Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in Australia and other Western countries.
As there is no cure for AMD, and treatments to stop its progression have met with limited success, there is an interest in identifying modifiable risk factors to prevent or slow disease progression.
To date, smoking is the only proven modifiable risk factor for AMD. Other factors under study include (i) cardiovascular risk factors such as hypertension, body mass index, and atherosclerosis; and (ii) dietary risk factors including fat and antioxidant intake, but so far these studies have produced conflicting results.
Dietary fat in relation to AMD has recently attracted media attention. Despite very limited work supporting an association between vegetable fat and AMD, widespread publicity advocating margarine as a cause of AMD and encouraging use of butter instead has caused confusion and anxiety among sufferers of AMD and the general public, as well as concern among health professionals.
The antioxidant carotenoids — lutein and zeaxanthin — found in dark green or yellow vegetables exist in high concentrations in the macula and are hypothesised to play a protective role. Of nine controlled trials of supplementation with carotenoids and other antioxidants, three suggested that various combinations of antioxidants and carotenoids were protective.
While a low-fat diet rich in dark green and yellow vegetables is advocated in general, any specific recommendations regarding certain fats or antioxidant supplementation and AMD are not based on consistent findings at this stage.
- 1. McCarty CA, Mukesh BN, Fu CL, et al. Risk factors for age-related maculopathy: the Visual Impairment Project. Arch Ophthalmol 2001; 119: 1455-1462.
- 2. Access Economics. Clear insight. The economic impact and cost of visual loss in Australia. Melbourne: Eye Research Australia, 2004. Available at: http://iris.medoph.unimelb.edu.au/new/clearinsight/pdf/ae1_final.pdf (accessed Mar 2006).
- 3. Klein R, Klein BE, Tomany SC, et al. Ten-year incidence and progression of age-related maculopathy: the Beaver Dam Eye Study. Ophthalmology 2002; 109: 1767-1779.
- 4. Vingerling JR, Hofman A, Grobbee DE, et al. Age-related macular degeneration and smoking. The Rotterdam Study. Arch Ophthalmol 1996; 114: 1193-1196.
- 5. Thornton J, Edwards R, Mitchell P, et al. Smoking and age-related macular degeneration: a review of association. Eye 2005; 19: 935-944.
- 6. Sperduto RD, Hiller R. Systemic hypertension and age-related maculopathy in the Framingham Study. Arch Ophthalmol 1986; 104: 216-219.
- 7. Goldberg J, Flowerdew G, Smith E, et al. Factors associated with age-related macular degeneration. An analysis of data from the first National Health and Nutrition Examination Survey. Am J Epidemiol 1988; 128: 700-710.
- 8. Vidaurri JS, Pe’er J, Halfon ST, et al. Association between drusen and some of the risk factors for coronary artery disease. Ophthalmologica 1984; 188: 243-247.
- 9. Hyman L, Schachat AP, He Q, et al. Hypertension, cardiovascular disease, and age-related macular degeneration. Age-Related Macular Degeneration Risk Factors Study Group. Arch Ophthalmol 2000; 118: 351-358.
- 10. Klein R, Klein BE, Franke T. The relationship of cardiovascular disease and its risk factors to age-related maculopathy. The Beaver Dam Eye Study. Ophthalmology 1993; 100: 406-414.
- 11. Smith W, Mitchell P, Leeder SR, et al. Plasma fibrinogen levels, other cardiovascular risk factors, and age-related maculopathy: the Blue Mountains Eye Study. Arch Ophthalmol 1998; 116: 583-587.
- 12. Schaumberg DA, Christen WG, Hankinson SE, et al. Body mass index and the incidence of visually significant age-related maculopathy in men. Arch Ophthalmol 2001; 119: 1259-1265.
- 13. Klein BE, Klein R, Lee KE, et al. Measures of obesity and age-related eye diseases. Ophthalmic Epidemiol 2001; 8: 251-262.
- 14. Chaine G, Hullo A, Sahel J, et al. Case-control study of the risk factors for age related macular degeneration. France-DMLA Study Group. Br J Ophthalmol 1998; 82: 996-1002.
- 15. Vingerling JR, Dielemans I, Bots ML, et al. Age-related macular degeneration is associated with atherosclerosis. The Rotterdam Study. Am J Epidemiol 1995; 142: 404-409.
