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Risk Factors determined by the Mayo Clinic
• Age. Your risk of macular degenera on increases as you age, especially a er age 50. Macular ARMD degenera on is most common in people older than 65. • Family history of macular degenera on. If someone in your family had macular degenera on, you're more likely to develop macular degenera on. From Spinach to Injec on • Race. Macular degenera on is more common in whites (Caucasians) than it is in other races. • Smoking. Smoking cigare es increases your risk of macular degenera on. • Obesity. Being severely overweight increases the chance that early or intermediate macular degenera on will progress to the more severe form of the disease. • Diet. A diet that includes few fruits and vegetables may increase the risk of macular degenera on. • High blood pressure. Diseases that affect the circulatory system, such as high blood pressure or high cholesterol, may increase the risk of macular degenera on. Steven M. Newman, O.D., C.N.S. • Inflamma on. Your immune system can cause swelling of your body ssues, which may Board Cer fied Optometric Physician increase the risk of macular degenera on. Florida Board of Optometry • Cardiovascular disease. If you have had diseases that affected your heart and blood vessels (cardiovascular disease), you may be at higher risk of macular degenera on Board Cer fied Nutri on Specialist American College of Nutri on
ARMD gene cs Hippocrates
– Alternate complement pathway – ARMS2/HTRA1 – HDL cholesterol pathway “He who does not know – Extracellular matrix – Angiogenesis pathway food, how can he – Vitamin D pathway understand the diseases of man?”
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Our body was designed to absorb nutrients the old fashioned way…by ea ng natural foods rich in an oxidants. Locally grown, organic fruits and vegetables contain the essen al vitamins and nutrients necessary for op mal health.
AREDS 2 AREDS 2 is a mul -center randomized trial designed to assess the effects of oral supplementa on of high doses of macular xanthophylls (lutein and zeaxanthin) and/or omega -3 LCPUFAs (DHA and EPA) for the treatment of AMD and cataract. All par cipants will be offered addi onal treatment with the study formula on used in AREDS. For those who elect to take this addi onal supplement, which is now considered the standard of care, further randomiza on may occur to evaluate the possibility of dele ng beta-carotene and decreasing the original levels of zinc in the formula on for the treatment of AMD, if consent is obtained.
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Study Chair: Emily Chew, MD AREDS 2 The primary objec ve of AREDS 2 is to evaluate the effect of dietary Na onal Eye Ins tute (NEI) xanthophylls (lutein/zeaxanthin) and/or omega -3 LCPUFAs (DHA and EPA) on progression to advanced AMD. This objec ve will be Division of Epidemiology and Clinical Research accomplished by collec ng and assessing the data on Clinical Trials Branch approximately 4,000 AREDS 2 par cipants aged 50 to 85 years, Bldg. 10, CRC, 3-2531 who at the me of enrollment have either:
10 Center Drive, MSC 1204 Bethesda, MD 20892-1204 1. bilateral large drusen or Tel: 301-496-6583 Fax: 301-496-7295 2. large drusen in one eye and advanced AMD (neovascular AMD or central geographic atrophy) in the fellow eye. E-mail: [email protected]
The objec ves of AREDS 2 are to: Study the effects of high supplemental doses of the dietary xanthophylls (lutein and zeaxanthin) and omega -3 LCPUFAs (DHA If the par cipant is a current smoker or a former and EPA) on the development of advanced AMD. smoker that has quit within the last year, he Study the effects of these supplements on cataract and moderate vision loss (doubling of the visual angle or the loss of 15 or more or she will be randomized to one of the two le ers on the ETDRS chart). arms without beta-carotene (Formula ons 2 Study the effects of elimina ng beta-carotene in the original AREDS formula on on the development and progression of AMD. or 3). If a par cipant does not consent to Study the effects of reducing zinc in the original AREDS formula on on randomiza on but wants to take the AREDS the development and progression of AMD. formula on, he or she will be provided the Validate the fundus photographic AMD scale developed from the Age- Related Eye Disease Study. supplements provided that they are not a Enrollment concluded in June 2008 and par cipants will be followed between five and six years. current smoker or a former smoker that has quit within the last year.
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Known for years
Too much Zinc is bad for us. It actually causes us to age more rapidly.
Most vitamin manufacturers, especially the ones owned and operated by optometrists, reduced their zinc concentra ons years ago.
