Our Readers Want to Know: Can You Tell Me More About Nutritional Supplements for Age-Related Macular Degeneration?

Editor’s note: One of the many benefits associated with an online information center and website, such as VisionAware, is the ability to track readers’ search terms [i.e., information readers are seeking as they search the Internet] as well as answer specific reader inquiries via email. Every month, questions about macular degeneration (AMD), including risks, treatments, and helpful resources, consistently rank among the top inquiries:

  • I am 76 years old and have dry AMD in my left eye and wet in the other, first diagnosed in 2009. Can supplements help me or am I wasting my money?
  • I am currently using [a pharmacy chain’s brand] AREDS Eye Health Multivitamins for age-related macular degeneration in both eyes. Is there another – or different – supplement I should be taking?

An Answer from Lylas G. Mogk, M.D.

Lylas G. Mogk, MD

Dr. Mogk is the is the author of Age-Related Macular Degeneration (AMD) on the VisionAware website; founding director of the Center for Vision Rehabilitation and Research, part of the Department of Ophthalmology at the Henry Ford Health System in Michigan; and co-author, with her daughter Marja Mogk, Ph.D., of Macular Degeneration: The Complete Guide to Saving and Maximizing Your Sight.

She is the former chair of the American Academy of Ophthalmology Vision Rehabilitation Committee; current chair of the Michigan Commission for the Blind, the advisory body for the Michigan Bureau of Services for Blind Persons; and Board member of the National Accreditation Council for Blind and Low Vision Services. She speaks regularly to physicians, vision rehabilitation specialists, occupational therapists, and community organizations nationwide about AMD and vision rehabilitation.

The First Age-Related Eye Disease Study (AREDS)

The first Age-Related Eye Disease Study (AREDS) was a major clinical trial sponsored by the National Eye Institute to:

  • Learn more about the history of, and risk factors for, age-related macular degeneration (AMD) and cataract;
  • Evaluate the effect of high doses of antioxidants and zinc on the progression of AMD and cataract.

Results from the first AREDS trial, which were reported in October 2001, indicated that five years of supplementation with high doses of antioxidant vitamins, copper, and zinc reduced the risk of developing advanced AMD in 30% of individuals in the study who took the supplements and had already-existing moderate to advanced dry or wet AMD.

The original AREDS formulation included:

  • 500 milligrams (mg) of vitamin C
  • 400 international units of vitamin E
  • 15 mg beta-carotene (for non-smokers only)
  • 80 mg zinc as zinc oxide
  • 2 mg copper as cupric oxide (to avoid anemia with high zinc intake)

The Second Age-Related Eye Disease Study (AREDS2)

In May 2013, The National Eye Institute concluded the Age-Related Eye Disease Study 2 (AREDS2), which tested several changes to the original AREDS formulation:

  • The primary goal of the AREDS2 study was to determine if (a) adding omega-3 fatty acids or (b) lutein and zeaxanthin (the anti-oxidants found in dark green leafy vegetables) to the original AREDS formulation would make it more effective for reducing the risk of advanced age-related macular degeneration (AMD) and cataract.
  • The AREDS2 research group also substituted lutein and zeaxanthin for beta-carotene, which prior studies had associated with an increased risk of lung cancer in smokers.

The researchers concluded that while omega-3 fatty acids had no effect on the formulation, lutein and zeaxanthin together appeared to be a safe and effective alternative to beta-carotene. Therefore, the addition of lutein and zeaxanthin to, and the subtraction of beta carotene from, the AREDS supplement formula was recommended by AREDS2.

The AREDS2 formulation now includes:

  • 500 milligrams (mg) of vitamin C
  • 400 international units of vitamin E
  • 80 mg zinc as zinc oxide
  • 2 mg copper as cupric oxide (to avoid anemia with high zinc intake)
  • 10 mg lutein
  • 2 mg zeaxanthin

Be sure to talk with your doctor before adding any nutritional or vitamin supplements to your diet. If you don’t have AMD and wish to take nutritional supplements, take a good multiple vitamin/mineral combination with additional lutein and omega-3 fatty acids. The AREDS formula is not recommended for persons who do not have macular degeneration because it contains a high dose of zinc.

A Cautionary Note, However

There is some new evidence that individuals whose AMD progression is slowed by the AREDS supplements were of a particular genetic makeup and that the supplements may speed AMD progression in those with a different genetic makeup.

This has prompted some scientists to call for genetic testing of everyone with macular degeneration before prescribing supplements, but the evidence is not sufficient for all scientists to agree on this. Individuals should discuss this with their own eye care specialists.

Something New: Mesoxanthin and MacuHealth

John Nolan, Ph.D., came from Ireland to speak at our hospital by invitation of the MacuHealth company and I found his research to be very solid and convincing. While the MacuHealth company paid for his research, Dr. Nolan stated that he agreed to do the research only on the basis that he would publish his findings no matter what they revealed.

What he showed was that another cousin of lutein and zeaxanthin named “mesoxanthin” is actually the most active of the three specifically in the macula and that the combination of lutein, zeaxanthin, and mesoxanthin is what’s needed. That’s what the MacuHealth supplement contains.

Mesoxanthin has not heretofore been commercially available and the MacuHealth company now has the sole right to manufacture and distribute it. It has not been subjected to a randomized, masked clinical trial, so whether – and to what degree – it may be helpful is unknown. It is unlikely to do harm, however, and the research suggests that it may help.

Additional Information about Macular Degeneration