25)?
What are common eye diseases?
Senile cataract ("cataract")
Age-related macular degeneration (AMD)
Glaucoma ("glaucoma")
Mitochondrial eye diseases
diabetic retinopathy
Myopia (short-sightedness)
Of course, the specific therapy of eye diseases primarily belongs in the hands of ophthalmologists. But micronutrients can be very useful for prevention & basic therapy.
A central cause of many age-related eye diseases is oxidative stress
The outer rod elements (with photoreceptors) of our eyes consist of 65% unsaturated fatty acids (highest proportion of all body tissue!)
Unsaturated fatty acids are easily peroxidized by free radicals, i.e. they are damaged by free radicals
The formation of free radicals generally occurs through
oxidative stress (oxidation of O2), but in the eye mainly by
photo-oxidative stress (UV light activates oxygen radicals very quickly)
Antioxidants defuse these free radicals
Antioxidative enzymes (produced in the body): peroxidases (e.g. glutathione peroxidase, phospholipid hydroperoxide glutathione peroxidase), catalases, superoxide dismutases (SOD)
Non-enzymatic antioxidants (essential = to be supplied through food): e.g. vitamin C and E, alpha-lipoic acid, phytochemicals such as quercetin, OPC, beta-carotene etc.
When there is an imbalance in antioxidants, free radical damage occurs to the eyes.
If this is the case, supplementation with a synergistic antioxidant complex could make sense.
In addition, the formation of free radicals can already be prevented by a kind of "internal sunglasses": Carotenoids such as lutein or beta-carotene and vitamins E and C protect against (blue ) Light
A) Cataract (“cataract”)
Causes
Change in lens protein structure
Conversion of water-soluble proteins into cloudy, water-insoluble proteins
Eye damage from UV radiation (especially oxidation from UV-B)
Inflammation and infections (e.g.by cytomegalovirus)
Symptoms
Lens opacity, lens transparency loss
Visual impairment (“fog vision”)
Can lead to blindness
Risk factors
Diabetes (diabetes increases the risk of cataracts 3-5 times! à osmotic stress / osmotic overpressure (through diffusion of glucose + galactose in the lens) à conversion into Sugar alcohols sorbitol + galactitol
Age & predisposition (genetics)
Smoking
Arteriosclerosis (including lipid peroxidation and inflammation)
Bright eyes
Light exposure
Photo-oxidative stress (e.g. solariums)
Blue light (especially computers and smartphones)
Stress
Conventional therapy
Surgery: implantation of an artificial, flexible lens (e.g. intraocular lens IOL “Tecnis”)
Risk reduction
diabetes
Overweight
Smoking
Light & radiation exposure
inflammation
B) Macular Degeneration
Symptoms
Annoying spot in the middle of the visual field
Colors fade
Cause: degenerative processes (exact causes are still unknown); play a 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: cells of the RPE dispose of oxidized (unusable) photoreceptor parts through phagocytosis and removal à disturbances of the process (lack of oxygen, 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)
Smoking
Arteriosclerosis (including lipid peroxidation and inflammation)
Bright eyes
Light exposure
Photo-oxidative stress (e.g. solariums)
Blue light (especially computers and smartphones)
Stress
Senile cataract 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 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)
Cf. 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 risk by a factor of 1.8 to 3.7 (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 the lens metabolism
Studies suggest a 40% reduction in the frequency of senile cataracts
Vitamin C
Prevents lens opacity
Reduces risk by about 40% (9 intervention studies with 80,675 subjects)
Zinc (has a regulating effect on the hormone balance)
Selenium (has an antioxidant effect)
Omega 3 fatty acids with a high EPA content (have an anti-inflammatory effect)
What is the difference between wet and dry macular degeneration?
