Abstract

BACKGROUND:

Reduced antioxidant defense of the retina secondary to poor nutrition and smoking combined with increased life expectancy and exposure to solar radiation can provide a triple assault on the aging retina. If left untreated, without prophylactic measures, 7.5 million American adults will suffer vision loss from ARM by the year 2020.

METHODS:

Better known pathobiologic interrelationships between ARM, nutritional/antioxidant status and UV/blue visible solar exposure risk based on animal research and recent epidemiologic studies is presented, along with an overview of ocular free radical biochemistry.

RESULTS:

Because ARM begins parafoveally, and confounding ocular lens changes often occur, there have been practical clinical/research difficulties in early diagnosis, and assessing improvement/loss from nutritional intervention. Threshold Amsler grid testing, contrast sensitivity and more recently red foveal flicker fusion frequency testing are presented as promising tests for discerning subtle pathologic and functional changes in vision.

CONCLUSIONS:

A conservative prevention/treatment strategy is presented involving identification of at-risk patients, solar radiation protection, nutritional counseling based on the new USDA Food Pyramid concept and vitamin/mineral supplementation if necessary for non-compliant high risk patients. Excessive vitamin intake of particular micronutrients has some drawbacks, and the optometrist should be aware of the implications of self-prescribed OTC ocular formulations, the difference between UV risk vs. "blue light hazard" and ongoing clinical trials.