Addressing AREDS2 controversies

Philadelphia-During the American Optometric Association’s Optometry’s Meeting, Diana Shechtman, OD, FAAO, and Jeffry Gerson, OD, FAAO, addressed some of the controversies surrounding the results of the Age-Related Eye Diseases Study 2 (AREDS2), including fish oil, lutein/zeaxanthin, and genetic testing.

“If you just read the abstract, it essentially says ‘AREDS2: A bust,’” says Dr. Gerson.

While the study found that lutein/zeaxanthin doesn’t appear to have a positive effect on AMD patients, patients in the lowest quintile who have the least lutein/zeaxanthin in their diets did benefit, Dr. Gerson says. AREDS2 featured a “highly nourished cohort,” but the majority of Americans fall within the range of the lowest quintile.

“In an initial analysis, no, there’s nothing we can do. But the people with the lowest lutein/zeaxanthin intake should be supplemented, and it’s likely to help-and that’s likely the majority of your patients,” he says.

Dr. Shechtman notes that the lutein/zeaxanthin supplement would be a therapeutic dose, not a preventative measure, for patients who already have the disease.

Genetic tests are available to predict a patient’s likelihood of developing AMD, the likelihood of his AMD worsening, and which therapies he should use and which ones he should avoid. If a patient’s genetic test says he shouldn’t take zinc, should his OD withhold it?

“At this point, because there is so much controversy, I don’t use genetic testing to determine pharmacogenomics. Until I have more evidenced-based medicine, I’m not changing my perspective yet,” says Dr. Shechtman.

There are a number of mixed messages coming out of research regarding fish oil. Dr. Gerson says early AMD patients should certainly take fish oil supplements. And for late-stage patients, it’s not contraindicated. "If it were me, I would take it,” he says.

Dr. Shechtman recommends evaluating patients on an individual basis. If they do not have much fish in their diet, they should take a supplement. She also recommends familiarizing yourself with the differentfish oil brands and making clear recommendations to patients.