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Macular Degeneration and AREDS 2 Supplements

What AMD does to vision

What AMD does to vision

Four years ago I wrote about the premature marketing of a diet supplement for macular degeneration before the results of a trial to test it were available. Now that we know the results of that trial, a follow-up post is in order.

Age-related macular degeneration (AMD) is a leading cause of blindness. The incidence increases with age; it affects 10% of people by age 66-74 and 30% of people by age 75-85. There are known risk factors including genetics and smoking, but there is no effective prevention. There are multiple diet supplement products on the market that are advertised as “supporting eye health.” Some are based on evidence from randomized, controlled studies; but the advertising hype goes beyond the evidence and tends to mislead consumers. There is evidence that supplementation may slow the progression of moderate to severe AMD, but there is no evidence that supplements are effective in milder disease or for preventing AMD from developing in the first place.

The AREDS trial

The original AREDS (Age-Related Eye Disease Study), was a large, multicenter trial of patients with established AMD to evaluate the effect of a combination of 3 antioxidants (vitamin C, 500 mg; vitamin E, 400 IU; and vitamin A in the form of beta carotene, 25,000 IU), with zinc and copper. Over 5 years, patients taking the antioxidant and zinc supplement had a 23% chance of developing vision loss from advanced AMD compared to a 29% chance of developing vision loss from advanced AMD for patients taking a placebo pill. This effect was statistically significant, but modest. Concerns were raised about the high dose of vitamin A, since beta carotene was known to cause harm at those levels, so another study was designed to evaluate a different combination that omitted the vitamin A and added other possibly beneficial components.

The AREDS 2 trial

In the new trial, there were four groups: (1) a control group got the original AREDS formula, and the other 3 got a formula that omitted the vitamin A and added (2) lutein and zeaxanthin, (3) the omega 3s DHA and EPA, and (4) both lutein/zeaxanthin and DHA/EPA. There was no control group of patients not taking any supplement.

They concluded:

Addition of lutein + zeaxanthin, DHA + EPA, or both to the AREDS formulation in primary analyses did not further reduce risk of progression to advanced AMD. However, because of potential increased incidence of lung cancer in former smokers, lutein + zeaxanthin could be an appropriate carotenoid substitute in the AREDS formulation.

AREDS 2 had a number of strengths. It was large (4,203 subjects), it lasted 5 years during which 1940 eyes progressed to advanced AMD, the drop-out rate was low, it assessed adherence, and it measured blood levels of the study nutrients.

It also had some weaknesses. They didn’t use a no-supplement control group because they assumed that the original AREDS had proved the benefit of supplementation. This is a bit worrisome, since we know it is risky to rely on a single study. The AREDS trial has not been replicated, and a Cochrane systematic review concluded:

People with AMD may experience delay in progression of the disease with antioxidant vitamin and mineral supplementation. This finding is drawn from one large trial conducted in a relatively well-nourished American population. The generalisability of these findings to other populations is not known. Although generally regarded as safe, vitamin supplements may have harmful effects. A systematic review of the evidence on harms of vitamin supplements is needed.

A personal note

I have macular degeneration that is due to myopia, not AMD. It has not yet caused any loss of visual acuity, but I am being monitored by a retinal specialist. A couple of years ago, she suggested I take a supplement based on AREDS 2, but with the addition of bilberry and omega 3’s, available directly from the manufacturer as a mail-order subscription service. She offered it more as an option than a recommendation, and she didn’t push it. I declined, because that particular formulation has not been studied, and because the AREDS evidence is only for AMD, not for myopic macular degeneration. I can understand her wanting to “do something,” and the rationale that it might help and couldn’t hurt, but that wasn’t enough to convince me.

Conclusion

The AREDS trial provided evidence that a mixture of diet supplements slowed the progression of moderate-to-advanced macular degeneration, and the AREDS 2 trial found that a safer formulation was equally effective. The evidence would be more convincing if there were confirmatory studies with no-supplement control groups. There is no evidence of benefit for patients with mild AMD, and no evidence that supplements can prevent AMD. Advertising that products “support eye health” is misleading.

I found it interesting that 50% of the AMD patients were smokers or former smokers, a much higher rate than in the general population. This suggests that smoking cessation might be as important or more important than any supplement (at least in well-nourished people), and it is an intervention that has many other health benefits.

