The Role of Vitamins in AMD

Hello Everyone, Dr. Steve Ferrucci here talking AMD with Visible Genomics. 

Today, I want to talk about vitamins and their role in AMD progression. At least two large, nationally funded studies have shown us that certain vitamins containing antioxidants plus zinc can decrease the risk for progression in certain patients with dry AMD.

This first of these studies was the Age Related Eye Disease Study (AREDS), completed in 2001. This study shows that patients with intermediate or worse AMD demonstrated a 25% risk reduction in developing advanced AMD if they used certain vitamins plus antioxidants. These vitamins were: 500 mg Vitamin C; 400 IU Vitamin E; 25,000 IU Beta Carotene; 80 mg Zinc; and 2 mg Copper. The results were inconclusive in patients with milder levels of AMD, mainly as even those in the control did not progress to advanced disease.  Therefore, it was reasonable based on this study to recommend this combination of vitamins and zinc in patients with intermediate or worse AMD.

However, this study as well as others showed that Beta-Carotene was associated with increased risk of lung cancer in current smokers and recent past smokers. Also, some people thought 80 mg Zinc might be too high. Lastly, some smaller studies showed a positive effect of certain carotenoids, mostly lutein and Zeaxanthin, as well as omega 3 fatty acids, on AMD.

Therefore, the AEDS2 study was undertaken, with the results released in 2013. This study evaluated the effect of Lutein, Zeaxanthin and Omegas 3 fatty acids on AMD, as well as the effect of eliminating Beta-Carotene, and reducing the amount of Zinc. These results demonstrated that the addition of Lutein (10mg) and Zeaxanthin (2mg) was both better than Beta-Carotene, as well as safer, although the results did not meet the primary endpoint in all patients. Overall, the addition of Lutein and Zeaxanthin did provide an additional 10% reduced risk over the previous supplements. Further, those patients with the lowest dietary intake of Lutein and Zeaxanthin had an additional 26% reduced risk. Omega 3’s were not associated with any change in AMD progression risk, nether positive nor negative, much to my surprise. Lastly, the reduced amount of 25 mg Zinc was nearly as effective as the original larger dose, but the authors recommended the dose be left alone at 80 mg.

Following the combined results of the two AREDS studies, it seems prudent to use the AREDS 2 formulation, with 10 mg of Lutein and 2 mg of Zeaxanthin and no Beta-Carotene, for our patients  with intermediate of worse AMD. Further, some formulations do have lower levels of Zinc if you are concerned about the level of Zinc. Lastly, although the studies do not support it, I would also encourage using at least a carotenoid such as Lutein in patients with less than intermediate AMD, but found to be a higher risk of regression, either through history or genetic testing.