AREDS2 supplement slows expansion of geographic atrophy, even in late-stage AMD
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Key takeaways:
- The AREDS2 supplement slowed the expansion of geographic atrophy toward the fovea by approximately 55% over 3 years in patients with dry AMD.
- There was little benefit in those with GA in their central vision.
Taking a daily supplement with antioxidant vitamins and minerals may slow the progression of late-stage dry age-related macular degeneration and could help maintain central vision in affected patients, according to researchers at NIH.
The original Age-Related Eye Diseases Study (AREDS), published in 2001, found that a supplement formulated with antioxidants — including vitamins C, E and beta-carotene — as well as zinc and copper could slow progression of intermediate to late-stage AMD. More than a decade later, the AREDS2 trial published in 2013 determined that substituting the antioxidants lutein and zeaxanthin for beta-carotene could not only improve efficacy but also prevent some risks. Neither study examined further benefits once patients progressed to late-stage disease.
“We’ve known for a long time that AREDS2 supplements help slow the progression from intermediate to late AMD,” lead study author Tiarnán Keenan, MD, PhD, staff clinician in retinal disease at National Eye Institute’s division of epidemiology and clinical applications, said in an NIH press release. “Our analysis shows that taking AREDS2 supplements can also slow disease progression in people with late dry AMD. These findings support the continued use of AREDS2 supplements by people with late dry AMD.”
In the new analysis published in Ophthalmology, researchers reviewed the retinal scans from 392 eyes in the AREDS trial and 1,210 eyes in AREDS2 that developed dry AMD and assessed the position and expansion rate of geographic atrophy (GA). According to the release, the supplements were most effective for participants who developed GA far from the fovea, by slowing the expansion rate toward the central foveal region by about 55% over an average of 3 years. There was little benefit reported for those with GA in their central vision.
“Given that there are few therapeutic options for people with late-stage dry AMD to retain or restore their vision, antioxidant supplementation is a simple step that may slow central vision loss, even for those with late disease,” Keenan said in the release. “We plan to confirm these findings in a dedicated clinical trial in the near future.”
References:
- Keenan TDL, et al. Ophthalmology. 2024;doi:10.1016/j.ophtha.2024.07.014.
Perspective
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After the original AREDS and AREDS2 studies, many people, including me, felt that AREDS supplementation was not that helpful for patients with GA. However, this study paints a different picture. It seems to show that GA, especially those lesions away from the fovea, which are in fact more common, does benefit from AREDS supplementation. In fact, the study showed the expansion rate was slowed by approximately 55% over 3 years, which is significant.
We learned from AREDS and AREDS2 to recommend AREDS supplements for patients with intermediate disease, as it reduced the risk for progression to advanced disease, but we often give up if the patient reaches advanced dry AMD. This study appears to show that we should continue with supplementation, even if they reach that stage.
The bottom line is optometrists should recommend AREDS supplementation for patients with extrafoveal GA, as it will help slow the progression of the disease and hopefully afford the patient longer time with useable vision, leading to a better quality of life.
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