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Experts: Use AREDS on a case-by-case basis
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WAIKOLOA, Hawaii — Although the Age-Related Eye Disease Study laid out guidelines for nutritional recommendations, experts here said they look at each case individually and sometimes stray from protocol.
In a panel discussion at Retina 2008, led by OSN Retina/Vitreous Section Editor Carmen A. Puliafito, MD, MBA, experts in AMD and nutrition, Johanna M. Seddon, MD, ScM, Andrew P. Schachat, MD, and Elias Reichel, MD, discussed their preferences in applying the AREDS formula to AMD patients.
Dr. Puliafito proposed hypothetical situations in which a patient comes for an initial consultation with stage 2 AMD. He asked the experts if they would prescribe the AREDS supplement.
"According to AREDS, no," Dr. Seddon said. Yet, in practice, "I actually highly recommend the dietary modification."
Dr. Schachat said he would, in light of growing evidence that vitamins have been shown to slow cataract progression.
If a long-time patient progressed from "pretty small drusen" to slightly larger drusen, but still within the stage 2 category, Dr. Seddon said she would start the patient on AREDS supplements.
"Of course, in the AREDS study, the problem is the study was not designed to detect the difference in these mild cases," Dr. Puliafito said. "So, there may be an impact; we just weren't able to detect it."
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On the other end of the spectrum, Dr. Puliafito asked the experts if they continue to treat with AREDS after patients have progressed to advanced AMD.
"Yes, because there is a possibility that atrophy can convert to neovascular disease. I know that's a small percentage, but it is a possibility," Dr. Seddon said.
In a comment that roused laughter from the crowd, Dr. Schachat said, "I tell them what they want to hear." He referred to both the costs to and the convictions of his patients as reasons for either terminating or continuing the supplements. Both Dr. Seddon and Dr. Puliafito agreed.
"It's true. We're living in the real world here. Patients have different preferences and you're interacting with them," Dr. Puliafito said.
"If I have a patient who comes in with bottles of lutein and omega-3 fatty acid pills that they're taking and they're convinced that they see better if they're taking them, then I say continue taking them," Dr. Seddon said.
She also confirmed a suggestion from the audience that Centrum Silver (multivitamin, Whitehall-Robins) is a satisfactory recommendation for early AMD patients or for use with the AREDS supplements.