Dr. Alan Mendelsohn on Macular Degeneration

Guest Post Written By: Dr. Alan Mendelsohn

As a South Florida ophthalmologist for the last 30 years, I can tell you that macular degeneration is the most common cause of blindness in the United States in those 50 years of age and older. Unfortunately, despite the advent of new medications and technologies, the incidence of macular degeneration continues to rise. The key goal of eye physicians and their patients is to prevent, or at least minimize, the development of macular degeneration. Luckily, this is a very achievable objective and can be accomplished with following five facets of ocular care:


First, and foremost, an exceedingly important aspect of macular degeneration prevention is to refrain from smoking. All prominent research studies, and especially ophthalmologists and optometrists, almost universally acknowledge that anecdotally they find a far higher incidence of macular degeneration among their smokers. Worse yet, smokers tend to get afflicted to a far greater degree with a substantial decline in central vision. There are three different mechanisms whereby smoking wrecks havoc on the macula:

1. Non-smokers have a blood level of carboxyhemoglobin (the percentage of hemoglobin that is bound to carbon monoxide, instead of oxygen, within red blood cells) that is zero or very close to this level.
Smoking one pack of cigarettes per day results in a substantially elevated level of carboxyhemoglobin; smoking more than this quantity raises the blood level to an even greater extent. The macula (the part of the eye that receives most visual input) receives oxygen and nourishment from small capillaries. With elevated carboxyhemoglobin levels, carbon monoxide from cigarettes replaces oxygen in the blood, and organs that are highly sensitive to changes in oxygen – like the macula – suffer damage earlier than other parts of the body. Needless to say, the macula takes a devastating hit over time. Second-hand smoke is also not innocuous, as it can slightly raise the blood level of carboxyhemoglobin, dependent on factors such as the duration of exposure, size and ventilation of the room, etc.

2. Macular pigments are very important to the health of the macular region. Throughout life, we all experience a decline in these macular pigments. Smoking will hasten the demise of the macular pigments, with a direct correlation between the extent of smoking and the acceleration of this decline.

3. Preeminent researchers have been conducting decades of research on the macula through the Age Related Eye Disease Study (AREDS), having isolated six key nutrients that are of paramount importance for the health and well-being of the macula. This will be discussed in detail in the next section. Smokers need these six nutrients to revitalize the macula, even more than the non-smoker because the macula is in perilous condition due to the aforementioned explanation. Very unfortunately, in smokers, the absorption and the effectivity of three of the six key nutrients (Vitamin E, Lutein, and Zeeaxanthin) is markedly impaired.

From my own 30 years of clinical experience, I believe that my patients who smoke are ten times more likely to develop macular degeneration as compared to my non-smokers. Furthermore, I am fortunate to have dozens of families where I am the ophthalmologist for the vast majority or the entire family tree. Family members who smoke are almost always those afflicted with macular degeneration, while those who do not smoke are more likely34 spared.


Brilliant researchers at the National Institute of Health have conducted decades of landmark research entitled, Age Releated Eye Disease Study (AREDS). They have isolated six key nutrients that are of great import to the health of the macula. These key six nutrients are Vitamin C, Vitamin E, Zinc, Copper, Lutein, and Zeeaxanthin, and these identical six ingredients are the key components of the AREDS 2 vitamins to help patients who exhibit early signs of macular degeneration. Conceptually, if one is philosophically opposed to vitamin supplementation, then he/she can eat food items that contain these key ingredients, but eating a sufficient quantity to ensure obtaining a full dosage is exceedingly difficult and highly unlikely.


Often neglected, but vitally important is for all of us to wear sunglasses with CORRECT protection from the Ultra Violet (UV) light rays that inflict damage on many ocular structures, including the macula. Ninety percent of sunglasses sold in the U.S. have zero to negligible protection. Very surprisingly, even with the purchase of a stylish or “high end” frame, the most important component of the sunglasses, namely the lenses, are very suboptimal. Sunglasses need to have UV-400 blocker and polarization on both lens surfaces to maximize protection, thereby preventing ocular toxicity from the sun exposure. Sunglasses should be worn while outdoors during daylight hours, including while a driver or passenger in a motor vehicle.


Increasing consumption of alpha-omega-3 fatty acid is very helpful and serves to decrease the percent chance of developing macular degeneration by 25-30%. The source can be fish, hazelnuts, walnuts, linseed oil, flaxseed oil, or supplements. Eating salmon is considered to be the single best food source, with consumption of at least one serving per week being very helpful for macular health.


Digital devices, including computers, tablets, and smartphones emit blue light. This exposure to blue light is cumulative over a lifetime and is a major risk factor contributing to the frequency and severity of macular degeneration, often causing the macula to deteriorate at a younger age. Additionally, blue light is emitted from the sun. While avoiding emissions of blue light from digital devices and the sun is not feasible, specialized eyeglass lenses have recently hit the market that have blue blocker incorporated within the lens, utilizing a product called yellow chromophore pigment. Very disappointingly, most optical labs use an ineffective lens coating and/or tinting while claiming supposed protection. In reality, the blue blocker must be embedded within the ophthalmic lens so as to protect from harmful blue light while concurrently allowing beneficial light to pass through.

Macular degeneration can have a devastating impact on one’s quality of vision. Adhering to the aforementioned lifestyle changes can minimize the severity of, or even prevent, macular degeneration. As an ophthalmologist who has seen patients with this malady for over 30 years, I am keenly aware of the wonderful benefit of preventive care. I know first-hand that these preventive maneuvers actually work because I have a considerable number of patients who have one or both parents and siblings clobbered by macular degeneration, while those adhering to these steps, have superb vision with a very healthy macula.

Dr. Alan Mendelsohn is an ophthalmologist in the Fort Lauderdale, Hollywood community. If you want to find out more information about him, go to dralanmendelsohn.com