The Age Related Eye Disease Study

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Philomena Lorin Spencer
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1 The Age Related Eye Disease Study Fatoumata Yanoga, MD Assistant Professor of Ophthalmology Ohio State University Wexner Medical Center 04/13/2018 No Relevant Financial Relationships with Commercial Interests

2 Age Related Macular Degeneration The leading cause of vision impairment and blindness in the United States Affecting more than 10 million Americans More common after age 60

3 Age Related Macular Degeneration

4 Age Related Macular Degeneration Distorted vision Loss of sharp, central vision needed for reading, driving, etc Difficulty seeing fine detail Difficulty seeing colors clearly

5 Risk Factors for Macular Degeneration Smoking Family history of the disease Obesity High blood pressure Having a lighter eye color Possible side effect of some drugs

6 Age Related Macular Degeneration Clinical course Different sub-classification of the disease Prognostic feature Preventive measure

7 Age-Related Eye Disease Study (AREDS) Long-term multicenter, prospective study to evaluate the clinical course of age-related macular degeneration (AMD) and age-related cataract. To increase the understanding of the clinical course of both conditions To generate hypotheses about etiology Identify prognostic risks factors Possible preventive measure Do Antioxidants and trace minerals have a role in reducing risk

8 Age-Related Eye Disease Study (AREDS) This is a National Institute of Health (NIH) funded study A long-term multicenter, prospective study of 4757 persons age 55 to 80 years Followed at 6-month intervals for at least 7 years

9 Study Design AMD progression Vision loss >15 lines loss Cataract progression +/+Antioxidants +/- Zinc +/- Antioxidants +/- Zinc +/- Antioxidants

10 AREDS Formula Supplement Dosage Antioxidants Beta-carotene 15 mg Vitamin C 500 mg Vitamin E 400 IU Essential Trace Elements Copper 2 mg Zinc 80 mg Age-Related Eye Disease Study Research Group. A Randomized, Placebo-Controlled, Clinical Trial of High-Dose Supplementation With Vitamins C and E, Beta Carotene, and Zinc for Age-Related Macular Degeneration and Vision Loss: AREDS Report No. 8. Arch Ophthalmol 2001;119(10):

11 Beta-Carotene Carotenoid with systemic Antioxidant capability 15 mg/day (AREDS) 2 Where can I get it in my diet? Carrots, broccoli, spinach, kale 15 mg beta-carotene = 1.6 cups of carrots 15 mg beta-carotene = 47.1 cups of broccoli

12 Vitamin C Antioxidant capability 500 mg/day (AREDS) 2 Where can I get it in my diet? Citrus fruits and juices mg vitamin C = 4 cups/32 fl oz of orange juice 3

13 Vitamin E Antioxidant capability 400 IU/day (AREDS) Where can I get it in my diet Nuts, fortified cereals, sweet potatoes 400 IU vitamin E = sweet potatoes 3

14 Zinc Essential trace element 80 mg zinc/day (AREDS) Where can I get it in my diet? Red meat, poultry, mixed nuts 80 mg zinc = 55.8 oz of red meat 80 mg zinc = 50.3 oz of nuts

15 Copper Why is it important? High zinc may cause copper deficiency What dose was studied? 2 mg/day (AREDS) 4 Where can I get it in my diet? Liver Seafood, Liver, Nuts, Legumes 2 2 mg copper = 1/2 oz of liver 5 2 mg copper = 5 cups of beans 5

16 Stages of AMD Early Intermediate Advance

17 Rates of Progression to Advanced AMD of 7 years

18 Rates of Progression to Advanced AMD over 10 years

19 AREDS Formulation Recommended: Patients with intermediate AMD (bilateral large drusen) Patients with advanced AMD in one eye NOT for current smokers

20 Who Should take the AREDS Formula? Should offprings of individuals with AMD take the vitamins? No, unless they have moderate macular degeneration in both eyes or advance macular degeneration in one eye AREDS formulation does not prevent early AMD from progressing along the mild to the moderate severity of AMD

21 Who Should take the AREDS Formula? Should the AREDS formula be taken for general eye health? No, unless they have bilateral intermediate AMD or advanced AMD in one eye AREDS formulation does not prevent cataract progression or early AMD progression

22 Who Should take the AREDS Formula? It is ok to take AREDS formula with daily multivitamins? Yes, AREDS study participants were given centrum as part of the study to standardize their vitamin intake Centrum and other daily multivitamins provide other vitamins such as vitamins D and the B complex

23 Adverse effects of the AREDS Formula Beta-carotene increased the risk of lung cancer and it associated mortality in smokers Contraindicated in smokers High levels of zinc resulted in increased hospitalizations for genitourinary causes (mostly hypertrophy of the prostate)

24 Age-Related Eye Disease Study 2 (AREDS 2) In 2006, the same research group, began a second study AREDS2 to determine if the AREDS formulation can be further improved Does removal of beta-carotene or reduction in the amount of zinc increase the risk of developing AMD?

25 Age-Related Eye Disease Study 2 (AREDS 2 ) Omega-3 fatty acids Lutein and zeaxanthin antioxidants same family of nutrients as beta-carotene Can beta-carotene be substituted for lutein and zeaxanthin

26 Significance of Lutein and Zeaxanthin Several carotenoids are present in human serum only lutein and zeaxanthin are present in macula This macular pigment protects the macula from the damaging photooxidative effects of blue light Powerful Antioxidant Reduces free radical damage in the eye Yellow macular pigment composed of lutein and zeaxanthin

27 Significant of Omega-3 Fatty Acids (DHA/EPA) Important for proper visual development and retinal function Docosahexaenoic acid (DHA) is found in the highest concentration in the retina Eicosapentaenoic acid (EPA) is used in DHA biosynthesis

28 AREDS2 Formula FloraGLO lutein (10mg) OPTISHARP zeaxanthin (2mg) Omega-3 fatty acids (350 mg DHA, 650 mg EPA) With and without β-carotene (15 mg vs 0 mg) High vs low zinc levels (80mg vs 25mg

29 AREDS 2 Results The study found that while omega-3 fatty acids had no effect on the formulation Lutein and zeaxanthin together appeared to be a safe and effective alternative to betacarotene.

30 Thank You

The Age-Related Eye Disease Study

What have the Age-Related Eye Disease Study (AREDS) and AREDS2 Taught Us? Emily Y. Chew, MD National Eye Institute/National Institutes of Health On Behalf of the AREDS and AREDS2 Research Groups Presenter