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S 12 S E P T E M B E R 2 0 1 5 • O P T O M E T R I C M A N A G E M E N T . C O M tion. 13 Vitamin A is actually the fuel for the visual cycle and while necessary in recommended amounts, in high doses is similar to treating diabetes with sugar. Zinc also is a Jekyll and Hyde element; in Alzheimer's and prostate health, it is the homeostasis of zinc that is pathogenic and why too much and too little zinc can potentiate cancer and amyloid formation. In the eyes, zinc over the long term appears to demon- strate its strong anti-angiogenic properties 14 by reducing the risk of choroidal neovascularization in AMD, 15 but also promotes its apoptogenic properties 16 as it potentially accelerates the development of central involving geo- graphic atrophy. 15 Recently, rational design of nutritional supplementa- tion has supplanted the less scientifcally stringent previ- ous strategies. Rational design of ocular nutrition should seek to understand the eyes' natural defenses and homeo- static mechanisms. For macular health, it is clear that the macular pigment serves as the main protectant and oxida- tive sink for the hypermetabolism found in the macula. Te macular pigment protects the macula from oxidative stress, photo stress and is also responsible for maintaining the macula's heightened visual performance. 17 Te impor- tance of macular pigment in visual health and prevention of macular degeneration has lead to a rational strategy for ocular nutritional supplementation. Macular pigment for the eye represents the enamel for the teeth or the crystalline network found in bone. Bio- logical understanding has rapidly led to the use of calci- um to combat bone degeneration and fuoride to strength- en teeth and prevent cavitation. Macular pigment biology has been harder to unravel. Te isomeric nature of carotenoids, made the identifca- tion of macular pigment composition difcult. While the carotenoids lutein and zeaxanthin had been difcult to dif- OPTOME TRIC MANAGEMENT CORPORATE PROFILE MACUHEALTH WITH LMZ 3 A LIFETIME OF MACULAR HEALTH AND IMPROVED VISUAL PERFORMANCE S P O N S O R E D B Y M A C U H E A L T H Michael Tolentino MD Associate Professor University of Central Florida A DVANCEMENT IN the under- standing of vision and macular disease has revolutionized and irreversibly changed our role as ophthalmic clinicians. We can no longer plead ignorance when it comes to promoting and main- taining ocular health, maximiz- ing vision and preventing macular degeneration. Clinicians are now medically responsible for educating our patients and legally responsible for advising the latest strategies to main- tain ocular health, early detection of macular disease and timely intervention to attenuate disease progression. Like it or not, the future of our feld requires that we understand the political, molecular and clinical basis of ocular nutrition and pathogenesis of age-related macular diseases. Ocular nutrition has been guided in the past by clini- cal anecdote rather than science. Without food and drug administration (FDA) oversight and lack of pathogenic understanding of eye disease, proof of efcacy and safety were replaced by marketing and opinion. With the ad- vancement in the scientifc understanding of normal ocu- lar health and ocular pathologies like macular degenera- tion, ocular nutrition now must be examined under the microscope of molecular science and safety. Without FDA oversight, many nutrients are used in ex- tremely high doses, which amplify both their potentially therapeutic efects and their accompanying toxicities. Vi- tamin A is an example of a necessary nutrient at normal doses converted into a carcinogen at higher doses. 1,2 Zinc is also another ocular nutrient that in normal doses is healthy but in higher doses it can be carcinogenic, predispose to genitourinary problems and is amyloidogenic. 3-12 Vitamin A is also an example of a nutrient found to increase risk of developing AMD in a select popula-