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Recent Conclusion
Perceived: AREDS 2 recently concluded that supplemen ng with Omega 3’s did not show any benefit towards hal ng or reversing macular degenera on.
Actual: The amount of ethyl-ester (Triglyceride form is the natural form) Omega 3 used in the AREDS 2 study did not show any benefits towards hal ng or reversing macular degenera on.
AREDS take home message Top Ten Vitamin C Foods
1. Green Chilis – 245mg/100g 2. Guava – 228mg/100g An oxidants 3. Bell Peppers – 184mg/100g (341/pepper) 4. Fresh Herbs – Thyme / Parsley – 160mg/100g Especially Vitamin C 5. Green Leafy Vegetables – 120mg/100g Are beneficial for people 6. Broccoli (Cauliflower / Brussels Sprouts) – 89mg/100g Suffering from ARMD 7. Kiwi – 93 mg/100g 8. Papaya – 62mg/100g 9. Orange – 59mg/100g 10. Strawberry – 59mg/100g
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RAW FOODS
Food source in most natural state Diet rich in fruits and vegetables Healthy fats via nuts PH levels naturally increase Easier to follow due to access
Really???
All par cipants in AREDS 2 taking a daily mul vitamin and/or mul mineral supplement will be asked to replace it with Centrum Silver®. This product will be provided free-of- charge (you get what you pay for).
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Hippocrates
“If we could give every individual the right amount of nourishment and exercise, not too li le and not too much, we would have found the safest way to health.”
Phototrop Study
Improvement of Visual Functions and Fundus Alterations in Early Age-Related Macular Degeneration Treated with a Combination of Acetyl- L -Carnitine, n-3 Fatty Acids, and Coenzyme Q10
Ophthalmologica 2005;219:154–166J
Fehera B. Kovacs I. Kovacs M. Schvöller A. Papale C. Balacco Gabrieli Ophthalmic Neuroscience Program, Department of Ophthalmology, University of Rome ‘La Sapienza’, Rome ,Italy Department of Ophthalmology, University of Pecs, Pecs , and Second Department of Ophthalmology,Semmelweis University, Budapest , Hungary
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Study Medica on consisted of 2 oral The aim of this randomized, double-blind, placebo- capsules per day, containing either: controlled clinical trial was to determine the efficacy of a combination of 100 mg of ALC Acetyl- L –Carnitine 530 mg of n-3FA 10 mg of CoQ10 n-3 Fatty Acids and Coenzyme Q10 (Phototrop ® ) or on the visual functions and an equal quan ty of soy oil. fundus alterations in early age-related macular degeneration
Inclusion criteria
Have a diagnosis of early bilateral AMD Have a visual acuity between 8/10 and 4/10 (Snellen chart decimal scale) Be 55–70 years old and of Caucasian origin Agree to discon nue any current vitamin regimen Be highly mo vated, alert, oriented, mentally competent and able to understand and comply with the requirements of the study, abide by the restric ons and return for all required visits Provide wri en informed consent
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Exclusion Criteria Exclusion Criteria
Late AMD (geographic atrophy or macular scarring) Severe or uncontrolled hepa c, renal, pulmonary, and thyroid disease or diabetes Exuda ve re nal disease, including exuda ve AMD History of HIV infec on, hepa s B or C, or other Clinically significant corneal opacity or cataracts immunosuppressive disorders Inherited re nal dystrophies or degenera ve myopia History of alcoholism, drug abuse, severe mental disorders Unstable glaucoma Were a prac cing vegetarian or had an abnormal diet (<1,600 or >3,500 kcal/day) PVR, rhegmatogenous re nal detachment Poor general health or unstable diseases Op c nerve disease Known or suggested hypersensi vity to study compounds Ac ve intraocular inflammatory disease Use of cor costeroid, phenothiazine and an malarial drugs Refrac ve error over +4 D and –6 D within 1 month prior to visit 1 or during the 12-month study Significant cardiovascular or cerebrovascular diseases period
Acetyl L Carni ne Foods Containing Acetyl L-Carni ne
Acetyl L Carni ne is a supplement to help Organic Grass Fed Beef – 81mg/3oz. people burn unwanted or excess body fat. Pork – 24mg/3oz. Acetyl L-Carni ne, also known simply as L- Organic Cow’s Milk – 8mg/8oz.