Wet macular degeneration
10% of all cases of macular degeneration
Collections of fluid under the macula (“maculoedema”)
Retina swells & protrudes
Loss of central visual acuity and distortion of lines & edges
Established forms of therapy available
Dry macular degeneration
90% of all cases of macular degeneration
Formation of “drusen”: Drusen are accumulations of waste products (crystalline-looking fatty dots/deposits) under the macula lutea, e.g. as a result of genetics and/or oxidative stress: many of the proteins found in drusen are the result of chronic inflammatory processes
Initially restricted to outer regions of the macula with little effect on photoreceptors
Later increasing deterioration in vision, in some cases loss of vision due to cell death
Currently not reliably treatable
Macular degeneration and micronutrients
So far there is only prophylaxis against the dry form of AMD : "Since dead photoreceptors cannot be replaced, one must hope that cell death will be inhibited." ( Source: Gerste RD; modulation of the visual cycle; Deutsches Ärzteblatt January 20, 2012; 82-83)
Antioxidants: Antioxidant vitamin and mineral supplements slow the progression of AMD (see Evans, J.R. and J.G. 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; cf. 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
Curcuma extract: Curcumin protects retinal pigment epithelial cells against oxidative stress by inducing heme oxygenase-1 expression and reducing reactive oxygen (cf. 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]." Vienna medical weekly (1946) 152.15-16 (2001): 423-426)
Zinc: reduces oxidative stress (is a building block of SOD); reduced zinc and copper levels in the retinal pigment epithelium and in the 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): "With the administration of 5 g/day EPA/DHA, there was an improvement in vision of more than one line in the eye test within 4.5 months Die The greatest improvement of 15 letters in the eye test was achieved by patients with an AA/EPA
L-arginine: has a vascular-relaxing effect and promotes blood circulation
Alpha-lipoic acid: antioxidant, improves glutathione supply
„In ARED-1 there is a positive effect of the high-dose micronutrients vitamin C and E, beta-carotene and zinc in intermediate AMD stages (OR 0.72). In ARED-2, lutein/zeaxanthin and omega-3 fatty acids are effective in intermediate and advanced stages (OR 0.89)" (Source: Stahl A; macular degeneration; Deutsches Ärzteblatt 8/2020, 371)
C) Glaucoma (“glaucoma”)
What are the specific causes and symptoms of glaucoma?
Symptoms
restriction of the field of vision
Blindness
Causes
Aqueous outflow disturbed
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 (e.g. arteriosclerosis)
Age (> 40 years)
Family burden for glaucoma
Myopia (myopia from -5 dioptres)
Neurodegenerative processes
Diabetes (cf. Bonovas et al.; Diabet Med 2004/21, 609-614)
Conventional therapy
Reduce eye pressure to 16-18 mm Hg
Medication: e.g. beta blocker timolol
Prostaglandin analogues (latanaprost / xalatan)
alpha-2 agonists
laser therapy / surgery
"Glaucoma" (glaucoma) and micronutrients: this is primarily about correcting deficits in antioxidants and omega 3 fatty acids that often occur with 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 vascular-relaxing effect and promotes blood circulation
Zinc: acts as an antagonist of copper against glaucoma
Chromium: 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; cf.: 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 occurrence, but not the severity, of primary open-angle glaucoma; cf. 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, especially in tissues with high energy expenditure. 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 to the mitochondria
Coenzyme Q10: as a ubiquinol/ubiquinone redox system, it is an essential part of the electron transport chain (“respiratory chain”) in the mitochondria
B vitamins: play a central role as cofactors in mitochondrial processes
E) Diabetic retinopathy
Beginning: 5-30 years after the “onset” of diabetes
Frequency:
With diabetes diagnosis: ~ 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, e.g.in the papilla
with vitreous hemorrhage & 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 in oxygen supply and thickening of the retinal capillary endothelium and finally to progressive capillary death
Conventional therapy
Optimized adjustment of the pre-existing metabolic syndrome (diabetes, dyslipidemia, overweight), accompanied by micronutrients:
Optimization of vitamin C and vitamin
Zinc: improves insulin formation, storage and release
Chromium: part of the glucose tolerance factor
In the case of a proliferative form
laser coagulation (reduces risk of visual loss by 50%)
Vitrectomy (for 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://wwwthieme-connect.com/products/ejournals/pdf/10.1055/a-0947-5712.pdf
F) Myopia ("short-sightedness")
Myopia rate continues to increase in the western world
Risk factors for myopia
Decreased time spent outdoors
Increased use of digital media (screen activity)
Increased close work (e.g. reading)
Daylight deficit
Parents smoking (especially mother during pregnancy)
Pollution (e.g. fine dust, nitrogen oxides)
Poor vitamin D supply
Childbirth and postpartum phase in seasons with lots of light increases risk (probably leads to increased growth in axial length of the eye)
Firstborns are at higher risk
Children of pregnant women over the age of 35 have a higher risk
Myopia and micronutrients: Several scientific studies have shown that a higher vitamin D level in the blood significantly reduces the risk of developing myopia. See e.g. 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."
.">
25)?
What are common eye diseases?
