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." .">
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Eye diseases and micronutrients

from Patrick Linder

What is my risk for eye diseases?

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

Freie Radikale

  • 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 ) LightInnere Sonnenbrille

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 fadeMakuladegeneration
    • 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 treatableDrusen
    • 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
        • 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)

    Glaukom Gruener Star Augendruck

    • 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

    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."
    .

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