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What recommendations do you make to your AMD patients regarding antioxidant vitamins and supplements specifically formulated to help prevent disease progression?
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Use caution when prescribing supplements
 Michael S. Ip |
I recommend my patients with nonexudative age-related macular degeneration take a formulation similar to what was used in the first Age-Related Eye Disease Study. That study showed that patients can have a reduction of risk of conversion to exudative AMD. I also recommend they eat a diet rich in lutein, including dark, leafy green vegetables, and omega-3 fatty acids, including cold-water fish. At this point, I do not specifically recommend that they take a supplement that contains lutein or omega-3 fatty acids because we do not have good level 1 evidence to show these additional supplements will have any effect on the prevention of exudative AMD.
Some patients will ask me about supplementation using lutein or omega-3 fatty acids if they have heard that these supplements may be beneficial. In these cases, I will tell them there is biologic rationale to adding these supplements to the original AREDS formulation and that it may be beneficial in preventing the onset of exudative AMD. However, I tell them they have to make up their own minds because we do not have definitive evidence yet, until the AREDS 2 results are released, but they are neither right nor wrong by taking them. I also caution them that taking a supplement can rarely have harmful effects, such as beta carotene causing an increased risk of lung cancer in people who smoke. Vitamins and supplements are not always completely benign.
Michael S. Ip, MD, is an associate professor at the University of Wisconsin Department of Ophthalmology and Visual Sciences.
Lutein and zeaxanthin in specific cases, a diet rich in carotenoids for all
 Paul S. Bernstein |
The positive AREDS results published in 2001 have had a profound impact on clinical retina practice in the United States. However, these recommendations were not without controversy, particularly in relation to the safety of beta-carotene. AREDS II is currently testing a modified formula, containing 10 mg of lutein and 2 mg of zeaxanthin along with 1,000 mg of omega-3 fatty acids derived from fish oil. Results will be released in 2012.
Meanwhile, in the absence of any definitive updated randomized clinical trial results, what are eye care professionals to do? In my practice, I am comfortable with recommending lutein and zeaxanthin at the AREDS II dose to my patients at significant risk for visual loss from AMD, and I emphasize a diet rich in carotenoids for all individuals, especially if they have a family history of AMD. Beyond multiple well-performed epidemiology studies, the biochemical and physiological evidence supporting their ocular health benefits are surprisingly strong.
Lutein and zeaxanthin are uniquely concentrated in the primate macula at levels not seen elsewhere in the body through the actions of specific high affinity binding proteins identified in my laboratory. Their proposed mechanisms of action — blue light filtering and antioxidant — are rational and plausible. Monkeys raised on carotenoid-deficient diets develop macular pathology consistent with dry AMD. Macular carotenoid levels are, in part, related to dietary intake, and most individuals exhibit increased levels of macular carotenoid pigment in response to high-dose supplementation, albeit quite slowly and with considerable variability.
Paul S. Bernstein, MD, PhD, is professor of ophthalmology and visual sciences at the Moran Eye Center, University of Utah School of Medicine, Salt Lake City.