Carni ne, transports fa y acids across the Vegetables in general do not make good sources of carni ne. However, there are two vegetables that contain small amounts of carni ne. inner mitochondra membrane where they are burned and used as energy. Without acetyl L- Avocados have the largest carni ne count in the vegetable food Carni ne, fa y acids pile up, leading to weight group, with 2 mg per 1 medium avocado
gain. L-Carni ne also helps enhance memory; Six spears of asparagus, or ½ cup, contains .2 mg of carni ne some people take it to help combat
Alzheimer's disease.
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Co-Q-10
Coenzyme Q10, commonly shortened to CoQ10, is a fat-soluble nutrient found throughout the human body. Recently, CoQ10 has become very popular as a dietary supplement and nutri onal medicine. Though evidence is s ll under inves ga on, CoQ10 shows promise in preven ng or trea ng common disorders. It is also referred to as ubiquinone
Cholesterol lowering agents Deplete our body of The "Q" in Coenzyme Q-10 refers to quinone, a chemical family that includes CoQ10 and several other biologically essen al substances, such as vitamin K1. This is also reflected by the chemical's other name, Vitamin A ubiquinone--a blend of "ubiquitous" because it is found throughout the body, and "quinone" because of its chemical makeup. Vitamin B12 CoQ10 is present in nearly every cell of the body, and is collected in cellular mitochondria. It is an essen al part of the process of cellular Vitamin D respira on, which creates ATP, the nucleo de responsible for nearly Vitamin E all of the body's energy produc on. Though it is found throughout the body, CoQ10 is most highly concentrated in the organs that require Vitamin K the most energy transfer, Co-Q-10 such as the heart Beta-Carotene
Folic acid Iron
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Foods That Contain Co-Q-10 Phototrope Study Results
Organic, grass fed meats contain a high concentra on of Improvement was found in each of the CoQ10. A report from Iowa State University lists beef, four parameters chicken and pork as all containing between 1.2 and 2.6 milligrams (mg) of CoQ10 in a three ounce serving, of visual functions in the most affected eyes of with beef containing the most at 2.6 mg per serving. EARLY AMD patients Fish also contain higher levels of CoQ10. Marinated herring is listed by the Linus Pauling Ins tute (LPI) as taking Phototrop. It is particularly important that containing 2.3 mg per three ounce serving. Following VFMD (Visual Field Mean Deviation, the primary herring is rainbow trout at 0.9 mg and salmon at 0.4 efficacy variable), visual acuity and mg per three ounce serving. foveolar sensitivity (secondary efficacy variables) showed statistically significant differences in
changes comparing treated with placebo groups.
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Absorp on
Transport and Retinal Capture of Lutein and Zeaxanthin with Reference to ARMD Several processes are required for op mal absorp on of carotenoids. These include Survey of Ophthalmology Volume 53 No. 1 Jan-Feb 2008 adequate diges on of the food matrix in order to release the carotenoids, forma on of lipid micelles in the small intes ne, uptake of the carotenoid by intes nal mucosal cells, and transport of carotenoids to the lympha c or portal circula on.
Transport Capture
The majority of plasma carotenoids are transported on LDL, with 55% of total Re nal capture of the xanthophyll carotenoids is carotenoids associated with it, whereas HDL is mediated largely by a specific xanthophyll associated with 33% and VLDL 10-19% binding protein (XBP), specifically the Pi respec vely isoform of GSTP1 in the case of zeaxanthin. The specific binding protein for lutein remains
elusive. Lutein and Zeaxanthin are equally distributed between LDL + HDL molecules
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Conclusion
The authors concluded that in order to fully explore the poten al beneficial effects of lutein and zeaxanthin, in par cular in the context of their puni ve role in the preven on of AMD, it is essen al that we understand the mechanisms by which they are absorbed from the GI system, transported in the serum and taken up by the re na.
