protect against (blue) light.Innere Sonnenbrille

A) Cataract (“Grey Star”)

  • causes
    • Changes in lens protein structure
    • Conversion of water-soluble proteins into cloudy, water-insoluble proteins
    • Eye damage caused by UV radiation (especially oxidation by UV-B)
    • Inflammation and infections (z.B.(by cytomegalovirus)
  • Symptoms
    • Lens clouding, lens loss
    • Impaired vision (“blurred vision”)
    • Can lead to blindness
  • Risk factors
    • Diabetes (diabetes Increases the risk of cataracts 3-5 times! Osmotic stress/osmotic overpressure ((through diffusion of glucose + galactose into the lens) → conversion to sugar alcohols sorbitol + galactite
    • Old &predisposition (genetics)
    • Smoke
    • Arteriosclerosis (including lipid peroxidation and inflammation)
    • Light eyes
    • Light exposure
      • Photo-oxidative stress (z.B(Solariums)
      • Blue light (especially from computers and smartphones)
    • stress
  • Conventional therapy
    • Operation: Implantation of an artificial, flexible lens (z.B. Intraocular lens IOL “Tecnis”)
    • Risk reduction
      • diabetes
      • Overweight
      • Smoke
      • Light- &radiation exposure
      • Inflammation

    B) Macular degeneration

    • Symptoms
      • Disturbing spot in the center of the field of vision
      • Colors become palerMakuladegeneration
    • Cause: Degenerative processes (exact causes are still unknown); playing a central role are:
      • Photoreceptors of the retina (especially in the macula) with high metabolic activity and high O2 consumption lead to increased radical formation.
      • Retinal pigment epithelium (RPE) behind the retina: RPE cells dispose of oxidized (unusable) photoreceptor components through phagocytosis and removal. Disruptions of this process (oxygen deficiency, metabolic disorders, and arteriosclerosis are discussed) lead to deposits (“drusen”).
        which accelerate the degeneration of RPE cells and promote macular degeneration
    • Risk factors
      • Old &predisposition (genetics)
      • Smoke
      • Arteriosclerosis (including lipid peroxidation and inflammation)
      • Light eyes
      • Light exposure
        • Photo-oxidative stress (z.B(Solariums)
        • Blue light (especially from computers and smartphones)
      • stress
    • Senile cataracts and micronutrients
      • Secondary plant compounds with strong antioxidant potential (Antioxidant enzymes such as glutathione peroxidase, SOD and catalase are reduced in cataracts!), such as...
        • Quercetin
        • Grape seed extract with a 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 opacity
        • Vitamin E deficiency increases the risk by 1.8 to 3.7 times (9 studies with 10,355 participants)
        • 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 opacity
        • Reduces risk by approximately 40% (9 intervention studies with 80,675 participants)
      • zinc (has a regulating effect on the hormonal balance)
      • selenium (has an antioxidant effect)
      • Omega 3 fatty acids with a high EPA content (have anti-inflammatory effects)

    How do wet and dry macular degeneration differ?

    • Wet macular degeneration
      • 10% of all cases of macular degeneration
      • Fluid accumulation under the macula (“macular edema”)
      • The retina swells &stands out
      • Loss of central visual acuity and distortion of lines && edges
      • Established forms of therapy are available
    • Dry macular degeneration
      • 90% of all cases of macular degeneration
      • Formation of “Druze”Druse are an accumulation of waste products. (crystalline-looking fatty spots/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 progressive deterioration of vision, in some cases vision loss due to cell death
      • Currently not reliably treatableDrusen
    • Macular degeneration and micronutrients
      • Against the dry form of AMD So far, only the prophylaxis"Since dead photoreceptors cannot be replaced, one must hope for the inhibition of cell death." (Source: Gerste RD; Modulation of the visual cycle; Deutsches Ärzteblatt 20.1.2012; 82-83)
        • AntioxidantsAntioxidant vitamins 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 compounds 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
        • TurmericExtract: 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)
        • ginkgoGinkgo extract for 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 (is a component of SOD); reduced zinc and copper levels in the retinal pigment epithelium and choroid in AMD (see 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): "Administering 5 g/day of EPA/DHA resulted in an improvement in visual acuity of more than one line in the eye test within 4.5 months. The greatest improvement of 15 letters in the eye test was achieved by patients who received 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 vasodilating effect and promotes blood circulation
        • Alpha-lipoic acidAntioxidant, improves glutathione supply
      • “ARED-1 shows a positive effect of the high doses of micronutrients. Vitamins C and E, beta-carotene and zinc in intermediate AMD stages (OR 0.72). In ARED-2, the following effects occur: 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 star”)

