Nutrition, Macular Pigments and AMD

The role of lutein and zeaxanthin supplements in nutrition, as discussed by leading optometrists, and their effects on macular degeneration and macular pigments. Taking lutein, zeaxanthin and dark green leafy vegetables such as spinach and kale can help with ocular nutrition. Caution is recommended for those with kidney stones or using blood thinners. Comments by Dr. Michael Lange OD CNS, certified nutrition specialist.

Increased levels of zeaxanthin and lutein can reduce the risk of AMD.
But just how much is needed and, how do we measure results?

Tara Rosenzweig, Contributing Editor for Optometric Management magazine

It’s commonly understood: Levels of the macular pigments lutein and zeaxanthin correlate to agerelated macular degeneration risk (AMD). So, as a measure of prevention, should optometrists recommend dietary and supplemental intake of these important nutrients — carotenoids that protect against phototoxic blue light and near-ultraviolet radiation and which are found naturally in the macula?

And if so:

How much of each is needed?
Should the nutrients come from food, supplements or a combination of both?
How can you determine the success of a supplement program? Should you consider the use of devices that measure the macular pigment optical density (MPOD)?

Here, experts on ocular nutrition and MPOD-measurement devices weigh in on these, among other common questions.

How much is enough?

It’s difficult for healthcare professionals and patients to know just how much lutein and zeaxanthin should be consumed on a daily basis. Supplements with lutein and zeaxanthin vary in nutrient content and packaging. For instance, they often accompany vitamins and nutrients, such as vitamins A, C, and E and zinc. And because no recommended daily intake for these nutrients exists, many O.D.s aren’t sure how much to recommend for optimal macular health benefits.

“In general, normal lutein/zeaxanthin supplements average in the 15 mg to 20 mg (range) for lutein and 2 mg to 4 mg for zeaxanthin,” says Jeffrey Anshel, O.D., F.A.A.O., president of the Ocular Nutrition Society. “Some supplement companies add more, but most of the science points to about these amounts.”

He adds the caveat: “Since lutein is sequestered in fat tissue, different patients may require different amounts.”

There’s no exact number, explains Paul S. Bernstein, M.D., Ph.D., Mary Boesche professor of Ophthalmology and Visual Sciences at Moran Eye Center at the University of Utah School of Medicine in Salt Lake City. “Based on epidemiology and studies on risk of macular degeneration, it’s generally come up somewhere between 6 mg and 10 mg [of each] a day. Those are the reasonable numbers.”

Dr. Bernstein and others say they hope that tests of 10 mg of lutein and 2 mg of zeaxanthin in the second Age Related Eye Disease Study (AREDS2) study will provide a definitive answer.

Michael Lange, O.D., C.N.S. (certified nutrition specialist), who owns Lange Eye Care and Associates in Florida and also founded Fortifeye Vitamins, recommends dosages by age and health status. For most patients, he says he advises 6 mg to 10 mg of lutein and 1 mg to 2 mg of zeaxanthin daily. But for patients with early-to-moderate AMD, he says he recommends 10 mg to 20 mg of lutein and 2 mg to 4 mg of zeaxanthin daily. For moderate-to-advanced AMD, he says he recommends 20 mg to 30 mg of lutein and 4 mg to 6 mg of zeaxanthin.

But are lutein and zeaxanthin equally important?

The answer is unknown, says Elizabeth Johnson, Ph.D., with the Carotenoids and Health Laboratory of the Jean Mayer United States Department of Agriculture (USDA) Human Nutrition Research Center on Aging at Tufts University in Boston. She points to interesting data.

“Work that we conducted here shows definitively that of the zeaxanthin in the retina, about half of that is actually derived from lutein,” she says.

From food or supplements?

Recommended dosages of the nutrients can be absorbed from food or supplements, but some experts say it’s unlikely many patients will derive lutein and zeaxanthin from diet alone.

Kimberly Reed, O.D., F.A.A.O., associate professor at the College of Optometry at Nova Southeastern University in Fort Lauderdale, Fla., and a member of the Nutrition Ocular Society’s board of directors, says sufficient amounts of the nutrients would be difficult to amass from the typical Western diet.

“This is where patient education is essential,” Dr. Reed says.

