For many patients diagnosed with macular degeneration, an important part of their treatment has to do with the AREDS 2 study. (Age-Related Eye Disease Study 2, www.areds2.org) This article explains the AREDS 2 Study, how the study was conducted, and why it is so important for those patients diagnosed with macular degeneration and their families.
AREDS 2 was a multi-center trial designed to assess the effects of oral supplements of high doses of macular xanthophylls (also known as lutein and zeaxanthin), and omega- 3 LCPUFAs (DHA and EPA) for the treatment of age-related macular degeneration and cataracts.
What is xanthophyll? Xanthophylls are yellow pigments that occur widely in nature and form one of two major divisions of the carotenoid group; the other division is formed by the carotenes. The carotenoid pigments, including lutein and zeaxanthin, are produced by green algae, and are found in the highest quantity in green, leafy vegetables and plants. The xanthophylls found in the bodies of animals, and in dietary animal products, are ultimately derived from plant sources in the diet. For example, the yellow color of chicken egg yolks, fat, and skin comes from ingested xanthophylls (primarily lutein, which is often added to chicken feed for this purpose). The yellow color of the human macula lutea in the retina of the eye results from lutein and zeaxanthin. It contains both xanthophylls, again requiring a source in the human diet to be present in the eye. These xanthophylls protect the eye from ionizing blue and ultraviolet light, which they absorb. These two specific xanthophylls do not function in the mechanism of sight since they cannot be converted to the retina.
What is Omega-3 LCPUFAs? Long-chain polyunsaturated fatty acids, known as “good fats,” because they are required for normal growth to support immunity, and can improve cardiovascular and brain health. DHA is the primary structural fat in the brain, retina of the eye, and a key component of the heart. Many studies have shown that DHA and EPA omega-3 are critical for the infant brain, eye heath, and nervous system development.
Why are Omega 3s so special? It has been found that these supplements can lower your triglycerides, which high levels of blood fat can cause heart disease. They boost the effectiveness of anti-inflammatory drugs, help boost the effectiveness of anti-depressant drugs and help with symptoms of bipolar disorder. Omega 3s improve lung function, improve mental skills for people with ADHD, and they have a positive effect on gradual memory loss linked to aging, such as Alzheimer’s disease and dementia.
Omega 3s are found in fatty fish, such as tuna and salmon, walnuts, flaxseed, canola and soybean oils. While foods containing omega 3 fatty acids have health benefits, some can be high in calories. Over the counter supplements can be a great option. The AREDS study showed those who eat fish were less likely to have AMD than those who did not. It also showed that for those who eat fatty fish once a week, it would cut the risks of AMD in half. But, be careful to choose fish with low levels of mercury.
The National Eye Institute released the findings of the AREDS 2 study in May 2013. The 4,203 participants randomly received either the supplement or a placebo. The individuals were chosen at random. Serum levels of lutein and zeaxanthin and the dietary habits of the participants were measured. At the end of the study, they looked at the development of advanced AMD, progressive vision loss, and safety of the supplements. The AREDS study found that a combination of antioxidant vitamins plus zinc help with slowing the progression of intermediate macular degeneration to an advanced stage. The study discovered that this combination reduced the risk of progression to advanced macular degeneration from 50-70%.
Macular degeneration can be passed genetically in families. Particular genes studied were identified as possible risk factors for the disease. Some of the genes are involved in transporting and processing high-density lipoprotein, also known as “good cholesterol,” and genes that have been associated with other forms of macular disease.
Of course, there are other factors that can increase a patient’s risk of macular degeneration, which includes overall health, circulation, diet, and smoking. Always be aware of your patient’s family history, and educate your patients on the risk if the disease runs in their families.
Linda Hardy received the American Optometric Association Paraoptometric of the Year Award at the 2016 SECO meeting in Atlanta, Georgia. Linda is a Certified Optometric Technician (COT) and Certified Ophthalmic Assistant (COA). She is also ABO and NCLE certified and a Licensed Dispensing Optician (LDO) in the state of Georgia.
A graduate of Georgia Medical Institute as a Registered/ Certified Medical Assistant, Linda began her optical career working with a group of ophthalmologists as an ophthalmic assistant. She has been the Clinical Coordinator with a private optometry practice in Newnan, Georgia for 15 years.
Linda is also a speaker and educator at regional optical meetings. She and her husband have five children, and she enjoys spending time with her family, exercising, reading and volunteering in her community.