Antioxidant vitamin and mineral supplements for slowing the progression of age-related macular degeneration

BACKGROUND: It has been proposed that antioxidants may prevent cellular damage in the retina by reacting with free radicals that are produced in the process of light absorption. OBJECTIVES: The objective of this review was to assess the effects of antioxidant vitamin or mineral supplementation, or both, on the progression of age-related macular degeneration (AMD). SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2005, Issue 4); MEDLINE (1966 to January 2006); SIGLE (1980 to March 2005); EMBASE (1980 to January 2005); NRR (2005, Issue 4); AMED (1985 to January 2006); and PubMed (24 January 2006 covering last 60 days), reference lists of identified reports and the Science Citation Index. We contacted investigators and experts in the field for details of unpublished studies. SELECTION CRITERIA: We included randomised trials comparing antioxidant vitamin or mineral supplemention (alone or in combination) to a control intervention in people with AMD. DATA COLLECTION AND ANALYSIS: The author extracted data and assessed trial quality. Where appropriate, data were pooled using a random-effects model unless three or fewer trials were available in which case a fixed-effects model was used. MAIN RESULTS: Eight trials were included in this review. The majority of people were randomised in one trial (AREDS in the USA) that found a beneficial effect of antioxidant (beta-carotene, vitamin C and vitamin E) and zinc supplementation on progression to advanced AMD (adjusted odds ratio 0.68, 99% confidence interval 0.49 to 0.93). People taking supplements were less likely to lose 15 or more letters of visual acuity (adjusted odds ratio 0.77, 99% confidence interval 0.58 to 1.03). Hospitalisation for genito-urinary problems was more common in people taking zinc and yellowing of skin was more common in people taking antioxidants. The other trials were, in general, small and the results were inconsistent. AUTHORS' CONCLUSIONS: The evidence as to the effectiveness of antioxidant vitamin and mineral supplementation in halting the progression of AMD comes mainly from one large trial in the USA. The generalisability of these findings to other populations with different nutritional status is not known. Further large, well-conducted randomised controlled trials in other populations are required. Long-term harm from supplementation cannot be ruled out. Beta-carotene has been found to increase the risk of lung cancer in smokers; vitamin E has been associated with an increased risk of heart failure in people with vascular disease or diabetes.