A look at quantities of lutein in foods sheds light on how difficult levels experts recommend may be to reach, she explains. While dark leafy greens, like spinach and kale, abound with lutein at 20.4 mg and 23.7 mg per cooked cup, respectively, other foods considered good lutein sources contain far less. For example, corn and green beans — consumed more often than spinach and kale — contain just 1.5 mg and 0.9 mg per cooked cup, which presents a recommended-dosage shortfall if dark leafy vegetables aren’t also consumed, according to the Lutein Information Bureau ( and the USDA’s Nutrient Database.

Dr. Johnson adds that patients who can’t eat green leafy vegetables because they’re on blood thinners or have a propensity toward kidney stones may benefit from lutein and zeaxanthin supplements.

Dr. Lange says he also believes in starting with diet and supplementing only if necessary.

“I will … tell my patients who aren’t on blood thinners and do not have kidney stones or gout to eat one-half-to-one-cup of dark green leafy vegetables a day,” he says.

But, Dr. Lange explains that even people with specific lutein and zeaxanthin restrictions usually don’t obtain sufficient amounts of lutein and zeaxanthin from their daily diet. This may be particularly true for the elderly, who may have limited access to shopping outlets, he says. They may need supplements, which Lange recommends “as an insurance policy for anyone with AMD.”

When should patients start?

At what age should patients start taking lutein and zeaxanthin supplementation, either through diet or supplements? Some experts suggest that people who have low MPOD should begin supplementation in their 20s. Our experts weren’t so sure.

“We know that interventions for macular degeneration are important when people are in the middle stages of macular degeneration,” Dr. Bernstein says.

When it comes to younger people with a family history of AMD, it’s more difficult to make recommendations, he adds.

“Patients have to realize the data are not as strong if they’re in their 20s and 30s,” he says. “I, in my practice as a macular degeneration specialist, counsel them most importantly to achieve a good, healthy diet: dark green, leafy vegetables and orange and yellow fruits and vegetables.”

Dr. Johnson adds that younger patients are most at risk for light damage and should know the importance lutein- and zeaxanthin-rich foods.

“The younger people are those who have the clear lens, and that makes the retina more vulnerable to light damage from being outdoors more often,” she says.

Supplements: How far should O.D.s go?

Should O.D.s recommend, or sell, lutein and zeaxanthin supplements to patients? Our experts say, “Yes,” with care and diligence.

“I make recommendations on supplements … and have them available as a convenience — just like I do glasses and contact lenses,” Dr. Anshel says. “There are several factors that the doctor must consider when evaluating a nutritional supplement, including knowing the science behind the ingredients and having a company that is third-party GMP (Good Manufacturing Practices) certified.”

The decision to recommend or sell supplements largely depends on the O.D.’s personal preference, Dr. Reed says, stressing responsibility.

“Many optometrists prefer to avoid the ‘retail’ end of nutrition, while others have seamlessly incorporated this into their already successful retail business,” she says.

She cautions that it is paramount that optometrists who begin nutritional counseling or retailing, or both, be properly educated on the topics and remain up-to-date on nutrition and the eye.

Dr. Lange recommends offering patients a whole-body supplement with enough lutein/zeaxanthin, along with various other vitamins, minerals, wholefood complexes and omega-3 essential fatty acids.

“Lutein and zeaxanthin are only two pieces of the puzzle,” Dr. Lange says, adding that optometrists should take nutrition courses and consider becoming a certified nutrition specialist (CNS) for confidence in helping patients with nutrition.

Measuring results

Of the methods used to measure MPOD, optometrists are likely most familiar with commercially available heterochromatic flicker photometry (HFP) devices. The authors of a recent review article in Clinical and Experimental Optometry (September 2010) write that due to concerns regarding the repeatability of test results, they recommend clinicians exercise caution when considering these instruments to monitor MPOD in patients who are taking lutein and zeaxanthin supplements.

Dr. Bernstein agrees with this conclusion, noting that HFP is a subjective test that is difficult for many people, even well-trained professionals, to use. He adds that often the operator or patient is not trained adequately in these devices.

“If you don’t have proper training, you’re going to get results that don’t mean very much,” he says.

So, should optometrists purchase and use the HFP devices to assess MPOD in patients? Dr. Bernstein answers “yes,” “with a healthy dose of caution.” He encourages optometrists to try the devices to determine reproducibility in their practices.