LAST study
Double-masked, placebo-controlled, randomized trial of lutein and an oxidant supplementa on in the interven on of atrophic ARMD: the Veterans LAST study
(Lutein An oxidant Supplementa on Trial) Optometry Vol. 75 No. 4
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Conclusion Foods That Contain Lutein
Vegetable/Fruit Lutein or Zeaxanthin (Micrograms) (100 grams or 1/2 cup)
Kale 21900 The LAST study concluded that visual func on is Collard Greens 16,300 improved with lutein alone or lutein together Spinach, cooked & drained 12,600 with other nutrients. Cress Leaf raw 12,500 Swiss Chard raw 11,000 Chicory Leaf raw 10,300 Parsley 10,200 Spinach raw 10,200
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Foods That Contain Lutein LAST 2 study
Vegetable/Fruit Lutein or Zeaxanthin (Micrograms) (100 grams or 1/2 cup)
Mustard Greens 9,900 Differen al temporal responses of macular Beet Greens 7,700 pigment op cal density in pa ents with Okra 6,800 Red Pepper 6,800 atrophic ARMD to dietary supplementa on Dill 6,700 Romaine Le uce 5,700 with xanthophylls Endive 4,000 Celery 3,600 Scallions 2,100 Optometry (2007) 78, 213-219 Leeks 1,900 Stuart Richer, O.D., Ph.D. Jenny Devenport, Ph.D. John C. Lang. Ph.D. Broccoli, cooked 1,800
LAST 2 study Objec ve LAST 2 Results The LAST study was to determine whether specific dietary interven ons increased macular pigment op cal density (MOPD) and visual func on in pa ents with atrophic MPOD increased with supplementa on and ARMD. decreased without. The highest increases in MOPD over me occurred in pa ents with lower baseline values of MPOD. The LAST 2 objec ve is to discern those specific characteris cs that increase MPOD.
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LAST 2 Conclusion
Noteworthy is the observa on that those individuals with the lowest MPOD, and in greatest need of supplementa on, were also most likely to benefit from either lutein or lutein plus an oxidant supplementa on.
Lycopene but not Lutein nor Zeaxanthin decreases in serum lipoproteins in ARMD pa ents
Clinica Chimica Acta 357 (2005) 34-42
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Study Objec ves Results
No difference was observed between ARMD Epidemiological studies have established that a pa ents and the control subjects in total serum carotenoids. low serum concentra on of carotenoids was
associated with ARMD. The aim of this study Concentra ons in serum and lipopar cle frac ons was to determine carotenoid levels in serum of lutein + Zeaxanthin were also equal between and in different lipoprotein frac ons in the two groups. pa ents diagnosed with ARMD and in a matched control group. Serum and lipopar cle frac ons of Lycopene was significantly decreased in ARMD pa ents.
Conclusion
Lycopene, a liposoluble an oxidant nutrient, is the only carotenoid altered in ARMD pa ents.
There he goes talking about fresh fruits again
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Plato Risk Reduc on Recommenda ons Reduce Weight Stress Smoking Rx medica ons
Increase “We shall eat animals Exercise Awareness of Diet Level of Happiness only at our own peril.” Supplement Use
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There’s nothing wrong with talking to your pa ents about exercise as a way to reduce their risk of AMD by reducing their body weight.
Risk factor dealt with: Obesity
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Aflibercept - Eylea
Intravitreal Aflibercept for Treatment-Resistant Neovascular Age-Related Macular Degera on
Ophthalmology Vol 121 No.1 January 2014
Objec ve Interven on
To assess the effec veness of intravitreal aflibercept in pa ents with neovascular age- A dose of 2mg intravitreal aflibercept was related macular degenera on previously administered as 3 ini al loading doses every 4 resistant to treatment with other an -vascular weeks, followed by further injec ons every 8 endothelial frowth factor agents. weeks across a 24-week period in total.
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Main Outcome Measures Results
BCVA improved and CRT was reduced Outcomes assessed included propor ons of significantly at all follow-up visits compared with pa ents with a gain or loss of more than 5 baseline (P<0.0001), with a mean improvement ETDRS le ers and a decrease or increase in of 6.9 le ers of BCVA and a decrease of 89.4um central re nal thickness of more than 150 um at in CRT at week24. Spacing of injec ons from week 24 compared with baseline, change in every 4 weeks to every 8 weeks resulted in an mean BCVA and CRT between baseline and increase of 37.4um in CRT (P<0.0001); however, week 24, and descrip ve safety data. this was not correlated with a significant change in vision.
Conclusion
Intravitreal Aflibercept is effec ve in previously treatment-resistant Age-Related Macular Degenera on
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