Link between iron overload and macular degeneration under study

The most common - and under-diagnosed - genetic disease in humans just may be a cause of the worst form of macular degeneration, Medical College of Georgia researchers report.

They are pursuing a link between hemochromatosis, which results in iron overload, and the wet form of macular degeneration, the leading cause of blindness in people 60 and older. They suspect that too much iron, known to wreak cumulative havoc on the body's organs, hastens normal aging of the eyes.

If they are correct, avoiding the most severe consequences of a disease that robs the central vision could be as simple as donating blood a couple times annually to reduce iron levels, said Dr. Vadivel Ganapathy, chairman of the MCG School of Medicine Department of Biochemistry and Molecular Biology.

A $1.5 million grant from the National Eye Institute is enabling the MCG scientists to define the impact of hemochromatosis on the eye's form and function. Support from MCG's Vision Discovery Institute is enabling screening for its causative genetic mutation in the blood of healthy individuals and those with macular degeneration.

"If this is a predisposing risk for macular degeneration, we have a very useful tool for screening patients," said Dr. Julian Nussbaum, a retinal specialist who chairs the School of Medicine's Department of Ophthalmology and co-directs MCG's Vision Discovery Institute. "We can give patients information right off the bat that may help them."

While linking iron overload to eye disease may seem odd, they have in common the result of too much of a good thing. The eyes need light to see and the body needs iron to deliver oxygen but the price of both is increased oxidative stress, Ganapathy said. "You need oxygen and you need iron to make this bad molecule," he said of oxygen radicals that can destroy tissue down to the DNA.

Light alone takes a slow toll on the retina, which converts it into electrical impulses sent to the brain via the optic nerve. This is despite multiple built-in safeguards such as filters in the cornea and lens that protect against the most harmful rays, like ultraviolet light, and a yellow pigment that provides extra protection for the most central point of vision. Retinal pigmented epithelial cells, which nourish sight-enabling cells in the retina, help gobble up and dump any resulting tissue trash into the circulation for elimination. Leftovers show up as fatty, yellow deposits called drusen.

Everyone experiences some age-related vision changes and accumulation of harmless levels of drusen, Nussbaum said. But when byproducts start accumulating under the retinal pigment epithelium, the risk increases for the wet form of macular degeneration in which fragile new blood vessels grow underneath the retina, leak and cloud vision. The question is why some people's condition worsens.

"We see it in one patient and it may stay that way for 20 years. We see it in another patient and within five years their vision has functionally started to decrease," said Dr. Emory Patterson, an MCG School of Medicine graduate completing his ophthalmology residency at MCG who is helping with the clinical study. Ganapathy first determined that the eye had the means to tightly regulate iron levels. Most organs don't have their own system rather the small intestine regulates absorption of the iron consumed in foods like beans and tofu.

But Ganapathy found the same genetic mutation that causes hemochromatosis in a back layer of the retina, which comes in contact with the blood. A mutation in this HFE gene impairs a protein that regulates iron absorption. The finding in the mouse eye and human retinal pigmented epithelial cells was published in 2004 in Investigative Ophthalmology and Visual Science.

His lab now has animal models for hemochromatosis as well as juvenile hemochromatosis, which is caused by a different genetic defect and produces much earlier symptoms. In the retina of the models, he's finding increased expression of vascular endothelial growth factors, or VEGF, that enable new blood vessel growth. This growth is the hallmark of the wet form of macular degeneration. In fact, anti-VEGF therapies are the most potent treatments available.

"I tell patients that caught early, they have a 92 percent chance of stabilizing their vision with anti-VEGF therapy but they only have about a 38 percent chance of improving their vision," Nussbaum said. "But at least we can treat it. I also remind them there is not a cure. It's similar to cancer therapy: we can put them
into remission but we don't know if it will come back."

Most people absorb about 10 percent of the iron they consume. Symptoms such as joint pain, fatigue, lack of energy, abdominal pain, loss of sex drive and heart problems indicate excess absorption although many with the condition have no symptoms when diagnosed.

Blind women take first in state Women's Club art competition

By Eric Louie
Contra Costa Times

There are things Virginia Macky and Gloria Smith can't do as they lose their eyesight. The two San Ramon Valley women — considered legally blind from macular degeneration — can't drive, and need help for other tasks around the house.

