• Written By: Chirag P. Shah, MD, MPH

    The results of this and related studies suggest that the addition of lutein/zeaxanthin to Age-Related Eye Disease Study (AREDS)-type supplements could be more appropriate than beta carotene and could reduce the risk of wet AMD.

    This article presents AREDS-2 results examining the effect of lutein/zeaxanthin supplementation on the progression to late AMD. These subanalyses suggest there is a benefit to lutein/zeaxanthin supplementation in reducing the risk of wet AMD but not of central geographic atrophy.

    The original AREDS formulation consisting of vitamin C, vitamin E, beta carotene and zinc reduced the five-year risk for developing late AMD in people at risk by an estimated 25 percent. Because beta carotene has been reported to increase the risk for lung cancer in cigarette smokers, a version of the AREDS formulation without beta carotene was tested in AREDS2.

    Lutein and zeaxanthin are of interest because they are the major components of the macular pigment and may serve a variety of functions, including filtering of presumably damaging blue and ultraviolet light and providing antioxidant capability. However, lutein was not commercially available at the start of the AREDS study.

    The AREDS2 study was a multicenter double-masked randomized trial with 4,203 participants at risk for developing late AMD followed for a median of 4.9 years. The researchers compared the original AREDS formulation without beta carotene but with lutein/zeaxanthin to the AREDS formulation with beta carotene and without lutein/zeaxanthin and found decreased progression to wet AMD in the lutein/zeaxanthin group (P = 0.01). However, there was no effect on central geographic atrophy (P = 0.67).

    These results remained consistent even when the lutein/zeaxantin group took beta carotene (P = 0.002 for wet AMD). For a subgroup of patients with bilateral large drusen, there was less risk of wet AMD among those taking lutein/zeaxanthin (P= 0.01).

    Despite reducing the risk of wet AMD, lutein/zeaxanthin supplementation did not affect visual loss when subjects took AREDS with beta carotene. However, when comparing lutein/zeaxanthin plus AREDS without beta carotene to AREDS plus beta carotene, the lutein/zeaxanthin group had less visual loss.