September is Healthy Aging Month. So what are some of the factors to consider when thinking about healthy aging of the eyes? Many of the eye conditions that we encounter in the aging population, such as age-related macular degeneration, cataract, glaucoma, diabetic retinopathy, and even dry eyes are impacted by the individual’s nutritional status and overall health. There are many variables, but simply put, a healthy body leads to healthy eyes.
One of the most common questions I am asked by my patients is, “Is there a supplement that can help my eyes?” The answer to that question is of course dependent on the specific eye condition. While there is no single magic supplement for the eyes, a landmark study called the Age-Related Eye Disease Study (AREDS) was the first to demonstrate that a collection of nutritional supplements can indeed be an important part of patient care, specifically related to macular degeneration. Prior to this study, most of us would recommend multivitamins or other supplements with an “it wouldn’t hurt and it might help” attitude. Now providers are able to confidently state that the formula of supplements studied in AREDS, as well as the improved formula that was studied in the follow-up report called the Age-Related Eye Disease Study 2 (AREDS2), are significantly helpful in slowing down the progression of dry macular degeneration.
As proven by these studies, nutrition is key. Of course, a healthy lifestyle is a very important component to maintaining healthy eyes. For example, smoking significantly increases the risk of developing macular degeneration. While I always advise my patients with macular degeneration to take the AREDS2 supplement, it makes good sense to recommend a diet that contains the ingredients of this particular supplement for the general population. The formula includes vitamin C, vitamin E, lutein, zeaxanthin, zinc, and copper. Foods that are rich in C, lutein, and zeaxanthin include fruits and vegetables with dark green leaves (kale, spinach, broccoli) as well as those that have a yellow or orange color (squash, kiwi, carrots). Vitamin E is found in nuts (almonds, hazelnuts, peanuts) as well as salmon. Zinc is found readily in meat, and legumes (chickpeas, lentils, and beans). On a side note, copper isn’t a critical component of the formula. The reason for its inclusion was to decrease the risk of copper deficiency that may occur with high zinc intake. While copper deficiency was not noted during the study of this formula, the investigators didn’t see the harm in including it for the possible benefit of balancing the higher zinc amount in the formula. Having said that, copper is readily found in nuts.
However, it is interesting to note that even the improved AREDS2 formula did not change the course of cataract development. Therefore, again, it is necessary to determine the problem at hand before making specific supplement recommendations. With regards to cataracts, the factors that speed up progression are numerous, which is perhaps why we don’t know of a certain supplement that will keep them at bay. The better way to improve your odds is to adopt a healthy lifestyle. Studies indicate that smoking significantly increases the risk of cataract development earlier in life. Alcohol has been linked to this condition as well. Finally, obesity appears to increase the risk of cataracts in addition to other problems like strokes and heart conditions. Obesity is linked to type 2 diabetes mellitus, high blood pressure, high cholesterol, and each of these individual factors themselves has a correlation to cataract development. So it’s no surprise that an obese individual generally is at higher risk for cataracts.
At its core, obesity is related to the amount of calories you eat and the kind of foods you eat, along with lack of physical activity level as well as the presence of chronic stress, which leads to an increase in cortisol production in the body that can lead to weight gain. While the topic of weight loss is too broad to tackle here, below are a few tips to get you started.
- 1. Avoid high fructose corn syrup. Once you start looking at the ingredients of the items in your grocery cart, you will realize how hard it is to avoid this. High fructose corn syrup overtaxes your liver and can turn directly into fat, especially into the most harmful type of fat called visceral fat, which surrounds the organs inside your body.
- 2. Decrease animal meat and fat consumption. Many studies link diabetes, heart disease, and high cholesterol to too much saturated fat, especially from animals. Like anyone, I love a good steak and fried chicken, but we don’t really need protein in that form with every single meal.
- 3. Eat slowly. It takes some time for your brain to realize that you are full and satiated. So when you eat too quickly, you may end up with more calories than necessary as the message to the hunger center arrives later.
- 4. Eat until 80% full. Americans love filling up. But do we really need to? In Japan, many folks abide by the concept of hara hachi bu, which means to eat until 80% full. This started in the city of Okinawa. Interestingly, they have one of the lowest rates of illness from heart disease, cancer, and stroke, and a fairly long-life expectancy.