But that didn't stop the two members of the Danville Women's Club from taking top prizes — one for painting and another for sculpture — in this year's California Federation of Women's Clubs statewide art contest.

"I can't really see what I'm doing, so it's Picaso-esque," said Smith, 84, of San Ramon. A longtime painter of realistic landscapes who also ran an art gallery for a few years in Redondo Beach, she spent four months using a magnifying glass to create her watercolor "My Cat Hates Me" from a magazine photograph. It won first place for advanced water color portrait. "I can't see how much paint is on the brush, which is one of the biggest things."

Macky, 81, of Danville, made a papier-mâché sculpture of her children's former dog Mot. She learned the craft last year in a class at a community center.

"We still do everything," said Macky, who worked off and on for years as a department store buyer. "I don't let (my eyesight) stop me."

Macky was diagnosed with macular degeneration in 1994. The incurable eye disease is the leading cause of blindness for Americans 55 and older, affecting more than 10 million Americans, according to the American Macular Degeneration Foundation.

"I can't recognize people from a distance unless I know what they have on," Macky said.

For Smith, the onset of the disease began in 2002. She said her eyesight was not so bad at first, but has gotten worse the past couple years.

"I can't see your face," she said to Macky, sitting across from her at a table during the Danville Women's Club's monthly meeting and lunch. "I can see the shape of your body, but your face is a blur."

To win at the state level, the two first competed in their club's local Mount Diablo district, which includes San Ramon Valley as well as clubs in Lafayette, Brentwood, Stockton and the Tri-Valley. Smith's work was picked for submission to the state from about a dozen, while Macky's was one of about 10, said Anita Carr, a district official. She said the judges — artists who were not in the club — did not know the women were blind.

Neither did the state judges, who picked the winners during the statewide convention last month in Burlingame, said Mary Linn Coleman, with the state federation. Winners got a ribbon and certificate.

"That's interesting," Coleman said upon hearing about the artists' eyesight. "They did an amazing job."

How Drug Muggers Can Slowly Steal the Life Out of You

By Suzy Cohen

Dear Pharmacist,
I bought your Drug Muggers book and learned that coffee is stealing iron from my body. I’ve had chronic fatigue for years, and now that I’m supplementing with the iron, I’m feeling MUCH better, so thank you! I’m not giving up coffee though. Suzy, would you be willing to share more drug muggers, as a public service, because some people can’t afford to buy your book, but they really need your help. --K.M., Kansas City, Kansas

Answer: Yes, of course and I’ve been sharing this information freely since 1999. The drug mugging effect can explain everything from nagging aches to life-threatening diseases. Replenishing the missing nutrient(s) might be just what the doctor should have ordered! Most people don’t know this but years ago, I asked major publishers to make a book out of this information, but none understood the importance of it, and some felt it would step on pharmaceutical toes. So I spent my own savings to publish “Drug Muggers” and now that book is sold at Amazon.com, NaturalNews.com and my own website, www.DearPharmacist.com where I offer free articles on the topic. For now, here are some very common ‘diseases’ that might be due to to the drug mugging effect:

Depression, osteoporosis or irregular heartbeat- It could be caused by a deficiency of the mineral magnesium. Common drug muggers include female hormones, diuretics, raloxifene, tea/coffee, anti-inflammatories and aspirin.

Bald patches, loss of taste/smell, erectile dysfunction or chronic diarrhea- It might be zinc deficiency. Common drug muggers are anti-inflammatories, antibiotics, antacids, ulcer/heartburn meds, diuretics and estrogen drugs used for birth control and menopause.

Leg cramps, muscle spasms, memory loss or fatigue- May be a deficiency of CoQ10 (ubiquinol). This life-sustaining antioxidant gets demolished by hundreds of medications including statin cholesterol drugs, metformin, anti-depressants, beta blockers and diuretics. I’ve posted a “Big List of Drugs that Mug CoQ10” for free at my website.
Cell damage, high homocysteine, cataracts, macular degeneration, liver problems- It could be tied to low glutathione, a powerful antioxidant needed to detoxify poisons in your body. Acetaminophen is a possible drug mugger of glutathione.

