OTC: overwhelming and total confusion?

During resident clinic recently, I met an elderly woman suffering from age-related macular degeneration (AMD). Upset with 20/300 vision in her left eye, she was desperate to maintain her right eye's 20/25 vision.

After counseling her about the causes of AMD, I advised her to stop smoking ("I've been trying to quit for years, honey") and eat plenty of green, leafy vegetables. The conversation then turned to nutritional supplements, and I explained that a very specific combination of vitamins and other nutrients could help decrease the rate of AMD progression by 25%.

"That's right. But, that combination also increased the chances of lung cancer in smokers," I said. "So we can either take that risk, or use the supplements without beta-carotene. They probably won't work as well for your vision, but they'll be safer."

"How do I know which ones are without beta-carotene?" she asked.

"Check the label. All the information will be right there."

We set up a follow-up appointment for 3 months, and I moved on to the next patient.

A dose of reality

I stopped to look around for a moment, bewildered by the choices. My local store carried vitamins from Bausch & Lomb, Alcon Laboratories, and a generic brand, all with catchy names ("PreserVision," "Ocuvite," "I-Caps," etc.). In addition, some mentioned AREDS directly, while others said "based on AREDS," and still others listed the names of other vitamins contained inside.

Now I was curious-and feeling a new empathy for my patient. Thinking back to an AMD lecture 2 months prior, I struggled to remember the exact nutrients that were studied in AREDS. Wasn't it vitamin A, C, and E, along with zinc and copper? But what about lutein and zeaxanthin-they are featured prominently on several of the boxes, but were they studied in AREDS? And how much of each nutrient was studied? I could only recall that it was high doses of each.