Needs Assessment for Elderly Eye Health
In developed countries, age-related macular degeneration (MD) is the most
common cause of visual impairment in individuals over the age of 55. The disease
develops slowly and asymptomatically over a number of years. The definition of agerelated DM differs in various studies but is generally characterized by extensive drusen,
usually associated with pigmentary abnormalities. Specifically in the USA, age-related
MD accounts for more than 54% of all vision loss in the white population. An estimated
8 million Americans are affected with early age-related MD, of whom over 1 million will
develop advanced age-related MD within the next 5 years.
Based on data taken from three population based studies- the Beaver Dam Eye
Study, the Rotterdam Study and the Blue Mountains Eye study, there is an estimated
prevalence of advanced age-related MD to be .2% in those aged 55-64, increasing to
13% in those older than 85 years. The same studies have found that the incidence of
advanced age-related MD increases with age, as does the development of large drusen
and pigmentary changes.
Unfortunately, a cure for MD has yet to be developed, therefore prevention is the
first approach to reduce vision loss. Control of modifiable risk factors such as smoking,
hypertension and body-mass index can reduce the risk of developing age-related MD by
half. Nutritional supplements can also be used as a preventive therapy. The AREDS
formulation of antioxidant multivitamins (vitamin C 500mg, vitamin E 400 IU, betacarotene 15mg) and zinc (zinc oxide 80mg and cupric oxide 2mg) have been shown to
reduce the risk of developing advanced age-related MD and its associated visual loss
by as much as 25% in individuals with at least moderate risk of age-related MD. From
studies conducted over the past ten years, omega-3 fatty acid supplements have been
shown to have positive effects on the prevention of MD as well (Coleman, Chan, Ferris
& Chew, 2008).
Docohexanoic acid, an omega-3 fatty acid, plays an important role in the
formation of the human brain, retina and central nervous system. Primarily found in fish,
both docohexanoic and another long chain polyunsaturated omega-3 fatty acid,
eicosapentaenoic acid, have been shown to reduce inflammatory and autoimmune
diseases. Increasing evidence has shown an inflammatory component for age-related
MD. Studies have shown that consumption of these two fatty acids can promote healthy
eye tissue, regulation of inflammatory and immune responses in the retina and
improvement of endothelial cell function and thereby reduce the risk of MD.
Today, Western diets are characterized by high omega-6 and low omega-3 fatty
acid intake. Omega-6 and omega-3 fatty acids are physiologically and metabolically
distinct, cannot by synthesized in the human body and must be obtained from the diet.
Findings have shown the need to maintain a healthy ratio between omega-6 and
omega-3 fatty acids (Simopoulous, 2010). That ideal ratio would be 3:1 to 4:1,
respectively. Due to a diet rich in processed foods containing or cooked in vegetable
oils (soybean, corn, safflower and linseed oil) the average American’s diet has an
omega-6/omega-3 ratio that ranges from 10:1 to 50:1. Other results have suggested this
type of diet increases the risk of MD (Seddon, George & Rosner, 2007).
From research conducted, the ocular benefits of omega-3 fatty acid
supplementation in the elderly population are very clear. Not only do they prevent age-
related MD, but they support healthy tissue moisture and tear production, protect
against age-related oxidative damage, maintain fluid and flexible eye cells and tissues
and help alleviate dryness and redness by supporting healthy inflammatory levels.
Overall EPA and DHA are among the most important nutrients for development,
function and maintenance of eye tissued throughout life. DHA actually attains its highest
concentration within eye tissue, where it accounts for approximately 30% of the total
fatty acids.
Because the research of the benefits of omega-3 fatty acid supplementation on
the prevention of age-related MD and other components of ocular health is so new, the
results are often not known among non-healthcare professionals. They’re still not known
among some optometrists and ophthalmologists. According to Chet Steinmetz, OD, the
majority of his patients know what age-related MD is but they don’t know the specifics of
the disease. They also know the benefits of omega-3 fatty acid supplementation on
cholesterol and cardiovascular health, however most don’t know the ocular benefits.
This concept is something he has to explain all the time.
While it is recommended to eat at least three servings of fish per week, this can
be expensive and inconvenient for a large portion of the elderly population. The benefits
of omega-3 fatty acid supplements for the elderly are that they can be found at any drug
store and through most health care providers. Although the omega-3 fatty acids sold in
drug stores are more inexpensive, many optometrists sell higher-end supplements
because the higher end products have a higher concentration of omega-3 fatty acids
and less chance of “fish burp” (a repulsive aftertaste/indigestion from the supplement).
A month’s supply of this version of supplementation is around $50.
The effects of omega-3 fatty acid supplementation are varied upon the dosage
consumed. 500mg of EPA and GHA are needed to avoid deficiency, 1000mg (1mg) of
EPA and DHA are needed for full benefits (proactive support) and 2-4g of EPA and
DHA are needed for high-intensity support. Side effects of too much omega-3 fatty acids
include easy bruising or bleeding; black, tarry stools; bright red blood in stool; vomiting
of blood; severe headaches; stroke; hyperglycemia; and signs of allergic reaction, such
as an unexplained rash, hives, itching, unexplained swelling, wheezing, and difficulty
breathing or swallowing. It’s also important that the omega-3 fatty acid supplements
have been adequately purified and tested for toxins.
In conclusion, age-related MD is a prominent condition in mature adults and the
elderly. Studies have found that omega-3 fatty acids help in the prevention and
protection against age-related MD. However, with a diet deficient in omega-3 fatty acids
and exceptionally high in omega-6 fatty acids, most Americans don’t consume enough
omega-3 fatty acids to receive the ocular benefits from it. Therefore, it is encouraged
that they take omega-3 fatty acid supplements. Because the research of omega-3 fatty
acids on ocular health is so new, it’s important to raise awareness among health care
professionals and their patients. It is also important to raise awareness of the
prevalence of age-related MD. Therefore, our program is designed to educate the
elderly population on the prevention of age-related MD and other ocular benefits (the
second most prevalent being dry eye, according to Chet Steinmetz) by the
supplementation of omega-3 fatty acids.