Pins and needles nerve pain, depression, fatigue, anemia, weight gain- This could be related to a deficiency of B vitamins. Your stash gets depleted by female hormones (menopause and birth control), antacids, ulcer meds, diuretics, raloxifene, cholestyramine, diabetic drugs, tea/coffee.

If you read this and just said, “Aha!” then get approval from your doctor to supplement, or order “micronutrient” testing. For pennies a day, you can get your life back! If you decide to wait and see if I’m right (and not replenish what the drug mugger is stealing), then expect these so-called side effects to get diagnosed as a new disease. You’ll get on a medication merry-go-round and it’s a hard ride to get off.

Smoking Increases The Risk Of Age Related Macular Degeneration

American Chronicle - Hayden Eck

Age related macular degeneration (AMD) is characterized by problems in the sharp and central vision of a person. It usually affects people who are 60 years and older and is one of the leading causes of vision loss.

Smoking and AMD

Various studies have provided conclusive results that link smoking with an increased risk of suffering from AMD. The chance of suffering from AMD both, atrophic age related macular degeneration and neo-vascular degeneration double in smokers. The studies have also shown that former smokers don´t show the same risk of suffering from this condition; and if compared to people who never smoked, the dice is just about loaded in favour of non smokers. Another finding of the study was that as a smoker you can develop AMD around ten years before non smokers. These studies also draw a link between specific genetic background, heavy smoking, and the risk of AMD. It´s been seen that there is a dramatic increase in the risk factor.

Quit smoking to reduce risk

AMD causes blindness. No two ways about the fact. If you don´t want to lose your vision, it´s important that you do something about your smoking habit. So, what is it that you want to do? Cutting down on your smoking habit is not going to help matters much. You need to cut down completely on cigarettes. It´s not going to be an easy task but you need to quit smoking. If you are having trouble quitting, you can take the help of prescription quit smoking pills like Chantix to help in your efforts to quit smoking.

Accurate and timely diagnosis of AMD

If you think you are facing chronic problems with your vision, its time that you consult your doctor. More so, if you are a smoker! A regular checkup session with your doctor is necessary to know if you are suffering from this condition. AMD is a progressive condition, so you don´t really want to leave it till very late to start off on a treatment plan. Any doctor will tell you that the first thing you must do to help manage your condition is to quit smoking. The doctor can also recommend the intake of various medications along with your quit smoking endeavor. If you have already begun your intake of prescription medications like Chantix, it´s important to make sure that you aren´t going to suffer from any adverse interaction of taking these medications.

Not just another risk factor of smoking

Many smokers might regard AMD as just another health risk of smoking. Also, the fact that it usually manifests itself when you are older, might also contribute to you not giving the due importance to this condition. But, the fact of the matter is that it needs to be treated with due seriousness, because if you don´t, you might start losing your vision. This is going to have a huge impact on the general quality of life. So, why wait for that to happen before you realize the seriousness of the situation.

Hayden Eck - Webmaster of leading online health clinic Chantix-Buy.com, has been providing health newsletters and articles since last three years. He discusses smoking effects with brief description about quit smoking pills

Acucela Enters Fast-Growth Phase As Macular Degeneration Drug Advances to Key Trial

Acucela has the ambitious goal of fundamentally changing the way doctors treat the so-called “dry” form of age-related macular degeneration, which damages the eyesight of an estimated 29 million elderly people worldwide. The company was spun out of the University of Washington in 2002 by Ryo Kubota, an ophthalmologist on the faculty at the time. His dream is to create a once-daily oral pill that can slow down the progressive vision loss that comes with the dry form of macular degeneration, and ultimately to keep these aging patients from going blind.

The company got a big lift in September 2008 when it struck a partnership with Japan-based Otsuka Pharmaceutical to co-develop its lead drug candidate, and this month it took another big step by entering the first clinical trial that will assess what kind of effect its drug will have on the eyesight of between 50 to 100 elderly patients.

“We want to build a great company, and we want to build it to last. Our investors and our partner believes in it,” Kubota says.

Since Acucela doesn’t usually make a lot of news, some background is certainly in order. Acucela is vying to develop the first effective therapy for the dry form of age-related macular degeneration. It’s caused by yellowish buildups and a loss of pigment in the retina as people age. There is no approved treatment for this disease, unlike the “wet” form of age-related macular degeneration, which can be treated with Roche’s bevacizumab (Avastin) and ranibizumab (Lucentis), which cut off blood flow to leaky vessels behind the eye. The dry form of the disease is generally milder, but the market opportunity is thought to be huge, because as populations around the world age, it is expected to double in incidence over the next two decades.