Posted in: Clinical Trials, Herbs & Supplements

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60 thoughts on “Macular Degeneration and AREDS 2 Supplements

  1. goodnightirene says:

    This is very timely as I have a neighbor (aged 92) for whom I provide some caregiving. She does NOT have MD, but has been “prescribed” this vitamin complex by her ophthalmologist (as a preventative?). As the number of her meds increase, she gets more wary about taking her pills and her daughter has considered eliminating these vitamins. We discussed “looking into it” and now your post appears. I will forward this to the daughter right away and thank you for doing the follow up.

  2. Angora Rabbit says:

    Guess I’ll jump in first…Interesting study and thank you for highlighting it. I’ve followed it a bit from the sidelines and am unsurprised that there was no benefit above the small benefit conferred by AREDS. As the authors said, this is a relatively well-nourished population with high rates of supplement use, and it suggests that supplementation above regular intakes from foods does not confer additional benefit. The serum analysis confirmed that serum levels did reflect their increased intakes from the AREDS2 interventions. I am pleased that the lutein/zeazanthin benefit did not differ from the beta-carotene as it is the safer alternative. I also was struck that there were more lung cancers in the beta-carotene group of former smokers – that’s a “wow” consistent with previous studies. Again, a good lesson in why supplementation should be viewed with caution.

    I don’t know this, but it’s possible that, because AREDS1 conferred a small benefit, IRB ethical review may have argued against using a “true” placebo instead of the modified AREDS formulation. This is just speculation.

  3. stanmrak says:

    No one will never be able to ‘prove’ to a skeptic that a nutritional supplement can prevent something like AMD. That is inherently impossible to do. In the meantime, your condition will probably worsen and you will continue to do nothing because of the lack of scientific evidence?

    In addition, the study you linked to used inferior types of supplements, and not all in “therapeutic dosages,” and without important synergistic nutrients that would make the formula more effective, making the study irrelevant at best. In other words, the parameters of the study ensured a negative result. I would have used a better quality of supplement and added astaxanthin.

    1. Harriet Hall says:

      “No one will never be able to ‘prove’ to a skeptic that a nutritional supplement can prevent something like AMD.”

      Wrong! We skeptics would love to know of a way to prevent AMD, and we would gladly accept good evidence for it. It makes no difference to us whether the preventive is a nutritional supplement, a Big Pharma creation, or an exercise program; we apply the same standards of evidence. Skepticism doesn’t mean doubting everything, it means not accepting a claim without evidence.

    2. Garrett Moffitt says:

      There are specific ways to test to see if it is effective. So yes there are ways to prove to a skeptic. We have a whole methodology called ‘science’. Look into it.

      1. stanmrak says:

        Skeptics look foolish when they take on things that they have no knowledge about, and think that science can provide an unequivocal answer. You can’t make an educated assessment about things you know nothing about just by pulling up a few studies, yet that is what skeptics resort to when they’re ignorant of the topic at hand.

        1. WilliamLawrenceUtridge says:

          Stan, you’re calling Garrett ignorant for claiming you actually can investigate the effects of supplements on AMD, but you back this up with nothing. Why can’t you? What makes AMD the one medical problem that you can’t investigate with science? And why should we take you at your word? Where are your citations to substantiate this point? I can claim that it’s impossible to test the theory of relativity – but clearly hundreds of experiments prove me wrong. As for your claim – this experiment seems to prove you wrong.

          I think what you’re really saying is “mean old science has refuted my claim, and skeptics are rude enough to point it out, so I’m going to call them stupid so I won’t have to change my mind or admit that I was wrong.”

    3. Angora Rabbit says:

      “In addition, the study you linked to used inferior types of supplements, and not all in “therapeutic dosages,” and without important synergistic nutrients that would make the formula more effective.”

      Evidence, please. And you will need to be specific as my BS detector is on full-blast. My red pen is out and I’m ready to grade.

      1. stanmrak says:

        Vitamin E is not a single compound, but a family of molecules composed of tocopherols and tocotrienols (fat-soluble alcohols). The four distinct tocopherols are named alpha-, beta-, gamma- and delta-tocopherols. The study used only one of these, and artificail one at that.

        Vitamin E also works together with the other antioxidants: vitamin C, glutathione and lipoic acid, as well as the mineral selenium. If you don’t have sufficient amounts of all these, the vitamin E’s effectiveness will be reduced. None of the subjects were tested for adequate levels of any of these, so the study mentioned is invalid.