    What are the specific causes and symptoms of glaucoma?

    • Symptoms
      • Restriction of the visual field
      • Blindness
    • causes
      • Aqueous humor drainage obstructed
        • Increase in intraocular pressure (normal: 14-18 mm Hg)
        • Damage and destruction of optic nerve fibers
      • Autoimmune processes involving the formation of auto-IgG antibodies are discussed (Source: Deutsches Ärzteblatt, 3/04)

    Glaukom Gruener Star Augendruck

    • Risk factors
      • Vascular processes (z.B. Arteriosclerosis)
      • Age (&(gt; 40 years)
      • Familial predisposition for glaucoma
      • Nearsightedness (myopia of -5 diopters or more)
      • Neurodegenerative processes
      • Diabetes (see Bonovas et al.; Diabet Med 2004/21, 609-614)
    • Conventional therapy
      • Lower eye pressure to 16-18 mmHg
      • Medications: z.BBeta-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 frequently occur in glaucoma
      • Vitamins C and E: reduce oxidative stress and eye pressure
      • Secondary plant compounds such as Quercetin, OPC, carotenoids etc.: improve blood circulation, reduce oxidative stress and eye pressure
      • L-Arginine: has a vasodilating effect and promotes blood circulation
      • zinc: acts as an antagonist of copper to counteract glaucoma
      • chromeLower chromium levels in the body are associated with high intraocular pressure.
      • Omega 3 fatty acids with a high EPA contentThey reduce inflammation and improve blood circulation; see also: 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 disturbances in mitochondrial energy production are the primary cause of disease:

    • 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 the 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 in mitochondrial processes

    E) Diabetic retinopathy

    • Onset: 5-30 years after the "breakdown" of diabetes
    • Frequency:
      • In cases of diabetes diagnosis: ~30%
      • After 20 years of diabetes: ~90%
    • Species (according to the Airlie House classification):
      • Non-proliferative form (early form)
        • with microaneurysms
        • with intraretinal microbleeds && exudates
      • Proliferative form (late form)
        • with fibrovascular neoplasms z.B.in the papilla
        • with vitreous hemorrhages &retinal detachment
      • Cause:
        • Reaction of glucose &Amino acids (especially lysine) &&amp; 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, thickening of the retinal capillary endothelium, and ultimately to progressive capillary death.
      • Conventional therapy
        • Optimized management 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) &am; proliferative):
          • Octreotide (somatostatin analogue)
          • Inhibits growth hormone production in the pituitary gland
        • Diabetic retinopathy and micronutrients

    F) Myopia (“nearsightedness”)

    • The myopia rate is steadily increasing 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
      • Parental smoking (especially mother during pregnancy)
      • Pollution (z.B(Particulate matter, nitrogen oxides)
      • Poor vitamin D supply
      • Birth and the postpartum period during seasons with high light levels increase the risk (likely leading to increased growth of the axial skeleton).
        (Length of the eye)
      • Firstborn children have a higher risk
      • Children of pregnant women over 35 have a higher risk.
    • Nearsightedness and micronutrients: Several scientific studies have demonstrated that a higher Vitamin D-Levels in the blood significantly reduce the risk of developing myopia. See, for example, [reference to relevant source]. 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."

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