AREDS2 Supplements and Geographic Atrophy Progression

—
Emily Chew, MD, explains how diet and key nutrients shape AMD management strategies

by
Greg Laub, Director, Video, MedPage Today

November 27, 2024

Post hoc analyses of the AREDS/AREDS2 studies presented at the recent American Academy of Ophthalmology meeting examined supplementation on the risk of geographic atrophy progression.

In this exclusive MedPage Today video, Emily Chew, MD, of the National Eye Institute in Bethesda, Maryland, discusses the pivotal role of diet and AREDS2 supplementation in slowing the progression of age-related macular degeneration (AMD), as well as insights from both landmark trials that continue to shape AMD management.

Following is a transcript of her remarks:

Of all the studies that we’ve done in medicine, we started this in 1992 with the Age-Related Eye Disease Study [AREDS], which was many years ago now. And we were interested in the natural course of macular degeneration and over the course of that we decided we should really look at some treatments.

During that period of time, there was a lot of interest in vitamins for heart disease and for cancer. So large doses were used to test this for early and intermediate macular degeneration. And to our surprise, it was actually a 25% reduction in the risk of progression of the disease to the late form. Now that sounds like not very much, but it’s a moderate effect. And what’s interesting is that because so many people are involved, the public health impact is actually pretty large.

So if you have intermediate AMD, you are advised to have a good diet, which means what we call a Mediterranean diet. And usually taking fish twice a week is what we found was really important. Eating lots of fruits and vegetables, is another part of the Mediterranean diet. Low on sort of the red meats and really high on fish and a little bit of chicken. A moderate amount of small/moderate amount of alcohol. But the other aspect, of course, is fruits and vegetables, which are really, really important.

And lutein, which is really found in green leafy vegetables, was found to be one of the most important aspects, along with omega-3 fatty acids, which is found in fish. That’s the reason why those two are really, really important.

So we tested, first of all the vitamin C, vitamin E, beta-carotene because that was what was tested for cancer and for cardiovascular disease. We were interested in lutein because we knew that was important. It’s found in the eye. We can’t make it, we have to eat it in green leafy vegetables. But unfortunately at the time, AREDS in 1992, it was not available commercially. So we tested later in AREDS2 study, which was a sequel to AREDS1. We found that lutein was also important. So that combination of lutein with vitamin C and E was important.

Beta-carotene during the course of the first study showed that unfortunately, people who were smokers had an increased risk of lung cancer. So for that reason we actually eliminated beta-carotene. And in our second study, the AREDS2 where we tested lutein, we also tested beta-carotene again but in people who were not cigarette smokers, but even if you were a former smoker, you had a risk of getting cancer. So for that reason, we completely eliminated beta-carotene. So lutein is really very important as part of the actual supplement.

And again, going back to the diet, we found that diet can reduce the risk of developing intermediate AMD. So if you have the early AMD, your risk of getting large drusen — which is your intermediate stage — was reduced by about 25%. So that’s nothing to be sneezed at. And even if you have intermediate AMD, you already have sort of the middle ground, and you eat a good diet that reduces your risk, especially for geographic atrophy.