Obesity and Macular Degeneration

Self-Help Series ® 2011 Alexander

Larry J Alexander, OD FAAO
larryalexander@tx.rr.com

Introduction

The self-help series is designed to give doctors and patients some guidelines to help minimize the risk of vision-threatening eye diseases. While directed specifically at age-related macular degeneration (ARMD), these guidelines are also applicable to other eye and systemic disorders. All of us should be developing Therapeutic Lifestyle Changes (TLC).

Does Your Weight Affect Macular Degeneration?

Unfortunately the world is plagued by both starvation and by excesses. In the developed countries we all probably eat more than necessary and the things we eat are often inappropriate to sustain proper health. Obesity is a chronic disease that potentiates the development of all kinds of symptoms including macular degeneration.

Diet and weight definitely influence the development of macular degeneration. One very interesting study related that excessive consumption of corn bread was significantly related to vision loss in ARMD. 1 This relationship was the result of high dietary glycemic indices often related to excessive consumption of carbohydrates. 2-3 Glycemic index is a measure of your spike in blood sugar after consuming any food. A follow-up article in this series will discuss how to minimize your glycemic index.

Evidence also exists that obesity was a risk factor for visually significant ARM in men, in particular for dry ARM. 4 Further studies point to the fact that in women, early age-related maculopathy was significantly associated with both body mass index and waist-to-hip ratio, but more so waist-to-hip ratio. 5 One seemingly contrary report suggested that recent studies indicate that obesity is a probable risk factor for progression of ARMD, but there is no significant relation with the presence of ARMD. 6 Evidence exists that visceral obesity also contributes to the overall aging process by facilitating inflammation 7 that is likewise linked to macular degeneration. A very profound study found that middle-aged persons who had a 3% or greater reduction in Waist-Hip-Ratio over time were less likely to have ARMD, particularly among those who were initially obese. 8 More evidence has been presented that smoking, cardiovascular risk factors, use of calcium channel blockers, diabetes, and obesity are risk factors for late AMD in women. 9-11 Additional work has found that macular pigment (lutein and zeaxanthin) which helps protect the eye from developing macular degeneration is also lower in persons with excessive abdominal obesity and large waist circumference. 12-13 Further work emphasized that overall obesity and abdominal obesity increased the risk for progression to advanced ARMD, and more physical activity tended to decrease the risk. 14

Recommended Action to Help Yourself

In view of the overwhelming evidence we should all watch our weight and get as close as we can to the recommendations of our general physicians. Not only does weight affect our general health but excesses can likewise increase our risk for progression of macular degeneration. You can go to the national heart, lung and blood website http://www.nhlbisupport.com/bmi/ to calculate your body mass index to determine your personal weight situation.

References:

1. Holcomb CA. Consumption of carotenoid-rich foods and central vision loss: a matched case-controlled study in Kansas. J Nutr Elder 2004;24(1):1-18.
2. Chiu CJ, Milton RC, Klein R, Gensler G, Taylor A. Dietary carbohydrate and the progression of age-related macular degeneration: a prospective study from the Age-Related Eye Disease Study. Am J Clin Nutr 2007;86(4):1210-8.
3. Chiu CJ, Milton RC, Klein R, Gensler G, Taylor A. Association between dietary glycemic index and age-related macular degeneration in nondiabetic participants in the Age-Related Eye Disease Study. Am J Clin Nutr 2007;86(1):180-8.
4. Schaumberg DA, Christen WG, Hankinson SE, Glynn RJ. Body mass index and the incidence of visually significant age-related maculopathy in men.
Arch Ophthalmol. 2001 Sep;119(9):1259-65.

5. Klein BE, Klein R, Lee KE, Jensen SC. Measures of obesity and age-related eye diseases. Ophthalmic Epidemiol. 2001 Sep;8(4):251-62.

6. Moeini M, Masoudpour H, Ghanbari H. A study of the relation between body mass index and the incidence of age related macular degeneration. Br J Ophthalmol. 2005 Aug;89(8):964-6.

7. Ishida S. [Lifestyle-related diseases and anti-aging ophthalmology: suppression of retinal and choroidal pathologies by inhibiting renin-angiotensin system and inflammation] Nippon Ganka Gakkai Zasshi. 2009 Mar;113(3):403-22; discussion 423.

8. Peeters A, Magliano DJ, Stevens J, Duncan BB, Klein R, Wong TY. Changes in abdominal obesity and age-related macular degeneration: the Atherosclerosis Risk in Communities Study. Arch Ophthalmol. 2008 Nov;126(11):1554-60.

9. Klein R, Deng Y, Klein BE, Hyman L, Seddon J, Frank RN, Wallace RB, Hendrix SL, Kuppermann BD, Langer RD, Kuller L, Brunner R, Johnson KC, Thomas AM, Haan M. Cardiovascular disease, its risk factors and treatment, and age-related macular degeneration: Women's Health Initiative Sight Exam ancillary study. Am J Ophthalmol. 2007 Mar;143(3):473-83.

10. Schaumberg DA, Hankinson SE, Guo Q, Rimm E, Hunter DJ. A prospective study of 2 major age-related macular degeneration susceptibility alleles and interactions with modifiable risk factors. Arch Ophthalmol. 2007 Jan;125(1):55-62.

11. Fraser-Bell S, Wu J, Klein R, Azen SP, Hooper C, Foong AW, Varma R. Cardiovascular risk factors and age-related macular degeneration: the Los Angeles Latino Eye Study. Am J Ophthalmol. 2008 Feb;145(2):308-16.

12. Mares JA, LaRowe TL, Snodderly DM, Moeller SM, Gruber MJ, Klein ML, Wooten BR, Johnson EJ, Chappell RJ; CAREDS Macular Pigment Study Group and Investigators. Predictors of optical density of lutein and zeaxanthin in retinas of older women in the Carotenoids in Age-Related Eye Disease Study, an ancillary study of the Women's Health Initiative. Am J Clin Nutr. 2006 Nov;84(5):1107-22.

13. Johnson EJ. Obesity, lutein metabolism, and age-related macular degeneration: a web of connections. Nutr Rev. 2005 Jan;63(1):9-15.

14. Seddon JM, Cote J, Davis N, Rosner B. Progression of age-related macular degeneration: association with body mass index, waist circumference, and waist-hip ratio. Arch Ophthalmol. 2003 Jun;121(6):785-92.