OSN Retina 150 survey

In your patients with intermediate AMD in one or both eyes, do you recommend dietary supplementation with the AREDS formula?

John W. Kitchens

I recommend AREDS vitamins for those patients with intermediate to advanced AMD. The evidence from the original AREDS study shows a significant reduction in vision loss (25%). This is particularly important in patients who have lost vision in one eye. No study has followed as many patients as the AREDS study over that period of time. The study is evidence-based medicine at its best. In a time when herbals and micronutrients are being marketed with very little in the way of true studies, it is nice to have something that is affordable and proven. A couple of things that I always like to keep in mind when recommending AREDS vitamins: (1) they do not reduce the progression of atrophy, and (2) if a patient has bilateral exudative AMD, “the horse is out of the barn” when it comes to AREDS, so I will stop them in these folks. Finally, discussing AREDS is important for participation in the Physician Quality Reporting Initiative.

John W. Kitchens, MD
Disclosure: Dr. Kitchens has no relevant financial disclosures.

Carl D. Regillo

The AREDS clinical trial showed that daily supplementation with a specific formula of antioxidant vitamins (beta-carotene, C and E) and zinc in patients with intermediate dry AMD features in both eyes (or in one eye if the other had advanced AMD) resulted in a statistically significant decreased rate of visual acuity loss and progression to advanced AMD at 5 years of follow-up. Because of these study results, I routinely recommend the AREDS formula for all non-smoking patients with this level of dry AMD. Because a different study subsequently showed that beta-carotene supplementation increased a smoker’s chances of getting lung cancer, I recommend products with a modified AREDS formula, which substitutes lutein for beta-carotene, in those who are active or recent smokers.

Carl D. Regillo, MD
Disclosure: Dr. Regillo is an investigator in the AREDS 2 trial but was not involved in the original AREDS trial.

In follow-up of patients who have been taking AREDS formula supplementation, do you believe the formula is effective in slowing progression of AMD?

Steve Charles

The AMD progression rate as well as the progression from drusen to dry or wet AMD is too low for any physician to have a valid opinion about the benefit of AREDS-type antioxidant supplementation. I believe in evidence-based medicine and the results of the AREDS and AREDS 2 studies designed and managed by the National Eye Institute. I use AREDS-type antioxidants (ICaps from Alcon Laboratories). Clearly smoking is a much more important risk factor (300% to 500%) than AREDS supplements, but a 25% risk reduction is not insignificant. What is unknown is whether patients willing to eat a diet rich in antioxidants (see Beaver Dam Eye Study), which confers approximately a 25% risk reduction, get an additional benefit from antioxidant supplements. What concerns me greatly is the mass media marketing of so-called eye vitamins for “ocular health” and ophthalmologists and optometrists selling their brand of “eye vitamins.”

Steve Charles, MD, FACS, FICS
Disclosure: Dr. Charles is a consultant for Alcon Laboratories for surgical products, but has no financial interest in promoting ICaps.

Timothy W. Olsen

During the funduscopic examination of patients older than age 55, ophthalmologists should carefully recognize and risk-assess the macula. Specifically, this includes a careful examination of the drusen in age-related macular degeneration. The key clinical criteria used to recommend high-dose antioxidant vitamins with zinc include any of the following: (1) a single large druse (larger than the diameter of a venule crossing the disc, 125 µm), (2) at least 15 to 20 intermediate drusen (63 µm to125 µm in diameter), (3) non-central geographic atrophy or advanced AMD in the fellow eye (central geographic atrophy or choroidal neovascularization). The AREDS found that these individuals lowered their risk of progression to more advanced stages by up to 25% when treated with a high-dose combination of vitamin C, vitamin E, beta-carotene and zinc. Smokers should avoid the use of beta-carotene. We are anxiously awaiting the evidence-based results of the AREDS 2.

Timothy W. Olsen, MD
Disclosure: Dr. Olsen has no relevant financial disclosures.

Reference:

Age Related Eye Disease Study Research Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 8. Arch Ophthalmol. 2001;119:1417-1436.