Acucela’s idea comes in the form of a once-daily pill it calls ACU-4429. The drug is designed to block an enzyme called isomerase. By blocking that enzyme, Acucela hopes to slow down the visual cycle in which Vitamin A is constantly replenished. While people need a constant source of Vitamin A to see, a fast visual cycle can also contribute to the buildup of toxic Vitamin A byproducts in the eye, particularly one called A2E.

Back in May, Acucela presented the first evidence from a clinical trial that said its drug was on track. The initial trial enrolled 36 healthy volunteers at an escalating series of doses, and basically concluded that the drug was safe and well-tolerated.

This month, Acucela is attempting to pass a tougher test. The company started enrolling elderly people with severe cases of the dry form of macular degeneration. The trial, called Envision, will randomly assign patients to get the drug, or a placebo, at a variety of once-daily doses. Patients will be followed up for three months, and researchers will look at how well they can read letters on the eye chart, and a secondary goal that will assess whether the drug is working as intended, by reducing the amount of toxic byproduct buildup in the eye. It’s possible that the trial, as long as it appears safe at escalating doses, could enroll as many as 100 patients, Kubota says. It’s expected to take about one year to complete enrollment, and results should be available by mid-2011, he says.

Although Acucela is entering uncharted territory with a new way of treating this disease, it has competition from Tampa, FL-based Sirion Therapeutics. The competing drug is an oral pill like Acucela’s, made to circulate through the bloodstream, although it is designed to hit a different target than Acucela’s, Kubota says.

While Acucela awaits results from its mid-stage clinical trial, it is working to build up a lot of organizational strength this year, Kubota says. People with expertise in clinical development, preclinical development, and regulatory affairs are being recruited this year. By the end of 2010, Acucela expects to have hired about 60 new people, bringing its staff to about 100, he says. The company hopes to have that organizational horsepower in place by the time it expects to enter the final phase of clinical trials with ACU-4429, for an even more rigorous study that will assess patients’ vision for 18 to 24 months, Kubota says.

Although it’s rare among biotech companies without marketed products, Acucela has been able to operate on a cash-flow positive basis of late, Kubota says. That’s because Otsuka is paying for the company’s R&D expenses, while Acucela has received undisclosed milestone payments for getting this far in development, Kubota says.

“We’re going to be running big clinical trials,” Kubota says. “We think we can change the disease paradigm. Our goal is to cure blindness. It’s a huge ambition.”

For more information go to www.maculardegenerationassociation.org

Injections, supplements can help limit age-related macular degeneration

Three years ago, Catherine Leisher began noticing words were blurred when she read the newspaper. A trip to the eye doctor yielded diagnosis of a condition she had never heard of: age-related macular degeneration.

“I can see to walk, I can look out the window, and I can write,” said the 83-year-old Swatara Twp. resident who has the disease in both eyes. “But I can’t read — it’s all blurred, and I just loved to read.”

Age-related macular degeneration, which affects some 15 million Americans, leads to damage of the macula, which is the central part of the retina responsible for central vision and controls the ability to read, drive and recognize people’s faces in detail.

“It’s a major public health issue,” said Dr. Ingrid Scott, professor of ophthalmology and public health sciences at Penn State Milton S. Hershey Medical Center. “Age-related macular degeneration is the leading cause of vision impairment and blindness in people over the age of 50 in the United States and the industrialized world.”

The incidence is expected to increase as baby boomers age, said Dr. Erik Chotiner, an ophthalmologist with Memorial Eye Institute in Lower Paxton Twp. “Statistics say that 1.75 million people have advanced AMD now, but that number is expected to rise to 2.95 million by 2025,” he said.

There are two types of the disease, dry and wet, which both can distort vision. Dry macular degeneration, the most common form, usually progresses gradually. The wet form, which occurs when abnormal or leaking blood vessels grow underneath the retina in the area of the macula, can lead to more rapid loss of central vision.

At first, Leisher, who suffers from the wet form, was frightened that she would eventually become blind. However, new drugs injected directly into the eye offer hope to people who suffer from the wet form of AMD.

