Dry Age Related Macular Degeneration – Oral Supplements, Which Combination and When ?

Abstract

Age related macular degeneration (AMD), a leading cause of visual loss in the elderly, is emerging as an important public health problem due to the increase in the ageing population. Dry AMD which is the more prevalent form has no effective treatment and so efforts are directed to slow down or prevent progression of retinal changes by optimizing the risk, factors for AMD. Oxidative stress in the retina has been identified as an important predisposing factor which can be most efficiently modified by nutritional supplementation. Two large randomized controlled trials namely AREDS (Age related eye disease study) 1 and 2 provided high quality evidence to support the use of vitamins and micronutrients in preventing the progression of disease, especially in those with intermediate or advanced AMD. Supplementation with oral antioxidants soon became the standard of care for dry AMD, both due to its perceived universal benefit and its cost effectiveness. Though a wide range of antioxidants are available in the market, hardly any of them contain ingredients recommended by AREDS in the correct dosage. It is therefore important that ophthalmologists should be equipped with proper information regarding these products and advise the patients appropriately after considering their individual needs. A comprehensive list of antioxidants available in our country is included in this article which can be used as a reference to guide the patients. Physicians should be familiar with AREDS recommendations and should select patients appropriately. Patient education to improve compliance and counseling regarding life style modifications are also important in controlling this public health problem.