Vision Problems

Image Credit: Nonsap Visuals

     Visual symptoms associated with MS include double vision, eye movement problems, dry eye (“xerophthalmia”), and the most common, optic neuritis — inflammation of the optic (vision) nerve. The latter usually occurs in one eye at a time, with signs including aching pain with eye movement (aching that differs from that characteristic of migraine headaches), blurred vision, dim vision, loss of color vision, or obstructed vision (“blind spots”).

     When experiencing any of these symptoms, it is important to consult a neurologist or other relevant health care professional to determine if emergent care is needed. He/she can assess whether the problem will resolve with or without administration of conventional medication such as steroids. Since vision is so key to functioning and the thought of irreversible damage so unsettling, no-one can blame someone for choosing steroids as the initial intervention. Following this or if the conventional path is not taken, healing care is crucial to full recovery and prevention of worsening of future episodes.

      In addition to the more general natural routes one can take – such as acupuncture or an antioxidant-rich or keto diet high in medium-chain triglycerides (MCT) and omega-3s1 – there are compounds shown in research studies to combat optic neuritis, and which can be taken as food supplements.

  • In an animal model of MS with optic neuritis, an injection of high-absorption resveratrol directly into the eye was associated with significantly reduced loss of retinal ganglion cells (a type of neuron located near the inner surface of the retina of the eye) and preserved local nerve cell function long after the injection, compared to both pre-treatment and controls2. In a later study by the same research group, animals were administered either 500 mg/kg or 1000 mg/kg resveratrol orally, with significant reductions in nerve cell damage in the eye3.

  • In an animal model of MS, oral pterostilbene at doses of 20 mg/kg and 40 mg/kg was associated with reduced risk factors for disease-related optic neuritis, protecting the optic nerves against demyelination and nerve fiber loss and the retina against destruction of key cells4.

  • A placebo-controlled, double-blind clinical study applying biotin in a 300 mg dose (100 mg three times per day) demonstrated benefit among sufferers of progressive optic neuropathy 5.

  • In an open study with RRMS patients suffering from permanent visual disability following acute optic neuritis, participants received oral high-doses of three B-vitamins including B12 (300 mg of vitamin B1 or thiamine, 450 mg of vitamin B6 or pyridoxine, and 1,500 mcg of vitamin B12), as add-on treatment to conventional medications. After 90 days of treatment, a statistically significant improvement was observed in the key measurements of ability to perceive light and distinguish details of objects at a given distance 6.

  • In an EAE study, a combination incorporating fatty acids (oleic, palmtoleic, palmitic, linoleic, myristic), lipoic acid, vitamins (C and E), and amino acids (L-methionine, L-cysteine, L-histadine, and taurine) or their derivatives (histamine, S-methoxyltryptamine) was associated with repair to myelin damage of the optic nerve7.

  • Xanthophylls are a class of carotenoids responsible for the yellow, orange, and red hues of flowers, fruits, vegetables (corn, pepper, etc.), egg yolks, and feathers, shells, or flesh of many animal species (flamingo, canary, shrimp, lobster, chicken, or salmonids). Two of the most studied are lutein and zeaxanthin, non-provitamin A carotenoids that constitute the macular pigment of the human retina. The macula is part of the retina, which is a layer at the back of the eyeball; it contains cells that are sensitive to light and trigger nerve impulses passing via the optic nerve to the brain, where a visual image is formed8,9. Lower macular xanthophyll concentrations were observed in individuals with MS+optic neuritis compared to healthy people. Further, macular xanthophylls were positively correlated with visual and cognitive health markers such as macular pigment in the MS group10. An increasing number of studies have indicated that optic neuritis might increase the oxidative burden (amount of free radicals)11, which might in turn increase cell damage. This increase results in greater use of inner antioxidant reserves and therefore lower concentrations. Indeed, research results have revealed that serum lutein and zeaxanthin, which are important antioxidants for the eye, are significantly lower in persons with MS. Other findings suggest that macular xanthophylls might confer protective effects for the integrity of eye blood flow even in MS patients without a history of optic neuritis. Macular carotenoids may confer neuroprotective benefits by reducing nerve loss and preserving macular volume10. Beta-carotene is another type of carotenoid, found mainly in orange and yellow fruits and vegetables such as carrots. In addition to being an antioxidant, it acts as “pro-vitamin A,” being converted in the body to vitamin A, which is essential for general eye health 12.

  • In homeopathy, phosphorus appears to be helpful in optic neuritis. Recommended therapy includes phosphorus 30C every day until resolution begins, sometimes in combination with Hypericum. The double vision which sometimes occurs may be helped with Gelsemium 13.

No less important are the following fatty acids – all available as supplements – which may help combat dry eye:

DHA + EPA

     DHA and EPA are omega-3 fatty acids, which benefit your eyes just as much as your body, being fundamental to the retina and optic membranes14. Having too little omega-3s in your diet can put you at a higher risk for AMD, diabetic retinopathy, and dry eye syndrome, among other conditions 15,16. Clinical studies have demonstrated benefits of DHA+EPA supplementation (360-750 mg/day) against dry eye syndrome17,18. You’ll find DHA and EPA in fish, such as salmon and tuna, as well as microalgae (Schizochytrium spp., Aurantiochytrium spp., Thraustochytrium spp., and Crypthecodinium cohnii).

Gamma Linolenic Acid (GLA)

    GLA is an antiinflammatory omega-6 fatty acid that can affect eye health and help with dry eyes according to clinical research19,20, including in concert with omega-3s21. To increase your GLA intake, it is recommended to incorporate the following foods into your diet: black currants, walnuts, peanut butter and safflower oil (preferably the “high-oleic” type, so as not to overdo other omega-6s).

