Multivitamins and the Eye

Damien Luviano, MD

#1 reason people over age 65 loose vision

Damien Luviano, MD, FACS2

March 14 in the Archives of Ophthalmology

The women were US healthcare professionals 45 years or older in 1993 who did not have a baseline history of cardiovascular disease or cancer and who were then assigned to aspirin, vitamin E, both, or neither

Among 38,022 women who completed the baseline food frequency questionnaire without a prior diagnosis of AMD, there were 235 cases of AMD at 10 years of follow-up.

Included were participants of the Women's Health Study, a randomized trial of low-dose aspirin and vitamin E for the primary prevention of cardiovascular disease and cancer.

Higher intakes of DHA and EPA are associated with 36% to 38% lower risk for AMD.

Consumption of tuna and dark fish at least once per week vs intake of less than once per month is associated with a lower risk for AMD.

CME: http://www.medscape.org/viewarticle/739316

3Damien Luviano, MD, FACS

Salisbury Eye Evaluation (SEE) Study participants

A random sample of 2520 Salisbury, Maryland, residents aged 65 to 84 years.

There was no relationship of AMD with intake of crab and oysters combined, each of which has high levels of zinc.

Those with advanced AMD (CNV or GA) were significantly less likely to consume fish/shellfish high in omega-3 fatty acids

These data support a protective effect of fish/shellfish intake against advanced AMD.

Source: http://www.ophsource.org/periodicals/ophtha/article/S0161-6420(10)00377-5/abstract

CME: N/A


December 13 in the Archives of Ophthalmology.

The study sample consisted of 1313 women, aged 55 to 74 years, enrolled in CAREDS

The goal of the study was to evaluate the associations between lifestyle behaviors of diet, smoking, and physical activity with subsequent AMD prevalence

However, the combination of 3 healthy behaviors (healthy diet, physical activity, and not smoking) was associated with 71% lower odds for AMD vs having high-risk scores

CME: http://www.medscape.org/viewarticle/734537


Age Related Eye Disease Study The formulations included: vitamin C (500 mg);

vitamin E (400 International Units [IU]);

beta-carotene (15 mg);

zinc (80 mg of zinc oxide); and

copper (2 mg of cupric oxide).

CME: http://www.medscape.org/viewarticle/578905_2

moderate reduction in the risk of developing advanced AMD over a median of 6.3 years of follow-up in persons at high risk.[7]

Specifically, the risk for progression was reduced by 25% for the entire study population (Categories 2-4)

and 34% for the population of patients with Categories 3 or 4 AMD.

The overall risk for moderate vision loss (decrease of 15 or more letters on the logarithmic chart compared with baseline) was reduced by 19% at 5 years.

For persons with early AMD, however, the AREDS-type supplements did not prevent progression from Category 2 to Category 3

During the course of AREDS, supplementation of beta-carotene was demonstrated to increase the risk for lung cancer and its associated mortality in smokers.[8,9]

Currently, the AREDS formulation is not recommended for smokers.

AREDS does NOT affect development or progression of cataract

analyses from AREDS and other studies using similar doses of vitamin E showed that there was no increased risk for mortality.[16] Analyses of 5-year mortality rates in AREDS also demonstrated no increased risk in those participants randomized to high-dose antioxidant vitamins and zinc


STUDY GROUPS

Original AREDS formulationvitamin E (400 International Units [IU])beta-carotene (15 mg);zinc (80 mg of zinc oxide); andcopper (2 mg of cupric oxide).

minus beta-carotene;

with 40 mg of zinc

without beta-carotene and with 40 mg zinc

plus Xannthophylls (lutein at 10 mg/day + zeaxanthin at 2 mg/day)

Plus omega-3 LCPUFAs, DHA 350 mg, and eicosapentaenoic acid (EPA) 650 mg


Approximately 4000 participants aged 50-85 years with either bilateral large drusen or large drusen in one eye and advanced AMD in the fellow eye are currently enrolled

The primary objective of AREDS2 is to determine whether oral supplementation with macular xanthophylls (lutein at 10 mg/day + zeaxanthin at 2 mg/day) and/or omega-3 LCPUFAs, DHA 350 mg, and eicosapentaenoic acid (EPA) 650 mg, will decrease the risk for progression to advanced AMD.

