While some research suggests that a diet high in omega-3 fatty acids can protect brain health, a large clinical trial by researchers at the National Institutes of Health found that omega-3 supplements did not slow cognitive decline in older persons. With 4,000 patients followed over a five-year period, the study is one of the largest and longest of its kind. It was published today in the Journal of the American Medical Association.

NIH study raises doubt about any benefits omega-3 and dietary supplements like these may have for cognitive decline. (Photo courtesy of NEI)

“Contrary to popular belief, we didn’t see any benefit of omega-3 supplements for stopping cognitive decline,” said Emily Chew, M.D., deputy director of the Division of Epidemiology and Clinical Applications and deputy clinical director at the National Eye Institute (NEI), part of NIH.

Dr. Chew leads the Age-Related Eye Disease Study (AREDS), which was designed to investigate a combination of nutritional supplements for slowing age-related macular degeneration (AMD), a major cause of vision loss among older Americans. That study established that daily high doses of certain antioxidants and minerals—called the AREDS formulation—can help slow the progression to advanced AMD.

A later study, called AREDS2, tested the addition of omega-3 fatty acids to the AREDS formula. But the omega-3’s made no difference. Omega-3 fatty acids are made by marine algae and are concentrated in fish oils; they are believed to be responsible for the health benefits associated with regularly eating fish, such as salmon, tuna, and halibut.*  Where studies have surveyed people on their dietary habits and health, they’ve found that regular consumption of fish is associated with lower rates of AMD, cardiovascular disease, and possibly dementia. “We’ve seen data that eating foods with omega-3 may have a benefit for eye, brain, and heart health,” Dr. Chew explained.

Omega-3 supplements are available over the counter and often labeled as supporting brain health. A large 2011 study found that omega-3 supplements did not improve the brain health of older patients with preexisting heart disease.

With AREDS2, Dr. Chew and her team saw another opportunity to investigate the possible cognitive benefits of omega-3 supplements, she said. All participants had early or intermediate AMD. They were 72 years old on average and 58 percent were female. They were randomly assigned to one of the following groups:

  1. Placebo (an inert pill)
  2. Omega-3 [specifically docosahexaenoic acid (DHA, 350 mg) and eicosapentaenoic acid (650 mg)]
  3. Lutein and zeaxanthin (nutrients found in large amounts in green leafy vegetables)
  4. Omega-3 and Lutein/zeaxanthin

Because all participants were at risk for worsening of their AMD, they were also offered the original or a modified version of the AREDS formulation (without omega-3 or lutein/zeaxanthin).

Participants were given cognitive function tests at the beginning of the study to establish a baseline, then at two and four years later. The tests, all validated and used in previous cognitive function studies, included eight parts designed to test immediate and delayed recall, attention and memory, and processing speed. The cognition scores of each subgroup decreased to a similar extent over time, indicating that no combination of nutritional supplements made a difference.

Alzheimer’s disease, which is the most common cause of dementia and affects as many as 5.1 million Americans age 65 and older in the U.S., may triple in the next 40 years. Some research has examined the potential benefits of DHA for Alzheimer’s. Studies in mice specially bred to have features of the disease found that DHA reduces beta-amyloid plaques, abnormal protein deposits in the brain that are a hallmark of Alzheimer’s, although a clinical trial of DHA showed no impact on people with mild to moderate Alzheimer’s disease.

“The AREDS2 data add to our efforts to understand the relationship between dietary components and Alzheimer’s disease and cognitive decline,” said Lenore Launer, Ph.D. senior investigator in the Laboratory of Epidemiology and Population Science at the National Institute on Aging. “It may be, for example, that the timing of nutrients, or consuming them in a certain dietary pattern, has an impact. More research would be needed to see if dietary patterns or taking the supplements earlier in the development of diseases like Alzheimer’s would make a difference.”

For more information about AMD and AREDS2, visit https://nei.nih.gov/areds2/.

* Other omega-3 fatty acids are found in plant foods such as flaxseed, walnuts, soy products, and canola and soybean oils. Specific omega-3 fatty acids from these sources were not studied.