        I don’t bother looking at any of these studies, regardless of the conclusions. They all use the same flawed methodology.

        1. weing says:

          “Vitamin E also works together with the other antioxidants: vitamin C, glutathione and lipoic acid, as well as the mineral selenium. If you don’t have sufficient amounts of all these, the vitamin E’s effectiveness will be reduced.”
          This is an assertion that needs data to back it up. Please supply the data or withdraw your assertion.

          1. Angora Rabbit says:

            Weing, buddy, see my answer. The mere fact that $tan said it means he hasn’t a clear understanding.

            1. weing says:

              @Angorra,
              Well said. Thanks for taking the time to address this point. I always hold out the hope that people will try to find and review references and come to a deeper understanding.

        2. Angora Rabbit says:

          Well, duh. Any of my students can tell you that. As well as the researchers on AREDS. Gosh, you think they didn’t think of that? You forgot to mention that there are EIGHT cmpds with some level of Vit E action, as there also 4 tototrienols.There are few differences in the bioactivity of these 8 vitamers; they all gobble up ROS beautifully, since they are just racemers, They also do not appreciably differ in their absorption, again because their absorption is isomer-independent. However, they do differ in their serum halflife. And can you tell me why? Because organisms have evolved a transport protein that only binds alpha Tocopherol, meaning the rest just get sent back out the bile when they hit the liver after digestion. This means that a-Tocopherol is the form PREFERRED BY THE BODY TO USE, not the other vitamers. So you can whinge all you want about the “wrong form.” We researchers already figured this out and that boat left long ago with you still bleating on the dock. This is why the studies now focus on alpha-Tocopherol – it’s the form the body uses and any other form just dilutes out its efficacy. And the reason it’s “artificial” is to eliminate the other racemers and thus test the efficacy only of the RRR form. So your “natural” compound is actually diluted out by the “contaminating” racemers that have much shorter bioactivities, the opposite of your claim.

          Any of my students can tell me that VitE works with other antioxidants, but not in the simple minded manner that you are stating. Your simple-minded model is how we teach it to undergrads, but not how they learn it in grad school when we crank up the complexity and discuss how the body REALLY works. Thus you ignore that we have so many antiox forms because they work in different compartments, not because they “need” each other. VitE isn’t going to interact with VC because they have completely different chemical properties thus one in lipids and one in water. Lipoate is bound up enzymatically and is preoccupied with regenerating FADH after decarboxylations. Selenium is not a true antioxidant but a sulfur mimetic in selenocysteine and one of its enzymes happens to be GPx, which regenerates glutathione, which is just a three-amino acid derivative. The common thread is their ability to interact with FADH2 and NADH/NADPH to recycle reducing equivalents, some of which are coming from their reduction of ROS.

          So your answer is at sophomore level, which is why you continue to misunderstand why these studies are the real thing. But you will continue to cling either because of cognitive dissonance or because you are wedded to the $$ your misinformation generates or both.

          So you get a C grade., which is being generous. Undergrad level understanding but NOT the understanding of a true professional.

          As Andrey and William said, this is really written for all the other readers who are wondering why $tan is wrong.

          1. Andrey Pavlov says:

            And for me! Thanks Angora – it always helps to have these things re-iterated and crystallized for me. Always much appreciated!

          2. WilliamLawrenceUtridge says:

            And boom goes the dynamite.

        3. WilliamLawrenceUtridge says:

          I don’t bother looking at any of these studies, regardless of the conclusions. They all use the same flawed methodology.

          I think what you’re really saying is “I don’t bother looking at these studies because they refute my beliefs.” Which is unsurprising.

          Just a curious question – does vitamin E only work when the appropriate combination of vitamin C, glutathione, lipoic acid and selenium are present in adequate amounts? What are the other effects of deprivation of these vitamins beyond the usual signs of vitamin E deficiency (blood, muscle, nerve, vision and immune dysfunction – did any of the participants in this study have said dysfunctions by the way)? I assume there were signs of deficiency, otherwise your claim is a little hollow.

    4. WilliamLawrenceUtridge says:

      No one will never be able to ‘prove’ to a skeptic that a nutritional supplement can prevent something like AMD.

      Why not? You take two random groups, you give one placebo and the other a nutritional supplement, and you count how many in each group develop AMD. Why wouldn’t this work? This is incredibly simple, why would the rules of causality suddenly be suspended?

