Supplements

Question 1

Vitamin A -

Answer 1

• (RDA [ug/d] = 900 (3000 IU) ♂ vs 700 (2300 IU) ♀)
• Fat soluble forms exhibit highest bioavailability
• Role in vision and cell growth/differentiation
• High dosing (15000 IU) for retinitis pigmentosa
• Deficiency: xerophthalmia
• Role in xanthophyll transport to the retina
• Vit A toxicity associated with papilledema
• Reported risk of cancer in (former) smokers and alcoholics taking high dose vitamin A
  *

Question 2

Vitamin C

Answer 2

• (RDA [mg/d] = 90 ♂ vs 75♀)
• Collagen synthesis, wound healing & capillary integrity
• May impair hepatic acetaminophen metabolism -> toxicity (high doses)
• Risk of blood thinning effects

Question 3

Is Vitamin A fat or water soluble?

Answer 3

Fat soluble

Question 4

Vitamin A deficiency relating to the eye

Answer 4

xerophthalmia (impared goblet cell function)

Question 5

Vitamin A dosing for retinitis pigmentosa

Answer 5

1500 IU

(RDA [ug/d] = 900 (3000 IU) ♂ vs 700 (2300 IU) ♀)

Question 6

What role does Vit A play in the eye

Answer 6

Role in xanthophyll transport to the retina

Question 7

Vit A toxicity associated with

Answer 7

Papilledema

Reported risk of cancer in (former) smokers and alcoholics taking high dose vitamin A

Question 8

Vitamin E

Answer 8

• Fat soluble vs water soluble acetate or succinate
• Deficiency: opthalmoplegia (palsy of extra ocular muscle)
• Platelet inhibition at high doses (>1000mg); hemorrhagic stroke
• Risk of prostate cancer; recommend adding 200 ug selenium

Question 9

Deficiency of Vit E relating to the eye

Answer 9

Opthalmoplegia

Question 10

Zinc

Answer 10

• (RDA [mg/d] = 11 ♂ vs 8 ♀)
• Supports antioxidant enzymes
• Decreased in macular degeneration
• Zinc deficiency mimics Vit A deficiency owing to Zn-dependent conversion of Retinol -> Retinal

Question 11

Copper

Answer 11

• (RDA [ug/d] = 900)
• Important role in critical enzyme function
• Absorption is decreased by excessive Zn ingestion; Cu supplementation is required with concomitant Zn administration to prevent Cu-deficiency anemia

Question 12

Carotenoids

Lutein and Zeaxanthin

Answer 12

• 2 of the 3 naturally occurring pigments found in the human retina giving it an orange/yellow color
• Antioxidants
• Anti-inflammatory
• Filter harmful blue and UVA light
• RDA is 5 mg lutein + 1 mg zeaxanthin (5:1)
• Reduce glare disability and discomfort
• Reduce photo-stress recovery times (regaining sight post bleach)
• Increase contrast sensitivity (e.g. enhance vision in foggy conditions)
• Increase chromatic contrast threshold (e.g. tennis ball visualization)
• Increase visual range

Question 13

Where is Lutein, meso-zeaxanthin concentrated in the Macula

Answer 13

Lutein: In the periphery

Meso-zeaxanthin: In the fovea

Question 14

Ratio of lutein to zeaxanthin and mesozeaxanthin

Answer 14

Lutein 50%, zeaxanthin 25% and mesozeaxanthin 25%

(relates to RDA)

Question 15

With what can you measure the macular pigment optical density (MPOD) and why

Answer 15

Maculoscope

Reduced MPOD is a suggested risk factor for macular degeneration

Question 16

Can Beta-carotine be used as a supplement for macular degeneration

Answer 16

Beta-carotene (a vitamin A precursor) supplements have been suggested to compete with lutein and zeaxanthin for macular pigmentation

Question 17

Omega 3

Answer 17

Ω3 Fatty Acids (AI [mg/d] 1600 ♂ vs 1100♀)

• Anti-inflammatory
• Antioxidant
• Blood thinner- bleeding risk
• Cholesterol lowering effects are mixed
• Help with dry eyes
• Short chain ALA18C is plant-derived and has 5% bioavailability in humans
• Long chain EPA20C & DHA22C are found in eggs & cold-water oily fish
• Grass-fed animals have Ω6:Ω3 ratios of 2:1
• Grain-fed animals have Ω6:Ω3 ratios of 4:1
• Concerns of fish oil contamination w/ heavy metals are unfounded; metals bind to proteins
• Some fish however have been found with high levels of mercury and potentially other heavy metals
• Products treated by molecular distillation under vacuum offer the lowest risk of contamination by fat-soluble pollutants

Bioavailability by Formulation and Structure

• Triglyceride (glyceryl) esters > Fish Body Oil > Free Fatty Acid > Ethyl Esters

DHA>EPA>ALA

Ratio of Ω6 to Ω3

• Dietary Ω6 intake averages 11x that of omega-3; largely due to its over-abundance in most meats and some oils
• Ideal ratios should be between 1:1-1:4 suggesting that intake of Ω3 should exceed Ω6
• Acceptable intake level of Ω3 is 1600 mg/d men vs 1100 mg/d women