The cognitive function component of AREDS2 was supported by the NEI Intramural Research Program and contracts HHS-N-260-2005-00007-C. Additional research funds were provided by the NIH Office of Dietary Supplements; the National Center for Complementary and Integrative Health; the National Institute on Aging; the National Heart, Lung, and Blood Institute; and the National Institute of Neurological Disorders and Stroke.

The AREDS trial is registered at www.ClinicalTrials.gov as NCT00594672. AREDS2 is registered as NCT00345176.

Reference:

Age-Related Eye Disease Study 2 (AREDS2) Research Group. “Effect of Omega-3 Fatty Acids, Lutein/Zeaxanthin, or other Nutrient Supplementation on Cognitive Function: The AREDS2 Randomized Clinical Trial.” JAMA. 2015;314(8):791-801. doi:10.1001/jama.2015.9677.

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NEI leads the federal government’s research on the visual system and eye diseases. NEI supports basic and clinical science programs that result in the development of sight-saving treatments. For more information, visit http://www.nei.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

NIH…Turning Discovery Into Health®

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When Kristina Howell of Laurel, Md. was 23 years old, she went in for a routine exam at her optometrist’s office to get contact lenses.

“They did some testing and they noticed that I wasn’t seeing in my peripheral, and they couldn’t tell me what it was,” Howell said.

The visit led to several follow-up exams, first with ophthalmologist Ronald Oser, M.D. in Laurel, and then with retina specialist Robert Stephens in Bethesda. After an electroretinography (ERG) eye test, it was confirmed: Kristina had a condition called retinitis pigmentosa, or RP. RP is a rare genetic disorder that involves a breakdown of cells in the retina and causes the loss of peripheral vision. While the progression of RP can differ greatly from person to person, eventually, most people with RP will lose most of their sight.

“I think when I left Dr. Stephens’ office in Bethesda, I cried for three straight days, devastated that he told me I was going to lose my vision,” said Howell, now 31 and a mother of two young daughters. “I’m OK with it now. … I’m not going to let that stop me from having a normal life.”

Eight years after her diagnosis, Howell is not only still a patient of Dr. Oser’s but works as a technician at his office, Laurel Eye Physicians and Surgeons.

“I build a bond with a lot of the patients,” Howell said. “They’ll call and ask me how I’m doing, and I’ll call and ask them how they’re doing.” As an employee of Laurel Eye Physicians, Howell said she can empathize with many patients who are going through vision loss. “It’s getting a little worse each year,” she said. “I think I’m down to 40 degrees (of visual field).”

Kristina Howell of Laurel, Md. stands with her daughter Emma at the 2014 Eye Run for POB.

On Sunday, Sept. 20, Howell will participate in the second annual Eye Run for POB, a 5K and fun run to support local vision programs by the Prevention of Blindness Society of Metropolitan Washington. She is participating with her coworkers on the Laurel Eye Physicians office team.

“Our office – we’re like family. We support each other in everything,” Howell said. “This is what we do, we care about people’s eyes.” The team has already raised $1,100 of its $2,000 fundraising goal and is the largest Eye Run team with 33 members.

“I’m doing this for me,” Howell said. “And hopefully, my kids will have a better chance of not going blind.” Howell attended the inaugural event last year with her daughters, as well. “It’s just fun; it’s nice to get together as a work office and do this together,” she said.

Eye Run for POB will be held at Westfield Montgomery Mall in Bethesda. The event will consist of a 5K and fun run, a vision health fair with vision screenings and information about eye health, and a family-friendly Kids Camp with children’s author Valerie Tripp in celebration of her new literary project, Boys Camp. POB is also proud to partner with Achilles International for this event to provide running guides for participants with visual impairments. For more information and to register for the event, please visit www.youreyes.org.