The vendors of the HFP measuring devices may also be able to lend assistance in this area as they offer training on the devices.

Dr. Anshel recommends taking a scientific approach to the devices — the same approach you would take when considering the acquisition of any diagnostic device.

“Choosing a measuring device should be based on the doctor’s confidence in using the device to obtain scientific information about macular pigment and not just for ‘marketing’ a nutritional approach,” he says.

Other MPOD-measurement tools — currently available only for research — may become more widely available, says Dr. Bernstein. Methods that could hold promise include more image-based ones, such as autofluorescence, Raman spectroscopy, and reflectometry.

Dr. Reed says clinicians also need to understand the limits of MPOD testing.

“MPOD testing is really measuring the levels of lutein and zeaxanthin in the macula, and we need to use caution when making the leap between macular pigment and AMD,” she says. “Certainly there is a strong association, but it may not be quite as linear as it would initially appear to be.”

Dr. Lange says he uses a blood test to see concentration in ug/l of lutein and zeaxanthin to help determine what dietary and supplement adjustments a patient needs.

Dr. Anshel raises another point in measuring these carotenoids: “Since lutein is sequestered in fat tissue, patient body mass index might be a factor in how much lutein is actually transferred to the eye.”

He adds that conversion of lutein to meso-zeaxanthin may also be an issue.

“Meso-zeaxanthin is converted from lutein by an enzyme, which needs to be present,” he says. “While we assume that it is, we have no way of being certain. This is relatively new science, so establishing a baseline might take more time.”

The bottom line: Be careful, and be educated

While the science is new and more research is needed, those interviewed for this article agree that with the proper education, optometrists can counsel patients on the relationship between nutrition and supplements, AMD and other eye diseases. An O.D.’s recommendation may also improve the overall care of the patient.

Says Dr. Lange: “I see it every day in clinical practice where we have made dietary and supplemental recommendations, and patients’ ocular health and overall health can improve dramatically.”

This article was originally published in the December 2010 issue of Optometric Management Magazine.


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More information: Dr. Michael P. Lange is a Board Certified Optometric Physician and a Certified Nutrition Specialist who started Lange Eye Care and Associates in Ocala, Florida, in March 1993. Lange Eye Care has grown to nine locations throughout the state of Florida with three Lasik centers. The Lange Eye Institute at The Villages in central Florida is home base for many of the nutritional studies that Fortifeye is involved in. Dr. Lange is one of the first doctors in the industry to utilize intracellular blood tests and blood absorption studies to improve the Fortifeye vitamin line. Dr. Lange travels the world for nutritional research gathering valuable information to continuously improve Fortifeye vitamin formulations. Dr. Lange is still involved in the clinical practice of eyecare. He is a guest lecturer, contributing author to many eyecare magazines, and a daily syndicated talk show host of ‘Ask The Doctor’ which broadcasts every weekday at 9am and Saturdays at 2pm from Tampa Bay on radio stations throughout the country and video streaming all over the world via the Internet.





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Changes in Diet, Vitamins and Lifestyle Modifications To Help Macular Degeneration

How Can Changes in Diet, Vitamins and Lifestyle Modifications Help Macular Degeneration?
Vitamin therapy and lifestyle modifications have proven to be extremely valuable at helping to stabilize Macular Degeneration.

Dr, Michael P. Lange, Board Certified Optometric Physician
and Board Certified Nutritional Specialist
Lange Eye Care and Associates / Lange Eye Institute

Macular Degeneration is the leading cause of vision impairment for people over the age of 55 in the United States.

Fortifeye Complete Macular Defense pillMacular Degeneration is the leading cause of legal blindness in the United States in the over 55 age group. Currently there are close to two million people living in our country that are vision impaired from macular degeneration. With our population living longer and longer it is estimated that over 3 million people by 2020 will have Age Related Macular Degeneration (ARMD). By then each of us will know someone that has lost their vision from macular degeneration. Macular degeneration is a medical condition that causes degeneration of the central part of the retina called the macula.

There are two basic types of Age Related Macular Degeneration:
1. Wet ARMD or neovascular ARMD, which means abnormal growth of new blood vessels which grow into the retina and leak causing edema and atrophy of the central retina.
2. Dry ARMD or non-neovascular ARMD. The dry form of macular degeneration is the most common type with around 85%-90% of sufferers having the dry form.

