Eyeworld

EW RETINA 18 January 2011 by Maxine Lipner Senior EyeWorld Senior Contributing Editor Supplement issues: low adherence to AREDS' guidelines AMD sufferers ill-informed about AREDS' recommendations J ust 43% of AMD patients, who could benefit from vi- tamin supplementation as recommended by the Age- Related Eye Disease Study (AREDS), are actually taking these supplements, according to Bradley S. Hochstetler, M.D., cornea fellow, Wilmer Eye Institute, Johns Hopkins University, Baltimore. In the Sep- tember 2010 issue of Retina, Dr. Hochstetler reported study results that delved into current adherence to AREDS' findings. "AREDS recommended vitamin supplementation for patients who demonstrated intermediate or ad- vanced macular degeneration in at least one eye," Dr. Hochstetler said. "In patients with those findings, for which taking a vitamin was recom- mended, the AREDS' study showed a 27% reduction in progression to ad- vanced macular degeneration in those who did take the vitamins." The specific AREDS formulation recommended included 500 mil- ligrams of vitamin C, 400 IU units of vitamin E, 80 milligrams of zinc, 2 milligrams of copper, and 15 mil- ligrams of beta carotene. Surveying AMD patients One of the study investigators, In- grid Scott, M.D., Hershey, Pa., won- dered just how many of the patients that she was seeing with macular de- generation were adhering to recom- mendations and taking this formulation. She saw the implica- tions as far reaching, according to Dr. Hochstetler. "The public implica- tions are pretty substantial when you consider a 27% reduction in progression," he said. Included in the study were 64 consecutive AMD patients who came to the retina clinic. "If some- one had told them that they had macular degeneration, they were given the survey," Dr. Hochstetler said. "After the survey was com- pleted, the patients were seen by a retina specialist who determined the level of macular degeneration that was present based upon the AREDS criteria." Investigators found that only 43% of those that met the AREDS criteria were using the recom- mended vitamin supplements. All of those on the supplements had been advised to do so by a retina specialist and were returning patients to the retina center. Communication breakdown Of those who said that they were not taking the supplements, three- fourths claimed that no one had ever mentioned these to them. "One of the things that was interesting in our study is that we asked patients who met this criteria and who weren't taking the vitamins why they weren't," Dr. Hochstetler said. "Seventy-five percent of those pa- tients said that no one had ever told them that this would be beneficial to them." Investigators viewed that as fairly significant. This response took investigators by surprise. It was unlike the re- sponses reported in other studies, such as an Australian one conducted by W.T. NG, published in the Janu- ary/February 2006 issue of Clinical and Experimental Ophthalmology, which implicated cost. In that study 53% of patients were aware that they should be taking vitamins but just 38% were taking them. "Patients tended to list cost as the reason that they didn't adhere to the recom- mendations, but that was not a find- ing of our study," Dr. Hochstetler said. "No patients here listed cost as a reason." Instead, patients indicated that they had not been informed. Dr. Hochstetler hopes that with this study, all ophthalmic practition- ers will keep the AREDS' recommen- dations in mind when dealing with AMD patients. "I think it's a re- minder that this is a fairly simple in- tervention in patients with macular degeneration," he said. "If there are 27% of these people that we can pre- vent from progressing to advanced macular degeneration, the actual im- pact is pretty significant in terms of saving and preserving vision in those patients." Overall, he would like to see the study serve as a reminder to general ophthalmologists and other non- retinal specialists, who may be treat- ing macular degeneration patients and not referring them to retinal specialists, of the importance of tak- ing supplements. "Recommending their use is a good way to serve [AMD] patients the best," Dr. Hochstetler said. EW Editors' note: Dr. Hochstetler has no fi- nancial interests related to his com- ments. Contact information Hochstetler: 410-955-5491, bhochst1@jhmi.edu The power of omega-3 fatty acids A recently published study helps to bolster the claim that a seafood diet rich in omega-3 fatty acids may help slow advanced macular degeneration, the leading cause of blindness in older adults. Salisbury Eye Evaluation (SEE) study author Bonnielin Swenor of the Wilmer Eye Institute at Johns Hopkins School of Medi- cine in Baltimore reported the findings in the December issue of Ophthalmology. The cross-sectional study of dietary and ophthalmologic data took a random sample of 2,520 Salisbury, Md., residents ages 65 to 84. A food frequency questionnaire was used to estimate weekly fish/shellfish consumption for each participant over the course of one year. Fundus photographs obtained at baseline and graded by two masked readers for drusen size, retinal pigment epithelium abnormalities, geographic atrophy and choroidal neovascularization, were used to determine AMD status. The research found that most participants averaged at least one serving of fish or shellfish a week, but those who had advanced AMD (CNV or GA) were "significantly less likely to consume fish/shellfish high in omega-3 fatty acids (odds ratio 0.4; confidence in- terval, 0.2–0.8)." The study also explored whether dietary zinc from crab and oyster consumption had an impact on AMD progression, but no significant relationship was found. This research may lend credence to other studies, including the major clinical trial Age-Related Eye Disease Study (AREDS), that looked at omega-3 fatty acids and other nu- trients as sources to protect against AMD. The Johns Hopkins study does not prove eating fatty fish will cut the risk of develop- ing exudative AMD, but it does add to the growing evidence that those who consume larger amounts of fish have lower rates of the disease and that the dietary practice of con- suming omega-3 fatty acids may affect the development or progression of AMD.

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