Dr. Rx: ‘Eye vitamins’ and macular degeneration

January 17, 2014 by Cynthia McMullen

Faculty and students at VCU School of Pharmacy have been providing the Dr. Rx column for Richmond’s Fifty Plus magazine since December 2009. Beginning this month, we will share those columns on the SOP website, as well, for those who might not have seen the most recent issue of Fifty Plus.

Tiffany Yoon, a fourth-year Pharm.D. student, served as the January 2014 Dr. Rx. She received her bachelor’s degree in chemistry at VCU; her area of interest is ambulatory care.

Dear Dr. Rx: A few of my friends have age-related macular degeneration, and they have been taking a vitamin for their eyes. What is that? Should I start taking these “eye vitamins,” too?

Age-related macular degeneration (AMD) is a leading cause of vision impairment and vision loss in older adults. While there are two types of AMD, wet and dry, the most common is dry AMD. It is characterized by a deteriorating macula, located in the center of the retina, causing your central vision to become distorted or blurred. This can affect one or both eyes. Age is a major risk factor for AMD, and is most common in Caucasians 65 years and older. Other risk factors include smoking, family history of macular degeneration and an unhealthy diet.

There are three stages of AMD: early, intermediate and late. People with early-stage AMD do not typically experience vision loss. They may have yellow deposits in the retina, but vision is unaffected. As you age, it is normal to develop small yellow deposits, but symptoms increase as the deposits grow in size. Intermediate-stage AMD is characterized by larger deposits, pigment changes in the retina or both. People with late-stage AMD have a damaged macula and vision loss. These changes can only be detected by an eye exam, therefore you are encouraged to visit your eye doctor when you experience any visual changes.

Very few treatments are available for dry AMD, which makes prevention and slowing the progression of the disease very important. This is where “eye vitamins” come in. There were two large studies done by the National Eye Institute, called the Age-Related Eye Disease Studies (AREDS and AREDS2). Since there are other treatment options for patients with wet AMD, they were not included in these studies.

The first AREDS study examined people in various stages of AMD. It found that a combination of vitamin C, vitamin E, beta-carotene, zinc and copper can reduce the risk of developing severe AMD in people with intermediate or late AMD. People with early AMD or no AMD did not gain benefit from taking AREDS supplements. It is important to note that a majority of study participants were also taking a general multivitamin in addition to the AREDS eye supplement. This can be a limitation to the study’s conclusions.

The AREDS2 study participants were those at highest risk for advanced AMD. This study looked at modifying the formulation by replacing beta-carotene with lutein, zeaxanthin or omega-3 fatty acids. Results showed no added benefit with omega-3 fatty acids, but lutein and zeaxanthin together were an effective alternative to beta-carotene. This formulation change is a safer alternative for current or former smokers due to the recent evidence of beta-carotene increasing their risk of lung cancer.

People with intermediate or late AMD could find benefit by adding an “eye vitamin” to their daily routine. Although these vitamins will not improve eyesight, further macular degeneration can be delayed. Smokers should use the products with lutein and zeaxanthin instead of beta-carotene.

To reduce your risk of AMD or to slow its progression, avoid smoking, change to a healthier diet and wear sunglasses if you don’t already. Before starting a supplement, consult with your doctor or eye care professional about which one, if any, is appropriate for you.