The wet form of macular degeneration is the most destructive and the onset can be fairly rapid. The dry form of ARMD can slowly steal a patients central vision until they become legally blind. Optometrists and Ophthalmologists work on new therapiesAn estimate of about 20% of dry ARMD can turn into wet ARMD. Some people may have an increased risk of developing macular degeneration because of their genetic makeup. However, most cases of macular degeneration are probably related to a combination of genetics, poor nutrition, sedimentary lifestyle and environmental factors. Significant research in the area of macular degeneration looks very promising. The evolving therapies the Board Certified Optometrists and Ophthalmologists have developed bring new hope for anyone diagnosed with ARMD. These new therapies may halt, improve or even cure forms of macular degeneration. Ongoing research in macular degeneration is constantly revealing new ways to help the macular degenerative patient and maintains a very high level of hope for the future care of ARMD. Ultimately we look forward to a future where macular degeneration no longer poses a threat to vision.

What can be done to decrease the risk of going blind from Macular Degeneration?

Keeping an eye on Macular DegenerationNutritional intervention and lifestyle modifications may be beneficial at helping to stabilize macular degeneration. I have personally seen thousands of patients with macular degeneration in clinical practice for over 18 years. I have seen the positive benefits that patients can realistically obtain thru nutritional intervention and lifestyle modifications. Many patients with macular degeneration are benefiting dramatically from visiting an eye care provider that is in tune with the latest in nutritional therapy. Doctors from all over the world are using dietary modifications, introduction of nutraceuticals and lifestyle changes to aid the patient with macular degeneration. These doctors have seen some incredible improvements in vision as well as overall health in these patients. Optometrists and ophthalmologists often times utilize intracellular and plasma blood testing along with advanced retinal imaging to help determine if a patient may have modifiable risk factors for macular degeneration. Some of these modifiable risk factors include elevated c-reactive protein, elevated cholesterol, elevated triglycerides, elevated homocysteine, lipofuscin pigment accumulation and nutritional deficiencies. The following is a list of 17 steps that can be utilized to decrease the risk of having progressive visual loss from macular degeneration. This list was compiled based on solid scientific evidence reported in related literature and from positive results we have seen clinically in several very large macular degeneration practices. This does not replace a comprehensive dilated eye examination by a board certified optometrist or ophthalmologist.

1. Eat wild Alaskan salmon for healthFollow a low fat diet. Decrease saturated fats and trans fatty acids. Eat more turkey, chicken , cold water fish and soy products like Garden Burgers (a popular vegetarian meat substitute), soy milk and tofu. Eat less corn fed beef, whole milk and cheese. Eat the breast meat of chicken and turkey from free roaming organically raised sources (if possible), and prepare without deep frying. Broiling, grilling, boiling or baking is healthier. Eat more fish (omega-3) but be careful when eating fish because many large fish have toxic levels of mercury, lead and PCBs (PCBs are persistent organic pollutants, banned since 1977, that entered the environment through both original use and later disposal). Eat cold water fish (sardines, tuna, mackerel, lake trout, Atlantic halibut, herring and wild—not farmed—salmon). Try to avoid farm raised fish and instead eat wild fish especially wild Alaskan salmon. Wild salmon are high in a super carotenoid called astaxanthin that is proving to be a key nutrient in the nutritional approach for macular degeneration. A lean organically raised GRASS FED steak in moderation is a good source of protein, Vitamin B complex, zinc, iron, folate, magnesium, selenium and omega-3 essential fatty acids. A good source of grass fed organic beef is Omega-6 fats predominate in commercially-raised (corn-fed) meat, poultry, dairy and eggs; and also in nuts, seeds, margarine, and vegetable oils (such as corn, peanut, canola, safflower, soybean, sunflower, and grape seed oils). Omega-6 increases inflammation in the body! Olive oil is an omega-9 and is beneficial; it should be the primary bottled oil in the kitchen for use in cooking and salad dressings. The typical American diet provides 10-20 times more omega-6 than omega-3, but a healthier ratio is 3:1 or 4:1! Cut back on your omega-6 (choosing healthy omega-6 foods like nuts, seeds, and avocado) and increase omega-3.