Founded in 1936, the Prevention of Blindness Society of Metropolitan Washington® is the largest local prevention of blindness agency in the United States, dedicated to the improvement and preservation of sight by providing services, education, advocacy and innovation. The organization serves the District of Columbia, Montgomery and Prince George’s counties of Maryland, and Northern Virginia. POB screens 8,000 children annually for vision loss and strabismus and 5,000 adults for glaucoma. POB also provides thousands of low-income and homeless individuals with low-cost eyeglasses. Its Aging Eye Network, Macular Degeneration Network and Stargardt’s Network provide public programs and support groups.

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NIH Scientists Propose Novel Mechanism to Explain Autoimmune Uveitis

The inflammatory eye disorder autoimmune uveitis occurs when a person’s immune system goes awry, attacking proteins in the eye. What spurs this response is a mystery, but now a study on mice suggests that bacteria in the gut may provide a kind of training ground for immune cells to attack the eye. The study was conducted by researchers at the National Eye Institute (NEI), part of the National Institutes of Health.

Microbiota in the gut activate T cells that are able to recognize retinal proteins. These activated T cells then migrate through the bloodstream to the eye, where they cause the inflammatory response associated with autoimmune uveitis.

Evidence increasingly suggests that there is an association between the microbiota in the gut – bacteria, fungi and viruses – and the development of autoimmune disorders. Findings from this study suggest how that association may be made and therefore have implications about the origins of autoimmune diseases not only in the eye, but also elsewhere in the body, said Rachel R. Caspi, Ph.D., a senior investigator at NEI whose lab led the study.

Autoimmune uveitis accounts for more than 10 percent of severe visual disability in the United States. Corticosteroids provide a blanket approach to the disorder by quelling inflammation, but their long-term use can lead to adverse side effects.

Understanding what spurs autoimmune uveitis is fundamental to the development of safer long-term therapies and possibly even strategies for preventing it, said Reiko Horai, Ph.D., a staff scientist at NEI and a lead author of the study, published in the journal Immunity. Carlos R. Zarate-Blades, Ph.D., a postdoctoral fellow at NEI, is the other lead author.

The eye is one of the places in the body that has immune privilege meaning it is protected by a blood-tissue barrier that physically separates it from the rest of the body and minimizes the exchange of substances and blood-borne cells going in and out of the eye.

In the case of autoimmune uveitis, immune cells (T cells) are thought to penetrate through this blood-ocular barrier. But first, they must become activated, which occurs when they come in contact with the protein that they are pre-programmed to recognize. This is how T cells fight an infection and some types of cancer – by targeting proteins on bacteria, viruses and cells. And herein lies a paradox that’s been puzzling uveitis researchers. The proteins believed to be targeted in autoimmune uveitis are sequestered in the eye; they don’t exist elsewhere in the body. So what activates the T cells and allows them to cross the blood-ocular barrier?

The researchers asked this question by studying mice genetically engineered to develop autoimmune uveitis, due to a high level of retina-reactive T cells in their bodies. Before the mice had developed signs of the disease, the team searched their bodies for activated T cells and made an interesting discovery. Levels of activated T cells were not elevated in the lymph nodes (the glands that tend to swell during infections), but they were abundant in the intestines. What’s more, the T cells in the gut produced a protein shown in previous studies by Dr. Caspi’s team to augment the damage in autoimmune uveitis.

“These discoveries support the idea that activation of T cells in the gut may actually precede the first signs of the disease,” she said. To test that idea, the researchers gave the mice an antibiotic cocktail designed to wipe out a broad spectrum of bacteria in the gut and by rearing them in a germ-free environment. They found that mice without gut bacteria developed autoimmune uveitis much later, and with less severity, compared to control mice with normal gut flora.

There was a similar delay in uveitis and decline in its severity when the uveitis-prone mice were raised in an environment free of bacteria and other germs. But when the same mice were later moved into normal housing, where they acquired normal gut bacteria, the uveitis roared in at full strength.

So how do bacteria in the gut activate T cells against cells in the eye? The researchers theorize that bacteria in the gut produce a molecule that, to T cells, looks similar to a protein in the retina. This gives the T cells marching orders to look for that retinal protein and attack it. Consistent with this idea, the researchers found that they could activate retina-specific T cells by exposing them to a soup of bacterial proteins extracted from mouse intestines. When those activated T cells were injected into normal mice (not prone to uveitis), the mice developed uveitis.

