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Vitamin & Diet Recommendations for ARMD

Diet and Vitamin Recommendations for ARMD, Randall Wong, M.D. Retinal SpecialistWith the AREDS 2 study recently published, the recommendations for vitamin supplements have not changed.

AREDS 2 did not change any of the recommendations for changing diet or adding supplements.  While it didn’t lead to any discoveries, it did validate the original AREDS study.

Take the AREDS Formulation!

The original AREDS formulation contains;

  • Vitamin C, 500 milligrams
  • Vitamin E, 400 IU
  • Beta-Carotene, 15 milligrams
  • Zinc Oxide, 80 milligrams
  • Cupric Oxide, 2 milligrams

Note that there is no lutein in the formulation.

Some popular brands containing the AREDS formulation;

There are others made by other vitamin companies but they also sell products for which their is no scientific data on efficacy.  In general, look for the AREDS formulation.  Compare to the ingredient list above.

AREDS and Multivitamins

AREDS vitamins and multivitamins are different.  One is not a substitute for the other.  There are elements found in the AREDS formulation not found in the multivitamin.

Consult your physician if your are considering stopping or starting either vitamin.

You do not need vitamins based upon the AREDS 2 formulation.

What Does this Mean?

The new study confirmed the AREDS study released in 2006.

1.  Take AREDS vitamins, but only if you have intermediate or high risk for developing ARMD.  You’ll have to ask your doctor if you meet the criteria.

2.  Lutein is not necessary.

3.  The vitamins do NOT improve or prevent the development of macular degeneration.   They may, when indicated, prevent severe vision loss from the wet form of the disease.

4.  Omega 3 Fatty Acids have no direct effect on macular degeneration.

Randy

Randall V. Wong, M.D.
Retina Specialist
Fairfax, Virginia 
www.RetinaEyeDoctor.com

 

 

 

AREDS 2 Vitamin Study for Macular Degeneration

Results of AREDS 2 Study for Vitamins to treat Macular DegenerationThe original AREDS study (Age-Related Eye Disease Study) was published in 2001 and concluded that a combination of vitamins and supplements, the “AREDS Formula,” consisting of  vitamin C, vitamin E, B-Carotene, zinc and copper could reduce the risk of developing advanced ARMD.

  1. The “AREDS Formula” has been recommended for patients with intermediate or high risk ARMD.  The AREDS study found that in these patients, the eye vitamins reduced the chance of severe vision loss by 25%.
  2. The eye vitamins do not improve the vision or stage of the disease, but do prevent those at high risk from getting worse.  Unless, there is evidence of macular degeneration showing these risk factors…there is no need for taking the AREDS vitamins.
  3. Lutein and  zeaxanthin (pigmented anti-oxidants) were never studied directly.  Both were associated with improvements in macular degeneration, but neither were ever proven to improve macular degeneration.
  4. Omega-3 fatty acids were suspected to retard macular degeneration, but never proven.
  5. B-Carotene increases the chance of lung cancer in smokers.

AREDS Formula (2001)

  • Vitamin C
  • Vitamin E
  • B-Carotene
  • Zinc
  • Copper

AREDS 2 Study Tested

In 2006, AREDS II was initiated to determine if improvements could be made on the AREDS formula.  Specifically questions asked

  1. Do omega-3 fatty acids (DHA/EPA) reduce AMD or cataract?
  2. Do antioxidants, lutein/zeaxanthin, reduce AMD or cataract?
  3. What is the role of zinc?
  4. What is the role of B-Carotene?

AREDS 2 Study Results

  1. Omega-3 fatty acids had no effect on reducing macular degeneration nor cataract formation.
  2. Antioxidants, lutein/zeaxanthin,  did not retard the progression of macular degeneration.
  3. Reducing the amount of zinc did not change the effectiveness of the AREDS formulation.
  4. B-Carotene did increase the rate of lung cancer in former smokers (active smokers were not given B-carotene), but there may be advantages to substituting lutein/zeaxanthin  for the B-carotene in smokers.

What Does this Mean?

Though it seems that little new information was produced from the AREDS 2 study, in fact, the study was very positive.

The results of the AREDS study were validated.  Patients who have high risk or intermediate risk factors for AMD should be recommended to take the AREDS formula vitamins.  Those who do not have these risk factors, including “normal” people, do not need to take these vitamins.

B-carotene should not be taken by smokers or former smokers.  This was suspected, but now has been validated.  There are AREDS formulations available for smokers (no B-Carotene).

Unfortunately, omega- 3 fatty acids (e.g. fish oils) and antioxidants also have no role in preventing macular degeneration.  This also means, those products touting the importance of lutein…are unfounded.

Randy

Randall V. Wong, M.D.
Retina Specialist
Fairfax, Virginia 
www.RetinaEyeDoctor.com

What Vitamins Prevent Macular Degeneration?

We’ve talked about this many times. Most people with macular degeneration do not need to be taking vitamins for macular degeneration. Whether the vitamins contain β-carotene, zeaxanthin or lutein, most people just don’t need to be taking them.

There is lots of anecdotal evidence that certain elements, such as β-carotene, zeaxanthin and lutein may be helpful, and indeed these specific questions are under study.  Read more about AREDS 1 and AREDS 2.  According to the AREDS1 study, very few people need to be taking these supplements.

Who DOES Need Vitamins? The only group of patients that “require” vitamins are those with “high or intermediate risk” wet macular degeneration.

  • Intermediate Risk – patients with either “intermediate” macaular degeneration in either eye.
  • High Risk – patients with advanced dry (geographic atrophy) or known “wet” macular degeneration in either eye.

Which Vitamins? The only vitamins “proven” to be effective are the vitamins containing the “AREDS Formulation.”  It is usually printed on the side of the bottle.  The AREDS formula contains;  Vitamins C and E, Beta-carotene, zinc and copper.  Examples of vitamins include;  Preservision® (Bausch and Lomb) and ICAPS® (Alcon).

What Will the Vitamins Do? The vitamins will reduce the chance of the “wet” form developing in either eye.  For example, if a patient has the “wet” form in the right eye, the vitamins reduce the risk of developing the “wet” form in the other eye by 25%.

What does this mean? This emphasizes the need for a regular eye examination.  Only your doctor can tell you if you have intermediate or high risk characteristics.

There are too many people randomly taking vitamins for the “eyes.”  It is important that you know the basis for which vitamins are suggested for you.

“Randy”

Randall V. Wong, M.D.
www.TotalRetina.com
Ophthalmologist, Retina Specialist

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Does Your Diet Reduce Risk for Macular Degeneration? Part 1

Good Morning!  I am going to review, over the next 2-3 days, the dietary and vitamin recommendations for patients that have been diagnosed with Macular Degeneration.

Today’s Post:  What has been proven and not proven to work.  Focusing on the AREDS study and the supplements.

Next:  Part II:  What looks promising from a dietary standpoint, i.e. what things to eat that may help AMD, but not proven.  Read Part II.

Last:  The AREDS 2 study, what questions it hopes to answer.

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A few years ago in 2001, the Age Related Eye Disease Study (AREDS or AREDS 1) study results were published. You can read the actual press release here…Click To Read AREDS Press Release.  It was a huge study that analyzed the risk of developing macular degeneration and cataract when given certain supplements.  The AREDS study has been the only study testing the effects of supplements on your eyes.  The AREDS 2 study is underway.

The Direct and Honest Answer.

1.  No diet has been proven to alter the chances of developing macular degeneration so far.  NOTHING!

2.  The only supplement/vitamin proven to be effective is the so-called AREDS formula (containing vitamin C, vitamin E, beta-carotene, and zinc) and this supplement/vitamin was only effective in patients with moderate to high-risk characteristics of macular degeneration (i.e. those with diagnosed macular degeneration).  Patients with low or no risk characteristics of macular degeneration did not benefit from the AREDS formula.

3.  Lutein and zeaxanthin have also not been studied directly (they will be in AREDS 2), that is, they have yet to be proven to work.

The Translation.

1.  Patients that have so-called high risk characteristics of macular degeneration had a 25% decrease in the likelihood of developing the ‘wet’ form of macular degeneration in one eye.  The chance of developing the wet form decreased from 28% to 21% while taking the supplements.  Patients at “intermediate risk” showed a 19% decrease in developing the wet form.

2.  No other benefit was shown from taking these vitamins.

3.  These high/intermediate risk patients should take the AREDS formulation (available over the counter) as long as they don’t smoke.  There is a smoker’s formulation, too.

The Not so Direct and Honest Answer. Beware of the hype.

There are a ton of vitamins available that claim to “cure” macular degeneration.  All of this is hype with exception of the AREDS study and formula.  Many doctors recommend taking vitamins to prevent macular degeneration, but there is no data or study to support this.  The AREDS study simply says that patients taking high doses of certain anti-oxidants, with zinc, may be beneficial.  Be careful when you read advertisements or listen the TV or radio.

There are also many products touting they contain the key ingredient “lutein” for macular degeneration.  There was an association in the AREDS 1 study, but there is no proof yet.

Read Part II

“Randy”

Randall V. Wong, M.D.
www.TotalRetina.com
Ophthalmologist, Retina Specialist

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From Fish to Nuts, Eating Right to Prevent Macular Degeneration

Eating more omega-3 polyunsaturated fat, such as that found in fish, may prevent the development of macular degeneration.  I have posted on this before.  No need to click back, but the highlights were;  eating one serving a week of fish, thereby increasing omega-3’s and decreasing foods containing linoleic acid (an unsaturated omega-6 fatty acid) decreased the incidence of macular degeneration!

The protective effect may be due to metabolites (by-products of what we eat) which lead to inflammation.  Inflammation has been implicated in the development of macular degeneration.  Eating foods with omega-3 fatty acids may reduce the inflammation.

There may also be a benefit from eating nuts, too. Nuts have been show to have anti-inflammatory and anti-oxidant properties, too.  In fact, nuts showed a similar benefit to fish, as one to two servings per week were associated with a decrease in the development of the disease.

What does this mean? Without a doubt, there are going to be more recommendations about what we eat and reducing macular degeneration.  Remember that none of these findings have truly been tested per se, but these are noted associations when researchers reviewed the original AREDS data.

Randy

Randall V. Wong, M.D.
Ophthalmologist, Retinal Specialist
www.TotalRetina.com

Something Fishy About Macular Degeneration

Eating more fish may slow down the progression of macular degeneration.  A new study based on the original AREDS (Age Related Eye Disease Study) data finds that eating cold water, fatty fish 1-2 times per week may reduce the advancement of macular degeneration.

Fatty fish include salmon, tuna, sardines, certain shellfish and herring.  Two specific compounds, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), have been shown to be protective in the disease.

Omega 3 fatty acids have also been implicated in other studies.

What does this mean? These are really associations noted by researchers.  This is not definitive proof that eating fish is helpful.  Large, randomized cohort studies are needed to have definite proof.

Randy

Randall V. Wong, M.D.
Ophthalmologist/Retina Specialist
www.TotalRetina.com

What About Vitamins?

What vitamins help macular degeneration?  I am asked this daily.  What should I take?  What should I eat?  What can I do?  The answer is simply………..I don’t really know.  The information about supplements, be they vitamins or foods, is really scarce.  I usually tell patients that my job is to report the hard data to you and not to promote remedies or pills which are unfounded.  I feel pretty strongly about this.  It is why western medicine is superior – most everything is tested (kind of like Google).

In 2001, a gigantic study was completed called the Age Related Eye Disease Study (AREDS).  It was unique in its size and scope.  It was a prospective study (vs. retrospective, prospective studies are better).  It was one of the first studies to show that dietary changes can influence as disease, in this case, macular degeneration.  Patients were examined for the development of macular degeneration while taking (aka the AREDS Formula); Vitamins C and E, Beta-carotene, zinc and copper.  The conclusions of the study;

1)  smokers should not take beta-carotene as it increases the chance of lung cancer,

2)  patients at moderate/high risk of AMD do benefit from the AREDS formulation supplements

Associated findings, but not conclusively studied;

1)  carotenoids such as lutein and zeaxanthin (found in green leafy veggies such as spinach) were associated with decreased AMD in those patients that ate them in the beginning of the study, that is, these were not directly studied.

2) omega 3 fatty acids may be associated with reduced macular degeneration and cardiovascular disease.

What does this mean? The original study was limited in its findings, but several dietary associations were made, but not studied.  From this, we assume that eating green leafy vegetables/foods such as spinach, kale, eggs (yolks!), turnip greens, collard greens, etc., are good for you.  Similarly, omega 3 fatty acids (found in fish) are good for your eyes and possibly your heart.

A second large, prospective, study is underway.  AREDS2 will hopefully answer these questions; 1)  the value of beta-carotene in non-smokers, 2) the role of omega 3 fatty acids, 3) the value of carotenoids lutein/zeaxanthin.

Recommendations about Vitamins and ARMD

If your doctor determines that you have moderate or high risk factors in one or both eyes or you have lost significant vision in one eye from either “wet” ARMD or “geographic” ARMD, and you don’t smoke, you should take the AREDS formulation.

Thanks for reading,

Randall V. Wong, M.D.
Retina Specialist/ Ophthalmologist
www.TotalRetina.com

Cataract Surgery Does Not Cause Macular Degeneration

A recent study reports that there is no link between cataract surgery and the development of macular degeneration.  The Age Related Eye Disease Study (AREDS) was a large randomized prospective trial that examined the chance of developing macular degeneration.  This was a prospective study where patients were examined before and afer cataract surgery for the presence of macular degeneration.  This is the first study, and perhaps the largest, that finds cataract surgery is safe for patients worried about macular degeneration.  Emily Chew, M.D., and her colleagues at the National Eye Institute, examined the data of over 4500 patients who were examined every six months for up to 11 years.

What does this mean? As a retinal specialist, I commonly examine patients that do not improve after successful cataract surgery.  Many times the culprit is macular degeneration, that is, patients fail to improve after cataract surgery due to macular degeneration.  For years, there has been an unproven feeling that cataract surgery makes macular degeneration worse.  Remember, there are two eye diseases that increase with age;  cataracts (okay, maybe not a disease) and macular degeneration.  To find both in the same patient is not surprising, yet it is truly frustrating to the patient who just had cataract surgery and can not see.

I would recommend that we take the conclusions of the AREDS trial at face value.  There is no relationship between cataract surgery and macular degeneration.  From a practical side, if you are worried about macular degeneration and are anticipating cataract surgery, get a second opinion from a retinal specialist.

Read the article.

Randall V. Wong, M.D.
Retina Specialist/ Ophthalmologist
www.TotalRetina.com

offices

Currently, I see patients with retinal diseases; macular degeneration, retinal detachment, macular holes, macular pucker within several different practices.....it's a different arrangement, but it allows more continuous care with many eye specialists. In addition, I am very accessible via the web. To schedule your own appointment, call any of the numbers below.

Virginia Lasik | Office of Anh Nguyen, M.D.
Randall V. Wong, M.D.
Contact: Layla

A: 431 Park Avenue, Suite 103 • Falls Church, Virginia 22046
Ph: 703.534. 4393
F:703.992.8158
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Dressler Ophthalmology Associates, PLC
Randall V. Wong, M.D.
Contact: Ashley (Surgery/Web)
Chrissy Megargee (Web)

A: 3930 Pender Drive, Suite 10 • Fairfax, Virginia 22030
Ph: 703.273.2398
F: 703.273.0239
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