Senile cataract ("cataract")
Age-related macular degeneration (AMD)
Glaucoma ("glaucoma")
Mitochondrial eye diseases
diabetic retinopathy
Myopia (short-sightedness)
Of course, the specific therapy of eye diseases primarily belongs in the hands of ophthalmologists. But micronutrients can be very useful for prevention & basic therapy.
A central cause of many age-related eye diseases is oxidative stress
The outer rod elements (with photoreceptors) of our eyes consist of 65% unsaturated fatty acids (highest proportion of all body tissue!)
Unsaturated fatty acids are easily peroxidized by free radicals, i.e. they are damaged by free radicals
The formation of free radicals generally occurs through
oxidative stress (oxidation of O2), but in the eye mainly by
photo-oxidative stress (UV light activates oxygen radicals very quickly)
Antioxidants defuse these free radicals
Antioxidative enzymes (produced in the body): peroxidases (e.g. glutathione peroxidase, phospholipid hydroperoxide glutathione peroxidase), catalases, superoxide dismutases (SOD)
Non-enzymatic antioxidants (essential = to be supplied through food): e.g. vitamin C and E, alpha-lipoic acid, phytochemicals such as quercetin, OPC, beta-carotene etc.
When there is an imbalance in antioxidants, free radical damage occurs to the eyes.
If this is the case, supplementation with a synergistic antioxidant complex could make sense.
In addition, the formation of free radicals can already be prevented by a kind of "internal sunglasses": Carotenoids such as lutein or beta-carotene and vitamins E and C protect against (blue ) Light
A) Cataract (“cataract”)
Causes
Change in lens protein structure
Conversion of water-soluble proteins into cloudy, water-insoluble proteins
Eye damage from UV radiation (especially oxidation from UV-B)
Inflammation and infections (e.g.by cytomegalovirus)
Symptoms
Lens opacity, lens transparency loss
Visual impairment (“fog vision”)
Can lead to blindness
Risk factors
Diabetes (diabetes increases the risk of cataracts 3-5 times! à osmotic stress / osmotic overpressure (through diffusion of glucose + galactose in the lens) à conversion into Sugar alcohols sorbitol + galactitol
Age & predisposition (genetics)
Smoking
Arteriosclerosis (including lipid peroxidation and inflammation)
Bright eyes
Light exposure
Photo-oxidative stress (e.g. solariums)
Blue light (especially computers and smartphones)
Stress
Conventional therapy
Surgery: implantation of an artificial, flexible lens (e.g. intraocular lens IOL “Tecnis”)
Risk reduction
diabetes
Overweight
Smoking
Light & radiation exposure
inflammation
B) Macular Degeneration
Symptoms
Annoying spot in the middle of the visual field
Colors fade
Cause: degenerative processes (exact causes are still unknown); play a 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: cells of the RPE dispose of oxidized (unusable) photoreceptor parts through phagocytosis and removal à disturbances of the process (lack of oxygen, 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)
Smoking
Arteriosclerosis (including lipid peroxidation and inflammation)
Bright eyes
Light exposure
Photo-oxidative stress (e.g. solariums)
Blue light (especially computers and smartphones)
Stress
Senile cataract 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 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)
Cf. 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 risk by a factor of 1.8 to 3.7 (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 the lens metabolism
Studies suggest a 40% reduction in the frequency of senile cataracts
Vitamin C
Prevents lens opacity
Reduces risk by about 40% (9 intervention studies with 80,675 subjects)
Zinc (has a regulating effect on the hormone balance)
Selenium (has an antioxidant effect)
Omega 3 fatty acids with a high EPA content (have an anti-inflammatory effect)
What is the difference between wet and dry macular degeneration?
