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Eye Education
Age Related Macular Degeneration (AMD)

Age related macular degeneration (AMD) is one of the most common causes of poor vision after age 60. AMD is a deterioration or breakdown of the macula. The macula is a small area at the center of the retina in the back of the eye that allows us to see fine details clearly and perform activities such as reading and driving.

The visual symptoms of AMD involve loss of central vision. While peripheral (side) vision is unaffected, one loses the sharp, straight-ahead vision necessary for driving, reading, recognizing faces, and looking at detail.

Although the specific cause is unknown, AMD seems to be part of aging. While age is the most significant risk factor for developing AMD, heredity, blue eyes, high blood pressure, cardiovascular disease, and smoking have also been identified as risk factors. AMD accounts for 90 percent of new legal blindness in the US.

Nine out of 10 people who have AMD have the dry form (called atrophic), which results in thinning of the macula. Dry AMD takes many years to develop. Currently there is no treatment for this form of AMD.

The wet form of AMD (called exudative) is less common (occurring in one out of 10 people with AMD), but is more serious. In the wet form of AMD, abnormal blood vessels may grow in a layer beneath the retina, leaking fluid and blood and creating distortion or a large blind spot in the center of your vision. If the blood vessels are not growing directly beneath the macula, laser surgery is the only proven effective treatment, to date, for wet AMD. The procedure usually does not improve vision but prevents further loss of vision. For those wet AMD patients whose blood vessels are growing directly under the center of the macula, a procedure called photodynamic therapy (PDT) may be used to treat some patients with fewer visual side effects than other treatments.

Promising AMD research is being done on many fronts. In the meantime, high-intensity reading lamps, magnifiers and other low-vision aids help people with AMD make the most of their remaining vision.



FAQ:

Who Should Take the AREDS Formulation?
People who are at high risk for developing advanced AMD should consider taking the combination of nutrients used in the study. Your eye care professional can tell you if you have AMD and are at risk for developing the advanced form of the disease. The doctor should give you a dilated eye exam in which drops are placed in your eyes. This allows for a careful examination of the inside of the eye to look for signs of AMD. Before taking these high levels of vitamins and minerals, you should talk with your doctor about the risk of developing advanced AMD and whether taking the AREDS formulation is right for you.
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What is the Dosage of the AREDS Formulation?
The specific daily amounts of antioxidants and zinc used by the study researchers were 500 milligrams of vitamin C; 400 International Units of vitamin E; 15 milligrams of beta-carotene (often labeled as equivalent to 25,000 International Units of vitamin A); 80 milligrams of zinc as zinc oxide; and two milligrams of copper as cupric oxide. Copper was added to the AREDS formulations containing zinc to prevent copper deficiency anemia, a condition associated with high levels of zinc intake.
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Can I Take a Daily Multivitamin if I Am Taking the AREDS Formulation?
Yes. A daily multivitamin contains many important nutrients not found in the AREDS formulation. For example, elderly people with osteoporosis need to be particularly concerned about taking vitamin D, which is not in the AREDS formulation. The AREDS formulation is not a substitute for a multivitamin. In the Age-Related Eye Disease Study, two-thirds of the study participants took multivitamins along with the AREDS formulation. If you are already taking daily multivitamins and your doctor suggests you take the AREDS formulation, be sure to review all your vitamins with your doctor before you begin.
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Can a Daily Multivitamin Alone Provide the Same High Levels of Antioxidants and Zinc as the AREDS Formulation?
No. The AREDS formulation's levels of antioxidants and zinc are considerably higher than the amounts in any daily multivitamin.
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Can Diet Alone Provide the Same High Levels of Antioxidants and Zinc as the AREDS Formulation?
No. The high levels of vitamins and minerals are difficult to achieve from diet alone. However, previous studies have suggested that people who have diets rich in green, leafy vegetables have a lower risk of developing AMD.
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Will Taking the AREDS Formulation Prevent a Person from Developing AMD?
No. There is no known treatment that can prevent the development of AMD. The study did not show that the AREDS formulation prevented people from developing early signs of AMD. No recommendation has been made for taking the AREDS formulation to prevent early AMD. Taking the formulation reduced the rate of advanced AMD in people at high risk by about 25 percent over a 6-year period. We do not know if this treatment effect will persist over a longer period. However, by continuing to follow the AREDS participants, we hope to find out if the treatment effect will last longer than six years.
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Where Can I Buy the AREDS Formulation?
You can purchase the AREDS formulation at drug stores, supermarkets, health food stores, and other retail outlets that sell pharmaceutical products. The vitamins and minerals can also be purchased separately; be certain to include copper whenever taking high levels of zinc. Taking beta-carotene is not recommended for smokers.
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Are There Any Side Effects from the AREDS Formulation?
Some AREDS participants reported minor side effects from the treatments. About 7.5 percent of participants assigned to the zinc treatments - compared with five percent who did not have zinc in their assigned treatment - had urinary tract problems that required hospitalization. Yellowing of the skin, a well-known side effect of large doses of beta-carotene, was reported slightly more often by participants taking antioxidants.
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Are Former Smokers at an Increased Risk for Developing Lung Cancer if They Take High Doses of Beta-Carotene?
Large clinical trials sponsored by the National Cancer Institute demonstrated that beta-carotene increases the risk of lung cancer in current smokers. In these trials, most of these smokers were heavy smokers. The only other large clinical trial evaluating beta-carotene was the Physicians Health Study (PHS). In the PHS, there was no evidence of increased cancer risk in those randomly assigned to beta-carotene, but few physicians were active smokers. There also was no evidence of an increased risk of lung cancer in former smokers. However, many studies suggest that former smokers maintain some increased risk of lung cancer for years after stopping smoking. Therefore, it is reasonable to expect that beta-carotene may also slightly increase their risk of cancer, at least for a period of several years. In deciding whether to include beta-carotene in a formulation designed to slow the development of advanced AMD, you and your doctor should balance the apparent increase in the risk of lung cancer associated with beta-carotene with the risk of AMD progression.
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What About Other Antioxidants Such as Bilberry and Lutein?
The AREDS did not study bilberry, lutein, or other antioxidants, so we don't know how they may affect eye disease. Future clinical trials may eventually provide answers about these or other antioxidants.
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Should Young People with Inherited Macular Degeneration Take the AREDS Formulation?
The AREDS only studied age-related macular degeneration. We have no recommendations for younger people with the inherited (juvenile) forms of macular degeneration.
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