It’s all in the eyes
Nutritional Focus

Age related changes to eyesight are a common problem in those over the age of 60, but there are plenty of things we can do to remedy problems with dry eye, prevent or slow macular degeneration and prevent cataracts. We take a look at various nutrients that may help us to look after these important windows to the soul.
Its All About The Eyes

We have all been told at some point in our lives that carrots can help you to see in the dark. You may have heard about Royal Airforce pilots eating bilberry jam to improve their vision during World War 2. But what truth is there in this folkloric wisdom? The answer is more than you might think. Although an age related decline in eyesight is a very common problem in those over 60 years old, there are plenty of things we can do to remedy problems with dry eye, prevent or slow macular degeneration and prevent cataracts. A great deal has now been learned about the human eye, and what is required to keep it functioning at its best. Relatively recent breakthroughs in our understanding of the pigments found in the eye, and the mechanisms by which it protects itself from the damage caused by the sun and the environment around us have led to lots of ongoing research into various nutrients that may help us to look after these important windows to the soul.

 

Dry Eyes

Dry eye complaints have always been relatively common in the over 50s, but they are now becoming increasingly common in younger people, which is believed to be in part due to increased exposure to blue-light emitting technology such as computer screens, mobile phones and tablets. They can also be one of the side effects of certain prescription medications. Age related dry eye problems in women can also be related to hormonal changes associated with the menopause.

Dry eyes can also be caused by a deficiency of fluid and disturbances in the flow of tears, or by excess evaporation of what is called the ‘tear film’ a complex structure composed of three layers including a mucous membrane which bathes the eye – protecting it from damage. Damage to the tear film can result in irritation and inflammation of the surface of the eye – resulting in red, puffy and streaming eyes. Deficiencies in vitamin A can lead to dry eyes too, which can in turn lead to corneal ulcers, clouding of the front of the eye, and to vision loss.

Occasional dry eyes may not be perceived as much of a problem, but the mucous membranes that are found in various places in the body such as the eyes have an important function. They are found where there are important channels for interactions between the body and the environment and are therefore major routes for pathogens, toxins and allergens to enter the body.

Sea Buckthorn for eyes

Supplements that can help:

Sea Buckthorn Oil

Sea buckthorn is a hardy plant that thrives on the Atlantic coasts of Europe across to Northwestern Mongolia, Northwestern China and Northern Pakistan. It was once more widespread than it is today along the coastlines of western Europe, but it may still be found where salt from sea spray prevents other larger plants from outcompeting it. In central Asia, it is more widespread in dry semi desert areas. The bright orange berries from sea buckthorn plants have been used for centuries both as food and as a medicine in all of the areas where it is native – from Scandinavia to Tibet, where is extensively listed in Tibetan texts as a remedy for various maladies.

Sea buckthorn fruit is rich in many nutrients, and as such it may well have been a staple food of our ancestors here on the British Isles. As well as containing antioxidant polyphenols, the fruit are very rich in vitamin C, and it was probably a significant source of this important nutrient for many hundreds of years. Sea buckthorn also contains vitamin E and many carotenoids, well known for their importance to eye health. However, it is most useful to modern populations for the unusually high content of essential fatty acids found in both the berry and seed. Sea buckthorn contains omegas 3, 6, 7, 9. Of these, it is the inclusion of cis-vaccenic acid and palmitoleic acid, also known as omega 7, that is most significant. It is thought to be as a result of these that sea buckthorn oil can support the health of the mucous membranes, including those in the eyes, combating common dryness symptoms.

In one double-blind placebo-controlled trial, the effect of oral sea buckthorn oil supplementation was studied in 100 individuals ages 20-75. Results included significantly reduced dryness, grittiness, soreness and burning redness of the eyes, and a reduction in blurred vision compared to placebo (1). Other studies seem to confirm its effectiveness (2,3) but perhaps one of the most powerful testaments to it’s benefit in individuals with dry eye must be the result of a survey conducted by nutritional company Pharma Nord into their patented sea buckthorn extract SBA24®. Out of 4232 respondents to their survey regarding omega 7 benefits, over 92% claimed that Pharma Nord Omega 7 SBA24® worked for them in 6 weeks or less. If you want to try sea buckthorn oil for dry eye, Pharma Nord Omega 7 SBA24® is a good choice. Take 2 capsules twice a day for the first two weeks, and one capsule twice a day thereafter.