2. Spinach is a dark green leafy vegetableConsume more dark green leafy vegetables like spinach, kale, collards and swiss chard (preferably organically grown). Carefully boil, steam or simmer these in extra virgin olive oil. Gentle cooking helps to break down the cell wall releasing the bio-availability of the greens. Juicing is also a good way of getting these nutrients. Lutein is abundant in dark green leafy vegetables and has been shown to potentially help slow down the devastating properties of macular degeneration. Lutein and its related compound zeaxanthin are highly concentrated in the macula, providing a yellow color known as the macular pigment (MP).The macular pigment acts like a built in sun screen and protects the macula from the damaging photo-oxidative effects of blue light. Eating more foods that contain lutein and/or taking a supplement with 10-30 mg of lutein daily will help replenish the macula pigment density that you are more prone to loose as you age with macular degeneration. If you are taking a blood thinner like Coumadin, consult with your physician prior to eating more dark green leafy vegetables.

3. Orange bell peppers are high in zeaxanthinEat more orange bell peppers (preferably organically grown), gently cooked or raw. Orange bell peppers are very high in zeaxanthin. Scientists believe this nutrient when combined with lutein helps filter out dangerous HEV light (blue light) and may help maintain macular health. Sauté spinach and orange bell peppers together in extra virgin olive oil for good macular health. Goji berries are also one of nature’s most powerful antioxidants that has a very high concentration of zeaxanthin. Goji berry is one of the richest edible plant sources known for zeaxanthin content. Up to 77% of total carotenoids present in goji berry exist as zeaxanthin. Both goji berry and zeaxanthin also may prove to be helpful in the irregular blood vessel growth and leakage that occurs in the wet form of macular degeneration due to their potential anti-VEGF properties.

4. Blackberries for macular functioningConsume more darkly pigmented berries (preferably organically grown). Studies indicate that eating more dark berries like blueberries, black berries and raspberries may help preserve macular health. Some of the “super fruits” like gogi berry, acai berry and mangosteen are powerful antioxidants that may prove to be beneficial for macular disease. These are not easily found in your local grocery unless they are in a juice or powdered form. If you are a diabetic consult with your physician prior to eating more fruits. Darkly pigmented berries may also exhibit some anti-VEGF attributes.

5. Get more omega 3 fatty acids by taking micro distilled triglyceride fish oil. Stay away from the ethyl ester form of fish oil due to alcohol being attached to the molecule and poorer absorption rate when compared to triglyceride fish oil. Fortifeye Super Omega-3 Fish Oil | Click To OrderDue to the large amount of pollutants in fish, molecularly distilled triglyceride fish oil may be a better option than eating the fish. Canned sardines are a good source of omega threes, protein, Co-Q10 and calcium, and are fairly contaminant free. Eat more cold-water fish (sardines, tuna, mackerel, lake trout, Atlantic halibut, herring and wild—not farmed—salmon). Flax seed oil is not a good source of omega-3 essential fatty acids! I recommend Fortifeye Super Omega since it is the more natural concentrated triglyceride form of omega-3 and goes through a triple molecular distillation process to insure it is contaminant free. This gel cap is also chewable with a great taste for those patients that have difficulty swallowing pills. Fortifeye Vitamins phone number is 1-866-503-9746 or go to

6. Eat less salt. Research may indicate that decreasing salt intake may decrease deposition of waste products in the macula called drusen. Reduction in salt intake may help decrease blood pressure and fluid retention.

7. Wear blue blocking sunglasses especially if you have had cataract surgery. There is science that indicates blocking the high energy visible spectrum (400nm-500nm, the “blue light”), may help prevent damage to the macula. Yellow, amber and orange colored lenses are good at blocking the blue light. Wear them any time you are outdoors during daylight. Wear polarized blue blockers while in the sun. Non-polarized lenses are better while indoors, during cloudy and overcast days and for certain sports like motorcycling, golf, road biking and mountain biking.