      Of course, my question is rhetorical. If the study had supported AMD being prevented by supplements, you would be crowing to the stars.

      In addition, the study you linked to used inferior types of supplements, and not all in “therapeutic dosages,” and without important synergistic nutrients that would make the formula more effective, making the study irrelevant at best. In other words, the parameters of the study ensured a negative result. I would have used a better quality of supplement and added astaxanthin.

      Some questions:
      1) The doses were borderline-dangerous (particularly given findings that high doses of supplements may be carcinogenic)
      2) How do you know the nutrients are “synergistic”?
      3) What are “superior” supplements, and how do you know they are “superior”? How is one batch of pharmaceutical-grade concentrated nutrient molecule different from another?
      4) What research supports adding astaxanthin?

      All this looks like handwaving and goalpost-moving to discredit a specific result you disagree with for ideological rather than logical or empirical reasons. Do you really think you, a marketing specialist and supplement salesman, are really smarter than the PhD and MDs that put the study together? If so – why not publish? Perhaps you can convince the world of your brilliance.

      1. Julia B says:

        An RCT showing that lutein and zeaxanthin prevents AMD would be not impossible to do, but very impractical. The mechanism proposed by which lutein and zeaxanthin prevent AMD is that both carotenoids accumulate in the macula over the vision sensors responsible for central vision, where they form a filter to protect the macula, and that their antioxidant function prevents some of the oxidative damage that occurs when light reaches the back of the retina. Lutein and zeaxanthin start to accumulate in the macula lutea in utero and there is evidence from monkey studies that early life levels of lutein and zeaxanthin, as well as at other times through the life span, are important to prevent AMD. My “ideal” RCT to test whether lutein and zeaxanthin do prevent AMD would be to run it over 80 years from conception, ideally at different doses, and also testing out whether supplementation at various life stages are more/less effective. This RCT would be incredibly impractical to perform, of course, and we would have the final results in over a century. I think that supplementation in people with early AMD, as was done with AREDS2, is likely to be far too late, as most of the damage to the macula has already occurred. I was surprised to see that there was any beneficial effect found over such a short period of time.

        Mechanism of role of lutein and zeaxanthin in AMD:
        Landrum JT, Bone RA. Lutein, zeaxanthin, and the macular pigment. Archives of Biochemistry and Biophysics 2001;385(1):28-40.

        Monkey study:
        Felix M. Barker, II, D. Max Snodderly, Elizabeth J. Johnson, Wolfgang Schalch, Wolfgang Koepcke, Joachim Gerss and Martha Neuringer. Nutritional Manipulation of Primate Retinas, V: Effects of Lutein, Zeaxanthin, and n–3 Fatty Acids on Retinal Sensitivity to Blue-Light–Induced Damage. IOVS, June 2011, Vol. 52, No. 7 http://www.iovs.org/content/52/7/3934.full.pdf

        1. WilliamLawrenceUtridge says:

          So stan’s idea of being able to prevent or treat AMD through high-dose (and apparently magical) supplements is indeed bogus then. HUGE surprise.

      2. stanmrak says:

        “You take two random groups, you give one placebo and the other a nutritional supplement, and you count how many in each group develop AMD. Why wouldn’t this work? This is incredibly simple, why would the rules of causality suddenly be suspended?”

        Because nutrients don’t work like drugs and you can’t test them like drugs…They don’t work in isolation. In order to have a good study, one also has to eliminate all other variables. This is never done because it’s impossible – there’s always way too many of them, and they’re different for every individual. You’re only demonstrating your complete lack of understanding about basic nutrition with your argument.

        1. Andrey Pavlov says:

          No Stan, this shows how incredibly poorly you understand science.

          One does not need to eliminate all other variables to conduct a serious scientific study. Science is not limited to being only able to study one single isolated thing in isolation. As you may have noticed the AREDS and AREDS 2 study both used multiple different compounds at the same time. The issue is that if it is only one thing we can’t say for sure which one it is. But we can say it is at least one, perhaps more, perhaps all, of these things that have the effect.

          The idea that they are “different for every individual” is ridiculous. If things were actually that different we’d not be able to do anything. There is variability and that is why we often say that in certain cases there may be a group of people that a responders hidden in the larger crowd that is not. But either way, we can tell something about it – that for most people it does or does not work.

