At this year's Association for Research in Vision and Ophthalmology Annual Meeting, Emily Y. Chew, MD, presented the 5-year AREDS2 data. The original AREDS study established that antioxidants, zinc supplements, or a combination of both can result in a reduction in risk for age-related macular degeneration (AMD) progression in patients at high risk, such as those with intermediate AMD, defined as drusen 63 μm or larger or at least 1 large drusen 125 μm and larger, or those with neovascular AMD or geographic atrophy in the fellow eye. The AREDS2 study authors sought to answer the question of whether lutein and zeaxanthine, which have been shown to be structural components of macular pigment, and omega-3 fatty acids, which are important components of photoreceptor membranes and modulators of inflammation, have a preventative effect in regard to AMD progression when added to the AREDS formula.

In this issue's Retina News section, we provide a full report of the data that were presented. Among the key points: (1) omega 3 fatty acids in this study population given as a 1-gram dose do not appear to have any beneficial effect on preventing progression to wet AMD; and (2) lutein and zeaxanthine, although showing no statistically significant advantage for preventing AMD progression, are reasonable substitutes for beta carotene in the original AREDS formula due to the increased risk of lung cancer associated with beta carotene.

When the results were announced, there was initial disappointment regarding the lack of significant effect of lutein and zeaxanthine and omega-3. However, the report notes that patients who were enrolled in AREDS2 were more educated and better nourished than the general population, which could skew these results; because this study group was more well nourished than our general patient population, it may be that omega-3 and lutein and zeaxanthine intake supplementation could have beneficial effects in our clinics. Certainly, there were no safety concerns from their use in AREDS2.

Clinical trial study populations, in general, tend to be more educated and of a higher socioeconomic background and are thus assumed to be more healthy than average, so the lutein and zeaxanthine may play a more significant role in preventing AMD progression than is seen within the confines of this study. It is also possible that the study investigators may have underdosed the omega-3 supplements at only 1 gram daily, as many of the cardiovascular studies that show benefit dose at 2 grams daily or higher. This idea is supported by the plethora of wide-ranging epidemiological data of general populations and study populations around the world showing that fish consumption is directly related to decreased rates of vascular disease including AMD.

So what do we tell our patients? Don't smoke, control your blood pressure, and get regular physical cardiovascular activity such as walking 30 minutes daily. Eat a variety of colors of fruits and vegetables and consider natural sources of omega-3 fatty acids such as tuna and wild salmon. Reasonable supplement recommendations include the new AREDS2 formulation.

Like any well-executed study, AREDS2 answers many questions but raises many others for us to address on behalf of our patients.