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February is Age-Related Macular Degeneration Month

Vitamin Supplements for Age-Related Macular Degeneration

By Randall L. Funderburk, MD

February is Age-Related Macular Degeneration awareness month. Age-related macular degeneration affects millions of people and is the most common cause of vision loss for patients aged 50 or greater in the U.S. The atrophic (“dry”) form is the most common type we practitioners encounter. As there is no proven therapy at this time for the atrophic form, we typically advise observation, Amsler grid testing, healthy lifestyle, and AREDS2 vitamins. We recently reported in this newsletter the findings of the National Eye Institute regarding this latest formulation of “eye vitamins.”
Earlier this month, the New York attorney general’s office accused four major retailers – GNC, Target, Walgreens, and Walmart – of selling fraudulent herbal supplements and demanded that the products be removed. Tests reportedly found that four out of five products did not contain any of the herbs on their labels. Some of the products contained absolutely none of the listed herbs, while others contained powdered rice, beans, houseplant components, etc.
Under the Dietary Supplement Health and Education Act of 1994, dietary supplements are not evaluated or regulated for efficacy or safety. Approval from the Food and Drug Administration is not required for manufacturers to market dietary supplements. The FDA requires that companies verify that every supplement they manufacture is safe and accurately labeled. But the system essentially operates on the honor code. Supplements are exempt from the FDA’s strict approval process required for prescription drugs.
So what does this have to do with AREDS2 supplements? The various manufacturers of these vitamins have no more oversight than do the makers of the herbal supplements. Yong et al published a study (Ophthalmology, November 2014) comparing ingredients contained in 5 top-selling brands of ocular nutritional supplements with the AREDS and AREDS2 formulae to investigate the validity of claims made by the manufacturers. The ingredients and manufacturer claims of 11 ocular nutritional supplements on the companies’ consumer information websites were compared with those contained in the AREDS and AREDS2 formulae.
The results? Although 100% of these supplements contained the ingredients in the AREDS or AREDS2 formula, only 36% (4/11) duplicated the AREDS or AREDS2 formula. All the individual supplements claimed to “support,” “protect,” “help,” or “promote” vision and eye health, but none specified that there is no proven benefit in using nutritional supplements for primary prevention of eye disease.
Conclusions: The majority of top-selling ocular nutritional supplements did not contain the identical ingredient dosages of the AREDS or AREDS2 formula and had product description claims that lacked level 1 evidence, underscoring the importance of eye care providers educating their patients on the evidence-based role of nutritional supplements in the management of eye health. Ophthalmology 2014; 1-5, (American Academy of Ophthalmology).

Table 1The Top Selling Eye Supplement Brands in the United States, June 2011 to June 2012
Brand (Company) Product Compared with AREDS†Ingredients Compared with AREDS/AREDS2‡Doses Manufacturer Claims
PreserVision (Bausch & Lomb, Rochester, NY) PreserVision Eye Vitamin AREDS Formula Tablets Same Same “The one and only vitamin and mineral supplement formula proven effective in the National Eye Institute’s AREDS”9“Proven to reduce the risk of progression in people with moderate-to-advanced AMD in the National Eye Institute’s AREDS”9
PreserVision Eye Vitamin AREDS Formula Soft Gels Same Same “Based on the original Bausch & Lomb PreserVision Eye Vitamin AREDS Formula”9
PreserVision Eye Vitamin Lutein Formula Soft Gels − Beta-carotene+ Lutein Same “AREDS-based formula that replaces beta-carotene with lutein. For those who should avoid beta-carotene, such as smokers”9
PreserVision AREDS2 Formula

− Beta-carotene+ Lutein

+ Zeaxanthin

Same “Builds on the original, clinically proven PreserVision AREDS formula”9
Ocuvite (Bausch & Lomb) Ocuvite Eye Vitamin Adult 50+ Formula

− Beta-carotene+ Lutein

+ Zeaxanthin

+ Omega-3 fatty acids

30% of vitamin C7.5% of vitamin E

50% of lutein

50% of zeaxanthin

11% of zinc

50% of copper

“Many people are not getting high levels of many important eye nutrients through diet alone”10“Help replenish the vital nutrients your eyes can lose as you age”; “unique formula to help protect your eye health”10

“Important for proper retinal function and support overall eye health”10

“Important to help maintain eye health”10

Ocuvite Lutein and Zeaxanthin Eye Vitamin and Mineral Supplements

− Beta-carotene+ Lutein

+ Zeaxanthin

12% of vitamin C7.5% of vitamin E

50% of lutein/zeaxanthin

19% of zinc

100% copper

“Help replenish essential nutrients to help protect the health of your eyes”10“Supports macular health by helping filter harmful blue light”10

“Helps keep the macula of the eye healthy, and the macula is critical to your vision”10

“As we age, lutein is depleted and must be constantly replaced”10

Ocuvite Lutein Eye Vitamin and Mineral Supplement + Lutein+ Selenium

40% of vitamin C15% of vitamin E

4% of beta-carotene

20% of lutein

50% of zinc

100% copper

“Work to help protect the health of your eyes”10“Supports macular health by helping filter harmful blue light”10
ICaps (Alcon Laboratories, Fort Worth, TX) ICaps Eye Vitamin Lutein & Omega-3 Formula

+ Vitamin A as retinol(−beta-carotene)

+ Vitamin B1, B2, B3, B6, B9, B12

+ Calcium

+ Selenium

+ Manganese

+ Lutein

+ Zeaxanthin

+ Omega-3 fatty acids

9% of vitamin C3% of vitamin E

100% of lutein

100% of zeaxanthin

9% of zinc

45% of copper

“Promotes healthy eyes in people at risk for age-related eye changes”11
ICaps Eye Vitamin Lutein & Zeaxanthin Formula

+ Riboflavin+ Manganese

+ Selenium

+ Calcium

80% of vitamin C38% of vitamin E

26% of beta- carotene

33% of lutein/zeaxanthin

75% of zinc

200% of copper

“Provides lutein with zeaxanthin to support eye health”11“Recommended for people who are interested in overall eye health”11

“For people who want to supplement their current multivitamin or are not currently taking a multivitamin”11

ICaps AREDS (Alcon Laboratories) ICaps Eye Vitamin AREDS Formula Same Same “Contains the exact formulation used in the AREDS”11“Supports eye health in people with intermediate to advanced AMD”11
EyeScience Macular Health Formula (EyeScience, Powell, OH) EyeScience Macular Health Formula

+ Vitamin D+ Selenium

+ Vitamin B6, B9

+ Lutein

+ Zeaxanthin

+ Bilberry extract

+ Alpha lipoic acid

+ Grapeseed extract

+ L-Glutathione

+ MacuGlo (EyeScience) proprietary blend

100% of vitamin C100% of vitamin E

100% of lutein

100% of zeaxanthin

50% of zinc

100% of copper

“The most complete ocular supplement designed for those with and without AMD”12“For older patients who may already be at an increased risk for AMD, it is better late than never when it comes to the use of nutraceuticals”12

Per Packaged Facts (Rockville, MD).
AREDS (500 mg of vitamin C, 400 IU of vitamin E, 15 mg of beta-carotene, 80 mg of zinc, 2 mg of copper).
AREDS2 (500 mg of vitamin C, 400 IU of vitamin E, 10 mg of lutein, 2 mg of zeaxanthin, 80 mg of zinc, 2 mg of copper).
Table reproduced from Ophthalmology 2014, American Academy of Ophthalmology