Health Promotion for AMD and the Role of Nutrition

*Alexander Martinez, Joseph J. Pizzimenti, Drake W. Lem and Pinakin Gunvant Davey*

### **Abstract**

There is an increase in demand for health promotion and preventative medicine playing a vital role in managing chronic illnesses. Many of these conditions stem from a poor diet, sedentary lifestyle and smoking, all of which are risk factors for age-related macular degeneration (AMD). To combat chronic diseases, the root of the conditions may be addressed through the concept of health promotion. Health promotion thoroughly assesses how a population's environmental, political, socioeconomic, behavioral, and cultural practices influence its health. This concept can be applied in a primary care setting which takes on a broader approach in treating and managing patients. Primary care providers need to be aware of the connections between common chronic illnesses and AMD. All primary care providers and eyecare specialists must be patients' advocate and help improve their systemic and ocular prognosis.

**Keywords:** age-related macular degeneration, choroidal neovascularization, modifiable and non-modifiable risk factors, health promotion, nutrition, lutein, and zeaxanthin

#### **1. Introduction**

Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in people over 50 years old [1]. It has been defined as a condition in which the structure and function of the central retina (macula) deteriorates. AMD results from a process by which the macula deteriorates over time in association with distinguishing signs and symptoms [2]. Approximately 11 million people are affected with AMD in the United States and approximately 170 million are living with AMD, worldwide [3]. In 2020, it was estimated approximately 196 million people will have AMD along with a predicted increase to 288 million by the year 2040 [4].

AMD is more commonly seen in females and individuals of Caucasian descent, especially in its late, advanced stage. Furthermore, the incidence rates vary by the stage of AMD and are related to genetics. Hispanics and Caucasians are known to have the highest incidence of early AMD. The incidence rates are 6 and 4% respectively for individuals less than fifty-five years of age which increases to 22 and 24% for individuals greater than seventy-five years of age. Overall, Asians and people of African descent show the lowest incidence of early AMD. For advanced AMD, which includes atrophic or neovascular forms, Caucasians of 75 years or older show the highest incidence at 6.5% [5].

AMD is a multifactorial disease that is influenced by age, genetics, health status, smoking habits and race [6]. With the increasing incidence of AMD secondary to a rapidly aging population, the focus is shifted on addressing modifiable risk factors like smoking cessation, altering unhealthy diets, and sedentary lifestyles [7]. AMD is the leading cause of irreversible vision loss in the developed world [8, 9]. To be proactive in addressing the rising incidence of the disease, primary care providers managing must be aware of the risk factors and associations of AMD. They are well-positioned to assist eye care professionals in preventing or slowing the progression of AMD. Primary care providers can implement a health promotion model, promoting the importance of regular eye examinations with a Doctor of Optometry or Ophthalmologists. This may enable earlier detection and treatment of AMD.

AMD is a chronic condition that currently has no known cure. Modifiable risk factors, such as an unhealthy diet, sedentary lifestyle, smoking and alcohol consumption may significantly contribute to disease onset and severity and there are successful treatment strategies [7, 10]. Health promotion is essential in reducing the risk of development and progression of AMD in high-risk groups. Health promotion also empowers patients with information, giving them control of their health. Health promotion looks into the root of the cause of the illness and assesses how environmental, political, socioeconomic, behavioral, and cultural practices influences health [11]. Primary care providers can help patients living with AMD to have a better understanding of their condition and the modifiable factors that influence their ocular and overall health. By incorporating these essential factors making up an individual's identity and influences on their health, the desired result may improve patient adherence to the management plan.
