Age-related macular degeneration (AMD) is a common eye disease, affecting one million people in Canada1. It is a disease that worsens over time affecting central vision, which can lead to an inability to read, drive or recognize the faces of family members1.  To determine ways to reduce the progression of AMD and vision loss, the American National Eye Institute sponsored multiple drug studies to evaluate the role of high doses of vitamins and minerals in this area. You have most likely come across bottles of Vitalux AREDS in the pharmacy aisles and you may have wondered what AREDS was all about. In 2001, researchers with the Age-Related Eye Disease Study  (AREDS I) reported that a formulation containing vitamin C (500 mg), vitamin E (400 IU), beta-carotene (15 mg), zinc (80 mg) and copper (2 mg) could reduce progression to advanced AMD (in patients who already had intermediate AMD or with advanced AMD in one eye) after 5 years 2. From 2008 to 2013, a second study (AREDS II) focused on figuring out if the AREDS formulation could be further improved. AREDS II added lutein, zeaxanthin and omega-3 fatty acids to the formulation, removed beta-carotene and lowered the dose of zinc.3

Normal Vision……

What it might look like if you have AMD……

What are the components of the changed formulation?

After observing people who took lutein and zeaxanthin over time, it was thought lutein and zeaxanthin could reduce the risk of developing AMD due to their antioxidant properties. They are generally found in diet and give color to the eye. AREDS II added 10 mg of lutein and 2 mg of zeaxanthin 2 mg2.

Omega 3-fatty acids are needed to maintain the structure of cells of the retina, which is the back part of the eye that contains the cells that respond to light and have also shown to promote development and repair in the retina. Omega-3 fatty acids are derived from the marine algae and enriched in fish oils3. The dose in the AREDS II formulation is 350 mg of Docosahexaenoic acid (DHA), and 650 mg of Eicosapentaenoic acid (EPA), which are types of omega-3 fatty acids.

Beta-carotene was found to increase lung cancer risk among smokers in two studies2. Lutein/zeaxanthin are thought to be safer and possibly more effective alternatives in the same family of nutrients as beta-carotene. As a result, the beta-carotene was removed in the AREDS2-trial.

Zinc was seen as an essential component in the AREDS formulation. However, nutritional experts recommended a lower dose of zinc based on the idea that the original AREDS formulation contained more zinc than can be absorbed2. As a result, patients in AREDS II trial either took 25 mg of zinc or none at all3.

What does the evidence say?

In the AREDSII study, addition of lutein/zeaxanthin did not reduce the rates of cataract surgery or moderate vision loss where patients were enrolled over two years and followed up for 5 years. Neither Lutein, Zeaxanthin, beta-carotene, zinc, DHA nor EPA reduced the rates of worsening vision2. Even though AREDS II trial did not show any clear advantage of lutein/zeanxanthin, both of these nutrients are considered safe with the exception of individuals who are allergic to them. Keep in mind that the lutein/zeaxanthin supplements are retailing from $12 – $21. 

Bottom Line

The AREDSI formulation can slow down the progression of AMD in individuals with an actual diagnosis but should not be used in smokers.  If you are a smoker, make sure you talk to your pharmacist about a formulation which is safe for you. A discussion with your health care professional is necessary especially in selected individuals with advanced AMD. General tips to help prevent vision loss include having your eyes checked regularly by an eye-care professional, quitting smoking, protecting your eyes from sunlight, keeping alcohol consumption moderate and increasing your intake of fresh fruit and green leafy vegetables as they provide nutrients that are healthy for the eye1.

 

Authors:
Sheldon Chow, B.Sc.Pharm (candidate)
Faculty of Pharmacy & Pharmaceutical Sciences
University of Alberta
Edmonton, AB
sheldon3@ualberta.ca

Corresponding Author:
Cheryl A. Sadowski, B.Sc.(Pharm), Pharm.D., FCSHP
Associate Professor
Faculty of Pharmacy & Pharmaceutical Sciences
University of Alberta
Edmonton, AB
cherylas@ualberta.ca 

Edited and Reviewed by The Health Aisle Team

References

  1. Canadian National Institute for the Blind. http://www.cnib.ca/en/your-eyes/eye-conditions/eye-connect/AMD/About/Pages/default.aspx
  2. Chow et Al. (2013). Lutein/Zeaxanthin for the Treatment of Age – Related Cataract. JAMA Ophthalmol. AREDS2 Randomized Trial Report No. 4: 843-850
  3. Catapang et Al. (2013). Lutein. Product Monograph, Natural Standard Database.http://www.naturalstandard.com.login.ezproxy.library.ualberta.ca/databases/herbssupplements/lutein.asp?hash=dosingtoxicology#precautions
  4. AREDS2 Research Group. “Lutein/Zeaxanthin and Omega-3 Fatty Acids for Age-Related Macular Degeneration. The Age-Related Eye Disease Study 2 (AREDS2) Controlled Randomized Clinical Trial.” JAMA, published online May 5, 2013.