Overview:

The eye contains a jelly-like substance called the vitreous. With age, the vitreous shrinks and pulls away from the surface of the retina. In most cases, this pulling away or vitreous separation occurs without any negative effect. A patient may notice floaters but no significant visual damage occurs. In some individuals, however, there may be an area where the vitreous is firmly attached to the surface of the retina. As the shrinkage and forward movement of the vitreous progresses, pulling can can be exerted on the retina, and eventually a small hole may form in the central portion of the retina (the macula), known as a macular hole. The fluid which has replaced the vitreous jell in many areas may then seep through the hole, causing a localized separation of the retina centrally. This process results in a defect or dark spot in the central vision with distortion and central vision loss resulting.

Symptoms:

The severity of the symptoms is dependent on whether the hole is partial or full-thickness.

• Blurred central vision
• Distorted, "wavy" vision
• Difficulty reading or performing tasks that require seeing detail
• Gray area in central vision
• Central blind spot

Causes:

In very rare instances, trauma or other conditions lead to the development of a macular hole. In the vast majority of cases, however, macular holes develop spontaneously. As a result, from traditional thinking there is no known way to prevent their development through any nutritional or chemical means, nor is there any way to know who is at risk for developing a hole prior to its appearance in one or both eyes.

Conventional Treatment:

A surgical procedure called vitrectomy is often used to treat holes that go all the way through the macula. The vitreous is removed to prevent it from pulling on the retina. It is replaced with a gas bubble that eventually fills with natural fluids.

Following surgery, patients must usually keep their faces down for two or three weeks. This position allows the bubble to press against the macula and seal the hole. At the end of the 2-3 week period of strict face-down positioning, the patient is then permitted to resume a more normal upright posture. The air bubble itself, however, may take anywhere from 6-8 weeks following surgery to completely disappear. The air bubble is gradually resorbed by the body, and the vitreous cavity is then filled with liquid produced by cells in the front of the eye.

Vitrectomy can lead to complications, most commonly an increase in how fast cataracts develop. Other less common complications include infection and retinal detachment either during surgery or afterward.

Typically, for macular holes less than six months in duration, a vision improvement of approximately three lines on the eye chart (or 50% improvement) can be achieved. Obviously, this is an "average" visual improvement. Vision recovery varies on a patient-by-patient basis, and each patient must be evaluated on an individual basis and discuss with their physician the expectations for visual recovery. Some patients achieve only a small amount of vision recovery, while others achieve a more significant improvement

Complementary Treatment:

We recommend the following protocol to help preserve vision for those with a macular hole. Where possible, we use products that can be taken in liquid form for best absorption.

To order either "Click Here" for the complete product list or click on any product below for a greater description or also to order.

The recommendations are given in order of priority. We suggest the following:

If you are not sure which nutrients you need, we offer free consultations either by e-mail or by telephone (845-255-8222).

Essential: Macula Complete Eye Multivitamin this formula is an excellent eye multivitamin foundation formula recommended for those with any retinal conditions.
Each bottle contains 180 capsules. Cost $60 per bottle ($58 on automatic delivery). Recommended dosage is 8 capsules per day taken with meals.
Essential: Pure Focus offered through Nutritional Focus, is in liquid form and contains lutein, zeaxanthin, vinpocetine and small levels of vitamin E to support absorption. Lutein and zeaxanthin filter light, and serve as potent free radical scavengers for the retina. Vinpocetine improves the utilization of glucose and oxygen in the brain and retina. Cost to patient is $28 per month for the first 2 months ($24 per month on automatic delivery). Recommended dosage is 1 pump 5 times per day under the tongue for the first two months, then 1 pump 3 times per day under the tongue thereafter.
Essential: Carlson's Fine Fish Oil is in liquid form. One bottle contains 6.7 fluid ounces, and 1 teaspoon contains 1600 mg of Omega-3 fatty acids (800 mg of EPA and 500 mg of DHA), plus 14 mg of antioxidants to preserve freshness. Omega-3 fatty acids help improve circulation, integrity of blood vessels, proper brain functioning, flexibility and permeability of cell membranes, and helps protect the retina's photoreceptor cells. Recommended dosage is 2-3 teaspoonfuls per day. Cost is $20 per bottle ($18 on automatic delivery).
Essential: Microcurrent Stimulation Home Unit (MicroStim or MCS): uses gentle waves of microcurrent around the eyes to promote improved energy and blood circulation in the retina, improved delivery of nutrients and removal of ongoing waste created in the retina by light. It is a therapy that has been helping people with macular degeneration stabilize their condition and preserve vision (click on above for summary of studies and pricing options). Recommended usage is one 5-minute cycle four times per day.

