|Find out about macular degeneration treatment options by Dr. Edward Paul. Dr. Paul takes on an integrative approach using traditional and complementary modalities. Learn what he has to say about nutrition, low vision, services and supplements.|
He has served as professor of ophthalmology at two international medical schools and was chosen as one of “America’s Top Optometrists” by the Consumer’s Research Council. He is a Diplomate of the International Academy of Low Vision Specialists and the author of several books, including Prevent and Reverse Eye Disease that was just released Summer 2012.
1. Your latest book Prevent & Reverse Eye Disease just came out as an ebook on Kindle. What prompted you to write it and what is the main message you want readers with macular degeneration to understand?The majority of eye doctors are not educating their patients on alternative or complimentary medical treatments when it comes to age related macular degeneration (AMD).
My practice philosophy is one that is "integrative" - which means including traditional therapies (for example - injections for patients with "wet" AMD), but also looking at emerging therapies that show promise. The main message I hope patients get from the book is there is hope! Going blind is not their only option. To get your e-book visit Amazon here:Prevent & Reverse Eye Disease
3. Why do you say that nutritional therapy should be included in every patient's macular degeneration treatment plan?
Nutritional therapy is the only treatment that has been shown to be effective in the "dry" form of AMD. New evidence now suggests that patients at risk for AMD may actually be able to prevent the disease with nutritional supplementation.
One example of this is that Vitamin D has shown to be reduce the incidence of AMD in women and omega-3 fatty acids have been effective in reducing the conversion from dry to wet AMD. Nutritional therapy is inexpensive, safe, and continues to show a tremendous benefit to the AMD community.
4. What are RDA levels? What do they mean and how should one interpret these numbers. Give us an example of perhaps Vitamin C.
RDA, or known by its full name - Recommended Daily Allowance - is being revised and will be called the Dietary Reference Intake (DRI) and is a collaborative effort between the USA and Canada. RDA is the daily intake level of a nutrient that is considered to be sufficient to meet the requirements of 97–98% of "healthy" individuals.
With Vitamin C, the RDA for adult men is 90 mg and for adult women 75 mg. That being said, the amount of Vitamin C found to be effective in the AREDS study was 500 mg. With nutritional formulations for eye disease, AMD in particular, the RDA levels found in most multi-vitamins is simply not enough to be effective therapeutically.
5. You write about the importance of lutein. What is lutein and what role does it play in macular health?
Lutein and zeaxanthin are carotenoids that filter harmful high-energy blue wavelengths of light and act as antioxidants in the eye, helping protect and maintain healthy cells.
Of the 600 carotenoids found in nature, only two are deposited in high quantities in the retina (macula) of the eye: lutein and zeaxanthin. The quantity of lutein and zeaxanthin in the macular region of the retina can be measured as macular pigment optical density (MPOD).
Recently, MPOD has become a useful biomarker for not only predicting disease but also visual function. Unfortunately, the human body does not synthesize the lutein and zeaxanthin it needs, which is the reason why green vegetables are essential to good nutrition. Daily intake of lutein and zeaxanthin through diet, nutritional supplements, or fortified foods and beverages is important for the maintenance of good eye health. I recommend at least 10 mg of Lutein and 2 mg of Zeaxanthin daily.
6. What are your suggestions for supplements for those with macular degeneration and for those wanting to prevent macular degeneration?
I recommend supplements that contain the original AREDS formulation in combination with 10 mg of Lutein, 2 mg of Zeaxanthin, and at least 500 mg EPA/DHA - Omega-3 fatty acids.
7. What treatments do you use in your practice that have shown some success in reversing macular degeneration?
I use a prescription eye vitamin - TOZAL - for my patients with AMD. This Rx Medical Food has been shown to improve vision in 56% of patients within 6 months. We have also been able to photodocument a decrease in the number of drusen and an improvement in the overall appearance in their OCT.
8. You also provide low vision exams in your practice. How is that exam different from a regular eye exam?
It is not anything like a regular eye exam. The Low Vision evaluation consists of three steps:
1. Find out the amount of vision the patient has.
2. Find out the amount of vision needed to do the task desired.
3. Figure out the best magnification device that allows the person to do the task.
We find out the amount of vision the patient has by performing a low vision evaluation. We use special charts and techniques to "draw out" any residual vision that may be "hiding" in the periphery. We recheck the regular eyeglass prescription to improve it if possible.
We see how magnification affects the level of vision. Next we find out the amount of vision needed to do the task desired with very specific questions and demonstrations.
We ask the patient to bring samples of print they want to see (racing charts, stock market pages, automobile repair manuals…). We ask the patient to bring samples of activities they do (needlework, spark plugs, bridge cards…).
We figure out the best magnification device that allows the person to do their desired task and we actually demonstrate the vision improvement the patient can expect in the office.
9. Give us an example of one of the more helpful low vision devices that is only available through a low vision center?
We have recently started using the E-Scoop® lens which was developed to bridge the gap between standard eyeglasses and head borne telescopes. Whether the patient's difficulty is night vision, bright sunlight, reading or simply seeing clearly in the distance, the E-Scoop® lens placed over a standard eyeglass prescription will improve eyesight. New in the United States, the E-Scoop® was developed by a Low Vision Specialist in Holland. Over 10,000 AMD patients in Europe have been successfully fitted with these lenses.
The E-Scoop® lens is comprised of five basic optical properties: custom yellow tint, anti-reflective coating, special lens thickness, base curve, and base up prism. When these five optical properties are combined into the E-Scoop lens, the image is enhanced and shifted to a different part of the macula allowing the patient to see up to 40% better.
10. If someone is interested in making an appointment with you for a second opinion for their macular degeneration what is the best way to contact you?
We welcome patients to call our office and I'm happy to speak with them personally about their case. Our office number is 910-256-6364. Patients can also visit our web site at www.DrEdwardPaul.com