AREDS2 will also study the effects of these nutritional supplements on moderate vision loss and on the development of cataracts.

Patients who are smokers should avoid taking beta-carotene

At the conclusion of AREDS2, which is not expected Until 2012 at least, we will have more data to address the effects of vitamins, minerals, and omega-3 LCPUFAs for the therapy of AMD


Direct association between the homocysteine level in the blood and risk of AMD16-23 and from the demonstration in intervention studies that treatment

with folic acid and B vitamin supplements could lower homocysteine levels

objective was to examine the incidence of AMD in a trial of combined folic acid, pyridoxine hydrochloride (vitamin B6), and cyanocobalamin (vitamin B12) therapy.

(2.5 mg/d), pyridoxine hydrochloride (50 mg/d), and cyanocobalamin (1 mg/d) vs Placebo

5442 female health care professionals 40 years or older with preexisting cardiovascular disease or 3 or more cardiovascular disease risk factors

After an average of 7.3 years of treatment and follow-up

statistically significant 35% to 40% decreased risk of AMD. The beneficial effect of treatment began to emerge at approximately 2 years of follow-up and persisted throughout the trial.

Source: http://archinte.ama-assn.org/cgi/content/full/169/4/335#IOI80186F2


The sample size was 1313 women, of whom 1287 without AMD were analyzed.

In women older than 75 years, there is an increased risk for early AMD, with higher vitamin D levels reflecting higher mortality and mortality bias in this age group.

Among women younger than 75 years, there is a lower risk for early AMD with higher vitamin D levels, with a threshold effect at 38 nmol/L serum 25(OH)D.

The authors concluded that vitamin D levels of 38 nmol/L and higher in women younger than 75 years were associated with reduced risk for early AMD.

CME: http://www.medscape.org/viewarticle/740922?src=cmemp


#1 reason in the world for blindness #1 surgery performed in the United States #1 eye surgery performed in the United

States


Four thousand five hundred ninety individuals with at least one natural lens and photographic follow-up (median, 6.3 years) were assessed for development or progression of lens opacities.

Observational data from the AREDS and other studies suggest that use of a multivitamin may delay the progression of lens opacities.

Source: http://www.ncbi.nlm.nih.gov/pubmed/16877067


• November 8 issue of Archives of Ophthalmology

• Study participants were male physicians age 50 years or older.

• 11,545 men provided data for study analysis. The mean age of participants was 62 years, and nearly 60% of subjects had never smoked cigarettes

• Neither vitamin C nor vitamin E supplements were more effective than placebo in the prevention of cataract in the current study of male physicians.

• CME: http://www.medscape.org/viewarticle/732166


The formulations included: vitamin C (500 mg);

vitamin E (400 International Units [IU]);

beta-carotene (15 mg);

zinc (80 mg of zinc oxide); and

copper (2 mg of cupric oxide).


moderate reduction in the risk of developing advanced AMD over a median of 6.3 years of follow-up in persons at high risk.[7]

Currently, the AREDS formulation is not recommended for smokers.

AREDS does NOT affect development or progression of cataract


Number one reason patients age 25-65 loose vision

Number one reason patients loose kidney function

Number one reason patients loose limbs


232,007 met inclusion criteria for this study.

14,130 cases of diabetes were diagnosed after 2000.

Of the 232,007 participants, 72,577 (53.6%) of men and 62,296 (64.5%) of women took multivitamin supplements.

In older persons, multivitamin use is not associated with a reduced risk for diabetes.

In older persons, intake of vitamin C and calcium supplements is associated with a reduced risk for diabetes, although further research is needed to confirm the association.

CME http://www.medscape.org/viewarticle/731777


• AREDS Vitamins any brand for Age related macular Degeneration patients who do not smoke

• PCP to consider Centrum multivitamins for any patient to delay the onset of cataract formation

• Omega-3 in the form of dark fish for patients who are at risk for macular degeneration such as family history, women, light colored eyes

• Folic acid, pyridoxine hydrochloride (vitamin B6), and cyanocobalamin

(vitamin B12) therapy

Exercise is good for macular degeneration

Smoking is bad for macular degeneration

Multiple life changes prolong life and improve health of all organs including the eyes and sight


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Multivitamins and the Eye