Fuchs' endothelial corneal dystrophy (FECD) is a progressive disorder affecting the corneal endothelium, leading to functional abnormalities and vision loss. While medical treatments are crucial, dietary and lifestyle modifications can play a supportive role in managing the condition and promoting overall eye health.
Understanding Fuchs' Dystrophy
Fuchs' dystrophy affects the corneal endothelium, the innermost layer of cells in the cornea. Healthy endothelial cells maintain corneal clarity by pumping out excess fluid. In Fuchs' dystrophy, these cells die off faster, and abnormal cobblestone-like bumps called guttata form, disrupting the smooth inner surface of the cornea.
How Fuchs’ Dystrophy Affects Vision
The formation of guttata causes light to scatter, leading to blurry vision, reduced contrast, and glare. As the condition progresses, the cornea swells, further blurring vision, especially in the morning. Severe swelling can cause painful blisters and scarring, leading to further vision impairment.
Is Fuchs’ Dystrophy Inherited?
Fuchs’ Dystrophy can be inherited, but not always. Family members can often be affected, although sometimes not at all. It is reasonable to have your immediate family examined to detect the disease as early as possible, but this is a personal decision.
The Role of Diet in Eye Health
Research indicates that nutrition can support eye health in Fuchs’ dystrophy by providing essential nutrients that protect and maintain the cornea. Antioxidants, omega-3 fatty acids, vitamin A, and zinc help reduce oxidative stress and inflammation while supporting tissue repair. Staying hydrated is also crucial for maintaining fluid balance in the eye.
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Key Nutrients for Eye Health
- Antioxidants: Vitamins A, C, and E reduce oxidative stress, protecting the cornea and other eye tissues.
- Food Sources: Carrots, spinach, oranges, almonds, and other dark leafy greens.
- Omega-3 Fatty Acids: Support corneal health, reduce inflammation, and alleviate dryness.
- Food Sources: Fatty fish (salmon, herring, sardines, tuna, lake trout, and mackerel), flaxseeds, and walnuts.
- Zinc: Plays a key role in maintaining retinal health and supporting overall vision.
- Food Sources: Shellfish, legumes, seeds, and nuts.
- Hydration: Maintains moisture in the eyes and supports tear film stability.
- Tips: Drink plenty of water, consume water-rich foods (cucumbers, watermelon), and limit dehydrating beverages like caffeine.
Foods to Include in Your Diet
- Leafy Greens and Colorful Vegetables: Spinach, kale, bell peppers, carrots, broccoli. Rich in antioxidants (vitamins A, C, and E) that protect the eyes from oxidative stress.
- Healthy Fats: Avocados, olive oil, nuts (almonds, walnuts, Brazil nuts, butternuts, hickory nuts, macadamia nuts, peanuts, almonds and hazelnuts). Provide omega-3 fatty acids and vitamin E, which reduce inflammation and support corneal health. Nuts are one of the best sources of plant-based omega-3 essential fatty acids.
- Lean Proteins: Fish (salmon, mackerel), poultry, lentils, beans, high protein and low-sugar yogurts. Supply zinc and omega-3s for retinal health and tissue repair.
- Whole Grains: Quinoa, brown rice, oats. Promote overall health and provide fiber, which supports stable blood sugar levels and reduces inflammation.
- Fresh Fruits: Blueberries, kiwi fruit, grapes, avocados and orange juice may be great for saving your sight.
- Snacks: Walnuts, Brazil nuts, butternuts, hickory nuts, macadamia nuts, peanuts, almonds and hazelnuts. Try eating them unsalted if you are concerned about sodium intake. And a word of caution: nuts are high in calories so be judicious in the amount you eat. Read the single serving size on the package and try not to exceed it.
Foods to Avoid or Limit
- Processed and Sugary Foods: Candy, cakes, pastries, doughnuts, sodas, energy drinks, sweetened teas, fruit juices with added sugar, white bread, muffins, ice cream, syrups, jams, jellies, chocolate spreads, flavored popcorn, sweetened trail mixes, popsicles, many cereals (especially those marketed to children). High sugar intake can exacerbate inflammation and negatively impact eye health.
