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 yrs. 11 centers.

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

ANTIOXIDANTS Vitamin C watersoluble antioxidant Vitamin E  -tocopherol ( lipid soluble antoxidant ) Carotenoids  &  - carotene, Lutein / zeaxanthin (- quenches singlet O  ) Zinc

AREDS study Age 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

AREDS Antioxidants + Zinc effective in preventing progression of intermediate AMD to advanced AMD % benefit But no to early AMD - no apparent benefit Vitamin C, E, ß-carotene

INDICATIONS OF AREDS Extensive intermediate size drusen 1 large drusen geographic atrophy in 1 or both eyes 1 eye lost in AMD

CI FOR ANTIOXIDANTS Smoking Dementia

Macular pigment Lutein Zeaxanthin protects macula- filtering blue light, scavenging free radicals

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.

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

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%

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

AMD Reactive oxygen OH, singlet oxygen lipid deoxidation of cell wall & DNA O  & Blue light  Macular oxidation