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Posted on 08-09-2016

This blog article is being written specifically for my Macular Degeneration patients.  All will be encouraged to read this article and urged to follow these guidelines.  Of course, visitors to this blog article may also find the information interesting and useful to share with their friends or loved ones. Before taking any new medication, over-the-counter or prescription, you should always ​
​check with your primary care physician to make him or her aware of what you are taking, and to obtain his or her okay.

Much of the following are excerpts from an article by Michael Cooney, M.D., that appeared in Review of Optometry, February 2009.  The excerpted information is just as pertinent today as it was then.

Nutritional supplementation has been a mainstay of therapy for age-related macular degeneration (AMD) since 2001.  The Age Related Eye Disease Study (AREDS) was a gold standard, randomized controlled clinical trial that proved that supplementation with a high dose antioxidant and zinc vitamin formula slowed the structural damage to the retina and progression of AMD and slowed the progression of vision loss in patients with intermediate and advanced AMD.

Of interest is that for many years prior to AREDS, doctors were prescribing similar antioxidant vitamin and nutritional therapy for AMD patients and observing similar results.  However, during those years prior to AREDS, some doctors would not guide their patients along these paths, saying that vitamin and nutritional therapy benefits were anecdotal at best.  Thank goodness AREDS came along!

The AREDS studied more than 3,000 patients over a five-year period.  Patients were divided into AMD categories 1 through 4 depending on the amount of AMD present. Briefly, Category 1 patients had no AMD, Category 2 patients had only the earliest signs of AMD, Category 3 patients had additional signs of AMD that clearly raised concerns (Intermediate AMD), and Category 4 patients had advanced AMD.

Category 2 patients had only a 1.3% probability of progression to advanced AMD within a five year period, whereas Category 3 and 4 patients had a probability of 18% to 43% respectively.  

AREDS analysis for Category 3 and 4 patients found that supplementing with the antioxidant and zinc formula (see table below) decreased the risk of progression to advanced AMD by 25% and decreased the risk of subsequent vision loss by 19%. Importantly, the antioxidant PLUS ZINC formula decreased the risk of converting from dry to wet AMD.  All of these endpoints reached statistical significance.  

The AREDS investigation found that antioxidant and zinc supplementation is safe. Given vitamin A's (beta carotene) association with an increased risk of lung cancer in smokers, AREDS recommended that smothers avoid beta-carotene supplementation. Lutein, another carotenoid, appears to be a reasonable and safe alternative to beta-carotene in smokers.  Additionally, although some studies have suggested an increased risk of cardiac mortality with high dosages of Vitamin E, the National Eye Institute's (NEI) position is that Vitamin E up to 400 IU appears to be safe.

AREDS investigators estimated that nutritional supplementation for AMD could potentially eliminate over 300,000 cases of advanced AMD and its associated vision loss over the next five years.  

Although compliance was high in the AREDS clinical study, real world compliance appears to be not as good.  Studies demonstrated that 40% of patients who should be supplementing with AREDS vitamins are not doing so.  Thus, patient education and encouragement of compliance are necessary - ergo... this blog article.

To further investigate omega-3 fatty acids and lutein/zeaxanthin, and their effects on AMD, the NEI launched AREDS-II (AREDS-II concluded its 5 year study with over 4,000 patients in 2013).

Age Related Eye Disease Studies (AREDS & AREDS-II &
Age Related Macular Degeneration (AMD)​

AREDS            Vitamin C (500 mg)
                       Vitamin A (15 mg)
                       Vitamin E (400 IU)
                       Zinc (80 mg)
                       Copper 2 mg)

AREDS-II        Vitamin C (500 mg)
                       Vitamin E (400 IU)
                       Zinc (80 mg)
                       Copper (2 mg)
                       Lutein 10 mg)
                       Zeaxanthin (2 mg)

*AREDS-II concluded that it was safer to eliminate Vitamin A and substitute Lutein (10 mg) and Zeaxanthin (2 mg).  Omega-3 fatty acids were not found to have a significant effect on the progression of AMD.  AREDS-II also concluded that Zinc could be reduced to as little as 25mg without effecting the study outcome, but 80mg remained in the formula.  Taking the AREDS or AREDS-II vitamin formula did not provide statistical support for the prevention of AMD development in non-AMD patients.

​This formula/combination of vitamins, zinc, copper, Lutein and Zeaxanthin can be found in over-the-counter PRESERVISION AREDS2 by Bausch & Lomb.  Be sure to purchase the AREDS2 formula rather than the AREDS formula.  AREDS2 formula vitamins are typically taken 1 tablet or gel cap twice a day.  This can be supplemented with your usual daily multi-vitamin.

As usual, I am interested in your comments.  Please write to me at Info@drcharm.com. I have enjoyed hearing from you and answering your questions.  It's a pleasure to learn together.

Be well,
Dr. Charm

Anaheim Hills Family Optometry
6200 E. Canyon Rim Rd., Suite 101
Anaheim Hills, CA 92807
(714) 998-2020 

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