The drugs, available since 2004, are called anti-VEGF, which stands for “vascular endothelial growth factor” — a family of proteins shown to be important in causing the growth of abnormal blood vessels that characterizes wet macular degeneration.

“Before these drugs, treatment was more primitive and really only helped stabilize, not improve, vision,” Chotiner said.

The anti-VEGF medications, which are injected into the back of the eye with a small needle, work by decreasing the growth of abnormal, leaky blood vessels.

“It can be uncomfortable, but I’ve never had a patient who wasn’t able to tolerate it,” said Scott, who administers a numbing medication to the eye before giving the shot. “With anti-VEGF drugs, 40 percent of patients have visual improvement, and 95 percent have stabilization of vision.”

“My vision is brighter,” said Leisher, who receives her injections at Penn State Milton S. Hershey Medical Center. “A lot of people I know won’t take the shots because they are afraid of the needle. I hesitated at first, but I think I’d be much worse off if I didn’t do it.”

Another option, called photodynamic therapy, involves injecting a photosensitive drug into a vein in the arm. The dye travels to the blood vessels in the eye and localizes preferentially to the abnormal blood vessels. A cold laser beam is shown into the eye and temporarily reduces blood flow to the abnormal blood vessels. This therapy can slow the rate of vision loss but is much less likely to improve vision like the anti-VEGF medications can, Scott said.

Randee Erb, a 62-year-old New Holland resident diagnosed with wet macular degeneration last spring, has had four anti-VEGF injections and is noticing that her blurred vision is better.

“I dread getting the shots,” said Erb, who has to take the day off work when she gets the injections because they make her eye burn. “But they give me hope that I will be able to see clearly again.”

Every day Erb tests her eyesight by looking at an Amsler grid, a chart of vertical and horizontal lines, which she has taped to her refrigerator. The grid helps patients gauge whether their vision is worsening and they should see their doctor, based on how clear and straight the lines appear. As in Erb’s case the daily exercise can also bring good news. “At first it was all gray; now I’m slowly seeing lines,” she said.

Some patients with AMD might benefit from taking vitamin supplements that can reduce the risk of severe vision loss due to the disease by 25 percent and/or reduce the risk of developing wet AMD by 25 percent, Scott said. Called the AREDS formulation, it includes vitamins A, C, E, zinc and copper.

There are preventative measures that people can take to decrease their chances of developing AMD, doctors said. These include wearing sunglasses, not smoking, cutting down on saturated fats and eating dark green, leafy and orange vegetables such as broccoli, spinach, carrots and sweet potatoes.

“It’s extremely important to have regular eye exams,” Scott said. “People have often just accepted a decline in vision as part of aging when, in fact, many causes of declining vision can be treated. For example, it’s been shown in clinical trial after clinical trial among patients with wet AMD that the leading predictive factor for a patient’s visual outcome is how early they are diagnosed and treated.”

For more information go to WWW.MACULARDEGENERATIONASSOCIATION.ORG

Smoking Increases Risk Of Age-Related Macular Degeneration

According to a new study, it is not a good idea for older people to continue to smoke, as smoking is the second most common risk factor for developing age-related macular degeneration (AMD).

AMD is a disease that progressively damages the macula i. e. the centre of the retina that makes it possible for us see fine details. Degeneration of the macula prevents people from being able to read, recognise faces or drive, due to experiencing darkness or blurring of their central vision.

What this means is that it is never too late to quit smoking, as even the eyes of the elderly benefit from kicking the habit.

The new study trying to determine whether age influences the effects of smoking on the risk of developing AMD, followed a group of 1,958-women of whom 75 smoked. These women 78-years of age at the start of the baseline exam underwent retinal photographs at five year intervals.

Their retinal images were compared at ages 78 and 83 to see whether AMD had made an appearance, including evaluating whether smoking played a role in their likelihood of developing the disease.

Researchers found that the women who smoked had 11% higher rates of AMD overall, than other women of the same age. As well, they found that 80-plus women who smoked were 5.5-times more likely than the same age women who did not smoke to develop AMD.

The bottom line is that aging increases the risk of AMD, but smoking raises the risk even more.

The study’s findings have been published in the January edition of the American Journal of Ophthalmology.

For more information go to www.maculardegenerationassociation.org