Vitamins to Prevent Vision Loss

July 14, 2011, 12:58 pm


Vitamins to Prevent Vision Loss
By THE NEW YORK TIMES
Josh Ritchie for The New York Times

This week, Stephen Rose, chief research officer for the Foundation Fighting Blindness, joined the Consults blog to answer reader questions about age-related macular degeneration and related disorders. Several readers had questions about vitamins and nutrients to combat the vision loss of macular degeneration.

Q.I am 68 and my eye doctor recently said I have precursor signs of macular degeneration. She recommended the Areds vitamin formula, 2 times each day. Do you think the vitamins really do any good to prevent development of macular degeneration? Is there anything else that you recommend to prevent it?
Reader, Bangor, Me.

Q.My 82-year-old mom has macular degeneration and is urging me to take a particular brand of very high-dose vitamins that claims to preserve vision. Is there a benefit to these products?
annieb3, Calif.

A.Dr. Stephen Rose responds:
The National Eye Institute at the National Institutes of Health conducted the first Age-Related Eye Disease Study, known as Areds, which evaluated supplements for slowing the progression of age-related macular degeneration. The first Areds study enrolled about 3,600 patients who took a combination of antioxidants and zinc. The formula included specific amounts of vitamin C, vitamin E, beta carotene, zinc and copper.

For people who had intermediate-stage age-related macular degeneration, or A.M.D., the formula reduced the risk of developing advanced disease by 25 percent. The formula also led to a 19 percent reduction in vision loss for people with intermediate A.M.D. in one or both eyes, or advanced dry or wet A.M.D. in only one eye. The Areds study also showed that age and smoking influenced progression of A.M.D. The formula did not have any apparent benefit for people without A.M.D. or with early disease.

The Areds formula is now available over the counter from pharmacies and other retail outlets, but you should take it only if your doctor recommends it.

Diet alone cannot provide the same high levels of antioxidants and zinc as the Areds formulation. Also, standard daily multivitamins cannot substitute for taking the Areds formula supplement. However, diets rich in green leafy vegetables have been shown to lower the risk of developing A.M.D.

It is important for you to talk with your doctor about your stage of A.M.D. and whether the Areds formula is right for you. No one can tell you how fast your A.M.D. will progress, but if you don’t smoke and eat a healthy diet with lots of fruits and vegetables, you are reducing your risk of vision loss from A.M.D.

The National Eye Institute is currently conducting a second Areds study, called Areds II, which is evaluating a second supplement for reducing the risk of vision loss from macular degeneration. The Areds II supplement contains DHA, EPA, lutein and zeaxanthin. DHA and EPA are found in the oils of cold-water fish like tuna and salmon. Lutein and zeaxanthin are prevalent in colorful fruits and vegetables. No results from Areds II have been reported yet.

Q.A study in (I think) The Archives of Ophthalmology from Rotterdam showed that nutritional intervention in carriers of genes predisposing for age-related macular degeneration, more than half the risk to get the disease by just making sure one gets enough lutein, zeaxanthin, zinc and omega-3 in their diet. Just test early and suggest the intervention while awaiting results of research in novel treatments (forget the protein that was described as defective a few months ago).
acstas, bangkok

A.Dr. Stephen Rose responds:
Regardless of whether you have age-related macular degeneration or are predisposed to getting A.M.D. because it runs in your family, maintaining a diet rich in omega-3 fatty acids (DHA and EPA), lutein and zeaxanthin is a good idea. If your diet includes cold-water fish like tuna and salmon, which are rich in DHA and EPA, and lots of leafy and colorful fruits and vegetables, rich in lutein, zeaxanthin and several other protective nutrients, you are likely to be healthier than if you ate a lot of junk food.

The Rotterdam study you reference suggests that a diet rich in the nutrients mentioned above prevents age-related macular degeneration. However, the Rotterdam study looked retrospectively at people’s dietary habits through a questionnaire, so it is scientifically less reliable than a prospective study like the Age-Related Eye Disease Study II, which is much better controlled in terms of who is in the study and what nutrients they are consuming. In Areds II, participants are being studied over time as they follow a strict protocol of nutrient intake.

The National Eye Institute is conducting Areds II because of the evidence that DHA, EPA, lutein, and zeaxanthin may lower macular degeneration risk. Because the study is so well controlled, I believe it will give us the best information about what really works and what doesn’t.

Keep in mind that taking large amounts of vitamins and nutrients can be unhealthy. That’s another reason these controlled studies are important; they give us an understanding of the right amounts of nutrients we need for optimal health.

Q.I have macular degeneration and have been taking the Areds formula capsules twice a day for several years on the advice of my excellent retinal specialist. My M.D. is stable and has not become worse since I began taking the Areds. I also take 1,000 milligrams of omega-3 every day. So far, so good.
Liz, Albany, Calif.

A.Dr. Stephen Rose responds:
I am glad to hear that you have found a good retinal specialist and a treatment approach that is working. It is imperative that everyone with age-related macular degeneration see an eye doctor regularly, and that the doctor answer your questions and respond to your needs and concerns. Vigilance is critical with A.M.D. You need to stay on top of the condition to ensure it isn’t getting worse, and if it does, take whatever action or treatment you can to reduce your chance of vision loss. If you have any significant changes in your vision, get to your doctor as quickly as possible.