Hyaluronic Acid

Hyaluronic acid is a compound that was discovered in 1934 by Karl Meyer. It naturally occurs in the body, and is mostly found in the joints, skin and eyes. Hyaluronic acid is associated with skin health due to its ability to retain a large amount of water and its important role in keeping the skin hydrated, and the eyes full of moisture. As a result of this it is frequently referred to as ‘nature’s moisturiser’ and is frequently included in skin-care products.

Chemically it is a mucopolysaccharide – a structure formed of glucuronic acid and N-acetyl glucosamine which binds with water and lubricates the moveable parts of the human body, especially joints and muscles. It also cushions nerves and the ends of bones and forms a barrier against the spread of disease. Your eyes rely on optimal levels of fluids in order to function properly – to produce tears, to absorb shocks, to transport nutrients and to protect the delicate tissues. When your eyes lack fluids, they can become dry, sensitive, and easily irritable, and sometimes your vision can become affected. Eyes that are not properly hydrated are more likely to become irritated by pollen, dust or other particles. Hyaluronic acid makes up part of the vitreous gel of the eye, keeping the central areas lubricated and replenishing any moisture that is lost. This vitreous gel also forms a protective barrier against bacteria and other pathogens. One study even found that hyaluronic acid can help to reduce oxidative stress in corneas affected by UV radiation! (5).

As you age, however, the body begins to lose its ability to produce and retain hyaluronic acid. Research indicates that after or around age 50, the eyes could lose up to 50 percent of their ability to produce the hyaluronic acid needed for optimal performance. Dryness and sensitivity may be indicators that the eye is lacking in this vital fluid. Levels of hyaluronic acid also drop during eye surgery. Now that this important substance is better understood in relation to maintaining proper eye functionality, hyaluronic acid is being used to improve eye surgery outcomes. It is now commonly injected into the eye during eye surgery to replace the fluid lost and protect the cells of the eyes from damage.

Hyaluronic acid is now commonly used as an additive to the production material, surface coating, and multipurpose solution of contact lenses. Hyaluronic acid on contact lenses retains moisture and increases the wearer’s comfort, and the hyaluronic acid absorbed by the lenses themselves can also benefit dry eye as it is gradually released while the lens is worn (5).

If your eyes are dry and aching, hyaluronic acid may be helpful. Try A. Vogel Extra Moisturising Eye Drops, which contain 2mg/ml hyaluronic acid plus the herb Eyebright which is traditionally used to relieve irritated or tired eyes. The drops are suitable for contact lens users and those with sensitive eyes. Apply 1 drop to each eye, up to three times daily.

 

Macular Degeneration

Macular degeneration is the leading cause of irreversible vision loss in adults over 60 but is most common in the over 75s. Also known as age-related macular degeneration (AMD or ARMD), it can result in blurred vision or no vision at all in the centre of the visual field (best defined as the entire area that can be seen when an eye is fixed straight at a point).

The early stages of AMD often don’t present any symptoms, but over time there tends to be a gradual worsening of vision in one or both eyes. In some forms of macular degeneration, this is rapid. If you are experiencing rapid sight loss, then you should seek immediate medical attention. Normally, age related macular degeneration progresses slowly, and doesn’t result in complete blindness, but as it gets more severe it can make it difficult for the sufferer to recognise faces, drive, read, or perform other daily activities. In some cases, it can even cause visual hallucinations. Although the very early stages are not always detectable, signs to look out for include the following:

  • Distorted vision – in which a grid of straight lines appears wavy and parts of the grid may appear blank, often first noticed when looking at things like telephone poles while driving, or at venetian blinds in the home.
  • The appearance of ‘shadows’ or missing areas of vision.
  • Slow recovery of visual function after exposure to bright light.
  • Trouble discerning colors, specifically dark ones from dark ones and light ones from light ones.
  • Blurred vision.

As well as advancing age, other risk factors for AMD include smoking, obesity, high blood pressure, atherosclerosis and high cholesterol. It is believed that there are also genetic factors involved in the development of AMD, so it is worth being aware of any history of the condition in your family. Although more advanced cases of macular degeneration are hard to treat, various nutritional supplements and herbal supplements may be effective in dramatically slowing its progression, particularly early on in its development.