- 16. Risk factors for choroidal neovascularization in the second eye of patients with juxtafoveal or subfoveal choroidal neovascularization secondary to age-related macular degeneration. Macular Photocoagulation Study Group. Arch Ophthalmol 1997; 115: 741-747.
- 17. Guymer RH, Chiu AW, Lim L, et al. HMG CoA reductase inhibitors (statins): do they have a role in age-related macular degeneration? Surv Ophthalmol 2005; 50: 194-206.
- 18. Klein R, Klein BE, Tomany SC, et al. Relation of statin use to the 5-year incidence and progression of age-related maculopathy. Arch Ophthalmol 2003; 121: 1151-1155.
- 19. McCarty CA, Mukesh BN, Guymer RH, et al. Cholesterol-lowering medications reduce the risk of age-related maculopathy progression [letter]. Med J Aust 2001; 175: 340.
- 20. Guymer RH, Robman L, Varsamidis M, et al. Can HMG Co-A reductase inhibitors (“Statins”) slow the progression of AMD? In: Association for Research in Vision and Ophthalmology Abstract No. 2364; 2005. Fort Lauderdale, Florida: ARVO, 2005.
- 21. Sheraidah G, Steinmetz R, Maguire J, et al. Correlation between lipids extracted from Bruch’s membrane and age. Ophthalmology 1993; 100: 47-51.
- 22. Ruberti JW, Curcio CA, Millican CL, et al. Quick-freeze/deep-etch visualization of age-related lipid accumulation in Bruch’s membrane. Invest Ophthalmol Vis Sci 2003; 44: 1753-1759.
- 23. Vinding T, Appleyard M, Nyboe J, et al. Risk factor analysis for atrophic and exudative age-related macular degeneration. An epidemiological study of 1000 aged individuals. Acta Ophthalmol (Copenh) 1992; 70: 66-72.
- 24. Seddon JM, Rosner B, Sperduto RD, et al. Dietary fat and risk for advanced age-related macular degeneration. Arch Ophthalmol 2001; 119: 1191-1199.
- 25. Seddon JM, Cote J, Rosner B. Progression of age-related macular degeneration: association with dietary fat, transunsaturated fat, nuts, and fish intake. Arch Ophthalmol 2003; 121: 1728-1737.
- 26. Mares-Perlman JA, Brady WE, Klein R, et al. Dietary fat and age-related maculopathy. Arch Ophthalmol 1995; 113: 743-748.
- 27. Cho E, Hung S, Willett WC, et al. Prospective study of dietary fat and the risk of age-related macular degeneration. Am J Clin Nutr 2001; 73: 209-218.
- 28. Mansour MP, Sinclair AJ. The trans fatty acid and positional (sn-2) fatty acid composition of some Australian margarines, dairy blends and animal fats. Asia Pac J Clin Nutr 1993; 2: 155-163.
- 29. Smith W, Mitchell P, Leeder SR. Dietary fat and fish intake and age-related maculopathy. Arch Ophthalmol 2000; 118: 401-404.
- 30. Chua B, Flood V, Rochtchina E, et al. Dietary fatty acids and the 5-year incidence of age related maculopathy. Arch Ophthalmol 2006. In press.
- 31. Mozaffarieh M, Sacu S, Wedrich A. The role of the carotenoids, lutein and zeaxanthin, in protecting against age-related macular degeneration: a review based on controversial evidence. Nutr J 2003; 2: 20.
- 32. Alves-Rodrigues A, Shao A. The science behind lutein. Toxicol Lett 2004; 150: 57-83.
- 33. 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. Arch Ophthalmol 2001; 119: 1417-1436.
- 34. Omenn GS, Goodman GE, Thornquist MD, et al. Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. N Engl J Med 1996; 334: 1150-1155.
- 35. The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group. N Engl J Med 1994; 330: 1029-1035.
- 36. Ng WT, Goggin M. Awareness of and compliance with recommended dietary supplement among age-related macular degeneration patients. Clin Experiment Ophthalmol 2006; 34: 9-14.
- 37. Taylor HR, Tikellis G, Robman LD, et al. Vitamin E supplementation and macular degeneration: randomised controlled trial. BMJ 2002; 325: 11.
- 38. Teikari JM, Laatikainen L, Virtamo J, et al. Six-year supplementation with alpha-tocopherol and beta-carotene and age-related maculopathy. Acta Ophthalmol Scand 1998; 76: 224-229.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.