“Given the huge variety of bacteria in our intestines, if they can mimic a retinal protein, it is conceivable that they could also mimic other self-proteins in the body. So we believe that normally harmless bacteria in the gut could be involved in promoting other autoimmune diseases as well,” Dr. Caspi said.

The results don’t have immediate implications for patients, but will help inform further research to understand the disease and help to develop new therapies, Dr. Caspi said. Eliminating bacteria from our bodies isn’t a treatment option, and a bacteria-free state would not be feasible. However, if scientists could one day identify the bacteria specifically involved in promoting autoimmune uveitis, it might be possible to target only those of interest.

References:

Horai, Zarate-Blades et al. “Microbiota-dependent activation of an autoreactive T cell receptor provokes autoimmunity in an immunologically privileged site.” Immunity, http://www.cell.com/immunity/abstract/S1074-7613(15)00303-9

NEI leads the federal government’s research on the visual system and eye diseases. NEI supports basic and clinical science programs that result in the development of sight-saving treatments. For more information, visit http://www.nei.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov/.

NIH…Turning Discovery Into Health®

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Save the date for a unique technology presentation

Sunday, October 18: 1:30 p.m. – 3 p.m. Aging Eye / Macular Degeneration Network Sibley Medical Building

MARK YOUR CALENDAR to attend a unique presentation that will focus on portable, mobile and “new wearable” technology including the much anticipated “OrCam.” These help with reading, writing, facial recognition, product recognition, color, money, I.D. and MUCH MORE!!

Guest Expert, Moira Williams, Enhanced Technology, helps to identify assistive technology solutions to promote access, function and productivity. Attend FOR YOURSELF or someone you CARE ABOUT! Free garage parking. Call the Sibley Senior Association at 202-364-7602.

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Celebrate “Two Monumental Milestones”

Thursday, October 8: 11 a.m. – 12:30 p.m. Low Vision Resource Group Lunch & Learn Charles E. Beatley, Jr. Central Library

POB continues to celebrate the July celebrations of the arts, culture and history of the disability community hosted by the Kennedy Center and the Smithsonian Institution. These celebrations were held in recognition of the 25th anniversary of the Americans with Disabilities Act and the 40th anniversary of Very Special Arts (VSA).

Meet Lorena Baines, Manager, Accessible Programs, National Gallery of Art, Washington, D.C. and learn about the magnificent opportunities we have in the Washington Metropolitan Area to remember how and why ART IS FOR EVERYONE. BECOME PART OF THIS AMAZING CONVERSATION! Mark your calendar Thursday, Oct. 8, and call Kym at the library at 703-746-1762 to reserve lunch.

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September Sight-Saving Seminars

Ophthalmologist? Optometrist? Optician? Ophthalmic Medical Personnel? Oculist? Low Vision Rehabilitation Specialist? Have you ever wondered about the various titles, roles, education and licensing requirements of different eye care professionals? These are the people to whom we entrust the health of our eyes, and you may want to ask yourself – Who are they and how did they prepare for their careers?

“Eye care professional” can refer to any health care worker, from one with a high school diploma to a practitioner with a doctoral education and residency/fellowship training. Join POB at one of three enlightening presentations in September to learn “Who’s Who in Eye Care.”

Remember: Information is power.

Tuesday, Sept. 8 at MedStar Washington Hospital Center

Thursday, Sept. 17 at Friendship Heights Village Center

Sunday, Sept. 20 at Sibley Medical Building

 

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About 38 million Americans have eye diseases such as glaucoma, diabetic retinopathy, age-related macular degeneration and cataracts – common causes of vision loss, low vision and blindness. As Baby Boomers age, the numbers are expected to double in the near future.

Individuals with low or no vision sometimes feel they have reached the end of the road with their vision problem because their sight cannot be restored, but it is essential that they continue to see an eye doctor regularly and that they are informed advocates for their own eye health.

