Advice on choosing AREDS or AREDS 2 in non-smokers

Take-home message: In this article, the authors discuss the benefits of nutritional supplementation in preventing AMD progression and consider which AREDS formulation is the most appropriate in smokers and non-smokers.

 

By Dr Paolo Lanzetta, Dr Valentina Sarao and Dr Daniele Veritti

Age-related macular degeneration (AMD) is the main cause of blindness in the developed world. To date, there are no available effective treatments to slow the progression of AMD and the number of people with advanced AMD is expected to double over the next 20 years.

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The pathogenesis of AMD is multifactorial, involving oxidative stress as well as genetic, inflammatory, and other environmental factors. Lifelong exposure to free radicals and the depletion of essential micronutrients are considered to be the key driving forces in disease progression.

The age-related eye disease study

Several epidemiological studies have hypothesised that people with low levels of antioxidants may be more prone to oxidative damage, which may ultimately lead to AMD.¹ Given the lack of definitive evidence for the beneficial effect of antioxidant supplementation and the growing concern of widespread use of unproven, high-dose supplements, the National Eye Institute performed a randomised, multi-centered, placebo-controlled clinical trial designed to assess the impact of an antioxidant and micronutrient combination on the incidence and progression of AMD. The Age-Related Eye Disease Study (AREDS) formulation contained 15 mg beta-carotene, 500 mg Vitamin C, 400 IU Vitamin E, 80 mg zinc oxide, and 2 mg of copper as cupric oxide. A total of 4757 persons were enrolled and stratified into four categories of AMD of increasing disease severity:

• Category 1 – patients with less than five small drusen and visual acuity of 20/32 or better in both eyes.

• Category 2 – patients with multiple small drusen, single or non-extensive intermediate drusen, pigment abnormalities or any combination of these in one or both eyes with a visual acuity of 20/32 or better in both eyes.

• Category 3  – patients with extensive intermediate drusen, large drusen, or noncentral geographic atrophy with a visual acuity 20/32 or better in at least one eye

• Category 4  – patients demonstrating visual acuity of 20/32 or better in the study eye with the fellow eye exhibiting visual acuity of less than 20/32 due to AMD related either to geographic atrophy involving the center of the macula or choroidal neovascularisation.

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