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ANTIOXIDANTS & AMD. Dr AJAY I DUDANI ZEN EYE CENTRE MUMBAI . AREDS. AREDS demonstrated beneficial effects of high dose antioxident vitamin and mineral supplementation in decreasing the risk of advanced ARMD. R.C.T.=4757 participants 55-81 yrs. 11 centers.

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ANTIOXIDANTS & AMD

Dr AJAY I DUDANI

ZEN EYE CENTRE

MUMBAI


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AREDS

  • AREDS demonstrated beneficial effects of high dose antioxident vitamin and mineral supplementation in decreasing the risk of advanced ARMD.

  • R.C.T.=4757 participants 55-81 yrs. 11 centers.


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ARES Stereoscopic Color Macular Photos.

  • Cat1 Few Small Drusen

  • Cat2 Extensive small Drusen or non extensive intermediate drusen

  • Cat3 Extensive intermediate drusen, one large drusen or non central Geographic atrophy.

  • Cat4 Unilateral Advanced AMD or Vision Loss worse than 20/32


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ANTIOXIDANTS

  • Vitamin C watersoluble antioxidant

  • Vitamin E -tocopherol ( lipid soluble antoxidant )

  • Carotenoids  &  - carotene, Lutein / zeaxanthin (- quenches singlet O) Zinc


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AREDS studyAge Related Eye Disease Study.

  • Report no 8, Arch of Ophthalmology -Vit C 500 IU -Vit E 400 IU - carotene 15 mg -Zinc oxide 80 mg with 2mg of Cupric Oxide -Lutein + Zeaxanthin


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AREDS

  • Antioxidants + Zinc effective in preventing progression of intermediate AMD to advanced AMD -25-30 % benefit

  • But no to early AMD - no apparent benefit

  • Vitamin C, E, ß-carotene


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INDICATIONS OF AREDS

  • Extensive intermediate size drusen

  • 1 large drusen

  • geographic atrophy in 1 or both eyes

  • 1 eye lost in AMD


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CI FOR ANTIOXIDANTS

  • Smoking

  • Dementia


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Macular pigment

  • Lutein

  • Zeaxanthin

  • protects macula- filtering blue light, scavenging free radicals


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Micro-nutrient supplementation

  • Macular Xanthophylls, leutin And Zeaxeatin –present in spinach,Collard greens & Kale.

  • 25% of total retinal carotenoids – in Rod outer Seg. To protect from oxidative damage from U.V. Light

  • Omega 3 long Chain PUFA -– is a major structural lipid in sensory Retina –Present in Fish

  • Is a part of docosahexanoic acid.- essential role in vision.


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Micro-nutrient supplementation

  • Higher intake of both Lutein and Zeaxanthin & Omega 3 LCPUFAs are Associated with decreased risk of wet ARMD and Geographic Atrophy


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New From AREDS

  • AREDS DEATHS 11%

  • Mortality increase severity of Macular disease.

  • Zn- beneficial to decrease mortality

  • Vn worse than 20/40 = increase risk

  • AMD Cat4 Associated with CVS deaths.

  • Neoplasms 31%


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DIET

  • Egg yolk,maize, kiwi, red grapes, pumpkin, spinach(palak), cucumber, peas, orange juice


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AMD

  • Reactive oxygen

  • OH , singlet oxygen

  • lipid deoxidation of cell wall & DNA

  • O & Blue light  Macular oxidation



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