FACE OFF

Further Exploration of AREDS Antioxidant Vitamins

COORDINATED BY ABDHISH R. BHAVSAR, MD

Welcome to Face Off, a column that explores controversial topics in the diagnosis and management of retinal diseases. Our typical format has involved covering several topics in each issue with 1 retina specialist voicing 1 line of thought in favor of the treatment or surgery and another retina specialist voicing an opposing line of thought. This column should be held in the spirit of a debate society. We do not advocate that you adopt these specific lines of thought, rather we hope this provides you with insight into how some retina specialists view these issues, with the desire that this will engage your thought process.

In this issue, we will further explore the use of Age-Related Eye Disease Study (AREDS) antioxidant vitamins with zinc with a dissenting opinion. In addition, we will present a pro-statement on the use of antioxidants with zinc supplements in AMD patients who have disciform scarring in 1 eye and are undergoing current treatment for exudative AMD in the other eye.

The main benefit of the AREDS formula was in the reduction of progression of intermediate AMD to advanced AMD. Once an individual has advanced AMD in 1 eye (eg, a disciform scar), and has active exudative disease in the other eye, which also qualifies as advanced disease, should we recommend antioxidant vitamins and zinc?

AGAINST: AREDS VITAMINS WITH ZINC – DO THEY HAVE MERIT?

No. Dietary questionnaire studies in 1994 and 2005 have demonstrated that trial participants who emphasize fruits and vegetables in their diet have a decreased incidence of AMD. And why might that be? Is it because fruits and vegetables are low in fat and high in complex carbohydrates and that they provide roughage to the diet? Well, maybe. Or could it be that fruits and vegetables are low in sodium and high in potassium, magnesium, and calcium? Well, perhaps.

Why, then, has so much been said about carotenoids, lutein, zinc, and zeaxanthin? As one National Eye Institute researcher who has been involved with ongoing AMD nutritional studies confided to the correspondent following a 2004 Retina Society Powerpoint presentation, "We know that seniors (with AMD) will not eat their fruits and vegetables, so this (antioxidant supplementation) is the next best thing."

But is it? Why should science cease and psychology begin in our management of AMD? Science lays the groundwork with proven facts. Management, the "art of medicine," follows. At this point, we simply don't know why fruits and vegetables are protective, which means the prescription of antioxidants not only distracts from proper nutritional measures but also provides a false sense of security.

FOR: AREDS VITAMINS WITH ZINC

I feel the main reason we should use AREDs vitamins with zinc in patients with a disciform scar in 1 eye who are presently undergoing treatment in the fellow eye is because we want our patients to feel they are doing something positive to help. There is no science behind the recommendation. I would also advise a fish oil capsule bid, which may or may not help the recurrence rate in the treated eye, but is good also for the heart and joints! Finally, I also suggest they use the AREDS formula substituting lutein for vitamin A. Vitamin A may have no effect on AMD, but may cause other problems in other organ systems. RP