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Could your eye vitamins be making macular degeneration worse?

Patients with AMD (Age-related Macular Degeneration), may currently be accelerating their condition by taking the wrong supplement.  Up to 65% of AMD patients using the AREDS formulation, currently the gold standard treatment for patients with intermediate AMD, may be on the wrong path depending on their personal genetics.  According to recent scientific work by Dr. Carl Awe, a vitreoretinal surgeon and leading author and advocate in clinical research on genetically guided therapy for AMD, a patients genetic makeup could have them speeding up their disease by 135% instead of slowing it down by taking an AREDS or AREDS 2 formulation.  

AREDS supplements containing anti-oxidants (vitamin E, C) as well as copper and zinc were postulated prognosis5-1.jpgand tested through a National Institute of Health funded study and further refined with a follow-up study, AREDS 2 in 2013.  This formulation has become the standard treatment for the dry form of the disease that millions of patients have been prescribed by ophthalmology and optometry since it was published.   Dr. Awe et al, over the last few years has discovered that applying genetic data to the original AREDS participants shows that although the "average" benefit of taking AREDS was demonstrated, the individual patients showed genotype-dependent responses.  Of particular concern from this was the response that some patients had a particularly 'bad reaction' to either zinc, anti-oxidants, or the combination thereof which put some patients at risk of advancing the disease.  There is also now some controversy over this subject between the 'genetically-guided' and the beholden 'AREDS' camps respectively.

Regardless, the findings are compelling and I am making my position clear that I believe the statistical strength of Dr. Awe's work moving enough for me to mark a change in the direction of care I deliver.  We have known for sometime that zinc can exacerbate certain retinal conditions and the upper daily limit by nutrition standards is 40mg, yet the AREDS calls for 80mg.  AREDS 2 showed no clinical difference in response to 80 mg vs. 25 mg yet, major AREDS supplement providers have remained at twice the recommended daily dose (their may be financially driven reasons for this).  This is but one point that has caused me to take pause in blanketing all patients with the same formula.

Current standard of care for all my AMD patients now involves providing patients with the option of a genetic test (cheek swab) that will match their genotype to the criteria derived from Dr. Awe's work and allow a specific formula for a patient to adhere to rather than the "AREDS for all" approach.  The age of personalized medicine is here and I believe it a professional responsibility to educate all patients on these new findings.   As scientists, we will differ in opinion and some eye care providers may choose to refute this new approach, which is reasonable and hopefully a result of significant due diligence.  It should be noted that both camps have conflicts of interest in this debate, however I will note that Dr. Awe has been up front about his, where as the NIH have been a bit quiet on this point.   All I can say is when a patients ask me what I would do if I had this disease....I answer without hesitation: in a heartbeat!

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