ANTIOXIDANTS & AMD
Dr AJAY I DUDANI
ZEN EYE CENTRE
MUMBAI
AREDS
AREDS demonstrated beneficial effects of high
dose antioxident vitamin and mineral
supplementation in decreasing the risk of
advanced ARMD.
R.C.T.=4757 participants 55-81 yrs. 11 centers.
ARES Stereoscopic Color Macular
Photos.
Cat1 Few Small Drusen
Cat2 Extensive small Drusen or non extensive
intermediate drusen
Cat3 Extensive intermediate drusen, one large
drusen or non central Geographic atrophy.
Cat4 Unilateral Advanced AMD or Vision Loss
worse than 20/32
ANTIOXIDANTS
Vitamin C
watersoluble antioxidant
Vitamin E
-tocopherol ( lipid soluble antoxidant )
Carotenoids
& - carotene, Lutein / zeaxanthin
(- quenches singlet O)
Zinc
AREDS study
Age Related Eye Disease Study.
Report no 8, Arch of Ophthalmology
-Vit C 500 IU
-Vit E 400 IU
- carotene 15 mg
-Zinc oxide 80 mg with 2mg of Cupric Oxide
-Lutein + Zeaxanthin
AREDS
Antioxidants + Zinc effective in preventing
progression of intermediate AMD to advanced
AMD -25-30 % benefit
But no to early AMD - no apparent benefit
Vitamin C, E, ß-carotene
INDICATIONS OF AREDS
Extensive intermediate size drusen
1 large drusen
geographic atrophy in 1 or both eyes
1 eye lost in AMD
CI FOR ANTIOXIDANTS
Smoking
Dementia
Macular pigment
Lutein
Zeaxanthin
protects macula- filtering blue light, scavenging
free radicals
Micro-nutrient supplementation
Macular Xanthophylls, leutin And Zeaxeatin –
present in spinach,Collard greens & Kale.
25% of total retinal carotenoids – in Rod outer
Seg. To protect from oxidative damage from U.V.
Light
Omega 3 long Chain PUFA -– is a major
structural lipid in sensory Retina –Present in Fish
Is a part of docosahexanoic acid.- essential role
in vision.
Micro-nutrient supplementation
Higher intake of both Lutein and Zeaxanthin &
Omega 3 LCPUFAs are Associated with
decreased risk of wet ARMD and Geographic
Atrophy
New From AREDS
AREDS DEATHS 11%
Mortality increase severity of Macular disease.
Zn- beneficial to decrease mortality
Vn worse than 20/40 = increase risk
AMD Cat4 Associated with CVS deaths.
Neoplasms 31%
DIET
Egg yolk,maize, kiwi, red grapes, pumpkin,
spinach(palak), cucumber, peas, orange juice
AMD
Reactive oxygen
OH , singlet oxygen
lipid deoxidation of cell wall & DNA
O & Blue light Macular oxidation