Question 18

Risk factors for macular degeneration

Answer 18

• Smoking
• Ultraviolet light
• Poor Diet: High BMI and carbohydrate intake
• Light Eyes
• Aging
• Family history: 50% lifetime risk of morbidity exists for patients with an affected relative vs a 12% to those without affected relatives
• Ethnicity: Caucasian > African Americans
• Macular drusen
• Co-morbidities: HTN

Question 19

Basic formulation of macular degeneration suplements

Answer 19

Vitamin C 500 mg

Vitamin E 400 IU

Zinc 80 mg (zinc oxide) (or 25mg according to newer studies)

Copper 2 mg (cupric oxide)

Lutein 10 mg

Zeaxanthin 2 mg

Question 20

Sources of AMD supplements

Answer 20

Question 21

Vitamin B

Answer 21

• B vitamins (6, 9 and 12) are known to lower homocysteine protein levels, reducing inflammation
• Early studies suggest that B vitamins can lower the risk of developing macular degeneration
• Riboflavin (B2) is a potent antioxidant that is associated with a reduced risk of cataracts
• Niacin (B3) is a key vitamin cofactor of mitochondrial metabolic pathways and a powerful antioxidant associated with reduced risks of glaucoma
• Thiamine (B1) also plays a role in mitochondrial activity and is associated with reduced risks of cataracts and diabetic retinopathy

Question 22

Which B vitamin is associated with a reduced risk for cataracts

Answer 22

B2 riboflavin

Question 23

Ginkgo Biloba effects on open angle glaucoma

Answer 23

• Some literature refers to the neuroprotective role of Ginkgo Biloba thru its ability to improve cerebral blood flow
• Mitochondrial antioxidant
• Risk of blood thinning effects, hyphema, retinal hemorrhage

Question 24

Marijuana effects on open angle glaucoma

Answer 24

• IOP lowering effects have never been proven to be therapeutically viable

Question 25

Which antioxidant supplements are thought to reduce age related cataract progression

Answer 25

* Vitamin A * Vitamin C * Vitamin E * Vitamin B Complex * Omega 3 fatty acids § Lutein & Zeaxanthin

Question 26

What supplement can be used to treat KERATOCONUS (KC)

Answer 26

* 1 in 500-2000 of people develop KC * Characterized by corneal ectasia, KC is often diagnosed in adolescence * As KC advances, vision diminishes, and the use of specialty contact lenses is a common non-surgical option * Studies show that cross-linking between cornea collagen fibrils increases with age due to oxidative reactions * In patients with diabetes, these oxidative reactions are also known to be enhanced, rendering them less susceptible to KC * Once patients reach an age of 40-50 years, their cornea is 35 thought to have undergone its maximum crosslinking potential * In April 2016, the FDA approved corneal crosslinking with Vit B2 and UV light for progressive KC, and 3 months later the procedure was approved for corneal ectasia * Topical application of Photrexa® (Avedro Inc) to the eye is done after removing (epi-off) the epithelium * The eye is then exposed to KXL® UVA light for up to 30 min leading to the production of ROS * Covalent cross-links formed between amino terminals of the collagen side chains as well as to proteoglycans of the extracellular matrix provide enhanced mechanical strength and long lasting stabilization1 * Corneal thickness must exceed 400um in order to avoid endo damage

Question 27

What supplements can be used for retinitis pigmentosa

Answer 27

As a degenerative, hereditary eye disease, the onset of RP sight deterioration can vary from one affected individual to the next Vitamin A • 15,000 IU of Vitamin A taken by adults with early or mid-stage RP • Intracranial hypertension is linked to large doses of retinoids used inbtreatment of acne, psoriasis or to induce leukemia remission Bilberry Fruit • It has been suggested that pilots in WWII consumed bilberry jam to enhance night vision

Question 28

Which supplements can be used against dry eye

Answer 28

Ω3 Fatty Acids * Particularly useful in the most susceptible population * AAO and AOA recommend Ω3 fatty acid for healthy tear film production * Triglyceride (glyceryl) esters \> Fish Body Oil \> Free Fatty Acid \> Ethyl Esters * DHA\>EPA\>ALA Vitamin A • Vitamin A deficiency can result in xerosis of the conjunctiva and cornea, and alopecia of the eyelashes

Question 29

Which antioxidants can be used against diabetic retinopathy

Answer 29

Bilberry fruit * Properties linked to tannin content Resveratrol * Acts as an agonist of PPAR gamma, a nuclear receptor targeted in some DM-2 therapeutics Vitamin B1 (Thiamin) * A 2009 clinical study linked vitamin B1 supplementation to a reduction in albuminuria which is ai indication of diabetic retinopathy in Type 2 Diabetes Vitamin D * Deficiency is more common in non-insulin dependent diabetics and is lowest in those with diabetic retinopathy Lutein & Zeaxanthin