From the Guidelines
The most effective treatment approach for dry macular degeneration is the use of the AREDS2 vitamin formula, which has been shown to slow disease progression by about 25% in patients with intermediate or advanced dry macular degeneration, as demonstrated in the 2021 study published in Ophthalmology 1. The AREDS2 supplement contains vitamin C (500 mg), vitamin E (400 IU), lutein (10 mg), zeaxanthin (2 mg), zinc (80 mg), and copper (2 mg), taken daily. These antioxidants help reduce oxidative stress in the retina, potentially slowing disease progression.
Key Recommendations
- Lifestyle modifications are equally important, including:
- Smoking cessation
- Maintaining a healthy diet rich in leafy greens and fish high in omega-3 fatty acids
- Regular exercise
- Blood pressure control
- Patients should wear sunglasses with UV protection when outdoors to reduce light exposure to the retina
- Regular eye examinations every 6-12 months are essential for monitoring progression
- Low vision aids such as magnifiers, special lighting, and electronic reading devices can help maintain independence as vision deteriorates
- Patients should also monitor their vision at home using an Amsler grid to detect any sudden changes that warrant immediate medical attention The 2020 study published in Ophthalmology 1 also supports the use of the AREDS2 supplement, and the 2016 study 1 highlights the importance of early treatment and comprehensive eye examinations in managing dry macular degeneration.
Additional Considerations
- Cigarette smoking has been consistently identified as a risk factor for progression of AMD, and smoking-cessation counseling may influence patients to stop smoking, reducing the risk of AMD progression 1
- Early treatment of AMD is associated with a more favorable prognosis, and anti-VEGF treatment given within 2 years after diagnosis of neovascular AMD has been shown to reduce legal blindness and visual impairment 1
From the Research
Treatment of Dry Macular Degeneration
The treatment of dry macular degeneration is a complex issue, and various studies have investigated the effectiveness of different approaches.
- The Age-Related Eye Disease Study (AREDS) formulation, which includes antioxidant vitamins C and E, beta carotene, and zinc, has been shown to reduce the risk of progression to advanced age-related macular degeneration (AMD) 2, 3.
- The addition of lutein + zeaxanthin, DHA + EPA, or both to the AREDS formulation did not further reduce the risk of progression to advanced AMD in primary analyses 2.
- However, secondary exploratory analyses suggested that lutein/zeaxanthin may be helpful in reducing the risk of progression to advanced AMD, and could be an appropriate carotenoid substitute in the AREDS formulation 2, 4.
- A review of the AREDS2 study results suggested that lutein/zeaxanthin could be more appropriate than beta-carotene in AREDS-type supplements, due to the potential increased incidence of lung cancer in former smokers taking beta-carotene 4.
- A systematic review of antioxidant vitamin and mineral supplements for slowing the progression of age-related macular degeneration found that people taking antioxidant vitamins were less likely to progress to late AMD, and that lutein/zeaxanthin may have similar or slightly reduced risk of progression to late AMD compared with control 5.
Mechanisms and Therapeutic Targets
- Dry age-related macular degeneration is characterized by the accumulation of deposits in the retina, and the formation of atrophic lesions 6.
- The genetic risk for AMD is associated with complement genes, and several complement-based therapeutic treatment approaches are being pursued 6.
- Potential treatment strategies against AMD deposit formation and protein and/or lipid deposition are being explored, including anti-amyloid therapies and modulation of the antioxidant system 6.
- The role of autophagy in AMD and the prevention of oxidative stress through modulation of the antioxidant system are also being investigated 6.
Imaging and Disease Progression
- The success of new therapies in clinical trials and beyond relies on early detection, disease typing, and predicting disease progression, areas that are currently being rapidly transformed by improving imaging modalities and functional assays 6.
- The AREDS2 study used centralized grading of annual fundus photographs to determine progression to advanced AMD 3.
- The use of imaging modalities such as optical coherence tomography (OCT) and fundus autofluorescence (FAF) may help to monitor disease progression and response to treatment 6.