New prevention and monitoring strategies for neovascular AMD
The NEI’s Emily Chew, MD, updates clinicians on latest developments
Bethesda, MD—Nutritional supplements continue to be a viable prevention strategy for neovascular age-related macular degeneration (AMD), said Emily Chew, MD.
With the original AREDS study conducted between 1992 and 2001, a combination of vitamin C, E, beta-carotene, and zinc created a 25% reduction in the progression to delay AMD after 5 years, but the combination “didn't work as well for geographic atrophy,” said Dr. Chew, deputy clinical director, National Eye Institute (NEI), Bethesda, MD.
“We've recommended this for patients with intermediate AMD. That means bilateral large drusen, or a late AMD in one eye,” she said.
Lutein and zeaxanthin—unavailable when the first study was initiated—were incorporated into the AREDS2 study, as were Omega-3s. The NEI had dietary data from AREDS that suggested they “may be very important, as well as Omega-3,” she said.
The AREDS 2 study was designed to determine what, if any, additive effect lutein, zeaxanthin, and Omega-3 would have to the original supplement.
The NEI also compared the addition of lutein and zeaxanthin versus the original supplement without it.
For advanced AMD and neovascular AMD, there is a protective effect. “It's specifically beneficial in reducing the risk of going to neovascular AMD, and less so for geographic atrophy,” she said.
“While we found there was a substitution for beta-carotene with lutein and zeaxanthin that was perhaps very important,” she said. “And omega-3 actually wasn't actually in any way successful or helpful.”
As most clinicians are now aware, the AREDS2 supplement substitutes lutein and zeaxanthin for beta-carotene as the former are better at reducing the risk of a cancer found in former smokers, Dr. Chew said.
The NEI also recommends the supplements for patients with geographic atrophy, because “30% of patients who have geographic atrophy will actually develop neovascularization,” she said. “It's important to actually prevent both groups with the oral supplements.”