Nutrition, Diet and Eye Health: The Role of Nutrition in LASIK Eye Surgery, Dry Eye, AMD, and Cataracts

Vitamins C and E, luteins, zeaxanthins, omega-3, DHA, flavanoids, and zinc have nutritional roles in eye surgery and prevention of eye diseases.

I have always been fascinated by the interplay of nutrition and health. In my own field, nutrition can affect nearly the entire eye — from healing after LASIK and PRK laser eye surgery to retinal diseases in the back of the eye. On a daily basis, I am using oral omega-3 to improve healing after LASIK and PRK and oral Vitamin C to improve healing after PRK. A combination of flax seed oil (short chain omega-3) and fish oil (long chain omega-3) has been shown to help with the dry eye sometimes seen after LASIK or PRK.

Beside the role of nutrition in improving results with PRK and LASIK laser vision correction, nutrition has significant impact on the diseases of aging that can affect the eye that are unrelated to the surgical laser vision correction work I do daily. In particular, nutrition has an impact on age-related macular degeneration (AMD). AMD is the leading cause of blindness in the United States, yet nutrition can help prevent or limit it.

The Age-Related Eye Disease Study (AREDS) is a particularly important study that was conducted by the National Eye Institute. It established that AMD is a “nutriton-responsive disorder” by which it is meant that nutrition can have a major impact on limiting this blinding disease. This study looked at the rates of progression to advanced AMD in high risk patients. It showed that patients who took Vitamin C and Vitamin E, both anti-oxidants, as well as beta-carotene, zinc, and copper had a 25% reduction in risk of progression of their disease. Copper was added to this mixture as high dose zinc consumption can cause copper deficiency anemia. Dietary sources of zinc include oysters, crab, toasted wheat germ, veal liver, low-fat roast beef, mutton, pumpkin seeds, dark chocolate, and peanuts.

It is important to note, however, that this study only should be extrapolated to patients who already are at risk of progression to advanced AMD and extrapolations to the general population may or may not be accurate. Nonetheless, it shows the strong role of nutrition in eye health.

A new study looking at the potential beneficial role of oral omega-3, AREDS2, now is currently in progress as well. I believe this study will show a beneficial role of oral omega-3. Already prospective data from a large cohort study of female health professionals shows consumption of DHA and fish is associated with a lower risk of AMD. (DHA is a long chain omega-3 fatty acid found in fish oil). The importance of dietary DHA in eye health is suggested by its high concentration in the macula. Omega-3 supplementation also has been shown to treat dry eye symptoms and clearly also helps in optimizing the results of LASIK and PRK surgeries.

Other potential dietary contributors to eye health are lutein and zeaxanthin. These are chemicals that are found in green, leafy vegetables that are deposited by the body in the the retina. Zeaxanthins are found in particular in corn, spinach, collard greens, lettuce, and tangerines. Luteins tend to be desposited in the peripheral retina outside the macula whereas zeaxanthin tend to be deposited in the central part of the retina — the macula. The body must obtain them in the diet as they cannot be synthesized. They have both anti-oxidant and light screen functions and, in the macula, they sustain optical density that is lost with aging. The best study to date of the role of these nutrients, the CARMA study, did not show any protective benefit to their consumption for preventing AMD. Increased oral consumption of lutein and zeaxanthin, however, did seem to lower the incidence of cataract formation!

Results of studies on Vitamin E supplementation in regard to ocular health have been somewhat of a disappointment. It had been hoped that, as an anti-oxidant, Vitamin E might by itself might have a beneficial role in preventing or slowing the development of AMD or cataracts. Scientific studies on nutritional Vitamin E have not shown this to be the case, unfortunately. Vitamin E, however, in conjunction with Vitamin C, zinc, copper, and beta-carotene did, as discussed above in regard to the AREDS Study, help lower the chances of high risk patients developing advanced AMD, but it is not clear what role the Vitamin E played.

Vitamin C, another oxidant in the AREDS formulation, was helpful in conjunction with the other components of the mix, but by itself has not been shown to help with AMD. A large randomized prospective study of physicians taking 500 mg of Vitamin C twice a day for 8 years showed neither benefit nor harm in regard to the development of AMD. Vitamin C might also help prevent cataracts, but so far studies in this regard also are inconclusive.

Another potential nutritional candidate for the prevention of cataracts are natural flavanoids. Flavanoids influence many biochemical pathways involved in cataract formation. The most common flavanoid consumed in a typical diet is quercitin, which is found in apples, tea, onions, nuts, and berries.

Nutrition clearly affects eye health and vision. Attention to nutrition can improve outcomes of LASIK and PRK laser eye surgery. In the future, I’m sure we will continue to learn more and more about how good nutrition can help the eye. In the meantime, a diet high in green leafy vegetables and omega-3 fatty acids clearly seems wise not only for the health of the eyes, but for the health of the rest of the body as well.

Nutrition, Diet and Eye Health: The Role of Nutrition in LASIK Eye Surgery, Dry Eye, AMD, and Cataracts

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