A diet rich in essential fatty acids and antioxidants can have an important protective effect on the cells in your eyes, and antioxidant nutrients taken in supplement form have been shown to help too. The herb bilberry in particular, has a good antioxidant effect in relation to the health of the eyes, and it is frequently included in eye health formulas for this reason (see bilberry for cataracts – below). In a famous study – high does of vitamin C, vitamin E, beta- carotene and zinc were shown to greatly reduce macular degeneration (6), but this research was conducted before much was known about lutein, zeaxanthin and meso-zeaxanthin, which are now believed to be by far the most effective antioxidants for eye health.

Carrots for Eyes

Supplements that can help:

Lutein, Zeaxanthin and Meso-zeaxanthin

There are more than 600 carotenoids found in nature, the most well-known of which is beta-carotene, an important source of vitamin A that is found in carrots and many other vegetables. It is the beta-carotene in carrots that makes them famous for helping you to see in the dark. This is not just an old wives’ tale, because beta-carotene is converted into vitamin A when it is metabolized in the body, and vitamin A is an essential vitamin that the body needs to protect the surface of the eye (cornea) and to improve night vision. Deficiencies in vitamin A, as stated above, can cause dry eyes and lead to corneal ulcers. All carotenoids are beneficial to human health, but it is known that lutein, meso-zeaxanthin and zeaxanthin are of particular importance for the health of your eyes too.

Meso-zeaxanthin, zeaxanthin, and lutein are collectively referred to as macular pigment or macular carotenoids because they accumulate in the macula of the eye, located in the center of the eye’s retina. These carotenoids contribute to overall eye health and are most well known for their help in the prevention and treatment of age-related macular degeneration (AMD).

Zeaxanthin and lutein are nutrients that are essential for the normal functioning of the eye. The central part of the retina in your eye features a yellow spot called the macula or macula lutea (from the latin macula, “spot” + lutea, “yellow”). This oval shaped spot is highly pigmented and is yellow because it contains zeaxanthin which absorbs the excess blue and ultraviolet light that enters the eye, acting as a sort of sun block for your eyes. Elsewhere in the retina, lutein performs this same function, protecting the eye from potentially harmful levels of blue and ultraviolet light (7). Lutein and zeaxanthin are powerful antioxidants that also protect your eyes from the damaging effects of oxygen free radicals in the eyes, which are produced when your eyes are exposed to both oxygen and light. These three carotenoids seem to work better together in cancelling out the damaging effects of these free radicals (7, 8).

It is therefore not surprising that there is significant evidence to suggest that ensuring you have enough of these carotenoids in your diet can reduce the onset and impact of age-related macular degeneration. People who eat lots of spinach and kale, which contain these nutrients in abundance, appear to have a lower risk of developing the condition (9). Harvard researchers found that people eating an average of 5.8 mg per day of lutein and zeaxanthin had a 57% decreased risk of macular degeneration, compared with people eating the least. Other research has shown that supplementing with just 10mg of lutein per day for one year can significantly improve vision.

If you suffer from macular degeneration, try to increase sources of these carotenoids in your diet. Kale and spinach remain the top sources – but others include swiss chard, mustard greens, green peas, summer squashes, brussel sprouts, sweetcorn and broccoli. Taking lutein and zeaxanthin in supplement form is also a good idea. Most good eye health formulas contain both of these nutrients, and high dose capsules such as LMZ3 MacuShield are also widely available.

The presence of meso-zeaxanthin in the retina is a fairly recent discovery. It is not found in many food sources but instead appears to be mostly created in the retina from ingested lutein (8). Some supplements (such as LMZ3 MacuShield) contain synthesized meso-zeaxanthin alongside lutein and zeaxanthin, but theoretically if you boost your dietary intake of lutein through foods or supplements your body should manufacture the meso-zeaxanthin it needs.

 

Cataracts

Cataracts are cloudy patches that develop on the lens – a small transparent disc inside your eye. Over time these patches often become bigger causing blurry, misty vision and eventually they can cause blindness. Cataracts usually appear in both eyes, but they may not necessarily develop at the same time or be the same in each eye. The obstruction and loss of vision caused by cataracts normally means that the sufferer can not drive or operate machinery safely. They’re much more common in older adults, but they can affect babies and young children too. Risk factors for the development of cataracts include smoking, diabetes, eye injury, long term use of steroids and drinking too much alcohol. Like macular degeneration, genetics are thought to predispose some people to the formation of cataracts.

Opticians always check for the presence of cataracts, but any change in your vision should always be brought to the attention of your doctor or optician. The usual and only effective way to treat cataracts is to remove them by conducting eye surgery. However, there are some widely available herbal and nutritional supplements that can prove effective in cataract prevention.

