Nutritional Supplements for the Prevention of Wet Macular Degeneration

  • Reference Number: HEY-043/2017
  • Departments: Ophthalmology Department

Introduction

This leaflet has been produced to give you information about nutritional supplements, which can reduce the risk of developing advanced macular degeneration in some patients and to help you to decide whether you wish to take these supplements.

In 2001, the results of a large well conducted American study looking at the benefits of taking a combination of vitamins and minerals to prevent wet macular degeneration were published. This study was called the ARED (Age Related Eye Disease) study. Since then, there have been a number of commercially available preparations of different combinations of vitamins and minerals produced that claim to protect patients from developing wet macular degeneration.

A second study, called ARED 2 was published in 2013. This study aimed to see if there was an additional benefit of adding omega-3 fatty acids and/or the antioxidants lutein/ zeaxanthin to the original ARED formula. This study also removed beta-carotene (Vitamin A) from the formulation, as this has been linked with lung cancer in patients who smoke or previously smoked. The amount of zinc was also reduced. The ARED 2 study showed no additional benefit from the change in formulation, except in patients who had a diet that was very poor in lutein and zeaxanthin. Lutein and zeaxanthin are present in leafy green vegetables and in orange-coloured vegetables such as carrots, pumpkin and squash. It is likely the ARED 2 type formulation is safer in smokers and former smokers due to the removal of beta-carotene.

What were the results of the ARED and ARED 2 Studies ?

The ARED and ARED 2 studies found that taking a specific combination of vitamins and minerals at high levels every day, over an average of six years, reduced the risk of losing vision by 19% and of developing advanced macular degeneration by 25%. These supplements cannot cure macular degeneration or restore vision that has already been lost; however, they may prevent loss of vision in the long-term.

The ARED study found that people with a history of advanced macular degeneration in one eye are at high risk of developing wet macular degeneration in the other eye and benefited from taking these tablets. Your eye doctor will be able to tell you if you have these changes.

There was a smaller benefit for patients who had less advanced dry macular degeneration changes in both eyes in preventing progression to advanced macular degeneration. There was no benefit to people who had already lost vision in both eyes due to macular degeneration or in patients with very early macular degeneration. These supplements need to be taken long-term for the benefits to be obtained, possibly for the rest of your life.

Are there any side-effects or risks?

The tablets used in the study contained vitamins and minerals in much higher quantities than the standard recommended daily allowances (RDA). It is important to discuss this treatment with your GP first as there may be a risk of the vitamin supplements interacting with other medicines you already take, or you may have other health problems that would be affected by these supplements.

Most people in the ARED study had no side-effects. Some patients developed a slight yellowing of the skin.

Smokers and ex-smokers and those who have been exposed to high levels of asbestos should not take the original ARED type supplements as they contain beta-carotene, which has been linked to an increased risk of lung cancer in these groups. It is recommended that they should take a preparation without the beta-carotene (see below).

What did the ARED Study tables contain?

Copper was included to prevent a shortage of copper which may result from taking this dose of zinc.

What did the ARED 2 Study tables contain?

 

How do I get these supplements?

There are a large number of supplements containing different combinations of vitamins and other nutritional supplements available that claim to reduce the risk of damage to the vision from macular degeneration. At present there is no good scientific evidence that other supplements are effective at preventing loss of vision due to macular degeneration.

Vitamins and nutritional supplements are usually not available on an NHS prescription but can be bought over the counter.

PreserVision Original tablets (two tablets taken twice a day) or PreserVision Original Soft Gels (one capsule taken twice a day) have the same content as the ARED study.

PreserVision Lutein soft gels are equivalent to the ARED 2 study formulation and are therefore safe and effective for smokers and former smokers.

Patients living within the catchment area of the Hull Clinical Commissioning Group (CCG) can obtain ARED vitamin supplements (for non-smokers) on an NHS prescription via your GP IF RECOMMENDED BY AN OPHTHALMOLOGIST because you are at high risk of developing wet macular degeneration in your other eye, i.e. those with confirmed wet macular degeneration in one eye to prevent wet macular degeneration in the other eye.

If you live in other areas, this agreement does not apply and you would need to purchase the vitamins yourself, if you wished to take them.

There is evidence that patients with multiple large drusen (ageing spots at the back of the eye) in one or both eyes receive some protective effect against the development of wet macular degeneration by taking ARED type supplements. At the moment, the CCGs have not approved this treatment being prescribed in this situation on an NHS prescription, although it is possible, to buy these supplements over the counter.  The ophthalmologist you see in the clinic would be able to advise you if you would benefit from the treatment.

There is some evidence that eating a diet rich in green leafy vegetables may have a similar protective effect.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Ophthalmic secretaries on (01482) 605326 or 605356

 

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

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