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

Abstract

Background: Observational and experimental data suggest that antioxidant and/or zinc supplements may delay progression of age-related macular degeneration (AMD) and vision loss. Objective: To evaluate the effect of high-dose vitamins C and E, beta carotene, and zinc supplements on AMD progression and visual acuity. Design: The Age-Related Eye Disease Study, an 11center double-masked clinical trial, enrolled participants in an AMD trial if they had extensive small drusen, intermediate drusen, large drusen, noncentral geographic atrophy, or pigment abnormalities in 1 or both eyes, or advanced AMD or vision loss due to AMD in 1 eye. At least 1 eye had best-corrected visual acuity of 20/32 or better. Participants were randomly assigned to receive daily oral tablets containing: (1) antioxidants (vitamin C, 500 mg; vitamin E, 400 IU; and beta carotene, 15 mg); (2) zinc, 80 mg, as zinc oxide and copper, 2 mg, as cupric oxide; (3) antioxidants plus zinc; or (4) placebo. Main Outcome Measures: (1)Photographic assessment of progression to or treatment for advanced AMD and (2) at least moderate visual acuity loss from baseline (Ն15 letters). Primary analyses used repeated-measures logistic regression with a significance level of .01, unadjusted for covariates. Serum level measurements, medical histories, and mortality rates were used for safety monitoring. Results: Average follow-up of the 3640 enrolled study participants, aged 55-80 years, was 6.3 years, with 2.4% lost

Recent studies provide an updated clinical perspective on blue light-filtering IOLs

“…The EUREYE study [99] has shown that patients with a low blood level of antioxidants are especially vulnerable to blue-light exposure. This finding also corroborates findings of the AREDS study [98] which recommended supplements of antioxidants and zinc for patients with high-risk AMD. Both of these studies validate the scientific hypothesis that high-energy blue light and its associated oxidative processes are potential risk factors for AMD, especially in elderly pseudophakic eyes [9, 74, 77–83].…”

Recent studies provide an updated clinical perspective on blue light-filtering IOLs

“…The EUREYE study [99] has shown that patients with a low blood level of antioxidants are especially vulnerable to blue-light exposure. This finding also corroborates findings of the AREDS study [98] which recommended supplements of antioxidants and zinc for patients with high-risk AMD. Both of these studies validate the scientific hypothesis that high-energy blue light and its associated oxidative processes are potential risk factors for AMD, especially in elderly pseudophakic eyes [9, 74, 77–83].…”

Choriocapillaris Flow Imbalance in Fellow Eyes in Age-Related Macular Degeneration

“…A reduction in the CCFA ratio in the AMD fellow eyes may have represented a reduction in choriocapillaris flow as an early change during AMD development, given that AMD fellow eyes are at high risk for future AMD development. 21 , 22 , 32 , 33 This is consistent with the pathological findings from postmortem eyes of patients with clinically documented early AMD, showing choriocapillaris dropout with confocal microscopy. 34 It was reported that the reduction in vessel density in the choriocapillaris of the macular area was approximately 20%.…”

C-reactive Protein Levels in Prediction of the Development or the Progression of Age-related Macular Degeneration in Patients Examined at Tuzla Canton

“…In the study by Čolak et al ( 16 ) the mean age of the ARMD patients was 71.47±7.02 which was quite similar to our study, probably because of large number of patients in advanced ARMD stages as well as in our study. The results of our study confirm the universal conclusion that ARMD occurs in older age, and age is the only constant and unchangeable risk factor for the development and progression of ARMD ( 17 , 18 ). The results of other studies, as well as ours, did not confirm a significant association between gender distribution and ARMD ( 19 , 20 , 21 , 22 ).…”

Recent studies provide an updated clinical perspective on blue light-filtering IOLs

“…The EUREYE study [99] has shown that patients with a low blood level of antioxidants are especially vulnerable to blue-light exposure. This finding also corroborates findings of the AREDS study [98] which recommended supplements of antioxidants and zinc for patients with high-risk AMD. Both of these studies validate the scientific hypothesis that high-energy blue light and its associated oxidative processes are potential risk factors for AMD, especially in elderly pseudophakic eyes [9, 74, 77–83].…”

Choriocapillaris Flow Imbalance in Fellow Eyes in Age-Related Macular Degeneration

“…A reduction in the CCFA ratio in the AMD fellow eyes may have represented a reduction in choriocapillaris flow as an early change during AMD development, given that AMD fellow eyes are at high risk for future AMD development. 21 , 22 , 32 , 33 This is consistent with the pathological findings from postmortem eyes of patients with clinically documented early AMD, showing choriocapillaris dropout with confocal microscopy. 34 It was reported that the reduction in vessel density in the choriocapillaris of the macular area was approximately 20%.…”

C-reactive Protein Levels in Prediction of the Development or the Progression of Age-related Macular Degeneration in Patients Examined at Tuzla Canton

“…In the study by Čolak et al ( 16 ) the mean age of the ARMD patients was 71.47±7.02 which was quite similar to our study, probably because of large number of patients in advanced ARMD stages as well as in our study. The results of our study confirm the universal conclusion that ARMD occurs in older age, and age is the only constant and unchangeable risk factor for the development and progression of ARMD ( 17 , 18 ). The results of other studies, as well as ours, did not confirm a significant association between gender distribution and ARMD ( 19 , 20 , 21 , 22 ).…”

Recent studies provide an updated clinical perspective on blue light-filtering IOLs

“…The EUREYE study [99] has shown that patients with a low blood level of antioxidants are especially vulnerable to blue-light exposure. This finding also corroborates findings of the AREDS study [98] which recommended supplements of antioxidants and zinc for patients with high-risk AMD. Both of these studies validate the scientific hypothesis that high-energy blue light and its associated oxidative processes are potential risk factors for AMD, especially in elderly pseudophakic eyes [9, 74, 77–83].…”

Choriocapillaris Flow Imbalance in Fellow Eyes in Age-Related Macular Degeneration

“…A reduction in the CCFA ratio in the AMD fellow eyes may have represented a reduction in choriocapillaris flow as an early change during AMD development, given that AMD fellow eyes are at high risk for future AMD development. 21 , 22 , 32 , 33 This is consistent with the pathological findings from postmortem eyes of patients with clinically documented early AMD, showing choriocapillaris dropout with confocal microscopy. 34 It was reported that the reduction in vessel density in the choriocapillaris of the macular area was approximately 20%.…”

C-reactive Protein Levels in Prediction of the Development or the Progression of Age-related Macular Degeneration in Patients Examined at Tuzla Canton

“…In the study by Čolak et al ( 16 ) the mean age of the ARMD patients was 71.47±7.02 which was quite similar to our study, probably because of large number of patients in advanced ARMD stages as well as in our study. The results of our study confirm the universal conclusion that ARMD occurs in older age, and age is the only constant and unchangeable risk factor for the development and progression of ARMD ( 17 , 18 ). The results of other studies, as well as ours, did not confirm a significant association between gender distribution and ARMD ( 19 , 20 , 21 , 22 ).…”