Questions regarding vitamin A

Of additional concern is vitamin A, he said. At the time of the first AREDS study, researchers wanted to include a caratenoid, of which lutein and vitamin A are forms. Since lutein wasn't available in pill form, researchers settled on vitamin A.

"It turns out that vitamin A in pill form doesn't do much for the eye; in fact, there is no benefit whatsoever," Dr. Samuel said. "It's better taken in from food source than a pill source."

In addition, vitamin A also is linked to increased incidences of lung cancer, he said. Since smoking is a major risk factor for AMD, patients already at risk for lung cancer are increasing their risks with high doses of vitamin A, Dr Samuel said.

In AREDS2, researchers are studying the effects of lutein and zeaxanthin supplements, as well as the impact of long-chain omega-3 fatty acids and eicosapentaenoic acid on the progression to advanced AMD. The study also will assess whether forms of the AREDS nutritional supplement with reduced zinc or no beta-carotene works as well as the original supplement advocated by AREDS.

Dr Samuel explained that researchers have already found that lutein by itself is not effective; it must be in a 5-to-1 ratio with zeaxanthin to work optimally. "Most products that have lutein by themselves are a complete waste and do nothing for you, in my opinion," he said.

The early results also indicate that the presence of omega-3 fatty acids is critical, he added."We learned that if there's one nutritional panacea out there, it's omega-3. It can prevent and slow down macular degeneration."

When a patient is referred to Dr Samuel's practice, one of his first questions to the patient is, "Are you taking an eye vitamin?" The vitamin he recommends (EyeScience Macular Health Formula, EyeScience Labs), is the only ocular vitamin on the retail market that is based on AREDS2 and has the proper ratio of lutein and zeaxanthin, omega-3, and other beneficial nutrients.

"At last count at (a major drug store chain), there were 20 different eye vitamins. I consider none of them, except for the (recommended vitamin), any good," he declared.

Jeff Northup, president and chief executive officer of EyeScience, said the vitamins were designed around the AREDS2 formula and were launched in February 2008. "The demand is getting bigger every day; with baby boomers getting older and healthcare in flux, prevention is key," he said. "Every ingredient that's been clinically shown to be good for the eye is represented in this formula."

The goal, he said, was to create a vitamin that is safe not only for patients with AMD, but also for people who may have a number of risk factors or be in early stages of the disease. For example, if a 45-year-old woman takes her elderly mother with AMD to the optometrist, the doctor can recommend the vitamins to the daughter as well.

"Before, vitamins were strictly for the patient with moderate to advanced AMD," Northup said. "EyeScience is safe not only for the AMD patient, but for their offspring as well."

The vitamins are available over-the-counter at drug stores, but Dr Evans finds it helpful to carry them in his office and sell them directly to patients, a practice that he's found boosts patient compliance. Last year, he sold $20,000 in nutraceuticals - a word that this 30-year optometrist admits he had not even heard 20 years ago.

"We do not recommend vitamins for everyone, only patients at risk or with current disease," explained Dr Evans. To help him determine which patients are most suited, he has all patients aged <30 years complete a risk assessment questionnaire, and tests macular pigment density as part of the examination.

"As far as improving macular pigment scores, these nutraceuticals really do work," Dr. Evans said. "I sleep well at night knowing that's an area of eye care I'm addressing."