Micronutrient Supplementation Usage Patterns in the Prevention of Advanced Age–related Macular Degeneration Among Patients Receiving Eye Care at a Tertiary Ophthalmic Center

Abstract

Abstract: : Purpose: To describe current micronutrient usage patterns among patients receiving eye care at a tertiary ophthalmic center. Design: Cross–sectional clinical case series. Methods: Adult patients with a diagnosis of age–related macular degeneration (AMD) examined at the Retinal Division of the Wilmer Eye Institute from July – August 2004 were surveyed about micronutrient usage patterns. The treating ophthalmologist recorded AMD severity at the time of examination using the AREDS classification system. Results: Among 264 participants, 156 (59%) were women, 255 (97%) Caucasian, and the median age was 78. 7% had no or early AMD, 12% had intermediate (AREDS group 3), 34% had unilateral advanced (AREDS group 4), and 47% had bilateral advanced AMD. 59 (22%) were surveyed at their first visit to the Retina Division. 243 (92%) reported using any supplements, among which 118 (45%) were supplementing with the full–dose AREDS formulation. Of these 118, 94 (80%) were graded as groups 3 or 4 or as having bilateral neovascular AMD with baseline visual acuity ≥ 20/100 in the better eye. An additional 26 (10%) reported use of the AREDS formulation but were not taking the recommended dosage. Half of these individuals were graded as having AMD that warranted AREDS supplement usage. Applying AREDS guidelines of recommending supplements to individuals with intermediate AMD, unilateral advanced AMD, or bilateral neovascular AMD with visual acuity ≥ 20/100, 176 (67%) participants should be considered for supplementation. Only 97 (55%) of these were using the correct formulation and dosage. Among the 39 new patients considered candidates for treatment, only 8 (21%) were receiving treatment; whereas, 89 (65%) of 137 return patients considered candidates for treatment reported usage commensurate with AREDS guidelines. Conclusions: Among patients receiving care for AMD at a tertiary retinal center, nearly half of those deemed candidates for AREDS type supplements were not using them or were using an incorrect dose. Roughly 20% of participants were taking high–dose supplements in the absence of data to support their doing so. Patients who had previously visited the Retina Division were three times more likely to use supplements in accordance with AREDS guidelines as compared to new patients. Increased patient education on supplement usage is needed in both primary and tertiary care centers to fully recognize the public health benefits of the AREDS study and to avoid unnecessary potential toxicity.

Keywords: age-related macular degeneration • antioxidants • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled