AREDS2: Insights Into Optimal Supplements for AMD
The AREDS trials are large, well controlled, and statistically impressive. AREDS1 provided level 1 evidence demonstrating the benefit of specific supplements for reducing the risk for advanced AMD in a specific patient population. AREDS2 expanded on these findings, enrolled only high-risk AMD eyes, and demonstrated that such patients should not use beta-carotene supplements and should replace this carotenoid with lutein and zeaxanthin.
As clinicians, we must remain thoughtful when prescribing supplements to our patients with AMD, for many reasons. First, the patients who benefited in AREDS1 and those enrolled in AREDS2 were specifically defined; the role of vitamin supplementation in earlier stages of AMD and in the primary prevention of AMD is unclear. Second, the dietary supplement industry in the United States is not as regulated as the pharmaceutical industry. The US Food and Drug Administration (FDA) regulates dietary supplements under a different set of regulations than those covering pharmaceuticals licensed for use as medications. The Dietary Supplement Health and Education Act of 1994 specifically states, "The manufacturer of a dietary supplement or dietary ingredient is responsible for ensuring that the product is safe before it is marketed." Third, many other factors contribute to a patient's risk for AMD; perhaps more than 80% of the risk for progression to advanced AMD is genetically determined. Additional work is needed to identify, and more completely understand, all AMD risk factors and possible steps towards their modification.
In summary, in appropriate patients at high risk for advanced AMD, specific supplements should be considered to reduce the risk for such progression. Patients who have ever smoked (and maybe all patients) should not take AREDS supplements with beta-carotene. Instead, the beta-carotene should be replaced with lutein and zeaxanthin. The final supplement combination recommended for all such patients at this time is 500 mg vitamin C, 400 IU vitamin E, 10 mg lutein, 2 mg zeaxanthin, 80 mg zinc, and 2 mg copper.
Clinical Recommendations
The AREDS trials are large, well controlled, and statistically impressive. AREDS1 provided level 1 evidence demonstrating the benefit of specific supplements for reducing the risk for advanced AMD in a specific patient population. AREDS2 expanded on these findings, enrolled only high-risk AMD eyes, and demonstrated that such patients should not use beta-carotene supplements and should replace this carotenoid with lutein and zeaxanthin.
As clinicians, we must remain thoughtful when prescribing supplements to our patients with AMD, for many reasons. First, the patients who benefited in AREDS1 and those enrolled in AREDS2 were specifically defined; the role of vitamin supplementation in earlier stages of AMD and in the primary prevention of AMD is unclear. Second, the dietary supplement industry in the United States is not as regulated as the pharmaceutical industry. The US Food and Drug Administration (FDA) regulates dietary supplements under a different set of regulations than those covering pharmaceuticals licensed for use as medications. The Dietary Supplement Health and Education Act of 1994 specifically states, "The manufacturer of a dietary supplement or dietary ingredient is responsible for ensuring that the product is safe before it is marketed." Third, many other factors contribute to a patient's risk for AMD; perhaps more than 80% of the risk for progression to advanced AMD is genetically determined. Additional work is needed to identify, and more completely understand, all AMD risk factors and possible steps towards their modification.
In summary, in appropriate patients at high risk for advanced AMD, specific supplements should be considered to reduce the risk for such progression. Patients who have ever smoked (and maybe all patients) should not take AREDS supplements with beta-carotene. Instead, the beta-carotene should be replaced with lutein and zeaxanthin. The final supplement combination recommended for all such patients at this time is 500 mg vitamin C, 400 IU vitamin E, 10 mg lutein, 2 mg zeaxanthin, 80 mg zinc, and 2 mg copper.
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