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  • By Alma Murphy, MD
    Comprehensive Ophthalmology

    This article reports the secondary outcomes of a randomized, double-masked clinical trial of oral carotenoids with antioxidants versus placebo in early AMD. This study, known as the CARMA trial, showed a statistically significant benefit in BCVA at 24 and 36 months of follow-up -- an improvement not seen in the previously reported 12-month follow-up. In addition, in terms of morphological severity, AMD progressed slower in participants taking the supplement.

    Subjects included 433 adults ages 55 years or older with early AMD in one eye and late-stage disease in the fellow eye (group 1) or early AMD in both eyes (group 2). The supplement consisted of a total daily dose of 12 mg lutein, 0.6 mg of zeaxanthin, 15 mg of vitamin E, 150 mg of vitamin C, 20 mg of zinc oxide, and 0.4 mg of copper gluconate. 

    The authors state this preparation is available under the brand name Ocuvite in Europe. Ocuvite lutein and zeaxanthin are the supplements available in the U.S. that I found to be the closest to the ingredients listed in the article. 

    BCVA at 36 months was 4.8 letters better in the supplement group than in the placebo group. Furthermore, macular pigment, as measured by Raman spectroscopy, declined steadily over time in the placebo group but rose in the supplementation group. The authors write that this decline in macular pigment over time in eyes with AMD has not been reported previously and is consistent with the loss of photoreceptors in association with this disease because macular pigment is housed in the photoreceptors and their axons.

    They note that although the CARMA study was not powered to detect differences in the development of late features of AMD, some 16.5 percent of eyes progressed to either geographic atrophy or choroidal neovascularization. However, eyes in the supplementation group progressed at a slower rate compared with the placebo group.

    The findings of the CARMA trial support the use of carotenoid and antioxidant supplementation in early AMD.