          But we can and do test this sort of stuff scientifically or not. Your protestations otherwise are nothing more than the BS complaint of all CAM that “you can’t test my quackery!” because testing it shows it doesn’t work. What’s the best way to try and save a quack modality that doesn’t work? Try to pretend it really does work but it just can’t be tested. Which is BS.

        2. WilliamLawrenceUtridge says:

          Because nutrients don’t work like drugs and you can’t test them like drugs…

          Why not? Nutrients do work like drugs in the sense that the molecules have specific effects on the body that can be demonstrated through deprivation and replacement in multiple models. Very drug-like, you can show dose-response curves and even overdoses for some.

          They don’t work in isolation.

          What prevents dosing with combinations of nutrients, say, “a combination of 3 antioxidants (vitamin C, 500 mg; vitamin E, 400 IU; and vitamin A in the form of beta carotene, 25,000 IU), with zinc and copper”? I ask, because that’s an exact quote from Dr. Hall, which seems to suggest the nutrients were not given in isolation.

          In order to have a good study, one also has to eliminate all other variables. This is never done because it’s impossible – there’s always way too many of them, and they’re different for every individual. You’re only demonstrating your complete lack of understanding about basic nutrition with your argument.

          Um…not really, you’re actually demonstrating your lack of understanding with yours. See, within science it’s actually quite easy to overcome individual variations and other variables – it’s called “randomization”. One can’t know every individual factor, which is why you aggregate large numbers of subjects (say, 4,000 or so) and randomize them into “intervention” and “control” groups. By using large numbers and randomization, the random statistical noise washes out and any difference is assumed to be due to the effect of the intervention. Sure, some in the intervention group might not benefit, but some in the control group wouldn’t have either. Some in each group might respond better, others worse. So I don’t really have to understand nutrition to see the flaw in this methodological argument. Now, if this study had found a difference, from there you can look for characteristics of individual responders and future studies can even stratify on the basis of those characteristics, and you can start to tease out what individual polymorphisms or even nutrient statuses that might exist that act to modulate the “blunt force” of a single intervention for the test group. No wonder you don’t trust science, you don’t even understand it! This is quite basic stuff, it’s covered in Snake Oil Science, or any research methodologies course or textbook.

          And as Angora Rabbit points out above, your allegedly superior understanding of nutrition appears to be quite out of step with what real scientists who study nutrition know.

  4. Angora Rabbit says:

    Typical Stan rant. It is only hi$ $upplement that is the One True Cure, ignoring boatloads of biochemical and physiological data. He’s like the Pope speaking about creation. Every time the data show that human characteristic X is also shared in animals, the Pope (okay, past Popes, not the current one yet), moves the line that defines “human.” For Stan, it doesn’t give him the re$ult he wants, so he comes up with another lame excuse that is not supported by data. He is so enthralled with his own hypothesis that he just keeps shifting the goal post. And before he accuses me of the same. let me point out that I love it when I get unexpected results, because it means I’m about to learn something cool. And if I get the expected result, that means there are now different rocks I can peer under. I win-win either way, so I really don’t give a rat’s patootie how the data come out, because the Data Are Always Right, and sometimes I’m clever enough to figure out why. Versus $tan, who just drags out yet other excuse. He is the CAM Apologist.

    PS – astaxanthin is sooo yesterday.

    PPS – if you bothered to read the study, you’d see that AREDS2 actually WORKED. It just worked no better than AREDS1. At least get your excuses right.

  5. dh says:

    Dr Hall-
    Yet another failure of vitamin supplements.

    Some of us still need to take certain vitamins – e.g. those with nutritional deficiencies (I am vegan and so take 4 specific types of vitamins, although one of them does not apply specifically to veganism).

    But on the whole, I do not believe in most vitamins for disease prevention.

  6. stanmrak says:

    I use eye supplements, and am getting results. I don’t use the cheap ones tho.

    1. Harriet Hall says:

      “I use eye supplements, and am getting results.”

      What results?

      1. Windriven says:

        “What results?”

        I presume something like this.

        For anyone who misses it, this is from the timeless Kubrick classic, “Dr. Strangelove,” 50 years old this year.

        1. Serge says:

          I don’t know how you keep your temper with Stan (and that Rodriguez fella). Their absolute inability to engage in reasonable arguments astonishes me, it truly does. As I think has been mentioned earlier in the thread, to be proven wrong is a wonderful thing and should be taken as an opportunity for further learning.