Other Helpful Nutrients Below:

Important: Gingko Biloba Liquid Extract manufactured by Gaia Herbs is in liquid form, and taken by dropper. According to a double blind study (see Research section for more details), Gingko Biloba may be helpful for those with macular degeneration. Gingko Biloba, among other benefits, improves circulation of blood to the brain and extremities. Cost is $22 per bottle ($20 on automatic delivery).
Helpful: Astaxanthin is a fat-soluble carotenoid and antioxidant that kills off free radicals in the body, and may help along with lutein maintain a healthy retina. Recommended dosage is 4 mg per day (1 capsule).. Each bottle contains 60 capsules. Cost is $22 per bottle ($20 on automatic delivery).
Helpful: Digestive Care: As we age, we produce less enzymes needed for absorbing essential nutrients from food. Digestive Care by RightFoods?is designed to aid in replacing these lost enzymes, providing a full-spectrum of seven plant-sourced enzymes to support optimal digestion and absorption. This formula also includes intestinal bacteria Lactobacillus acidophilus to promote improved intestinal flora for digestion. Recommended dosage is 1 capsule per day with meals. Each bottle contains 30 capsules. Cost is $13 per bottle ($11 on automatic delivery).

Helpful: RejuVeinate: is a unique formula that combines the antioxidant vitamin C with the herbs horse chestnut, butcher's broom, bilberry, and the bioflavonoid hesperidin ?all of which maximize vascular integrity. Horse chestnut helps improve the overall tone and strength of veins, control fluid levels within blood vessel walls, and may also help decrease vascular permeability. Butcher's broom helps address inflammation within the vascular system, and helps maintain vascular integrity. It works best when used in conjunction with vitamin C and hesperidin. RejuVeinate enhances vascular integrity by:
- Improving the overall tone and strength of veins and capillaries.
- Maintaining healthy vein constriction and dilation.
- Decreasing vascular permeability.
- Promoting blood flow to the tiny capillaries in the extremities.
Recommended Dosage is 2 capsules daily. Cost is $16.00 per bottle ($14.00 on automatic delivery). Each bottle contains 60 capsules.

Helpful: PaleoGreens Formula is excellent Green formula with a full array of organic vegetables, organic fruits and wheatgrasses. Cost is $42 per bottle ($40 per bottle on automatic delivery)

Note: Zinc may be helpful in protecting against vision loss due to macular degeneration. It is found in high concentrations in the eye, and helps bind the protective layer of the retina to the underlying tissue. We recommend up to 30 mg daily, with up to 2 mg of Copper.

Automatic delivery is available. Click Here for more information.

Self Help:

Since we consider most eye conditions to be a reflection of the health of the whole body, lifestyle choices and diet can play a major factor in getting and maintaining good vision. Below are some recommendations:

• Vision Diet recommended in Natural Eye Care, co-authored by Marc Grossman, O.D., L.Ac., helps maintain a healthy lens that easily drains away metabolic wastes and toxins from eye tissues.
• Reduce or eliminate drinking caffeine and sodas, avoid aspartame (labeled diet foods)and man made fats (corn oil and safflower oil, trans fats and hydrogenated vegetable oils including canola oil, and especially margarines).
• Eliminate deep fat fried foods, monosodium glutanate (MSG) used as a flavor enhancer which is a potential retinal toxin (Inv Oph 1996; 37: 1618-24), and fat blockers like Olestra which impair the absorption of carotenoids (Argus, August 1996;19:18:July 1996;19:22). Eating greater amounts of saturated fat and cholesterol appear to increase the risk of AMD.
• Limit your alcohol consumption to 1 glass of red wine at night. Alcohol interferes with liver functions, reducing protective glutathione levels (Alcohol 1993;10;469-75).
• Eliminate smoking. Smoking among other things produces cyanide, a retinal toxin.
• Supplement your diet with a good multivitamin such as One Plus Vitamin Mineral: or PaleoGreens Formula.
• Limit the amount of medications (both prescription and non-prescription as much as possible. Make sure to work closely with your doctor.
• Exercise daily - do at least 20 minutes of aerobic exercise daily. Walking and swimming are two excellent forms of exercise.
• Managing your emotional health is very important in maintaining physical health. Fear (fear of failure, responsibility, of being alone, of death, etc.) is at the root of many of life’s problems, and is a major factor in many diseases. Take up the practice of meditation, yoga, tai chi, walks in the woods or prayer on a daily basis.