Wet macular degeneration
10% of all cases of macular degeneration
Collections of fluid under the macula (“maculoedema”)
Retina swells & protrudes
Loss of central visual acuity and distortion of lines & edges
Established forms of therapy available
Dry macular degeneration
90% of all cases of macular degeneration
Formation of “drusen”: Drusen are accumulations of waste products (crystalline-looking fatty dots/deposits) under the macula lutea, e.g. as a result of genetics and/or oxidative stress: many of the proteins found in drusen are the result of chronic inflammatory processes
Initially restricted to outer regions of the macula with little effect on photoreceptors
Later increasing deterioration in vision, in some cases loss of vision due to cell death
Currently not reliably treatable
Macular degeneration and micronutrients
So far there is only prophylaxis against the dry form of AMD : "Since dead photoreceptors cannot be replaced, one must hope that cell death will be inhibited." ( Source: Gerste RD; modulation of the visual cycle; Deutsches Ärzteblatt January 20, 2012; 82-83)
Antioxidants: Antioxidant vitamin and mineral supplements slow the progression of AMD (see Evans, J.R. and J.G. 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; cf. 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
Curcuma extract: Curcumin protects retinal pigment epithelial cells against oxidative stress by inducing heme oxygenase-1 expression and reducing reactive oxygen (cf. 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]." Vienna medical weekly (1946) 152.15-16 (2001): 423-426)
Zinc: reduces oxidative stress (is a building block of SOD); reduced zinc and copper levels in the retinal pigment epithelium and in the 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): "With the administration of 5 g/day EPA/DHA, there was an improvement in vision of more than one line in the eye test within 4.5 months Die The greatest improvement of 15 letters in the eye test was achieved by patients with an AA/EPA
L-arginine: has a vascular-relaxing effect and promotes blood circulation
Alpha-lipoic acid: antioxidant, improves glutathione supply
„In ARED-1 there is a positive effect of the high-dose micronutrients vitamin C and E, beta-carotene and zinc in intermediate AMD stages (OR 0.72). In ARED-2, lutein/zeaxanthin and omega-3 fatty acids are effective in intermediate and advanced stages (OR 0.89)" (Source: Stahl A; macular degeneration; Deutsches Ärzteblatt 8/2020, 371)
C) Glaucoma (“glaucoma”)
What are the specific causes and symptoms of glaucoma?
Symptoms
restriction of the field of vision
Blindness
Causes
Aqueous outflow disturbed
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 (e.g. arteriosclerosis)
Age (> 40 years)
Family burden for glaucoma
Myopia (myopia from -5 dioptres)
Neurodegenerative processes
Diabetes (cf. Bonovas et al.; Diabet Med 2004/21, 609-614)
Conventional therapy
Reduce eye pressure to 16-18 mm Hg
Medication: e.g. beta blocker timolol
Prostaglandin analogues (latanaprost / xalatan)
alpha-2 agonists
laser therapy / surgery
"Glaucoma" (glaucoma) and micronutrients: this is primarily about correcting deficits in antioxidants and omega 3 fatty acids that often occur with 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 vascular-relaxing effect and promotes blood circulation
Zinc: acts as an antagonist of copper against glaucoma
Chromium: 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; cf.: 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 occurrence, but not the severity, of primary open-angle glaucoma; cf. 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, especially in tissues with high energy expenditure. 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 to the mitochondria
Coenzyme Q10: as a ubiquinol/ubiquinone redox system, it is an essential part of the electron transport chain (“respiratory chain”) in the mitochondria
B vitamins: play a central role as cofactors in mitochondrial processes
E) Diabetic retinopathy
Beginning: 5-30 years after the “onset” of diabetes
Frequency:
With diabetes diagnosis: ~ 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, e.g.in the papilla
with vitreous hemorrhage & 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 in oxygen supply and thickening of the retinal capillary endothelium and finally to progressive capillary death
Conventional therapy
Optimized adjustment of the pre-existing metabolic syndrome (diabetes, dyslipidemia, overweight), accompanied by micronutrients:
Optimization of vitamin C and vitamin
Zinc: improves insulin formation, storage and release
Chromium: part of the glucose tolerance factor
In the case of a proliferative form
laser coagulation (reduces risk of visual loss by 50%)
Vitrectomy (for 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://wwwthieme-connect.com/products/ejournals/pdf/10.1055/a-0947-5712.pdf
F) Myopia ("short-sightedness")
Myopia rate continues to increase in the western world
Risk factors for myopia
Decreased time spent outdoors
Increased use of digital media (screen activity)
Increased close work (e.g. reading)
Daylight deficit
Parents smoking (especially mother during pregnancy)
Pollution (e.g. fine dust, nitrogen oxides)
Poor vitamin D supply
Childbirth and postpartum phase in seasons with lots of light increases risk (probably leads to increased growth in axial length of the eye)
Firstborns are at higher risk
Children of pregnant women over the age of 35 have a higher risk
Myopia and micronutrients: Several scientific studies have shown that a higher vitamin D level in the blood significantly reduces the risk of developing myopia. See e.g. 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."
.">
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 is there regular (daily) smoking in your area?
Are you often exposed to the sun or bright light (solarium, 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 nearsighted?
Are you regularly exposed to psychological or physical stress?
Do you or a blood relative suffer from type 1 or type 2 diabetes?