          1. Windriven says:

            “I don’t know how you keep your temper with Stan (and that Rodriguez fella). ”

            Stan is just stan; I don’t think there is anything more to him than what you get from his comments.

            By popular request I am trying to be the new, kinder, gentler, more politically correct Windriven. So I’ve mostly stopped calling drooling, microcephalic, butt-sniffing morons what they are. An unfortunate side effect is that now when I come home at night my dog won’t come around till I’m on my second drink. ;-)

            All joking aside, Rodrigues is a puzzlement to me. There’s something that I acutally like about the guy. My latest theory is that he was employed by a doc-in-the-box or some horrific medical mill early in his career and he became convinced that straight medicine is largely exploitative. He went, I think, to Howard – not the worst medical school in the country – graduated and passed his boards. One presumes he isn’t just vanilla stupid. But he sure does a good impression.

            1. n brownlee says:

              I thought so, too. But the choice seems to be that either he IS just that stupid, or he’s been jerking you all around for a year.

              1. Windriven says:

                I hate to say it Nancy, but I’m coming around to that view myself, and I don’t mean the jerking me around option.

            2. n brownlee says:

              PS Also I have known quite a few less-than-brilliant MDs. Have you not?

              1. Windriven says:

                “I have known quite a few less-than-brilliant MDs. Have you not?”

                I’ve known a few including a couple of real howlers. But I must say that the vast proportion I’ve known have been reasonably bright, if sometimes less educated scientifically than would be my preference.

          2. WilliamLawrenceUtridge says:

            I don’t know how you keep your temper with Stan (and that Rodriguez fella). Their absolute inability to engage in reasonable arguments astonishes me, it truly does.

            You keep your eye on the prize – it’s never about stan or steve, it’s about the fence-sitters or unconvinced who read the comment and can’t see how they could be wrong. stan and steve will never change their minds, the best we can hope for is an agonizing dea- I mean their untimely demi- ahem that they simply stop posting. But a civil reply pointing out they are wrong and stupid might reach someone else. Plus, like playing a video game that’s a bit too easy – it’s often fun.

            Of course, once in a while one must try something new, like a blatant ad hominem, because it’s like a vacation for your frontal lobes. And it feels soooooo good.

      2. Sawyer says:

        Cheap supplements only improve your vision. The amazing supplements stan uses are so powerful, they enable him to selectively read the 1% of SBM content that support his viewpoint, and not see the other 99% at all.

        You have to admit this is an extremely impressive ocular achievement.

      3. stanmrak says:

        I noticed that I never have to use sunglasses anymore, my eyes adjust to bright sun without them. I also can stay out in the sun much longer without burning, without resorting to chemical sunscreens. The effect is unmistakable. There is evidence to suggest that astaxanthin is very beneficial for your eyes. I’m not looking for “proof.”

        1. e canfield says:

          Here’s an anecdote to counter your anecdote: My husband has congenital glaucoma (from removing the rubella-caused cataracts he was born with) and an Irish hide. Supplements have never helped him with either issue. Chemicals have, timolol and sunscreen respectively.

          On a related note; our infant will be getting the MMR the week he turns 1.

        2. WilliamLawrenceUtridge says:

          I noticed that I never have to use sunglasses anymore, my eyes adjust to bright sun without them. I also can stay out in the sun much longer without burning, without resorting to chemical sunscreens. The effect is unmistakable. There is evidence to suggest that astaxanthin is very beneficial for your eyes. I’m not looking for “proof.”

          Maybe your retina is degenerating and you’re losing rod cells, or perhaps there are distortions or damage to the retina that are scattering more light. Maybe it’s not the magic expensive vitamins you sell.

          Also, it’s quite easy to stay out in the sun longer without burning, it’s called “tanning”. And indeed, it is unmistakable.

        3. EBMOD says:

          As an eye doctor, I have to ask, how old are you? The media in our eyes naturally cloud with time. Even though cataracts are thought of as an elderly thing, they are like gray hair. It sets in relatively young, but progresses slowly. Most of us get our first grey hair in our 20′s, but do not turn fully gray until 50-60.

          Cataracts are the same way. While it may not be visually debilitating, we can see early start of cataracts in your 40′s. It is only when they are quite advanced (usually 30 years after they start) that they interfere with vision enough to require surgery. By the time you are 60, roughly 1/3 the amount of light is reaching your retina due to this clouding.

