COMMENTARY

ARVO 2013 Wrap-up: Noteworthy Retinal News

Association for Research in Vision and Ophthalmology (ARVO) 2013 Annual Meeting

Roger F. Steinert, MD; Baruch D. Kuppermann, MD, PhD

Disclosures

June 17, 2013

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In This Article

First Up, AREDS2

Roger F. Steinert, MD: Hello. I am Dr. Roger Steinert, Professor and Chair of Ophthalmology at the University of California, Irvine, and Director of the Gavin Herbert Eye Institute. I have the pleasure of welcoming Dr. Barry Kuppermann, who is Director of the Retina Service here at the Gavin Herbert Eye Institute, to our Medscape discussion about the Association for Research in Vision and Ophthalmology (ARVO®) meeting. We both recently returned from the annual ARVO meeting, held this year for the first time in Seattle.

Retina is a major part of ARVO, and because most clinicians don't have the opportunity to attend ARVO, this is a great opportunity for you to bring people up to speed with the latest news in retina. Let's start with the trials on the anti-vascular endothelial growth factor (VEGF) therapies.

Baruch D. Kuppermann, MD, PhD: Data from 3 big clinical trials were presented for the first time, and there were some follow-on data from other trials.

The biggest news, however, was the AREDS2 trial,[1] which looked at the addition of lutein and zeaxanthin to the AREDS formulation, as well as reducing the amount of zinc and removing beta-carotene. There had been some concerns in the original AREDS trial that the dose of zinc was toxic, and that beta-carotene might not be necessary. The original AREDS study[2] was a dietary intake survey, and people who ate a lot of fish and had high levels of omega-3 fatty acids in their diets, as well as those who had high intakes of dark leafy green vegetables, which are high in lutein and zeaxanthin, appeared to derive benefit.

The purpose of AREDS2 was to study those various permutations. As a result, the study had many arms and was a complicated study. To summarize the results, omega-3 fatty acids did not have any additional benefit. There is no recommendation to add omega-3 fatty acids for the purposes of inhibiting progression to advanced age-related macular degeneration (AMD). Certainly, there are other perceived benefits to omega-3 fatty acids and fish in the diet.

With respect to lutein and zeaxanthin, the results became more interesting. Lutein and zeaxanthin are carotenoids that function as antioxidants in the retina and may be protective against the progression of AMD. Lutein and zeaxanthin instead of beta-carotene were associated with a 10%-18% reduced progression to advanced AMD over the 5-year study. So, that will remain in the formulation.

Beta-carotene inhibits the absorption of lutein and zeaxanthin. Although there was not a big difference overall to show that lutein and zeaxanthin were unequivocally beneficial, when you look at the specific subsets, there is inhibition of dietary absorption of the carotenoids by beta-carotene.

Furthermore, in previous smokers, there is an increased risk for lung cancer with beta-carotene, so the lutein and zeaxanthin formulation is safer. We are going to see a switch away from the old AREDS formulation that contained beta-carotene to new ones that are primarily lutein and zeaxanthin-based. This formulation already exists, but sometimes it can be hard to find. Those formulations will probably be promoted more given the data from AREDS2. This trial was probably the most significant news of the meeting from a large clinical trial standpoint.

Dr. Steinert: I won't stop taking my omega-3 fatty acids because of the other benefits. But it is interesting that the antioxidant properties of omega-3 fatty acids didn't make a difference.

Dr. Kuppermann: In the original AREDS study, people who had higher dietary intakes of fish appeared to have a benefit. It wasn't the primary outcome; it was a dietary intake survey. The question still remains whether eating fish is better than taking omega-3 supplements. That has always been a question: Do you take your sources from supplements or from good diet? There are many reasons to continue eating fish, although there are other health concerns with fish, such as mercury content.

Dr. Steinert: There is some controversy about the bioactivity of some of the omega-3 fatty acids. You can be taking big fat capsules and not get much benefit, depending on how it is prepared, in addition to the potential toxicity.

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