Are you aware of arteriosclerosis or circulatory disorders in the heart, brain or legs?
Are there cases of glaucoma ("glaucoma") in your family?
Are you overweight (BMI >25)?
What are common eye diseases?
Senile cataract ("cataract")
Age-related macular degeneration (AMD)
Glaucoma ("glaucoma")
Mitochondrial eye diseases
diabetic retinopathy
Myopia (short-sightedness)
Of course, the specific therapy of eye diseases primarily belongs in the hands of ophthalmologists. But micronutrients can be very useful for prevention & basic therapy.
A central cause of many age-related eye diseases is oxidative stress
The outer rod elements (with photoreceptors) of our eyes consist of 65% unsaturated fatty acids (highest proportion of all body tissue!)
Unsaturated fatty acids are easily peroxidized by free radicals, i.e. they are damaged by free radicals
The formation of free radicals generally occurs through
oxidative stress (oxidation of O2), but in the eye mainly by
photo-oxidative stress (UV light activates oxygen radicals very quickly)
Antioxidants defuse these free radicals
Antioxidative enzymes (produced in the body): peroxidases (e.g. glutathione peroxidase, phospholipid hydroperoxide glutathione peroxidase), catalases, superoxide dismutases (SOD)
Non-enzymatic antioxidants (essential = to be supplied through food): e.g. vitamin C and E, alpha-lipoic acid, phytochemicals such as quercetin, OPC, beta-carotene etc.
When there is an imbalance in antioxidants, free radical damage occurs to the eyes.
If this is the case, supplementation with a synergistic antioxidant complex could make sense.
In addition, the formation of free radicals can already be prevented by a kind of "internal sunglasses": Carotenoids such as lutein or beta-carotene and vitamins E and C protect against (blue ) Light
A) Cataract (“cataract”)
Causes
Change in lens protein structure
Conversion of water-soluble proteins into cloudy, water-insoluble proteins
Eye damage from UV radiation (especially oxidation from UV-B)
Inflammation and infections (e.g.by cytomegalovirus)
Symptoms
Lens opacity, lens transparency loss
Visual impairment (“fog vision”)
Can lead to blindness
Risk factors
Diabetes (diabetes increases the risk of cataracts 3-5 times! à osmotic stress / osmotic overpressure (through diffusion of glucose + galactose in the lens) à conversion into Sugar alcohols sorbitol + galactitol
Age & predisposition (genetics)
Smoking
Arteriosclerosis (including lipid peroxidation and inflammation)
Bright eyes
Light exposure
Photo-oxidative stress (e.g. solariums)
Blue light (especially computers and smartphones)
Stress
Conventional therapy
Surgery: implantation of an artificial, flexible lens (e.g. intraocular lens IOL “Tecnis”)
Risk reduction
diabetes
Overweight
Smoking
Light & radiation exposure
inflammation
B) Macular Degeneration
Symptoms
Annoying spot in the middle of the visual field
Colors fade
Cause: degenerative processes (exact causes are still unknown); play a 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: cells of the RPE dispose of oxidized (unusable) photoreceptor parts through phagocytosis and removal à disturbances of the process (lack of oxygen, 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)
Smoking
Arteriosclerosis (including lipid peroxidation and inflammation)
Bright eyes
Light exposure
Photo-oxidative stress (e.g. solariums)
Blue light (especially computers and smartphones)
Stress
Senile cataract 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 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 )
Studies suggest a 40% reduction in the frequency of senile cataracts
Vitamin C
Prevents lens opacity
Reduces risk by about 40% (9 intervention studies with 80,675 subjects)
Zinc (has a regulating effect on the hormone balance)
Selenium (has an antioxidant effect)
Omega 3 fatty acids with a high EPA content (have an anti-inflammatory effect)
What is the difference between wet and dry macular degeneration?