          In other words, your new found tolerance to bright light is probably natural aging of the media in your eye and you are conveniently attributing it to your supplement.

          Second, I have to take you to task for a very irresponsible article on your website. You promote an anti-oxidant as a way to prevent/cure glaucoma, when there is essentially no evidence that it is a disease caused by oxidative stress. Further, considering that glaucoma is impossible to diagnose or follow without examination of the optic nerve head, how was it determined that your supplement was improving outcomes?

          Patients with glaucoma do not have any visual symptoms until the disease is quite advanced and that loss is irreversible, so you can’t rely on patient self-reports either. Implying that your supplements are an alternative to proven remedies such as prostaglandins and beta-blockers is dangerous and requires a disturbing level of hubris.

          1. WilliamLawrenceUtridge says:

            EBMOD, first, welcome. Second, stan is a waste of time, unethical and cares for science only when it supports him. Third, it is always, always delightful when a subject-matter expert such as yourself shows up to provide valuable details and expertise in a specific area. Thanks for your comments, I was not aware of these details and it’s always fascinating to learn these things.

    2. WilliamLawrenceUtridge says:

      I use eye supplements, and am getting results. I don’t use the cheap ones tho.

      How do you know you aren’t merely urinating a cure for third-world nutrient deficiencies?

      How do you know your eyes would not be exactly the same (or better) without said supplements?

      How do you know your supplements are not fueling a vicious, chemo-resistant lung cancer? Not that you would ever take chemo, I’m sure you’d stick to your vitamins, clutching them to your chest as the tumor eroded its agonizing way through your bones, nerves and rib cage. Have fun with that, be sure to chew willow bark and eat a lot of poppy seeds.

      1. Kultakutri says:

        What’s wrong with poppy seeds? They taste good, if nothing else.

        1. Angora Rabbit says:

          “Poppies…poppies…Sleep…sleep, my pretty.”

          Role model.

        2. WilliamLawrenceUtridge says:

          Nothing’s wrong with poppy seeds, but if you’re using them as a substitute for morphine during end-stage cancer, you’re in for a shitty, shitty death.

  7. irenegoodnight says:

    How do y’all know that stan is a vitamin dealer? I don’t question it, I’m just always curious how you guys know these things.

  8. Simon G says:

    Did you look into astaxanthin?

    Wu TH, Liao JH, Hou WC, et al. Astaxanthin protects against oxidative stress and calcium-induced porcine lens protein degradation. J Agric Food Chem . 2006;54:2418-2423.

    http://www.valensa.com/resources/Astaxanthin.php

  9. http://reverseamd.com/

    I use this in the office and it helps some of my patients.

    1. Harriet Hall says:

      Everybody! Click on that link! It’s hilarious. It claims that AMD can be REVERSED!!! And look how that is accomplished!

      Note: my visual acuity improves by one line when the person testing me encourages me to try to read the next line even if it seems blurry.

      SSR continues to demonstrate his value as a bad example and for comic relief.

      1. Hmmm.
        Are you saying you would restrict people from this treatment just because YOU think it’s hookey?

        YOU want to impose your “will” on free people because YOU think they are unwise, uneducated, misinformed and gullible?

        Seems you want to impose authoritarian, dictatorial, totalitarian ideals on society. That is not what scientist do, that is what despotic people do.

        I advocate for ALL possible, relevant, tested and safe therapeutic options, let free citizens choose for themselves. I would also want to monitor the clinical outcomes in an ongoing based so ALL would have this updated data.

        1. Vicki says:

          Who said anything about restricting it?

          Why is it appropriate for you to say “I think this works, try it” and not appropriate for someone else to say “There is no evidence that this works, and one version might give you cancer, don’t do it”? You’re coming onto someone else’s blog and trying to tell them that your opinion is inherently valid and theirs is inherently worthless.

          Dr. Hall and the other bloggers here are being extremely patient with you.

          1. Windriven says:

            “Dr. Hall and the other bloggers here are being extremely patient with you.”

            To a fault.

            1. Has anyone of you read the articles or do you not want to know (as scientist and provider) all of a possible treatment options that could slow the destructive process?

              Are you saying NO to this therapy at all? If you say, “yes,” then you would allow someone to go blind just because of the statistics?

              The research, data, along with the option is open and available to the public (you or anyone else) to process and make informed choices. NOT for dictators to decide, which would be unethical!!!