Bilberry for eyes

Supplements that can help:

Bilberry

The bilberry is a relative of the cranberry, huckleberry, and American blueberry that grows wild, primarily in northern Europe. The bilberry looks very much like a blueberry, but its flesh is darker.

Bilberry extracts are rich in a flavonoid known as anthocyanoside, which exerts potent effects primarily through improving blood flow and the delivery of oxygen to the eye. The potent antioxidant effects of bilberry also protect the eyes from free-radical damage, the causative factor involved in the development of cataracts and macular degeneration (10). The collagen
protecting effects of bilberry may also play a significant role in prevention and treatment of glaucoma too, but there is as yet no scientific evidence for this (11). Bilberry may lower the risk of some diabetic complications, such as diabetic cataracts and retinopathy. One study found that a standardised extract of bilberry could improve symptoms of retinal damage in some people with diabetic retinopathy (12). Try Viridian Bilberry & Eyebright capsules – which provide 175mg of bilberry 4:1 extract plus 50mg of bilberry fruit powder alongside 100mg of eyebright powder per capsule. Take 1-3 per day with food.

Lutein, Zeaxanthin and Meso-zeaxanthin

Meso-zeaxanthin, zeaxanthin, and lutein as already noted above, are essential for the normal functioning of the eye. Found in leafy green vegetables like spinach, kale and other greens (see above), both lutein and zeaxanthin are carotenoids that have been linked to reducing the risk of cataract formation (13), and this is undoubtedly because both lutein and zeaxanthin function as blue light filters (7). Both bilberry and these important carotenoids are frequently featured in general eye health supplements such as Viridian Lutein Plus (Take 1-3 capsules per day with food).

However, when it comes to the best general advice for helping to protect the health of your eyes – it is simply to eat a healthy and varied diet, and one that includes sources of omega fats and plenty of fresh fruit and vegetables. If you are at risk of either macular degeneration or cataracts – it makes sense to make sure that plenty of orange foods and leafy greens that are rich in carotenoids are included in the mix. There is no doubt that a wide range of nutrients is key – as well as essential fats and carotenoids, antioxidant polyphenols, vitamins C and E, glutathione, manganese and zinc have all been linked to eye health

 

REFERENCES
1. Larmo PS, Järvinen RL, Niko L et al. Oral sea buckthorn oil attenuates tear film osmolarity and symptoms in individuals with dry eye. J Nutr. 2010 Aug;140(8):1462-8.
2. Jarvinen R, Larmo P, Setala N, et al. Effects of oral se buckthorn oil on tear film fatty acids in individuals with dry eye. Cornea 2011;30;9:1-13-1018.
3. Erkkola R, Yang B. Sea buckthron oils: towards healthy mucous membranes. AGROFood.(2003)
4. www.ncbi.nlm.nih.gov/pubmed/20860695
5. Chang WH, Liu PY, Lin MH et al. Applications of Hyaluronic Acid in Ophthalmology and Contact Lenses. Molecules 2021 Apr 24;26(9):2485.
6. Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 8. Archives of Ophthalmology. 2001;119:1417-1436.
7. Roberts DE, Dennison J. The Photobiology of Lutein and Zeaxanthin in the Eye. J Ophthalmol. 2015; 2015: 687173.
8. Bernstein PS, Li B, Vachali PP et al. Lutein, Zeaxanthin, and meso-Zeaxanthin: The Basic and Clinical Science Underlying Carotenoid-based Nutritional Interventions against Ocular Disease. Prog Retin Eye Res. 2016 Jan; 50: 34–66.
9. Li S, Wang H et al. Efficacy of different nutrients in age-related macular degeneration: A systematic review and network meta-analysis. Semin Ophthalmol. 2022 May 19;37(4):515-523.
10. Fursova AZ, Gesarevich OG, et al. Dietary supplementation with bilberry extract prevents macular degeneration and cataracts. Adv Gerontol. 2005;16:76-9.
11. Ige M, Liu J. Herbal Medicines in Glaucoma Treatment. Yale J Biol Med. 2020 Jun 29;93(2):347-353.
12. Vorob ‘eva IV, et al. Current data on the role of anthocyanosides and flavonoids in the treatment of eye diseases] Vestn Oftalmol. 2015 Sep-Oct;131(5):104-110.
13. Liu XH, Yu RB, et al. Association between Lutein and Zeaxanthin Status and the Risk of Cataract: A Meta-Analysis. Nutrients. 2014 Jan; 6(1): 452–465.

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