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The jury is still out on that question. There is some supportive experimental data in animal models but no well-done human studies that show significant benefit.

What you shouldn’t do is pass up taking the AREDS 2 nutritional supplement formula, which is clinically proven to reduce the risk of severe visual loss that can happen with macular degeneration. Almost all the data supporting the POSSIBLE benefits of bilberry in visual conditions is related to NON-HUMANS. Stick with the AREDS 2 formula that has excellent clinical evidence.

So, what is bilberry and why do some people use it?

Bilberry (Vaccinium myrtillus), a low-growing shrub that produces a blue-colored berry, is native to Northern Europe and grows in North America and Asia. It is naturally rich in anthocyanins, which have anti-oxidant properties.

It is said that during World War II, British pilots in the Royal Air Force ate bilberry jam, hoping to improve their night vision. No one is exactly sure where the impetus to do this came from, but it is believed that this story is what lead to some widespread claims that bilberry was good for your eyes.

A study by JH Kramer,  Anthocyanosides of Vaccinium myrtillus (Bilberry) for Night Vision - A Systematic Review of Placebo-Controlled Trials, reviewed most of the literature pertaining to the claim that bilberry improves night vision. He found that the four trials, which were all rigorous randomized controlled trials (RCTs), showed no correlation with bilberry extract and improved night vision. A fifth RCT and seven non-randomized controlled trials reported positive effects on outcome measures relevant to night vision, but these studies had less-rigorous methodology.

Healthy subjects with normal or above-average eyesight were tested in 11 of the 12 trials. The hypothesis that V. myrtillus improves normal night vision is not supported by evidence from rigorous clinical studies. There is a complete absence of rigorous research into the effects of the extract on subjects suffering impaired night vision due to pathological eye conditions.

Even though there is no solid evidence in human studies that bilberry produces any positive visual effects on night vision there is some experimental evidence that implies it might be useful in some ocular conditions whose mode of action is oxidative stress. There are recent epidemiologic, molecular and genetic studies that show a major role of oxidative stress in age-related macular degeneration.

There have been some studies showing oxidative protective effects of bilberry in non-human models. 

In Protective Effects of Bilberry and Lingonberry Extracts Against Blue-light Emitting Diode Light-induced Retinal Photoreceptor Cell Damage in Vitro, Ogawa et al showed that cultured mouse cells that had bilberry extract added before subjection to high-energy short-wavelength light survived better than those that hadn't received the extract. 

In Retinoprotective Effects of Bilberry Anthocyanins via Antioxidant, Anti-Inflammatory, and Anti-Apoptotic Mechanisms in a Visible Light-Induced Retinal Degeneration Model in Pigmented Rabbits, Wang et al found similarly improved survival of pigmented rabbit retinal cells when exposed to bilberry abstract prior to high-intensity light.

But bilberry is not without potential side effects.

Bilberry possesses anti-platelet activity and it might interact with NSAIDs, particularly aspirin. Excessive drinking of bilberry juice might cause diarrhea. One study of 2,295 people given bilberry extract found a 4% incidence of side effects or adverse events. Further, bilberry side effects may include mild digestive distress, skin rashes and drowsiness. Chronic uses of the bilberry leaf may lead to serious side effects. High doses of bilberry leaf can be poisonous.

Bilberry has not been evaluated by the Food and Drug Administration for safety, effectiveness, or purity.

Article contributed by Dr. Brian Wnorowski, M.D.

You’ve been diagnosed with a cataract and you’ve been told you should have cataract surgery. The surgeon is also telling you that you should consider paying extra out-of-pocket for it.

Where did this come from? Why should you have to pay out-of-pocket for cataract surgery? Shouldn’t your health insurance just cover it?

In trying to answer these questions, you will first need a little history of both cataract and refractive surgery, which corrects errors of refraction such as nearsightedness, farsightedness, and astigmatism.

Radial keratotomy (RK) was the first widely used refractive surgery for nearsightedness. It was invented in 1974 by Russian ophthalmologist Svyatoslav Fyodorov, and it was the primary refractive procedure done until the mid-1990s. Then it was surpassed by the laser procedure called PRK and then, eventually, LASIK; they are still the predominately pure refractive surgeries done today.

Cataract surgery has its origins all the way back to at least 800 BC in a procedure called couching. In this procedure, the cataract was pushed into the back of the eye with a sharp instrument so the person could look around the cataract. Medically that is all that was done with cataracts until around 1784 when a cataract was actually removed from the eye.

The next big advance was implants to replace the removed cataract. The invention of implants was spurred by Harold Ridley, who recognized that injured Royal Air Force pilots could retain shards of their canopy made out of a substance called PMMA in their eye without the body rejecting it. Implants became commonplace after the FDA approved them in 1981. The implants have improved over the years and most implants today are foldable, enabling them to fit through tiny incisions of around 3 millimeters.

Medicare and most other insurances cover the cost of MEDICALLY NECESSARY cataract surgery. This means they will cover the surgery when someone has symptoms of visual trouble that is interfering with their normal daily activities AND the cataract is the cause of those visual disturbances. There is no reason to remove a cataract just because it is there. It needs to be causing a problem to make it medically necessary to remove it.

Medicare and most other insurance do not cover refractive surgery (LASIK, PRK, etc.). The general perception of refractive surgery by the insurance industry is that it is not MEDICALLY NECESSARY. You can correct the refractive errors in almost all cases by non-surgical means, such as glasses an/ or contact lenses.

Today there are methods of doing additional procedures, or using special implants, at the time of cataract surgery to correct more than just the cataract alone. This is where the two types of surgeries, refractive and cataract, have merged into a single operation that tries to take care of both problems.

The merging of cataract and refractive surgeries is why there are now options to not only get your cataract removed but also to correct your astigmatism (irregular shape to the cornea) and/or presbyopia (the inability to see well up close that hits nearly everyone in their 40’s).

This is where the "paying for cataract surgery" comes in. Surgery to correct astigmatism and presbyopia are not considered MEDICALLY NECESSARY because they can be corrected with eyeglasses or contacts.

Your cataract, once it hits a certain point, cannot be corrected with glasses or contacts and therefore it is MEDICALLY NECESSARY and your insurance will pay for that component of your surgery. What it won’t pay for is any additional amount that is charged to correct your astigmatism or presbyopia.

If you want to address your astigmatism and/or presbyopia at the time of cataract surgery in order to be less dependent on wearing glasses after surgery, then paying for those components is going to be an out-of-pocket payment for you.

Article contributed by Dr. Brian Wnorowski, M.D.

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