              1. WilliamLawrenceUtridge says:

                Has anyone of you read the articles or do you not want to know (as scientist and provider) all of a possible treatment options that could slow the destructive process?

                What articles? Do you mean the 50-year-old books I commented on here or the irrelevant list I commented on here? Or do you have a specific list of how acupuncture applies to AMD? Because I’m always happy to look at your lists.

                Are you saying NO to this therapy at all? If you say, “yes,” then you would allow someone to go blind just because of the statistics?

                I would say no to sticking needles in my eyes unnecessarily with no evidence to support it. And if there were a study supporting the benefits of stabbing needles in my eyes, I would hope for at a minimum a statistical benefit but would be much more interested in something with a clinical benefit.

                Do you have peer-reviewed journal articles supporting either?

                The research, data, along with the option is open and available to the public (you or anyone else) to process and make informed choices. NOT for dictators to decide, which would be unethical!!!

                What research and what data?

                Don’t you think part of making an “informed choice” is being informed that there is no research supporting being stabbed in the eye with a needle as an effective treatment? Or do you think we should just say “it might work” for everything? Here, take this tamoxifen, it might work. Or try this interferon, it might work. I mean, it’s never been tested – but the guy who sells it says it might work.

                Call me crazy, but I like to think a patient should actually be told just how effective the treatment is in controlled trials.

              2. David Weinberg says:

                “Has anyone of you read the articles or do you not want to know (as scientist and provider) ”

                If you are talking about the acupuncture for AMD website you linked at the top of this thread; yes Stephen I have read the website, the articles, and even engaged in an email conversation with the author. The scientific rationale and “explanations” are completely empty. The data he has presented to support the effectiveness of treatment are so poor they are meaningless.

            2. Windriven says:

              “Has anyone of you read the articles or do you not want to know (as scientist and provider) all of a possible treatment options that could slow the destructive process?”

              No, Steve. I haven’t read any Archie comics either – at least not since the age of twelve or so. Just because some quack can get a paper into the American Journal of Quackery doesn’t make it worth reading.

        2. WilliamLawrenceUtridge says:

          Are you saying you would restrict people from this treatment just because YOU think it’s hookey?

          YOU want to impose your “will” on free people because YOU think they are unwise, uneducated, misinformed and gullible?

          You read into the situation. Few here would restrict or prohibit it in absolute terms. I, for instance, would not permit medical claims to be made, and would not reimburse it through any public health care option. I would also ensure that government websites would clearly state that acupuncture is unsupported. Licensing for acupuncturists would consist solely of sterile measures and anatomical structures, for patient safety.

          Seems you want to impose authoritarian, dictatorial, totalitarian ideals on society. That is not what scientist do, that is what despotic people do.

          Of course, not, and nobody here argues for that, you lunatic. We merely want consumers to understand that acupuncture doesn’t work, and it presents an extremely low risk of significant harm such as pneumothorax, infection, cancer, and even death. No jackbooted thugs are kicking down your door, and indeed – no scientist would support it. Merely an honest description of what is scientifically supported and what is not. Don’t pretend this is more dramatic than what it actually is – all that is being asked for is honesty. Your histrionics are distasteful.

          I advocate for ALL possible, relevant, tested and safe therapeutic options, let free citizens choose for themselves. I would also want to monitor the clinical outcomes in an ongoing based so ALL would have this updated data.

          That’s ironic, given you consistently advocate for acupuncture and it has failed testing for decades, in over three thousand clinical trials. If you adhered to your own criteria, you would have to abandon your favoured practice, you hypocrite.

    2. Windriven says:

      Hysterical! Is there no pile of steaming bull excrement so foul that you will not embrace it as a true elixir? Do your patients know you’ll dabble in any kind of nonsense or are you at least honest that you’re just taking their money?

      Are credits in medical ethics required as part of CME?

  10. Jeff says:

    The best way to prevent AMD might be to avoid certain pharmaceuticals:

    http://www.ncbi.nlm.nih.gov/pubmed/24793737

    1. Harriet Hall says:

      That’s an interesting study, but the most we can conclude from it is that those two meds may be risk factors associated with an increase in the incidence of AMD. People on those two drugs are taking them because they have significant CV disease, which might itself be the real culprit. “The best way” implies a comparison with other preventive measures, and there have been no comparisons. I’d guess the “best way” would be to stop smoking.

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