In the news: AREDS2 Supplement Shows Benefit In Late Stage Dry AMD

Background: Stages and Forms of AMD

In the early and intermediate stages of age-related macular degeneration (AMD), the light-sensing retina at the back of the eye develops small yellow deposits of fatty proteins called drusen.

When the disease progresses to the late stage, people can develop leaky blood vessels (wet AMD) or can lose regions of light-sensitive cells in the retina (dry AMD). In dry AMD, also known as geographic atrophy, these regions slowly expand over time, causing people to progressively lose their central vision.

Remember that the AREDS trial showed that a formula containg vitamins C and E, and beta-carotene, zinc and copper slowed the progression from the intermediate to late stage AMD in people with the disease.

The later AREDS2 trial then showed that replacing beta-carotene with lutein and zeaxanthin produced a formula that was more effective and presented fewer risks.

But whether AREDS2 supplements are of any benefit to people with the late-stage of dry AMD has been an unanswered question. That’s because neither the AREDS or AREDS2 trials was able to detect any further benefit of the supplements once the participants had developed the late-stage of the disease.

AREDS2 Formula Helps Slow Late Stage AMD

Now a new analysis by the National Eye Institute-sponsored ARED and AREDS2 trial researchers suggests that AREDS2 supplements can help put the brakes on late stage dry AMD progression(1,2).

This finding is promising because the treatments for dry AMD today are only modestly effective, have important risks, and high costs.

In the study, the investigators reviewed retinal scans of participants in both trials who developd dry AMD, a total of 1,602 eyes from both studies.

They measured the position and expansion rate of the participants’ regions of geography atrophy in their eyes.

Most commonly, people with dry AMD develop leisons away from the center of the macula, the fovea which is responsible for the clearest central vision. As the disease progresses these areas of dry AMD gradually expand in toward the fovea.

The analyses showed that for the majority of people who developed geographic atrophy far away from the fovea, both the AREDS and AREDS2 supplements delayed the rate of expansion toward the fovea by 55% over an average 3 year period.

Overall, both supplements slowed the rate of expansion by 35-36% for those who had regions of geographic atrophy that had not reached the center of the macula.

They also found that the AREDS2 formula with lutein and zeaxanthin, but not the AREDS formula, also slowed the decline in visual acuity.

Neither supplement slowed degeneration in advanced cases where geographic atrophy was already in their central vision.

The authors of the study theorized that AREDS2 supplements are of benefit in late-stage AMD because they enhance a nautral phenomenon called “foveal sparing”, where dry AMD expansion into the central macula is much slower than advancement into the surrounding areas.

In the National Eye Institute’s new release, the lead study author states that “these findings support the continued use of AREDS2 supplements by people with late dry AMD.”

References

1. Keenan TDL, et al. for the AREDS and AREDS2 Research Groups. Oral antioxidant and lutein/zeaxanthin supplements slow geographic atrophy progression to the fovea in age-related macular degeneration. Ophthalmol. July 16, 2024. https://doi.org/10.1016/j.ophtha.2024.07.014
2. National Institutes of Health and National Eye Instiute News release. https://www.nih.gov/news July 16, 2024.