8. No smoking!NO SMOKING! If you do smoke try to quit. Smoking lowers your serum antioxidant levels in your blood and thus causes a nutritional deficiency at the cellular level. Second hand smoke is just as bad. Smokers increase their risk dramatically of developing the more advanced stages of macular degeneration. Smoking increases C-reactive protein (inflammatory marker in blood that is a risk factor for macular degeneration). If you smoke be sure you do NOT take high levels of the supplement called beta-carotene. High dosages of beta-carotene my increase ones risk of lung cancer. New science also indicates beta-carotene may interfere with the absorption of lutein (a beneficial carotenoid for macular health). Beta-carotene should not be in a vitamin formula especially if you have macular degeneration. Vegans may want to supplement with beta-carotene since they arent getting any vitamin A from animal sources, however most Americans that do eat some animal protein will not be deficient in Vitamin A and thus dont need any beta-carotene. Beta-carotene has shown some form of competitive inhibition against lutein that may begin in the stomach.

9. Do cardiovascular exercises for 20-30 minutes 5 times a week (discuss this with your physician first). Research indicates that patients who did cardiovascular exercise (treadmill, stationary bike, elliptical, walking, jogging, swimming etc.) were less likely to develop macular degeneration. These forms of exercise may be beneficial for glaucoma patients as well.

10. If you are overweight, LOSE WEIGHT! Overweight people are twice as likely to develop macular degeneration. Losing weight will also reduce C-reactive protein and help to normalize cholesterol and triglycerides. Controlling C-reactive, cholesterol and triglycerides may benefit macular degeneration. Overweight patients are also more likely to develop glaucoma and cataracts at an earlier age. Reducing your caloric intake and increasing your cardiovascular exercise will aid in weight reduction. Patients who are over weight with pre-existing health conditions may want to seek help from a physician supervised weight loss program.

11. Control systemic health problems such as hypertension, diabetes, elevated C-reactive protein and elevated homocysteine. Elevated homocysteine has been linked to macular degeneration as well as optic neuropathies, certain types of glaucoma, retinal occlusive disease and diabetic retinopathy. Patients who are overweight can have a dramatic improvement in these systemic health problems once they start a weight management program and stick to it.

Choose red wine for eye health12. Drink red wine and green tea! New research may indicate that drinking red wine in moderation, sipping green tea, eating more soy products and cooking with curry may have some positive impact on macular degeneration, cataracts and inflammatory diseases in the eye. Consume more Pinot Noir from the New York region, because this wine has some of the highest resveratrol content. Resveratrol is a powerful antioxidant proving to have many health benefits. Walnuts are also a good source of resveratrol. The latest research shows that soy, resveratrol, green tea and curcumin may all have the ability to inhibit new fragile blood vessel growth (anti VEG-F). This may prove to be beneficial at decreasing the chance of the dry form of macular degeneration from turning into the wet form. Some other specific nutrients that may also exhibit effects on VEGF are Vitamin D, rutin, zeaxanthin, tocotrienols, super berries and even B vitamins.

Macular Degeneration sufferer13. Have a vitamin D blood test; 25 (OH) D done routinely, making sure you are not deficient in Vitamin D. Recent research shows patients with low levels of serum Vitamin D may be more likely to develop macular degeneration. Vitamin D is a potent steroid hormone and deficiencies are linked to cancer, cardiovascular disease, stroke, hypertension, diabetes, osteoathritis, osteoporosis, depression, multiple sclerosis, muscle wasting, schizophrenia and even the flu. The sun is the best source of Vitamin D. Just 15-20 minutes of sun exposure during the peak hours in shorts and a tank top while wearing a good pair of blue blocking sunglasses and a wide brimmed hat may be beneficial. Consult with your physician before too much sun exposure especially if there is a history of skin cancers or melanoma.

14. Dark Chocolate is high in polyphenols and antioxidants that may prove to be beneficial for macular degeneration. The darker the chocolate the better. Dark chocolate is proving to be good for for many health conditions including diabetes, hypertension, and elevated cholesterol and may reduce the risk of blood clots, strokes and heart attacks. Polyphenols from dark chocolate may also exhibit some anti-VEGF properties and may prove to be beneficial for macular degeneration. Try to eat the dark chocolate with the highest percent of cocoa and the least amount of sugar.

15. Do not take supplemental beta-carotene! Many emerging studies are proving that supplemental beta-carotene blocks the absorption of lutein. Beta-carotene also increases the risk of lung cancer among smokers. There is no beta-carotene in the eye, however, there is a high percent of lutein concentrated in the macula, so macular degeneration patients do not want to block this valuable carotenoid. Do not take Vitamin A palmitate as studies now indicate that it may increase the risk of macular degeneration and it may also increase the risk of osteoparosis, liver problems and neuro degenerative diseases. If you are deficient in Vitamin A then a physician needs to determine why and treat accordingly.