Wet macular degeneration
10% of all cases of macular degeneration
Collections of fluid under the macula (“maculoedema”)
Retina swells & protrudes
Loss of central visual acuity and distortion of lines & edges
Established forms of therapy available
Dry macular degeneration
90% of all cases of macular degeneration
Formation of “drusen”: Drusen are accumulations of waste products (crystalline-looking fatty dots/deposits) under the macula lutea, e.g. as a result of genetics and/or oxidative stress: many of the proteins found in drusen are the result of chronic inflammatory processes
Initially restricted to outer regions of the macula with little effect on photoreceptors
Later increasing deterioration in vision, in some cases loss of vision due to cell death
Currently not reliably treatable
Macular degeneration and micronutrients
So far there is only prophylaxis against the dry form of AMD : "Since dead photoreceptors cannot be replaced, one must hope that cell death will be inhibited." ( Source: Gerste RD; modulation of the visual cycle; Deutsches Ärzteblatt January 20, 2012; 82-83)
Antioxidants: Antioxidant vitamin and mineral supplements slow the progression of AMD (see Evans, J.R. and J.G. 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; cf. 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
Curcuma extract: Curcumin protects retinal pigment epithelial cells against oxidative stress by inducing heme oxygenase-1 expression and reducing reactive oxygen (cf. 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]." Vienna medical weekly (1946) 152.15-16 (2001): 423-426)
Zinc: reduces oxidative stress (is a building block of SOD); reduced zinc and copper levels in the retinal pigment epithelium and in the 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): "With the administration of 5 g/day EPA/DHA, there was an improvement in vision of more than one line in the eye test within 4.5 months Die The greatest improvement of 15 letters in the eye test was achieved by patients with an AA/EPA < 2. Even patients with severe AMD were able to achieve a 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 vascular-relaxing effect and promotes blood circulation
„In ARED-1 there is a positive effect of the high-dose micronutrients vitamin C and E, beta-carotene and zinc in intermediate AMD stages (OR 0.72). In ARED-2, lutein/zeaxanthin and omega-3 fatty acids are effective in intermediate and advanced stages (OR 0.89)" (Source: Stahl A; macular degeneration; Deutsches Ärzteblatt 8/2020, 371)
C) Glaucoma (“glaucoma”)
What are the specific causes and symptoms of glaucoma?
Symptoms
restriction of the field of vision
Blindness
Causes
Aqueous outflow disturbed
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 (e.g. arteriosclerosis)
Age (> 40 years)
Family burden for glaucoma
Myopia (myopia from -5 dioptres)
Neurodegenerative processes
Diabetes (cf. Bonovas et al.; Diabet Med 2004/21, 609-614)
Conventional therapy
Reduce eye pressure to 16-18 mm Hg
Medication: e.g. beta blocker timolol
Prostaglandin analogues (latanaprost / xalatan)
alpha-2 agonists
laser therapy / surgery
"Glaucoma" (glaucoma) and micronutrients: this is primarily about correcting deficits in antioxidants and omega 3 fatty acids that often occur with 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 vascular-relaxing effect and promotes blood circulation
Zinc: acts as an antagonist of copper against glaucoma
Chromium: 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; cf.: 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 occurrence, but not the severity, of primary open-angle glaucoma; cf. 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, especially in tissues with high energy expenditure. But there are also diseases in which disorders of mitochondrial energy production are the primary cause:
Neuropathy, ataxia and retinitis pigmentosa (NARP)
L-carnitine: serves as a carrier for fatty acids on their way to the mitochondria
Coenzyme Q10: as a ubiquinol/ubiquinone redox system, it is an essential part of the electron transport chain (“respiratory chain”) in the mitochondria
B vitamins: play a central role as cofactors in mitochondrial processes
E) Diabetic retinopathy
Beginning: 5-30 years after the “onset” of diabetes
Frequency:
With diabetes diagnosis: ~ 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, e.g.in the papilla
with vitreous hemorrhage & 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 in oxygen supply and thickening of the retinal capillary endothelium and finally to progressive capillary death
Conventional therapy
Optimized adjustment of the pre-existing metabolic syndrome (diabetes, dyslipidemia, overweight), accompanied by micronutrients:
Optimization of vitamin C and vitamin
Zinc: improves insulin formation, storage and release
Chromium: part of the glucose tolerance factor
In the case of a proliferative form
laser coagulation (reduces risk of visual loss by 50%)
Vitrectomy (for 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
Myopia rate continues to increase in the western world
Risk factors for myopia
Decreased time spent outdoors
Increased use of digital media (screen activity)
Increased close work (e.g. reading)
Daylight deficit
Parents smoking (especially mother during pregnancy)
Pollution (e.g. fine dust, nitrogen oxides)
Poor vitamin D supply
Childbirth and postpartum phase in seasons with lots of light increases risk (probably leads to increased growth in axial length of the eye)
Firstborns are at higher risk
Children of pregnant women over the age of 35 have a higher risk
Myopia and micronutrients: Several scientific studies have shown that a higher vitamin D level in the blood significantly reduces the risk of developing myopia. See e.g. 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."