Vitamins and Age Related Macular Degeneration
When I was starting to practice retina in 1988, an article was published by Dr. Newsom discussing the effects of dietary Zinc supplement (100mg/day) on Age Related Macular Degeneration (ARMD). This was one of the first articles to show that we could help our patients better manage ARMD, both wet and dry type, using vitamin supplements. A little more than a decade later the National Institutes of Health published studies (AREDS) confirming the zinc supplements improved patient outcomes, but they also added Lutein to the mix as providing a “statistically significant positive effect”.
What was confusing about the formulation of the first vitamins was that other ingredients that did not make a difference in outcome at a statistically significant level were still included in the first “AREDS” supplements. An ingredient is either statistically significant or not, but the ambiguity of ingredients whose impacts are “close enough” only complicates the study and dilutes the importance of the effective ingredients. The initial supplements were not recommend at our clinic as they cut the zinc level too low to allow inclusion of more of the non-significant ingredients.
Ten years worth of patient exams in our clinic before AREDS ;was done demonstrated the beneficial effect of a 60-100mg daily dose of zinc on ARMD clinic patients. A new patient to the clinic would come in and be put on 60-100mg of zinc per day. Some would forget and only take one tablet of 40mg/day (40mg zinc tablets were available at that time). They would be back with increasing subretinal fluid within 2 years (this is pre anti VEGF drug era). If they would boost the dose to 80mg/day, then it would settle down and the vision would recover.
Not all AREDS2 are the same
Fast forward to today. The new AREDS2 formula establishes the correct zinc level and this is now considered the standard of care. However, it is interesting to go to the grocery store and look at the labels on vitamins advertising “eye vitamins” and its benefits. The only brand that actually followed the AREDS2 formula is “Preservision AREDS2” as it was the formula used in the study. All of the others I have seen have “AREDS2” on the label, but not the right amounts. This is like advertising that you are making “chocolate cake” but only put a pinch of chocolate in the mix to save money. Many patients try to comply with our advice, only to be thwarted at the grocery store by unclear and deceptive labeling. We need to make sure they understand how to buy the vitamins that will actually give them the benefit they seek and deserve. Using the vitamins do not make you see better but it is like changing the motor oil in your car: it will not make the car go faster but it might slow down the wear and tear and last longer. We can still slowly get worse but a a much slower rate.
As a side effect of taking the Zinc mineral in these vitamins, it has been shown that you can live longer by taking the AREDS2 supplements. National Institutes of Health looked at the longevity of the patients taking the vitamins. They divided the patients into three groups:
1: Patients taking AREDS2 with Zinc and Lutein,
2: Patients taking no additional vitamins,
3: Patients taking the “anti-oxidants” (like vitamin E etc)
They discovered that Group 2 had the normal life span of 74-76 years of age, Group 1 lived the longest and Group 3 died the youngest by several years. Like all studies, this needs to be re-evaluated by others before it is thought to be verified. It is a rather interesting finding however.
Fish oil or Omega 3
There are studies that seem to indicate that adding fish oil or eating fish a few times a week can have all kinds of benefits from heart health to macular degeneration. Some of the studies are being verified by others and other claims are not verified. Stay tuned to this area as this post will change as more quality information surfaces as to which omega oil and how much becomes clearer. At this time, it is not clear what to endorse but the safe bet is to eat salmon or other oily fish once or twice a week.
“Just my observations” PVH