Age-related macular degeneration is a dreadful condition, and with the growth of our aging population, the impact on healthcare services will be overwhelming if nothing is done.
Funding is being injected into research to identify how patients with AMD can be helped, and my life’s work has drilled into the impact of diet on macular conditions.
Our recent clinical trial, exploring the use of dietary supplements to improve vision in patients with early AMD, is a genuine game-changer. Yet, our trial has been met, by some, with caution and cynicism. And that is what I have to call into question.
The hypotheses and findings of our study would lose credibility if I said this research offers a silver bullet to cure AMD, because it is such a multi-faceted disease. Some of the factors are modifiable, some are not. Let us be clear – it is a complicated equation to tackle AMD. However, crucially, nutrition is one modifiable variable and it has a significant impact.
The fact is that if you have AMD, and if it progresses to the advanced stages, you will lose your central vision. After all, it is the biggest cause of vision loss in the UK. What we discovered is that dietary supplements containing the three macular pigments, meso-zeaxanthin, lutein and zeaxanthin are now proven to actually improve vision in patients with early AMD. This was previously unknown. What normally happens is ongoing deterioration of sight, but based on our trial, we mapped the trend doing the opposite. It is a ground-breaking finding for this disease.
However, we hear that some believe the use of supplements are controversial, or that research is conflicting, and my response is this; it is not controversial, nor conflicting, it is extremely clear cut.
In fact, there is not one single study across the world, conducted properly and using credible methodology, that is inconsistent with our findings – specifically that using this combination of supplements can improve visual function.
To claim categorically that treatments can work as a preventative strategy, you need to look at the disease progression over 20 or 30 years, which is a huge, almost impossible, undertaking.
But based on the information we have, on early stage AMD sufferers, we can say that if healthcare professionals and organisations supporting these patients are not promoting the use of dietary supplements, they are not doing their job correctly because they are not using up-to-date science.
Moreover, anyone saying the area of research is controversial are at best ill-informed, and at worse, negligent.
To address the cynics, I actually entered this space anti-supplement. I spent many years examining the nutritional content of foods, such as eggs, to identify how they can help people with impaired sight. My conclusion is that we cannot get enough of the nutrients we need from food alone. It is simply not possible. The quality of our food also continues to deteriorate, but that is another story.
Within optical health, much is made of ‘eye-friendly’ diets. It is absolutely crazy to suggest that eating five portions of fruit and vegetables, incorporating these ‘eye-friendly’ nutrients can help anyone living with AMD to the same level as the clinically tested carotenoid food supplement (Macushield), which contains 10-times more eye carotenoids than a typical diet and also the central carotenoid (meso-zeaxanthin), which is difficult to get from diet.
In fact, studies show a significant percentage (12%) of the population cannot make meso-zeaxanthin. You could eat kale and spinach all day every day and it would still be ineffective.
Do not misunderstand me – I completely support the five-a-day message. I believe it is important for us to encourage good nutrition as a vital route to safeguarding our health. But for AMD sufferers, giving this advice is missing the point. Good diet is a starting point. The question is, is good diet enough? The answer is no.
To continue to believe so demonstrates a lack of knowledge and this is unacceptable, and is against what level one clinical studies have proven. If someone close to me developed the condition and a society or professional said to them ‘don’t bother with the supplements just eat carrots’, I’d be angry. Put simply, not providing the up-to-date guidance and care that is now available from evidence-based science – which confirms the benefits of supplements containing the three macular carotenoids – puts a person with AMD at increased risk of vision loss.
With our aging population, AMD will become a public health crisis, and professionals are failing their patients if they are not advising them about supplements. Two hundred people are diagnosed with AMD in the UK every day and the number of those affected nationwide is set to more than double by 2050. If you elect to ignore the evidence from our studies and, indeed, from studies across the world, many AMD sufferers are going to miss out on the chance to improve their vision.
In the US, this issue has been the subject of litigation, with doctors being successfully sued because it has been ruled that based on the evidence to not recommend supplements is negligent, and the healthcare professional culpable.
I have only got one reputation, and this is my area of specialism, so I make no apologies for being so direct in my opinion on this issue. It is unfair that organisations that represent people with AMD, and others within the healthcare industry, are dismissive of supplements. They see them [supplements] as commercial and default to the negative without studying the evidence.
When we are commissioned to do research, we are accountable for what we deliver, and I believe organisations and healthcare professionals need to be equally accountable. They have an obligation to their members and patients to do right by them.
The world is changing, we are living longer, and we need to think differently. Those with a stake in AMD treatment or support need to recognise the advice they are giving is outdated and in conflict with the evidence before them. I have spent 18 years studying the link between nutrition and eye health.
We have, via competitive research grants, invested heavily to get to this stage of our understanding. This work is the result of many careers of skilled people. Also, thankfully, over the past 10 years we have had access to cutting edge technology that has allowed us to test our research ideas in a super sensitive way, with clear and definite outcomes. This data must now be used to enhance and protect vision for society.
Some may point to the patient numbers on our trial – 121 individuals – and consider it small, and query the significance. In fact, the impressive part of this research is the fact that the changes to vision through supplements were statistically significant and clinically meaningful in our sample. You may need 5,000 subjects if the impact is minimal. We spent five years designing these trials and the power is in the vision improvement – to pick out the number of trial subjects misses the point entirely.
I had one patient sit in my office crying – she had tears of happiness because she could see things she could not before our study began, and she thought she had lost that level of sight for good. That is why we are doing this.
We can put our hand on heart and say that we know that appropriate dietary supplements are the answer to improving vision for people affected by AMD. And we feel strongly that our findings have to be actioned, no question.
If not, in 50 years the impact on our aging population will be truly unmanageable. I have done the maths. If these supplements were provided free of charge to patients with early AMD in the Republic of Ireland (a population of just four million), it would save the health service more than ¤200 million over five years.
I urge healthcare professionals, care-givers, member organisations and people who live with AMD every day, to open their eyes to what is a crucial step forward in the management of this devastating condition.
Professor John Nolan is Principal Investigator, Howard Chair in Human Nutrition, Nutrition Research Centre Ireland.