What supplements are helpful in vitreous degeneration, particularly in patients with age-related macular degeneration (AMD)?

Supplements for Vitreous Degeneration in AMD

For patients with age-related macular degeneration (AMD), the AREDS2 supplement formulation (vitamin C, vitamin E, zinc, copper, lutein, and zeaxanthin) is the most effective supplement regimen to slow disease progression and should be recommended for those with intermediate or advanced AMD.

Patient Selection for AREDS2 Supplementation

The American Academy of Ophthalmology guidelines clearly identify which patients benefit from supplementation:

• Patients with intermediate AMD (bilateral large drusen, many medium-sized drusen)
• Patients with advanced AMD in one eye
• Patients aged 55 years or older with high-risk features 1

These patients are considered at high risk for progression to advanced AMD, and supplementation can delay disease progression and associated vision loss in approximately 300,000 patients 1.

Recommended Supplement Formulation

The AREDS2 formulation consists of:

• Vitamin C (500 mg)
• Vitamin E (400 IU)
• Zinc (25-80 mg)
• Copper (2 mg)
• Lutein (10 mg)
• Zeaxanthin (2 mg) 1

Important Modifications:

• Beta-carotene should be avoided, especially in current or former smokers, due to increased risk of lung cancer (18% higher incidence, p=0.01) 1
• Lower zinc doses (25 mg vs. original 80 mg) appear equally effective with fewer genitourinary side effects 1

Evidence Supporting Supplementation

The Age-Related Eye Disease Study (AREDS) demonstrated a 25% reduction in risk of progression to advanced AMD with antioxidant and mineral supplementation 2. This finding was supported by the Cochrane review showing:

• 28% reduced odds of progression to late AMD (OR 0.72,95% CI 0.58-0.90) 3
• 38% reduced odds of progression to neovascular AMD (OR 0.62,95% CI 0.47-0.82) 3
• 23% reduced odds of losing 3+ lines of visual acuity (OR 0.77,95% CI 0.62-0.96) 3

Potential Adverse Effects

When recommending AREDS2 supplements, be aware of these potential adverse effects:

• Zinc (80 mg): Increased risk of genitourinary hospitalizations (7.5% vs. 4.9%, p=0.001) 1
• Beta-carotene: Yellowing of skin (8.3% vs. 6.0%, p=0.008) and increased lung cancer risk in smokers 1
• Copper deficiency anemia (if zinc is taken without copper) 1

Additional Recommendations

Beyond supplementation, patients with AMD should be advised to:

1. Stop smoking - Smoking is consistently identified as a risk factor for AMD progression 1
2. Maintain healthy body mass index - Obesity is associated with increased AMD risk 4
3. Protect eyes from sunlight - Excessive sun exposure may contribute to AMD progression 4
4. Regular monitoring - Follow-up examinations with Amsler grid testing and stereoscopic biomicroscopic examination of the fundus 1

Limitations and Considerations

• Supplements are preventive, not curative, and work best when started early
• Benefits are primarily seen in patients with intermediate or advanced AMD
• Patients with early AMD or no AMD have insufficient evidence to recommend routine supplementation 5, 6
• The AREDS2 formulation should be reviewed by the patient's primary care physician due to potential adverse effects 1

For patients with vitreous degeneration without AMD, there is insufficient evidence to recommend specific supplements for slowing progression.