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Dr. Joseph Burrascano's 2008 Lyme Disease Treatment Guidelines
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guidelines
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Eye on Lyme: Evidence Suggests Lyme Disease
May Contribute to Macular Degeneration
by Susan T. Williams
Earlier this year, I learned that I am in the beginning stages of macular degeneration. I am only in my 30s, and my ophthalmologist commented that I am the youngest case he has ever seen.
"I have Lyme disease. Could that be causing it?" I asked. "Hmmm," he replied thoughtfully. "Yes, it certainly could." I had known that Lyme often causes vision problems such as "floaters" and uveitis, but the connection to macular degeneration was a new one to me.
While most people associate macular degeneration solely with old age, many patients - such as myself -who are afflicted with Lyme disease and similar chronic infections are learning otherwise.
According to the National Eye Institute, Age-related Macular Degeneration (AMD) is the leading cause of central vision loss among those over 60 years of age. It results from deterioration to the macula, a portion of the retina that is located on the inside back wall of the eye. The macula is much more sensitive than the rest of the retina and is responsible for clear, sharp vision that enables us to see detail and vivid color.
Specialized photoreceptor cells in the eye need a constant supply of oxygen and nutrients from a layer of fine blood vessels underneath the retina. These photoreceptors sit on a layer called the retinal pigment epithelium (RPE). This RPE forms a blood-retina barrier that continuously transports nutrients and eliminates damaged and discarded cells.
When something causes this "recycling" process to fail, the cells produce deposits of a collagen-like material called drusens. These drusens are like a garbage dump that accumulates due to a lack of antioxidants that clear waste products from the eyes. This "dry" form of macular degeneration accounts for approximately 90% of all cases.
Sometimes the body attempts to make new blood vessels to supply oxygen and nutrients to the dying photoreceptors. However, these new vessels are usually very fragile and have weak walls that tend to bleed into the eye. This "wet" form of macular degeneration accounts for approximately 10% of all cases. Although the wet form is far less common, loss of vision occurs faster so it is essential to get it diagnosed as quickly as possible. Since dry AMD can progress to the more severe wet form, regular checkups are important. Neither form of AMD causes pain.
Risk Factors
Although the main risk factor for AMD is advancing age, nutritional deficiencies and poor digestion and absorption are risk factors as well. For people with Lyme and other similar systemic infections that contribute to such deficiencies, this should be cause for concern. AMD patients are often found to be deficient in essential fatty acids, lutein, zeaxanthin, taurine, antioxidants, bioflavenoids, zinc, selenium, and B complex vitamins.
Macular degeneration can also be caused by free radical damage. Free radicals are highly unstable chemicals that occur normally during metabolism. If antioxidants are unavailable or free radical production is excessive, healthy cells can be damaged. This process tends to be accelerated in those with compromised immune systems.
Other risk factors of AMD include: people who have cataracts, high blood pressure or Type II diabetes, Caucasian ethnicity, family history of AMD, obesity or high fat intake, or being female. Additionally, individuals with blue or light-colored irises may be at higher risk because light-colored eyes allow more light to reach the retina since there is less melanin (pigment) to absorb it.
The Connection to Infection
Although many eye specialists will likely tell you that Lyme and other chronic illnesses do not contribute to your risk for developing AMD, research proves otherwise. Numerous studies cite a connection between inflammatory disease processes and damage or deterioration to the eye.
A 2005 study by the Massachusetts Eye and Ear Infirmary found a high incidence of infection with C. pneumoniae bacterium in AMD patients. A similar study by Columbia University Medical Center and the University of Iowa suggests that a common variation in a gene might cause AMD when triggered by inflammation or other immune responses. In 2007, a German Ophthalmology journal reported the case of a 30-year woman infected with Bartonella henselae, which presented as
maculopathy. The Macular Degeneration Foundation theorizes that anything that interferes with the macula's blood supply may cause it to malfunction and become diseased. Smoking can reduce this vital blood supply, as can a high-fat, high cholesterol diet. Many patients with chronic illness suffer from
hyper-
coagulation issues of the blood, which may also be a contributing factor.
Charles L. Schepens, M.D., and J. Wallace McMeel, M.D., of the Schepens Retina Associates Foundation, discuss this connection on the Foundation's website: "Sometimes, degenerative or hemorrhagic macular changes are observed in subjects who are either relatively young or who show a total absence of drusen and other signs of early macular degeneration. These patients often display signs of a chronic type of systemic infection. In all such cases, the patient's blood tested positive for such agents as Lyme disease, Chlamydia pneumoniae, toxoplasmosis or other infectious agents associated with subretinal neovascularization in younger individuals. Anecdotal evidence indicates that an appropriate oral antibiotic improves both the general condition and the status of the retina."
(http://www.schepens.com/
macula_degeneration.htm)
Symptoms and Diagnosis
Common symptoms include a gradual loss of ability to see objects clearly; distorted vision (objects appear to be the wrong size or shape, or straight lines appear wavy); trouble discerning colors; a dark or empty area in the center of vision; and slow recovery of vision after exposure to bright light. Often, however, there is little or no loss of vision but an eye-care professional may see drusen deposits in the macula.