- 5. Exercise for 2 minutes per day. Developing a workout routine is one of the most difficult things to do. The last thing we want to do after a hard day at work is to run for 30 minutes on a treadmill. However, there are indications that even two minutes of intense exercise (30-second sprints on a stationary bicycle, 4 sets) may indeed be equivalent to 30 minutes of moderate exercise. Two minutes a day is an achievable goal. The key is to develop a pattern and a habit. Once in a while, I might even workout for 5 minutes!
One of the most overlooked conditions related to eye health is sleep apnea. The odds of ending up with glaucoma are ten times higher in individuals with obstructive sleep apnea. Therefore, if you are concerned about sleep apnea, make sure you talk to your doctor about a possible sleep study. Also, since glaucoma is a silent condition without symptoms at the early stages, make sure you see your eye provider annually even if you don’t need glasses. This advice holds true for everyone, but especially for those at risk for sleep apnea. Poor quality sleep or just a plain lack of sleep has many implications as sleep is critical for the repair of the body and mind. In addition to giving your body the rest it needs, good sleep helps with emotional stability. Poor sleep contributes to demotivation, depression, and sometimes a short-fuse when dealing with a stressful situation. Sometimes, a good night of sleep can make the difference between hope and despair. So develop a good pattern by going to bed at a consistent, regular time, and avoid caffeine after 4 pm. Also to reduce the disruption of your circadian rhythm, avoid exposure to blue light from your smartphone or tablet devices before bed. Finally, limit naps to 20-30 minutes.
Lastly, one of the most common issues I encounter in the aging population is dry eyes. Interestingly, most people have no symptoms or minimal symptoms of dryness, burning, or irritation. Some experience subtle symptoms of eye fatigue, strain, or intermittent focusing problems. I universally recommend over-the-counter artificial tears or moisture drops a few times a day for all of my patients whether they have symptoms or not. The reason I do this is that I believe that “proactive daily skincare” is helpful for the fragile surface of the eyes as much as it is for the face. Some patients worry that putting in too many artificial tears will lead to a decrease in the production of your natural tears. But no need to be concerned. Just as your skin will appreciate as much moisture as you provide, so will your eyes. Once I tune in the patient to the concept of skincare, they realize that more moisture drops are better than less (short of an adverse reaction or allergy to the ingredients in the product).
In addition to artificial tears, I often recommend omega-3 supplements for dry eyes. Fish oil is the most efficient way to obtain omega-3. Of course, eating salmon, mackerel, and other oily species is a great addition to a healthy diet. For those who are strictly vegan or allergic to fish, other sources include walnuts and flaxseed. However, the type of omega-3 (ALA) found in these sources needs to be converted into the more beneficial versions (EPA and DHA) by the body. In the end, with only a small percent being converted to the beneficial kind, marine sources are still the best. When looking for a good quality omega-3 supplement, verify that the omega-3 comes in the “triglyceride” form for best absorption. While there may be a host of other benefits for the body, omega-3 is an important part of the dry eye skincare regimen for my patients. Perhaps we will never stop the aging process of our skin, whether it’s on the face or the ocular surface, but proactive skincare can decrease the trajectory of the decline, and lead to fewer frustrations that are related to advanced dry eyes such as poor quality vision, unstable vision, and eye irritation. Take care of the very important external lens of the eyes by keeping the “skin” there as smooth as possible.
In summary, a healthy body leads to healthy eyes. While supplements are helpful, and sometimes necessary, there is no better way to stay healthy than by eating a well-rounded diet that limits high fructose corn syrup, sugar, and saturated fat. As my wife always reminds me, try to eat a “rainbow of foods” since the variety of colors and types of food will ensure that you get all the important nutritional elements necessary to support your body. Of course, the other components of a healthy lifestyle such as exercise, even just for 2 minutes a day, and proper sleep are critical. No matter your age, it’s never too late to adopt a healthy lifestyle. But as always, talk to your doctor to make sure that these recommendations are incorporated into your regimen in a safe manner.