Vitamin D treats and prevents a variety of eye problems (need 70 ng) – June 2018

Spectrum of Darkness, Agent of Light: Myopia, Keratoconus, Ocular Surface Disease, and Evidence for a Profoundly Vitamin D-dependent Eye

Cureus. 2018 Jun; 10(6): e2744., online 2018 Jun 5. doi: 10.7759/cureus.2744
James McMillan medinaeye at msn.com

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Serial observations obtained over more than eight years and 10,000 patient encounters in a general ophthalmology practice serving a population highly prone to chronic vitamin D (D3) deficiency, facilitated by the Oculus Pentacam Scheimpflug imaging system (Oculus Optikgeräte GmbH, Wetzlar, Germany), resulted in the recognition of consistent, predictable, and highly reproducible patterns of mechanical, optical, and physiologic change in the cornea and other ocular structures correlated to adequate vs. inadequate vitamin D availability. These patterns were identified from an analysis of more than 20,000 topographical and digital imaging studies, manifest refraction results, and other clinical ophthalmic exam findings recorded during patient visits.

The main outcome measures included

• improved corneal and global optical quality and function,
• decreased ametropia,
• improved stability, and
• decreased subjective symptoms of compromised acuity and comfort.

Adequate D3 replacement consistently yielded some degree of objective structural improvement in all subjects observed. The rate of improvement varied and synergistic interaction with cofactors was also suggested in particular topical steroids. A plausible explanation for the cause and mechanism of most myopia emerged and keratoconus, in particular, appears to be the extreme presentation of otherwise common corneal disturbances associated with inadequate vitamin D availability. Emmetropization mechanisms appear to awaken and reactivate with adequate D3. Intraocular pressure control likewise shows evidence of being vitamin D regulated and may play a significant interactive role in emmetropization and relief from ametropia.
Ocular surface disease and inflammatory activity can be markedly alleviated in addition. As the findings are most readily appreciated via topographical map changes, a series of case reports are presented, selected from the mass of similar data, to illustrate specific aspects of these findings in the hope of inspiring controlled trials to better delineate their significance.

Taken as a whole, these observations suggest the human eye may be profoundly dependent upon adequate vitamin D availability for many critical optical, structural, and physiologic properties.

Myopia may represent the end result of adverse emmetropization feedback generated by low vitamin D-related irregular corneal astigmatism.

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Sections from PDF

Vitamin D supplementation

A critical observation is that beneficial responses are usually only realized when the serum 25(OH)D3 level rises above 50 ng/cc and optimal response begins around 70-80 ng/cc. Historically, laboratories referenced a normal range of 30 to 100 ng/cc, so, in that respect, the apparent ideal coincides with the middle of the normal range—ordinarily a desirable thing. In keeping, levels above 50 ng/cc are found in contemporary populations with significant daily sun exposure [30].
By contrast, in the author’s experience, the majority of inadequately supplemented residents of Western Washington State have 25(OH)D3 levels well below 30 ng/cc. A recent study suggests levels under 30 ng/cc are likewise prevalent throughout the USA, even at lower latitudes, with theoretical access to adequate sunshine [12], reflecting population trends toward predominantly indoor employment and education, sunprotective clothing, sunblocks, air pollution, etc. Faced with such a baseline, to achieve serum 25(OH)D3 greater than 50 ng/cc, local experience has been that most adults require vitamin D3 supplementation somewhere between 5,000 and 10,000 IU/day and a small number have needed 15,000 IU/day. Children have been found to require approximately 1000 IU/25 pounds (ll.3 kilograms) body weight/day. These are substantially above the currently recommended dose of 600-800 IU/day (and the “safe upper limit” of 4000 IU/day) advocated by the Institute of Medicine since 2011 but consistent with recommendations from the Endocrine Society [30]. An additional concern is that the responses and improvements described have not yet been observed in the studied population via supplementation by ergocalciferol (vitamin D2), even at very high doses and in prescription formulations.
Given that ergocalciferol is by far the most common food additive and fortification analogue of vitamin D, and the most common form available by prescription in the United States, the lack of a response in the cornea—despite proving 100 % predictable in the case of cholecalciferol/D3—raises questions about the physiologic efficacy of vitamin D2 in many regards. Knapp did report a response to ergocalciferol/D2 in his 1938 keratoconus research, but it was given at an extremely high dose by comparison, up to 50,000 IU daily. Interestingly, in the author’s experience, 5,000 IU/day of cholecalciferol/D3 quickly normalized and stabilized serum calcium levels of a patient with presumed secondary hypoparathyroidism, who had been consistently hypocalcemic for years while taking prescription ergocalciferol at 50,000 IU every other day. This phenomenon would likewise benefit from further investigation

Conclusions

The adequate replacement of vitamin D3 in the population under evaluation has resulted in the arrest and reversal of keratoconus and myopic progression and, in addition, suggests a promising, beneficial impact upon dry eye, glaucoma, cataract, and macular degeneration concerns. Unlike many conditions under scientific study, the response is fast and, so far, has been amazingly predictable. The ability to prevent the onset of myopia may even prove absolute. It is hoped that the wide applicability of these insights will rapidly encourage controlled studies to confirm, explore, and further delineate and extend upon these findings.