Summerfield 3 blOn July 23, ophthalmologist Michael Summerfield spoke at “Eye Care is for Everyone,” a free public event at the Seabury Resources for Aging Center for the Blind and Visually Impaired in Washington, D.C. He encouraged attendees, many of whom live with impaired or no vision, to continue to visit an ophthalmologist regularly for six important reasons:

1)      All vision is worth saving

Individuals living with limited vision learn to make use of what sight they have, and even a very small amount of sight is worth a lot. Even if it isn’t possible to improve visual acuity or regain sight, if that small amount of vision can be maintained, it can still be useful vision. Continual care is essential to maintaining small amounts of vision that can make a tremendous difference in the life of the patient.

2)      Other diseases can be picked up through eye exams

Health conditions that have nothing to do with vision can often be detected through eye exams with an ophthalmologist. Small changes in the blood vessels in the eyes can help doctors detect even subtle forms of hypertension; inflammation in the eye can be evidence of systemic inflammation conditions such as rheumatoid arthritis and sarcoidosis; and evidence of diabetic retinopathy can be an early indicator that a patient has diabetes.

3)      Continual eye care can be vital for maintaining comfort

Even if a doctor can’t bring back vision, there are still things he or she can do to keep the eyes comfortable. When an eye doesn’t see anymore, it can experience a chronic, aching pain that the patient might assume is unavoidable. Other times, the ocular surface of the eye may become dry, scratchy and irritated. Pain and discomfort can be alleviated by ophthalmologists with the right treatment.

4)      Eye doctors can help with patients’ cosmetic goals

It’s common for eye diseases and conditions that impair vision to affect the appearance of the eyes, and it’s not superficial or vain for a patient to want to address this. Patients shouldn’t be afraid to ask their eye doctor about their personal cosmetic goals with their eyes, because often there is something doctors can do to help.

5)      New research and therapies are constantly being conducted

The amount of new information that comes out about eye diseases on a regular basis is growing exponentially. New technologies, assistive devices and therapies are continually being created and tested. A patient’s eye doctor might know something now that didn’t exist a year ago that can improve the patient’s life.

6)      Patients can teach their doctors

Patients with vision loss have unique insight into the personal experience of living with low or no vision. In most cases, eye doctors haven’t experienced these conditions themselves. When patients share this information with their ophthalmologists, it creates a richer and more complete understanding of the experience of the condition that doctors may be able to use to help other patients.

Michael Summerfield, M.D., is the director of the MedStar Georgetown University / MedStar Washington Hospital Center Ophthalmology Residency Program.

“Eye Care is for Everyone” was co-sponsored by Seabury Resources for Aging, the Prevention of Blindness Society of Metropolitan Washington (POB), the DC Office on Aging and MedStar Health.

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For proper protection, sunglasses should offer the following:

• Ability to absorb and block 99-100 percent of UVA/UVB light

• Sufficient size to shield eyes, eyelids and surrounding area

• A close fit and UV-protective side shields are ideal

• Durability and impact resistance

• Polarized lenses to eliminate glare, especially if driving, in the snow or on the water.

For more information about protecting your eyes from the sun, visit www.skincancer.org/prevention/sun-protection

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Department of Justice unveils new online Americans With Disabilities complaint form

The Department of Justice recently announced that individuals wishing to file ADA complaints with the Department will be able to fill out the form and submit it completely electronically. Filers will also immediately receive a “reference number” that can be used whenever contacting the Department about that complaint. Please visit www.ada.gov to view the new electronic form. As of March 15, e-mail complaints are no longer accepted by the Department. However, complaints are still accepted by U.S. mail. Contact the Department’s ADA Information Line at 800-514-0301 (voice) or 800-514-0383 (TTY or Text Telephone) to receive a paper complaint form by mail.

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Company offers voice-controlled TV remote plus audio-described programming

Comcast announced the consumer launch of its new remote with voice control, which lets viewers search for networks, shows and movies; set DVR recordings; navigate Xfinity On Demand and more. For more information, call 1-800-COMCAST (266-2278) or visit www.Xfinity.com/VoiceRemote.

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