AREDS2: The Bottom Line on Supplements for AMD

Julia A. Haller, MD; Joseph I. Maguire, MD


June 12, 2013

Editorial Collaboration

Medscape &

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Julia A. Haller, MD: Hi. I am Julia Haller, Ophthalmologist-in-Chief at Wills Eye Institute here in Philadelphia. I am with my colleague, Dr. Joseph Maguire of our retina service, who serves as the principal investigator on the AREDS2 (Age-Related Eye Disease Study 2) trial, the results of which were recently released.

Our commentary is a collaboration between Wills Eye Institute and Medscape. Joe, we are here to talk about the results of the AREDS2 study. What is the bottom line?

Joseph I. Maguire, MD: The first AREDS trial[1] was initiated to see whether nutritional supplements could reduce the risk for progression to advanced age-related macular degeneration (AMD) as people mature through life. The original results were released in 2001 and showed that a combination of vitamins C and E with zinc and copper, as well as vitamin A in the form of beta-carotene, reduce by 25% the risk of developing high-risk macular degeneration over time.

The AREDS2 trial[2] asked whether we could augment that benefit by adding to the supplement. The first addition was omega-3 fatty acids (fish oil), and the second was a combination of 2 carotenoids, lutein and zeaxanthin, which are prevalent in leafy green vegetables and highly colored fruits and vegetables.

Dr. Haller: This was a complicated study with lots of different groups and randomizations. What are you telling your patients now?

Dr. Maguire: Correct. A lot of different subgroups were included. The take-home message is twofold: First, omega-3 fatty acids did not confer additional benefit to reducing the risk for progression to high-risk AMD over time; and second, lutein and zeaxanthin did add to the benefit, but only in the lowest-quintile group of folks who may not have been getting as much lutein and zeaxanthin in their usual diet compared with the other groups. Because there were so many subgroups, it seemed that the folks who took lutein and zeaxanthin instead of beta-carotene had more of a benefit. We theorized that beta-carotene may have inhibited the absorption of lutein and zeaxanthin in those folks.

Dr. Haller: In other words, the people who were taking all of the supplements, including beta-carotene, effectively got less lutein and zeaxanthin.

Dr. Maguire: Effectively, yes. Finally, we know from previous studies that beta-carotene increases the risk for cancer in active smokers or people who have had lung cancer previously. In AREDS2, folks who were previous smokers also had a higher risk for lung cancer.

Dr. Haller: It may be a risk from the beta-carotene.

Dr. Maguire: Exactly. The study concluded that omega-3 fatty acids are not necessary to enhance the vitamin supplement, but that lutein and zeaxanthin could be substituted for beta-carotene.

Dr. Haller: That is what I am telling my patients about new dietary supplements. What is the buzz in your clinic? Are patients interested in supplements? Are they asking about nutritional factors that may be involved with their AMD?

Dr. Maguire: They always are. Omega-3 fatty acids have been shown to be beneficial in cardiac disease, stroke prevention, et cetera, so it is a bit of a disappointment that it did not help in AMD. Patients are very informed about that. Of course, people are more interested in healthy diets these days, and the carotenoids lutein and zeaxanthin, which are present in very high concentrations in vegetables and fruit were a positive, although a mild one.

Dr. Haller: What do you say when patients ask, "Where do I get this supplement, Dr. Maguire? Can I buy it at the store?"

Dr. Maguire: You will see a big shift in the vitamins at the pharmacy now. There is not a commercially available supplement that includes all of these elements. It takes a while for the industry to revamp things and get it onto the shelves. An AREDS2 vitamin supplement is commercially available, but that has fish oil in it and it is a little bit more expensive. It has all of the other components though. You can take one of the products that has lutein in it instead of the beta-carotene, which we previously directed our smoking patients to take, but it does not include the zeaxanthin just yet.

Dr. Haller: This is good news for people with macular degeneration. There is no other treatment for the dry macular degeneration. It is exciting news that there is the potential of as much as a 15%-20% increase in their protection against advanced AMD with an adjustment of their drugs.

Dr. Maguire: I think so, too.

Dr. Haller: Thank you, Joe. It is a pleasure to be here with Dr. Maguire from Wills Eye Institute in Philadelphia, in collaboration with Medscape. Thank you.