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Oral docosahexaenoic acid in the prevention of exudative age-related macular degeneration: the Nutritional AMD Treatment 2 study.

Abstract

OBJECTIVE

To evaluate the efficacy of docosahexaenoic acid (DHA)-enriched oral supplementation in preventing exudative age-related macular degeneration (AMD).

DESIGN

The Nutritional AMD Treatment 2 study was a randomized, placebo-controlled, double-blind, parallel, comparative study.

PARTICIPANTS

Two hundred sixty-three patients 55 years of age or older and younger than 85 years with early lesions of age-related maculopathy and visual acuity better than 0.4 logarithm of minimum angle of resolution units in the study eye and neovascular AMD in the fellow eye.

METHODS

Patients were assigned randomly to receive either 840 mg/day DHA and 270 mg/day eicosapentaenoic acid (EPA) from fish oil capsules or the placebo (olive oil capsules) for 3 years.

MAIN OUTCOME MEASURES

The primary outcome measure was time to occurrence of choroidal neovascularization (CNV) in the study eye. Secondary outcome measures in the study eye were: incidence of CNV developing in patients, changes in visual acuity, occurrence and progression of drusen, and changes in EPA plus DHA level in red blood cell membrane (RBCM).

RESULTS

Time to occurrence and incidence of CNV in the study eye were not significantly different between the DHA group (19.5±10.9 months and 28.4%, respectively) and the placebo group (18.7±10.6 months and 25.6%, respectively). In the DHA group, EPA plus DHA levels increased significantly in RBCM (+70%; P<0.001), suggesting that DHA easily penetrated cells, but this occurred unexpectedly also in the placebo group (+9%; P = 0.007). In the DHA-allocated group, patients steadily achieving the highest tertile of EPA plus DHA levels in RBCM had significantly lower risk (-68%; P = 0.047; hazard ratio, 0.32; 95% confidence interval, 0.10-0.99) of CNV developing over 3 years. No marked changes from baseline in best-corrected visual acuity, drusen progression, or geographic atrophy in the study eye were observed throughout the study in either group.

CONCLUSIONS

In patients with unilateral exudative AMD, 3 years of oral DHA-enriched supplementation had the same effect on CNV incidence in the second eye as did the placebo. However, RBCM fatty acid measurements revealed that CNV incidence was significantly reduced in DHA-supplemented patients showing a steadily high EPA plus DHA index over 3 years.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Ophthalmology Department, Hôpital Intercommunal de Créteil, University Paris Est Créteil, Créteil, France. eric.souied@chicreteil.fr

    , , , , , , ,

    Source

    Ophthalmology 120:8 2013 Aug pg 1619-31

    MeSH

    Administration, Oral
    Aged
    Aged, 80 and over
    Capsules
    Dietary Supplements
    Docosahexaenoic Acids
    Double-Blind Method
    Drug Combinations
    Eicosapentaenoic Acid
    Female
    Fluorescein Angiography
    Humans
    Lipids
    Male
    Middle Aged
    Prospective Studies
    Retinal Drusen
    Visual Acuity
    Vitamin E
    Wet Macular Degeneration

    Pub Type(s)

    Comparative Study
    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    23395546

    Citation

    Souied, Eric H., et al. "Oral Docosahexaenoic Acid in the Prevention of Exudative Age-related Macular Degeneration: the Nutritional AMD Treatment 2 Study." Ophthalmology, vol. 120, no. 8, 2013, pp. 1619-31.
    Souied EH, Delcourt C, Querques G, et al. Oral docosahexaenoic acid in the prevention of exudative age-related macular degeneration: the Nutritional AMD Treatment 2 study. Ophthalmology. 2013;120(8):1619-31.
    Souied, E. H., Delcourt, C., Querques, G., Bassols, A., Merle, B., Zourdani, A., ... Benlian, P. (2013). Oral docosahexaenoic acid in the prevention of exudative age-related macular degeneration: the Nutritional AMD Treatment 2 study. Ophthalmology, 120(8), pp. 1619-31. doi:10.1016/j.ophtha.2013.01.005.
    Souied EH, et al. Oral Docosahexaenoic Acid in the Prevention of Exudative Age-related Macular Degeneration: the Nutritional AMD Treatment 2 Study. Ophthalmology. 2013;120(8):1619-31. PubMed PMID: 23395546.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Oral docosahexaenoic acid in the prevention of exudative age-related macular degeneration: the Nutritional AMD Treatment 2 study. AU - Souied,Eric H, AU - Delcourt,Cécile, AU - Querques,Giuseppe, AU - Bassols,Ana, AU - Merle,Bénédicte, AU - Zourdani,Alain, AU - Smith,Theodore, AU - Benlian,Pascale, AU - ,, Y1 - 2013/02/08/ PY - 2012/08/06/received PY - 2013/01/02/revised PY - 2013/01/02/accepted PY - 2013/2/12/entrez PY - 2013/2/12/pubmed PY - 2013/11/7/medline SP - 1619 EP - 31 JF - Ophthalmology JO - Ophthalmology VL - 120 IS - 8 N2 - OBJECTIVE: To evaluate the efficacy of docosahexaenoic acid (DHA)-enriched oral supplementation in preventing exudative age-related macular degeneration (AMD). DESIGN: The Nutritional AMD Treatment 2 study was a randomized, placebo-controlled, double-blind, parallel, comparative study. PARTICIPANTS: Two hundred sixty-three patients 55 years of age or older and younger than 85 years with early lesions of age-related maculopathy and visual acuity better than 0.4 logarithm of minimum angle of resolution units in the study eye and neovascular AMD in the fellow eye. METHODS: Patients were assigned randomly to receive either 840 mg/day DHA and 270 mg/day eicosapentaenoic acid (EPA) from fish oil capsules or the placebo (olive oil capsules) for 3 years. MAIN OUTCOME MEASURES: The primary outcome measure was time to occurrence of choroidal neovascularization (CNV) in the study eye. Secondary outcome measures in the study eye were: incidence of CNV developing in patients, changes in visual acuity, occurrence and progression of drusen, and changes in EPA plus DHA level in red blood cell membrane (RBCM). RESULTS: Time to occurrence and incidence of CNV in the study eye were not significantly different between the DHA group (19.5±10.9 months and 28.4%, respectively) and the placebo group (18.7±10.6 months and 25.6%, respectively). In the DHA group, EPA plus DHA levels increased significantly in RBCM (+70%; P<0.001), suggesting that DHA easily penetrated cells, but this occurred unexpectedly also in the placebo group (+9%; P = 0.007). In the DHA-allocated group, patients steadily achieving the highest tertile of EPA plus DHA levels in RBCM had significantly lower risk (-68%; P = 0.047; hazard ratio, 0.32; 95% confidence interval, 0.10-0.99) of CNV developing over 3 years. No marked changes from baseline in best-corrected visual acuity, drusen progression, or geographic atrophy in the study eye were observed throughout the study in either group. CONCLUSIONS: In patients with unilateral exudative AMD, 3 years of oral DHA-enriched supplementation had the same effect on CNV incidence in the second eye as did the placebo. However, RBCM fatty acid measurements revealed that CNV incidence was significantly reduced in DHA-supplemented patients showing a steadily high EPA plus DHA index over 3 years. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/23395546/Oral_docosahexaenoic_acid_in_the_prevention_of_exudative_age_related_macular_degeneration:_the_Nutritional_AMD_Treatment_2_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(13)00007-9 DB - PRIME DP - Unbound Medicine ER -