 

References

1. Zyla-Jackson K, Walton DA, Plafker KS, et al. Dietary protection against the visual and motor deficits induced by experimental autoimmune encephalomyelitis. Front Neurol. 2023;14:1113954. doi:10.3389/fneur.2023.1113954

2. Shindler KS, Ventura E, Rex TS, Elliott P, Rostami A. SIRT1 activation confers neuroprotection in experimental optic neuritis. Invest Ophthalmol Vis Sci. Aug 2007;48(8):3602-9. doi:10.1167/iovs.07-0131

3. Shindler KS, Ventura E, Dutt M, Elliott P, Fitzgerald DC, Rostami A. Oral resveratrol reduces neuronal damage in a model of multiple sclerosis. J Neuroophthalmol. Dec 2010;30(4):328-39. doi:10.1097/WNO.0b013e3181f7f833

4. Guo J, Wang J, Guo R, Shao H, Guo L. Pterostilbene protects the optic nerves and retina in a murine model of experimental autoimmune encephalomyelitis via activation of SIRT1 signaling. Neuroscience. Jan 25 2022;doi:10.1016/j.neuroscience.2022.01.016

5. Tourbah A, Gout O, Vighetto A, et al. MD1003 (High-Dose Pharmaceutical-Grade Biotin) for the Treatment of Chronic Visual Loss Related to Optic Neuritis in Multiple Sclerosis: A Randomized, Double-Blind, Placebo-Controlled Study. CNS Drugs. Jul 2018;32(7):661-672. doi:10.1007/s40263-018-0528-2

6. Mallone F, Lucchino L, Franzone F, Marenco M, Carlesimo SC, Moramarco A. High-dose vitamin B supplementation for persistent visual deficit in multiple sclerosis: a pilot study. Drug Discov Ther. 2020;14(3):122-128. doi:10.5582/ddt.2020.03031

7. Mangas A, Vecino E, David Rodriguez F, Geffard M, Covenas R. GEMSP exerts a myelin-protecting role in the rat optic nerve. Neurol Res. Nov 2013;35(9):903-11. doi:10.1179/1743132813Y.0000000233

8. Tanumihardjo SA. Carotenoids: Health Effects. In: Caballero B, ed. Encyclopedia of Human Nutrition (Third Edition). Elsevier; 2013:290-297.

9. Widomska J, Subczynski, W.K. Mechanisms enhancing the protective functions of macular xanthophylls in the retina during oxidative stress. Exper Eye Res. 2019;178:238-246.

10. Cerna J, Anaraki NSA, Robbs CM, et al. Macular Xanthophylls and Markers of the Anterior Visual Pathway among Persons with Multiple Sclerosis. J Nutr. Sep 4 2021;151(9):2680-2688. doi:10.1093/jn/nxab164

11. Sanz-Morello B, Ahmadi H, Vohra R, et al. Oxidative Stress in Optic Neuropathies. Antioxidants (Basel). Sep 28 2021;10(10)doi:10.3390/antiox10101538

12. Johra FT, Bepari AK, Bristy AT, Reza HM. A Mechanistic Review of beta-Carotene, Lutein, and Zeaxanthin in Eye Health and Disease. Antioxidants (Basel). Oct 26 2020;9(11)doi:10.3390/antiox9111046

13. Whitmarsh TE. Homeopathy in multiple sclerosis. Complement Ther Nurs Midwifery. Feb 2003;9(1):5-9. doi:10.1016/S1353-6117(02)00105-1

14. Hodge W, Barnes, D., Schachter, H.M., Pan, Y., Lowcock, E.C., Zhang, L., Sampson, M., Morrison, A., Tran, K., Miguelez, M., Lewin, G. Effects of Omega-3 Fatty Acids on Eye Health: Summary. AHRQ Evidence Report Summaries. National Institutes of Health; 2005:chap 117.

15. Gregori NZ. Diet and Nutrition. American Academy of Ophthalmology (AAO). Accessed October 25, 2024, https://www.aao.org/eye-health/tips-prevention/diet-nutrition

16. Roark MW, Charters, L. AOA 2023: Nutritional strategies in dry eye disease: The importance of omega-3s. MJH Life Sciences. https://www.optometrytimes.com/view/aoa-2023-nutritional-strategies-in-dry-eye-disease-the-importance-of-omaga-3s

17. Kangari H, Eftekhari MH, Sardari S, et al. Short-term consumption of oral omega-3 and dry eye syndrome. Ophthalmology. Nov 2013;120(11):2191-6. doi:10.1016/j.ophtha.2013.04.006

18. Wojtowicz JC, Butovich I, Uchiyama E, Aronowicz J, Agee S, McCulley JP. Pilot, prospective, randomized, double-masked, placebo-controlled clinical trial of an omega-3 supplement for dry eye. Cornea. Mar 2011;30(3):308-14. doi:10.1097/ICO.0b013e3181f22e03

19. Aragona P, Bucolo C, Spinella R, Giuffrida S, Ferreri G. Systemic omega-6 essential fatty acid treatment and pge1 tear content in Sjogren’s syndrome patients. Invest Ophthalmol Vis Sci. Dec 2005;46(12):4474-9. doi:10.1167/iovs.04-1394

20. Das UN. Molecular pathobiology of scleritis and its therapeutic implications. Int J Ophthalmol. 2020;13(1):163-175. doi:10.18240/ijo.2020.01.23

21. Brignole-Baudouin F, Baudouin C, Aragona P, et al. A multicentre, double-masked, randomized, controlled trial assessing the effect of oral supplementation of omega-3 and omega-6 fatty acids on a conjunctival inflammatory marker in dry eye patients. Acta Ophthalmol. Nov 2011;89(7):e591-7. doi:10.1111/j.1755-3768.2011.02196.x

Share this:

Like this:

Like Loading...