The best way to look for signs of the disease is through a regular annual comprehensive dilated eye exam. In addition to a visual acuity test, eye drops are placed in the eyes to enlarge the pupils and provide a better view of the back of the eyes. During this exam, the eye-care professional will use a special magnifying lens to examine the retina and optic nerve for signs of AMD and other eye problems. Additional tests may be performed to learn more about the structure and health of the eye. It may be necessary to take photographs of each macula to compare with future examinations. This will aid in evaluating changes in the degree of damage to the retina.
Advanced AMD can result in legal blindness, leaving an individual unable to drive, write, and read all but very large type. Unfortunately, central vision damage cannot be restored. However, because AMD does not damage side vision, low vision aids such as special lenses, magnifying glasses, and electronic magnifiers for close work can be prescribed to help make the most of remaining vision. Specialized screen-reading computer software can provide access to word processing, spreadsheets, and e-mail.
Treatment and Prevention
Wet AMD can be treated with laser surgery, photodynamic therapy, and injections into the eye, but none of these is a cure and loss of vision may progress anyway. Actions that may help prevent advanced AMD include not smoking and eating foods rich in antioxidants, zinc, and Vitamins A, C and E.
Current studies are underway to evaluate the effectiveness of the RHEO™ procedure, a process somewhat akin to dialysis, which filters excess levels of macro-proteins and fatty components in the blood that are associated with AMD, such as LDL cholesterol, fibrinogen and alpha-2-macroglobulin.
Many studies are now finding that macular pigment in the retina may help prevent people from advancing to the worst stages of the disease. This yellow pigment is made up of two phytochemicals, lutein and zeaxanthin, powerful antioxidants that are part of the carotenoid family. Foods which are considered good sources of these nutrients include dark green and orange/yellow vegetables and fruits, such as kale, mustard and collard greens, spinach, okra, broccoli, pumpkin, carrots, and squash. Bear in mind that antioxidants are most abundant in raw form and are lost through cooking, canning, drying, and even freezing. Since many patients with Lyme and other systemic infections have difficulty absorbing enough nutrients
from food, they should consider taking extra supplements.
Nutritional Supplementation
The National Eye Institute's Age Related Eye Disease Study (AREDS) found that taking a specific high dose formulation of antioxidants and zinc significantly reduces the risk of advanced AMD. The specific daily amounts used by researchers were 500 milligrams of vitamin C, 400 IU of vitamin E, 15 milligrams of beta carotene (often labeled as 25,000 IU of vitamin A), 80 milligrams of zinc oxide, and 2 milligrams of cupric oxide.
A second AREDS study is currently underway, which includes the addition of lutein, zeaxanthin, and omega-3 fatty acids. Researchers note that subjects in the original AREDS trial were less likely to progress to advanced AMD when they had high dietary levels of lutein and zeaxanthin. A 2005 study published in Developments in Opthamology reported that the two carotenoids may serve as antioxidants and filters for damaging blue light. Those who consumed at least two servings of fish a week were less likely to develop advanced AMD as well. Omega-3 fatty acids in the AREDS2 formulation will include both DHA and EPA, naturally found in fish oils. Researchers hope these modifications will further reduce progression of AMD in patients.
The National Eye Institute notes that these high levels of antioxidants are difficult to achieve from daily diet and regular multi-vitamins alone. Specially-formulated vitamin supplements can be purchased over-the-counter without a prescription. Some examples of available products include I-Caps by Alcon Labs, and PreserVision or Ocuvite, both by Bausch & Lomb.
While no recommended daily allowance currently exists for lutein, a study conducted by Dr. Johanna Seddon of Harvard University, published in the Journal of the American Medical Association, found a high correlation of macular degeneration prevention at levels of 6 mg per day. A sublingual spray is available for individuals with absorption difficulties. Lutein is lipid-soluble, so it is best absorbed when taken with small amounts of fat during a meal.
Nutritional Approaches
"Conventional medical therapies don't help much with macular degeneration, which makes nutritional approaches look all the more appealing," explained James 'Jim' Duke, Ph.D., a renowned ethnobotanist and prolific author. "Quite a few foods and herbs might help."
Dr. Duke's book "The Green Pharmacy Herbal Handbook" specifically mentions some of these helpful foods and herbs, explains why each is potentially useful, and even offers suggestions on how to consume them (steep as a tea, take as a tincture, etc). His recommendations include Bilberry, dark green leafy vegetables, Ginkgo, Peanut, Clove, and Wolfberry. The section about macular degeneration from Dr. Duke's book can be found at http://www.mothernature.com/library/bookshelf/books/41/82.cfm, although this is an excellent reference manual that many readers will likely want to own.
Additionally, Dr. Duke brought his "Father Nature's Farmacy" database online at the USDA for public use. The database catalogs the best food sources for antioxidants such as lutein, and the Multiple Activity Menu query lists the particular phytochemicals in various foods and herbs. The database can be accessed free of charge at
http://www.ars-grin.gov/duke.
While macular degeneration can be a very significant issue, there are methods available to help inhibit its progress. Anyone who suffers from Lyme disease or any other chronic infection should seriously consider utilizing these methods in order to prevent the onset or advancement of macular degeneration.
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