Daily Supplements May Slow ‘Dry’ Form of Age-Related Macular Degeneration

• Dry age-related macular degeneration is an eye disorder that can lead to blindness. It affects millions of Americans.
• A formulation of over-the-counter antioxidant supplements appears to prevent the progression of the disease, even in its advanced stage, known as geographic atrophy.
• There is no cure for AMD, and current pharmaceutical options can be cumbersome and expensive.

A widely available formulation of antioxidant supplements appears to slow the progression of dry age-related macular degeneration (AMD).

Dry AMD is a common eye disorder in individuals aged 55 and over that causes blurred vision, and is a leading cause of legal blindness .

As its name suggests, the condition occurs naturally during aging and is more common in older individuals. It may have little to no effect on vision but may also progress to a more severe, vision-threatening form known as geographic atrophy .

Based on recent estimates, dry AMD is believed to affect nearly 20 million Americans aged 40 and older. However, less than one percent of them have a vision-threatening form of it.

There is no treatment to reverse damage from dry AMD. However, new evidence suggests that a cocktail of over-the-counter antioxidant supplements can slow progression of the disease significantly, even in individuals with geographic atrophy.

55% less disease progression over placebo

In an article published this month in the journal Ophthalmology , researchers from the National Eye Institute found that antioxidant supplementation slowed progression by as much as 55% over three years compared to a placebo.

“These findings are very significant as geographic atrophy affects approximately 5 million people worldwide and, up until recently, we had no treatments to prevent geographic atrophy occurring, slow its expansion, or restore vision to affected areas. The oral supplements have the advantages of a large treatment effect, excellent safety profile, ease of use, and low cost,” Tiarnan D. L. Keenan, BM BCh, PhD, a researcher in the Division of Epidemiology and Clinical Applications at the National Institute of Health’s National Eye Institute, and first author of the study, told Healthline.

Theodore Leng, MD , an Associate Professor of Ophthalmology at Stanford Medicine who wasn’t affiliated with the study, told Healthline, “This study was great because it really confirms some of our suspicions about vitamin supplementation in this specific form of advanced macular degeneration.”

Antioxidant cocktail shows promise

Researchers conducted a post hoc analysis of two major clinical trials that previously investigated the link between antioxidant supplementation and dry AMD progression. Those trials, known as AREDS and AREDS2 , honed in on six supplements believed to support eye health and slow disease progression:

• Vitamin C
• Vitamin E
• Copper
• Zinc
• Lutein
• Zeaxanthin

The original studies found that taking this combination of supplements reduced the risk of progression from intermediate to advanced AMD by one-fourth. However, there was nothing to suggest that the supplements would slow progression in individuals whose eyes had already advanced to geographic atrophy, the most extreme form of dry AMD.

Keenan and his team wanted to find out whether the AREDS2 supplement formulation could also help slow disease progression in individuals with the advanced form of the disease.

“Our study shows that the oral supplements have an important role even when geographic atrophy is present,” he told Healthline.

Specifically, they found that over a three year period, the eyes of individuals with geographic atrophy who took antioxidants showed 39.8 microns of disease progression, compared to 73.2 microns in the eyes of those who took a placebo. That’s 55% less progression simply by taking an antioxidant supplement.

Wet vs dry AMD

The vast majority, about 90% , of all cases of AMD are the dry form. However, about 10% of AMD cases may progress to another form, known as wet AMD.

Dry AMD is associated with the presence of large yellow protein deposits under the retina, known as drusen . These deposits damage a small but important area at the back of the eye known as the macula , which allows your eyes to precisely focus on objects in front of you. Dry AMD may progress, but doesn’t always, to geographic atrophy, which can cause permanent loss of vision.

“Imagine you have a camera or a computer screen and you have dead pixels on the screen. That area of dead pixels just expands slowly over time. That’s basically the patient’s experience who has geographic atrophy. They have areas of the retina that are dead or not functional and that area grows in a kind of concentric manner,” said Leng.

Sometimes, wet AMD may develop. Wet AMD or neovascular AMD, is defined by the abnormal presence of blood vessels under the retina that can cause swelling and bleeding. This bleeding and fluid accumulation are where the condition derives its “wet” moniker.

Wet AMD tends to be more severe, progresses more quickly, and always affects the central vision of the macula. It is always considered an advanced stage of AMD.

At this time, AREDS2 antioxidant supplements only appear to be beneficial for dry AMD, not wet.

“Individuals with geographic atrophy should benefit from the AREDS2 formulation supplement. In addition, our previous research has shown that a healthy diet (particularly a Mediterranean-type dietary pattern) and avoiding smoking are strongly associated with slower atrophy growth rates. So a healthy lifestyle is important alongside the supplements,” said Keenan.

The bottom line

A combination of antioxidant supplements known as AREDS2, which includes vitamin A, vitamin C, copper, zinc, lutein, and zeaxanthin, helps slow the progression of dry AMD, even in the advanced stage known as geographic atrophy.

A novel study found that compared to placebo, those taking the antioxidant formulation showed 55% less disease progression.

The supplements are not recommended for wet AMD, a less common but more severe form of AMD.