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Fish Oil and Macular Degeneration
Age-related macular degeneration (AMD) is one of the leading causes of vision loss, particularly among the elderly. The macula, located at the center of the retina, is susceptible to degenerative changes, such as drusen, as well as changes in the retinal pigment epithelium and subretinal neovascular
membranes. Treatment options are currently limited and efforts to prevent the disease and its progression are being actively investigated.
Long-chain omega-3 fatty acids, especially docosahexaenoic acid (DHA), are abundant in the retina and are essential in the development of vision
2. Fatty fish and fish oil are excellent sources of omega-3 fatty acids. In fact, several recent epidemiological studies have shown that consuming the fatty acids found in fish and fish oil reduces the risks associated with AMD.
In a study published in 2001, for example, 567 cases of AMD in patients 50 years of age or older were followed for more than a decade. While high
total fat consumption was associated with increased risk and diets high in linolenic acid showed the highest risk, high consumption of fish (and lower
consumption of linolenic acid, found in mayonnaise, margarine, beef, pork, and some cheeses) showed reduced risk
3. Another 2001 case-control study involved 349 individuals aged 55-80 years
with advanced AMD and 504 individuals without AMD (but with other ocular diseases). All participants were administered an extensively validated
food-frequency questionnaire. Results showed that higher vegetable fat consumption was associated with an elevated risk for AMD progression; higher
intake of omega-3 fatty acids in fish, however, was again associated with a lower risk for AMD among individuals consuming diets low in linoleic acid, an
omega-6 fatty acid
4. A prospective cohort study, published in 2003, also agreed with these results, finding that fish intake was inversely associated with AMD progression. Of the 261 subjects aged 60 years or older, those with diets high in fish and low in linoleic acid had a lower risk of AMD progression.
5. And an even larger study of 4,513 individuals aged 60-80 years with various stages of AMD showed that those with the highest intake of omega-3 long-chain polyunsaturated fatty acids had the lowest risk of progression to neovascular AMD, a severe form of
6. Laboratory studies (both in vitro and animal) also confirm that diets rich in fish oil-derived omega-3 fatty acids may well reduce retinal pigment epithelium
(RPE) lipofuscin accumulation and RPE oxidative damage, processes linked to the development of AMD.
7. A second in vitro study of RPE cells showed that omega-3 fatty acids function at the cellular level to reduce risk of AMD.
8. Lastly, blood DHA concentrations have been shown to be inversely related to other degenerative diseases of the retina, such as retinitis pigmentosa.and one branch of research is looking at the relationship of blood concentrations of DHA and AMD. In a recent controlled clinical study (patients aged 72.74 ±6.25 years)10, 22 patients affected with drusenoid pigment epithelial detachment, a subgroup of AMD, were orally supplemented for 6months with fish oil, which supplied 720mg/day of EPA and 480mg/day of DHA. An unsupplemented control group of 16 patients was also followed. The percentage concentration of blood levels of EPA and DHA increased in the supplemented group to the following extent: EPA-serum (S) increased from 0.79 to 2.20 (p<0.0001); EPA-red blood cell membrane (RBCM) increased from 0.85 to 2.24 (p<0.0001). DHA-S increased from 1.56 to 2.47 (p<0.0001), and DHA-RBCM increased from 4.67 to 6.47 (p<0.0001). No significant changes in blood levels were observed in the control group. During the study, no progression of the AMD occurred in the supplemented group and no side effects were reported.
Current clinically-controlled human data support a safe and efficacious role for fish oil both to prevent and to reduce the progression in those afflicted with AMD.
In addition, human data suggests that fish oil supplementation may be beneficial for other degenerative diseases of the retina as well.
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