- Excessive Caffeine and Alcohol: Both can dehydrate the body, leading to dry eyes and affecting tear film stability. Consider herbal teas (chamomile, ginger, peppermint), decaffeinated coffee, golden milk (turmeric latte), or matcha latte (low-caffeine option).
- High-Sodium Foods: Processed meats, canned soups and broths, snack foods (chips, pretzels, crackers), frozen meals, condiments and sauces, fast food, processed cheeses, cheese spreads. Too much salt can disrupt fluid balance, potentially increasing eye pressure and impacting eye health.
Lifestyle Tips to Complement Your Diet
- Regular Eye Exams: Essential for monitoring the progression of Fuchs’ dystrophy and detecting any changes early. Schedule annual or biannual check-ups with an eye care professional.
- UV Protection: Protects the cornea and other eye structures from harmful UV rays, which can worsen eye conditions. Wear sunglasses with 100% UV protection whenever outdoors, even on cloudy days. Protective glasses or goggles with UV protection should be worn when engaged in snow or water skiing. Exposure to the sun in moderation is good for us. Too much exposure to intense sunlight may increase the risk of cataracts and corneal disease. Scientists and eye doctors recommend protecting your eyes from the ultraviolet A and B, and blue light spectrums by wearing wide-brimmed hats when you are outdoors.
- Balanced Lifestyle: Combines diet with exercise and stress management to support overall health, including eye health. Engage in regular physical activity to improve circulation and reduce inflammation. Practice stress-reducing techniques like meditation or yoga to lower the risk of eye strain and related issues. Maintain a healthy sleep schedule to allow your eyes to rest and recover.
- Smoking Cessation: Smoking is a major risk factor for age-related macular degeneration (AMD) and can worsen dry eye symptoms and cataract development. Quitting smoking allows the body to recover and become stronger.
- Protective Eyewear: Wear approved American National Standards Institute (ANSI) protective eyewear (safety goggles) when doing projects or activities that create the risk of eye injuries. Choose protective eyewear with “ANSI Z87.1” marked on the lens or frame.
Additional Considerations
Eye Drops for Corneal Swelling
Currently available eye drops treat the corneal swelling caused by Fuchs’ but not the diseased endothelial cells that cause the swelling. Muro128 is the most commonly prescribed eye drop for corneal swelling. It is a salt solution that comes in 2% and 5% concentrations, in an ointment or an eye drop, and can be applied to the cornea’s surface 3-4 times a day and at bedtime. The salt in Muro 128 dries out the superficial layers of a swollen cornea, much like salt dries out cured deli meats. The medication can be effective in the early stages of Fuchs’, but it does not address symptoms caused by guttata or deeper swelling. Salt solutions are ineffective in more advanced stages of the disease. Muro128 is available over the counter without a prescription and is also available as a less costly generic.
Corneal Transplant Surgery
DMEK (Descemet Membrane Endothelial Keratoplasty) is currently the most advanced surgical treatment available for Fuchs’, but you should also be aware of other corneal transplant surgeries that came before DMEK. PK (Penetrating Keratoplasty) was the first surgery available for Fuchs’ and has been in existence for about 100 years. EK (Endothelial Keratoplasty) was developed around 2000. Early forms of EK were eventually replaced by DSAEK, which has been the most common treatment for Fuchs’ in the United States since about 2011. DMEK was developed in 2006 and has become increasingly popular since the introduction of innovative surgical technology and techniques after 2010, including: eye bank-prepared DMEK tissue, specialized tissue-injection devices, methods for determining right-side-up orientation of DMEK tissue during surgery, approaches to manipulating and positioning DMEK tissue in the eye without directly touching the tissue, and the incorporation of gases used in retinal surgery to support DMEK tissue.
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