The Effect of Antioxidant Vitamins and Zinc on Age-Related Macular Degeneration (and lack of effect on Cataract)

In October, ‘01, the National Eye Institute publicized the results of the Age Related Eye Disease Study (“AREDS”). Among other things, the study investigated vision loss from age related maculopathy (“ARM,” also called ‘age-related macular degeneration’ or AMD). Several patient groups were followed for a 7-year period, some taking vitamin supplements and some not. In the study, patients were given either antioxidant vitamins alone, zinc alone, zinc plus vitamins, or placebo. Loss of vision and/or advancement of ARM was tracked along with other factors. Here are the results.

In the group using antioxidants alone, over a 7-year period, vision loss was reduced by 10% compared to a ‘control’ group taking placebo without antioxidants. Development of advanced ARM was reduced by 17% compared to the placebo group. Using zinc alone, over the same period, vision loss was reduced by 11% compared to the placebo group. Development of ARM was reduced by 21%. Using a combination of antioxidants and zinc, vision loss was reduced by 19% compared to the placebo group. Development of ARM was reduced by 25%. Interestingly, the AREDS study found that dietary supplements had NO apparent beneficial effect on the appearance or progression of cataract.

This study provides the first scientific data that vitamin supplements can reduce vision loss and affect the course of ARM. However, some perspective is needed: At 7 years, 30% of the supplemented group had progression of ARM, vs. 40% of the placebo group. These numbers are statistically significant, but do not represent a cure for this very troublesome and common disease. Also, a significant benefit was fount only for those with pre-existing ARM. In patients with extremely slight ARM not affecting vision, no beneficial effect was found. Patients in this latter group may take longer to develop vision loss related to ARM than the 7 years over which the study was conducted.

Of significance to me is to the specific formula of antioxidant vitamins and zinc used in this study. Bausch & Lomb supplied a custom formula, not at all similar to the commercial supplement preparations now widely available, which include “OcuVite” and “I-Caps” among others. In addition, all patients in the study (including the placebo group) were allowed to take Centrum to meet their regular, daily multivitamin needs. Interestingly, 70% of the patients in the AREDS study did take Centrum in addition to the supplements studied.

The following table shows the specific components incorporated into common commercial vitamin supplements, and that for the AREDS study. Copper supplementation was included in the formulation to prevent possible development of copper deficiency, which is known to be associated with increased zinc intake in adults.

Preparation Vitamin A Vitamin C Vitamin E Zinc Copper

(IU) (mg) (mg) (mg) (mg)

AREDS Study 30,440 500 400 80 1.6

OcuVite Extra Lutein 1,000 300 100 40 2.0

I-Caps Lutein 6,600 400 150 60 4.0

AREDS Study Formula 7,610 113 100 17.5 0.4

Centrum Multivitamins 5,000 60 30 15 2.0 *

* Centrum also contains: Vitamin D 400U, Vitamin K 25mcg, Thiamine 1.5mg, Riboflavin 1.7mg, Niacin 20mg, Vitamin B6 2mg, Folic acid 400mcg, Vitamin B12 6mcg, Biotin 30mcg, Pantothenic acid 10mg, Calcium 162mg, Iron 18mg, Phosporous 109mg, Iodine 150mcg, Magnesium 100mg, Selenium 20ug, Manganese 2mg, Chromium 120mcg, Chloride 72mg, Potassium 80mg, Molybdenum 75mcg, Boron 150ug, Nickel 5ug, Silicone 2mg, Tin 10ug, Vanadium 10ug, Lutein 250ug

Conclusions & Recommendations: For the first time, the National Eye Institute is advising that everyone at risk for ARM consider taking appropriate vitamin supplements. This includes people of Caucasian descent over 50 years of age, and anyone with a family history of ARM. It is now clear that antioxidant vitamins and certain mineral supplements can definitely affect the course of certain age-related eye diseases that contribute to significant vision impairment in the senior population. If you are concerned about your vision and/or your risk for ARM, call our office at (310) 828-2020 and set up an appointment with Dr. Wallace.

Where Can I Obtain the Recommended Formulation Used in the Study? We now have scientific evidence to guide recommendations for daily vitamin and mineral supplement doses. The composition of supplements in the AREDS study was very different than that in current commercially available “eye vitamin” preparations. Our office can assist you in finding and obtaining the proper formulations if you wish. Please refer to the “formulation” note below for specifics.

Are There Any Side Effects from the Nutrients? The AREDS participants reported few side effects from the treatments. About 7.5 percent of participants assigned to the zinc treatments--compared with five percent who did not have zinc in their assigned treatment--had urinary tract problems that required hospitalization. Participants in the two groups that took zinc also reported anemia at a slightly higher rate; however, testing of all patients for this disorder showed no difference among treatment groups. Yellowing of the skin, a well-known side effect of large doses of beta-carotene, was reported slightly more often by participants taking antioxidants. In two large clinical trials sponsored by the National Cancer Institute, beta-carotene was shown to significantly increase the risk of lung cancer among smokers.

For more information: Contact our office or that of your eye care professional, or the National Eye Institute at 301-496-5248. Or, simply point your browser to http://www.nei.nih.gov/amd/.

We encourage your feedback! If you found this information helpful, please let us know. If you have any questions, or suggestions for other news-worthy bulletins, please let us know. You can email us at info01@la-sight.com

Thank you!

Dr. Wallace and the LA Sight staff

Formulation: For most ARM patients, we should try to suggest a daily supplement which duplicates the one used in the study. This can be accomplished with the following regimen:

Vitamin A (Beta Carotene): one 25,000 IU tablet (15mg) daily

Vitamin C: one 500mg tablet daily

Vitamin E: 400 IU daily

Zinc (as zinc oxide): 80mg daily

Copper: 2mg daily

Centrum Silver with Lutein: one daily.

(Lutein supplementation was not studied in the AREDS, as the study commenced prior to discovery of lutein’s potential benefits and before availability in dietary supplements became widespread.)