In the JournalsPerspective

Antioxidants improve visual function in nonadvanced AMD

Supplementation with macular carotenoids in two formulations, containing and not containing mesozeaxanthin, in combination with coantioxidants, showed efficacy in improving vision in patients with nonadvanced age-related macular degeneration.

The Central Retinal Enrichment Supplementation Trial 2 (CREST 2) included 121 patients randomized to receive the AREDS 2 formula with a reduced amount of zinc (10 mg/d lutein, 2 mg/d zeaxanthin plus 500 mg/d vitamin C, 400 IU/d of vitamin E, 25 mg/d zinc and 2 mg/d copper), with or without the addition of 10 mg of mesozeaxanthin.

All patients had nonadvanced AMD with best corrected visual acuity of 20/40 or better and no more than 5 D of spherical equivalent in the study eye. Ninety-eight participants completed the final assessment at 2 years.

A significant improvement in contrast sensitivity (CS) was reported during the study period, with no statistically significant difference between the two groups.

CS was chosen as the primary outcome, because it “can effectively predict how well patients see targets typical of everyday life, which has important implications for quality of life,” the authors wrote.

Other measures of visual function also improved significantly in both groups, including BCVA, glare disability, retinal straylight, photostress recovery and reading performance.

Importantly, only one participant (from the group without additional mesozeaxanthin) progressed to advanced AMD during the study period. No serious adverse events relating to the study intervention were reported.

“Eye care professionals should be aware of the observed visual benefits afforded to patients with nonadvanced AMD as a result of supplementation with macular carotenoids (and coantioxidants) in the short, medium and long terms, and the indication for recommending such supplements should no longer be limited to risk reduction for disease progression in the long term,” the authors wrote.

Of note, the study was representative of a well-nourished population. The benefits of supplementation may be even more remarkable in subjects with less healthy eating habits, they said. – by Michela Cimberle

Disclosure: The authors reported no relevant financial disclosures.

Supplementation with macular carotenoids in two formulations, containing and not containing mesozeaxanthin, in combination with coantioxidants, showed efficacy in improving vision in patients with nonadvanced age-related macular degeneration.

The Central Retinal Enrichment Supplementation Trial 2 (CREST 2) included 121 patients randomized to receive the AREDS 2 formula with a reduced amount of zinc (10 mg/d lutein, 2 mg/d zeaxanthin plus 500 mg/d vitamin C, 400 IU/d of vitamin E, 25 mg/d zinc and 2 mg/d copper), with or without the addition of 10 mg of mesozeaxanthin.

All patients had nonadvanced AMD with best corrected visual acuity of 20/40 or better and no more than 5 D of spherical equivalent in the study eye. Ninety-eight participants completed the final assessment at 2 years.

A significant improvement in contrast sensitivity (CS) was reported during the study period, with no statistically significant difference between the two groups.

CS was chosen as the primary outcome, because it “can effectively predict how well patients see targets typical of everyday life, which has important implications for quality of life,” the authors wrote.

Other measures of visual function also improved significantly in both groups, including BCVA, glare disability, retinal straylight, photostress recovery and reading performance.

Importantly, only one participant (from the group without additional mesozeaxanthin) progressed to advanced AMD during the study period. No serious adverse events relating to the study intervention were reported.

“Eye care professionals should be aware of the observed visual benefits afforded to patients with nonadvanced AMD as a result of supplementation with macular carotenoids (and coantioxidants) in the short, medium and long terms, and the indication for recommending such supplements should no longer be limited to risk reduction for disease progression in the long term,” the authors wrote.

Of note, the study was representative of a well-nourished population. The benefits of supplementation may be even more remarkable in subjects with less healthy eating habits, they said. – by Michela Cimberle

Disclosure: The authors reported no relevant financial disclosures.

    Perspective
    Kuniyoshi Kanai

    Kuniyoshi Kanai

    While anti-VEGF therapy has revolutionized treatment of wet AMD, there is no current pharmaceutical therapy for the more prevalent dry AMD. The highly-anticipated pharmaceutical agent, lampalizumab, did not result in significant improvement of advanced dry AMD in the CHROMA and SPECTRI studies (Holz et al.).

    The landmark study, AREDS, demonstrated a beneficial effect of nutritional therapy with antioxidants for dry AMD. While AREDS 2 did not show added benefit of lutein and zeaxanthin in the primary outcome measure, in this randomized clinical trial, researchers found that mesozeaxanthin supplementation in patients with nonadvanced AMD resulted in significant increases in macular pigment, as well as improvements in contrast sensitivity and other measures of visual function (AREDS Research Group). This suggests the potential augmented benefit of adding carotenoids to the management of dry AMD.  In the absence of a breakthrough, every incremental benefit may matter to our patients.

    References:

    AREDS Research Group. JAMA. 2013;doi:10.1001/jama.2013.4997.

    Holz FG, et al. JAMA Ophthalmol. 2018;doi:10.1001/jamaophthalmol.2018.1544.

    • Kuniyoshi Kanai, OD, FAAO
    • Director of residencies, on-campus programs,
      University of California, School of Optometry

    Disclosures: Kanai reports he is a consultant for EyePACS LLC and Fuji Optical Co. Ltd.