Antioxidants



Antioxidant Vitamins and Zinc Reduce Risk of Vision Loss from Age-Related Macular Degeneration

High levels of antioxidants and zinc significantly reduce the risk of advanced age-related macular degeneration (AMD) and its associated vision loss. These findings from a nationwide clinical trial are reported in the October 2001 issue of Archives of Ophthalmology.

AMD is a leading cause of vision loss and blindness.  Here is what the world looks like to someone suffering from AMD:
Vision with AMD
Vision with AMD
Normal Vision


When you loose vision to AMD, you never get it back.  That is why prevention is the only weapon against AMD.
Scientists found that people at high risk of developing advanced stages of AMD, lowered their risk by about 25 percent when treated with a high-dose combination of vitamin C, vitamin E, beta-carotene, and zinc. In the same high risk group -- which includes people with intermediate AMD, or advanced AMD in one eye but not the other eye -- the nutrients reduced the risk of vision loss caused by advanced AMD by about 19 percent. For those study participants who had either no AMD or early AMD, the nutrients did not provide an apparent benefit. The study, called the Age-Related Eye Disease Study (AREDS) -- was sponsored by the National Eye Institute (NEI), one of the American government's National Institutes of Health.
The study is important for people at high risk for developing advanced AMD because it shows that these nutrients are the first effective treatment to slow the progression of the disease. AMD is a leading cause of visual impairment and blindness in people 65 years of age and older. Apart from nutrition, treatment for advanced AMD is quite limited. These nutrients will delay the progression to advanced AMD in people who are at high risk -- those with intermediate AMD in one or both eyes, or those with advanced AMD in one eye already.
It is important to keep in mind that the nutrients are not a cure for AMD and they can't restore vision already lost from the disease.  If you have lost vision, you will never get it back.  That's why nutrition is so important to prevent it in the first place and regular eye exams are critical in monitoring the health of your eye to ensure that you are dong as much as you can to keep your eyes healthy for life.  
A common feature of AMD that your optometrist looks for when he or she examines your eyes,  is the presence of drusen.  Drusen are yellow deposits under the retina. Optometrists observe and monitor during an eye exam in which the pupils are dilated. Drusen by themselves do not usually cause vision loss, but an increase in their size and/or number increases a person's risk of developing advanced AMD, which can cause serious vision loss.
The three stages of AMD analyzed in this study are:

Early AMD


People with early AMD have, in one or both eyes, either several small drusen or a few medium-sized drusen; these people do not have vision loss from AMD.

Intermediate AMD 


People with intermediate AMD have, in one or both eyes, either many medium-sized drusen or one or more large drusen; in these people, there is usually little or no vision loss.


Advanced AMD


In addition to drusen, people with advanced AMD have, in one or both eyes, either:
  • A breakdown of light-sensitive cells and supporting tissue in the central retinal area (advanced dry form); or
  • Abnormal and fragile blood vessels under the retina that can leak fluid or bleed (wet form).

These two forms of advanced AMD can cause serious vision loss. Scientists are unsure about how or why an increase in the size and/or number of drusen can sometimes lead to advanced AMD, which affects the sharp, central vision required for the 'straight ahead' activities in our daily routine, such as reading, driving, and recognizing faces of friends. 

One observation is that the larger and more numerous the drusen, the higher the risk of developing either form of advanced AMD. People who have advanced AMD in one eye are at especially high risk of developing advanced AMD in the other eye. The formulation used in the study contained several antioxidant vitamins, which are nutrients that can help maintain healthy cells and tissues. They also contained zinc, which is an important mineral incorporated into many body tissues.

Which nutrients are beneficial in AMD?



The nutrients evaluated by the AREDS researchers contained 500 milligrams of vitamin C; 400 international units of vitamin E; 15 milligrams of beta-carotene; 80 milligrams of zinc as zinc oxide; and two milligrams of copper as cupric oxide (Copper was added to the AREDS formulations containing zinc to prevent copper deficiency, which may be associated with high levels of zinc supplementation). 






Can you get enough nutrients in food?


The AREDS study builds on previous studies suggested that people who have diets rich in green, leafy vegetables have a lower risk of developing AMD.   While the nutrients evaluated by the study are available in food, the high levels of nutrients that were evaluated in the AREDS study are very difficult to achieve from diet alone.



Are multi-vitamins enough or do I need special eye vitamins?

Almost two-thirds of AREDS participants chose to take a daily multivitamin in addition to their assigned study treatment.  The AREDS also showed that, even with a daily multivitamin, people at high risk for developing advanced AMD can lower the risk of vision loss by adding a formulation with the same high levels of antioxidants and zinc used in the study.  That means that it is better to take specially formulated eye vitamins in addition to a regular multi-vitamin.


How was the AREDS study conducted?


The Age-Related Eye Disease Study involved 4,757 participants, 55-80 years of age, in 11 clinical centers nationwide. Participants in the study were given one of four treatments: 1) zinc alone; 2) antioxidants alone; 3) a combination of antioxidants and zinc; or 4) a placebo, a harmless substance that has no medical effect. The benefits of the nutrients were seen only in people who began the study at high risk for developing advanced AMD -- those with intermediate AMD, and those with advanced AMD in one eye only. In this group, those taking "antioxidants plus zinc" had the lowest risk of developing advanced stages of AMD and its accompanying visual loss. Those in the "zinc alone" or "antioxidant alone" groups also reduced their risk of developing advanced AMD, but at more moderate rates compared to the "antioxidants plus zinc" group. Those in the placebo group had the highest risk of developing advanced AMD.


Do I need to see a doctor before taking eye vitamins?

Yes.  For example, some people with intermediate AMD may not wish to take large doses of antioxidant vitamins or zinc because of medical reasons. For instance,  beta-carotene has been shown to increase the risk of lung cancer among smokers.  Interactions like these are a reason why patients should discuss vitamins with their optometrist of family doctor before taking them.   Another important consideration is that with the use of the high levels of zinc, it is important to add appropriate amounts of copper to the diet to prevent copper deficiency.


Are there any side effects to taking vitamins to slow the progression of AMD?

The AREDS participants reported few side effects from the treatments. About 7.5 percent of participants assigned to the zinc treatments -- compared with five percent who did not have zinc in their assigned treatment -- had urinary tract problems that required hospitalization. Participants in the two groups that took zinc also reported anemia at a slightly higher rate; however, testing of all patients for this disorder showed no difference among treatment groups. Yellowing of the skin, a well-known side effect of large doses of beta-carotene, was reported slightly more often by participants taking antioxidants.
"The AREDS formula is the first demonstrated treatment for people at high risk for developing advanced AMD," he said. "Slowing the progression of AMD to its advanced stage will save the vision of many who would otherwise have had serious vision impairment."
Citations
  • 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 Oct.PubMed

  • 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 Cataract and Vision Loss: AREDS Report No. 9. Arch Ophthalmol. 2001 Oct. PubMed