How Do I Counsel My Patients With Dry Age-Related Macular Degeneration and What About Various Vitamin Supplements?

Let us first review the rationale and results of the original Age-Related Eye Disease Study (AREDS). Beginning in the early 1990s, several observational studies showed the protective association of increased antioxidant vitamin intake with decreased risk of age-related macular degeneration (AMD) development. AREDS, beginning in 2001 under National Eye Institute sponsorship, was designed to evaluate this suggested nutritional role in a prospective clinical trial. Specifically, AREDS was a 5-year randomized study of 4757 participants evaluating whether high-dose antioxidants and zinc could reduce progression of both AMD and age-related lens opacity. Participants were categorized according to drusen size. Small drusen were defined as less than 63 Μm, intermediate drusen as 63 Μm to 124 Μm, and large drusen as greater than or equal to 125 Μm. Patients were then randomized to oral supplementation of high-dose antioxidant vitamins and/or zinc. Final analysis demonstrated that 500 mg vitamin C, 400 IU vitamin E, 15 mg beta-carotene, and 80 mg zinc oxide (along with 2 mg cupric oxide to prevent copper-deficiency anemia) reduced the risk of advanced AMD, defined as neovascular AMD or geographic atrophy (GA) involving the fovea, by 25% in participants with intermediate AMD (extensive intermediate drusen and/or any large drusen) or with advanced AMD in one eye. ¹.