Vitamins don’t have effect on glaucoma

Dear Dr. Roach: Iama 72-year-old male in good health who was told this week that my eyes have shown the beginning of glaucoma. There is no change in my 20/20 vision yet. In 2014, I had cataract surgery in both eyes. Is there any evidence that AREDS 2 vitamins will do anything to moderate the effects of glaucoma?

R.C.

Answer: Although there are many eye diseases, three of the most important ones in older adults are glaucoma, cataracts and age-related macular degeneration. There can be some confusion over what these are.

Glaucoma is a disease of the retina that is usually (but not always) associated with high pressure in the eye. A person can get glaucoma with normal eye pressures, and some people with high eye pressures never get glaucoma. But, we often treat people with high pressures to prevent glaucoma from developing, and will certainly treat people with glaucoma and normal eye pressures with medication — almost always eye drops to reduce eye pressure.

Some people with glaucoma, or those who are at risk due to eye pressure or anatomy, benefit from laser surgery rather than medication.

Eye doctors screen for glaucoma with a comprehensive eye exam, including a careful look at the retina, and by measuring eye pressures. Vision loss in glaucoma is gradual and is often not noticed, since it is in the peripheral vision. Vitamins have no effect on glaucoma.

Age-related macular degeneration (AMD) is a very different condition. It’s not clear exactly how the condition starts, but it can be “wet” (with abnormal blood vessels) or “dry” (more common, with atrophy of the macula, the part of the retina in the center where our vision is sharpest). AMD is diagnosed by an eye exam. Wet AMD has treatment options, such as injections into the eye of medications to stop abnormal blood vessels from growing. Dry AMD is treated with the AREDS or AREDS 2 vitamins, which slow progression of the disease. You know all about cataracts, having had surgery. They are opacities in the lens of the eye, causing gradual cloudiness of the vision. If you live long enough, you will develop cataracts. Surgery is the treatment for cataracts.

Dear Dr. Roach: Which type of calcium supplement is best absorbed? How many milligrams do you suggest for a woman in her 60s?

D.R.

Answer: Most calcium supplements sold are either calcium carbonate or calcium citrate, and either one is reasonable in people who need calcium supplementation. I prefer dietary calcium when possible: Calcium supplements increase the risk of kidney stones, while calcium in food (dairy products and fish with tiny bones, such as sardines, are excellent sources) decreases kidney stone risk. Further, there is some suggestion that calcium supplementation may increase heart disease risk, and while the evidence is conflicting, calcium from food seems safer than calcium supplements to me. The standard recommendation is 1,200 mg of elemental calcium a day from a combination of food and supplements for a woman over 50 or a man over 70. Calcium carbonate is best absorbed with food, while calcium citrate is well absorbed with or without food. Calcium carbonate is not well-absorbed by people taking proton pump inhibitor medicines like omeprazole (Prilosec).