16. Get a good night’s sleep. More and more research is indicating that sleep deprivation is a major risk factor for many health problems. Sleep deprivation can suppress the immune system, increase inflammation in the body, lead to weight gain, high blood pressure and possibly Alzheimer’s disease. Sleep deprivation may increase your risk of optic nerve problems as well as macular degeneration. The National Sleep Foundation recommends 7-9 hours of sleep a night for adults.

17. Take a good nutritional supplement based Fortifeye Complete Plus | Click To Orderon the latest scientific data, preferably one that does not have any artificial dyes and synthetic nutrients. Be careful of supplements that have only “window dressing” amounts of specific nutrients. Many vitamin companies will add tiny amounts of popular nutrients just to be able to put it on the label. These small amounts may have no nutritional value. Patients must also be extremely careful not to take too many supplements as well. Vitamins can build up toxic levels, especially the fat soluble forms. The leading company that takes all of the current science into consideration in the development of their nutraceuticals is Fortifeye® Vitamins. The Fortifeye® products are all natural with no dyes. They provide therapeutic levels of nutrients and no window dressing. The Fortifeye Vitamins mission is stated as promoting proper vision and whole body health with the right ingredients at the right levels. I recommend to all of my patients the multivitamin Fortifeye™ Complete Plus, which Fortifeye Complete | Click To Orderis a combination of vitamins, minerals, phytonutrients, enzymes, whole foods and omega-3 essential fatty acids designed to lay a strong foundation for eye and total body health. If the patient has macular degeneration or is a smoker, I recommend Fortifeye™ Complete Macular Defense which is a nutritional system to help prevent any further vision loss from macular degeneration and gives the additional antioxidants necessary for smokers. I have seen many patients in clinical practice improve, some quite dramatically, while taking these supplements. Many doctors throughout the country are now recommending Fortifeye™ Vitamins to their patients with macular degeneration. Fortifeye stays abreast of the most current science in regards to nutritional supplementation for the eye and body, and because of this, their vitamins for macular degeneration and total body health are constantly evolving. Visit for the latest information, or call toll free 1-866-503-9746.

Michael P. Lange, O.D.
Dr. Michael P. Lange
Board Certified Optometric Physician and Board Certified Nutritional Specialist


You can see that many patients will require a total overhaul in their dietary habits and lifestyles, and others will have some minor adjustments. If patients would only do these 17 things faithfully we would see much less vision loss from macular degeneration and have a much healthier society. Remember there is no miracle cure for macular degeneration. However if you implement the 17 steps outlined, you will decrease your risk of going blind from macular degeneration. Keep the faith!


Dr. Michael P. Lange

Board Certified Optometric Physician
and Board Certified Nutritional Specialist
Lange Eye Care and Associates
The Lange Eye Institute
(Located in Central/North Central Florida)
Dec 27, 2009

Author: Dr. Michael P. Lange is a Board Certified Optometric Physician and a Certified Nutrition Specialist who started Lange Eye Care and Associates in Ocala, Florida, in March 1993. Lange Eye Care has grown to nine locations throughout the state of Florida with three Lasik centers. The Lange Eye Institute at The Villages in central Florida is home base for many of the nutritional studies that inspired the Fortifeye Brand of vitamin supplements. Dr. Lange is one of the first doctors in the industry to utilize intracellular blood tests and blood absorption studies to improve the Fortifeye vitamin line. Dr. Lange travels the world for nutritional research gathering valuable information to continuously improve Fortifeye vitamin formulations. Dr. Lange is still involved in the clinical practice of eyecare. He is a guest lecturer, contributing author to many eyecare magazines, and a daily syndicated talk show host of ‘Ask The Doctor’ which broadcasts every weekday at 9 a.m. and Saturdays at 2 p.m. from Tampa Bay on radio stations throughout the country and video streaming all over the world via the Internet. Detailed information on the nutritional research Dr. Lange has been involved in, and the eye vitamins and whole body formulas he has formulated, are at If you are looking for a great group of eye doctors in Florida go to For more, read this article about Dr. Michael Lange, Ocala optometrist involved in research on nutrition and UV protection, or read this biography of Dr. Michael Lange, Ocala eye doctor (optometrist).