AREDS Supplementation and the Progression Towards Exudative AMD

Abstract

Age-related macular degeneration (AMD) is the third leading cause of blindness in the world and is a degenerative disease that is characterized by changes in the retinal pigment epithelium and Bruch’s membrane. These retinal findings can range from drusen and pigmentary changes to more advanced forms of the disease including RPE atrophy and/or choroidal neovascularization. Oxidative stress is thought to play a significant role in the development and progression of AMD. In support of this hypothesis, much has been published regarding the protective association between diets rich in antioxidants and the development of AMD. These findings led to the development of the Age-Related Eye Disease Study (AREDS). This study showed supplementation with antioxidants, and zinc had a 25 % reduction in the risk of progressing to advanced disease for those with intermediate AMD when compared with placebo. In addition to the AREDS findings, additional observational studies showed possible benefits of adding additional supplements to the original AREDS formula, leading to the AREDS2 study. Although the primary analysis of AREDS2 demonstrated no beneficial or harmful effects of adding lutein/zeaxanthin, secondary analysis did show a benefit of adding these carotenoids. This chapter reviews the findings from AREDS and AREDS2, with an emphasis on the AREDS supplementation and the development of choroidal neovascularization.