Sasaki M, Shinoda H, Koto T, Uchida A, Tsubota K, Ozawa Y. Use of Micronutrient Supplement for Preventing Advanced Age-Related Macular Degeneration in Japan. Arch Ophthalmol. 2012;130(2):254–255. doi:10.1001/archopthalmol.2011.1368
Author Affiliations: Department of Ophthalmology (Drs Sasaki, Shinoda, Koto, Uchida, Tsubota, and Ozawa) and Laboratory of Retinal Cell Biology (Drs Sasaki and Ozawa), Keio University School of Medicine, Tokyo, Japan.
In accordance with the results of the Age-Related Eye Disease Study (AREDS),1 a randomized controlled trial performed in the United States, patients with age-related macular degeneration (AMD) in the United States have been instructed to take micronutrient supplements when their lesion fits the inclusion criteria.2 We conducted a survey about the patients' supplement use and the ophthalmologists' attitudes toward supplements in Japan, where the use is not based on ophthalmologists' prescription.
The questionnaire was given to patients diagnosed as having AMD at the Medical Retina Division, Department of Ophthalmology, Keio University Hospital, Tokyo, Japan, between January 8, 2010, and June 25, 2010. Another questionnaire was given to the ophthalmologists in our department. Supplements containing more than 50% of the AREDS-recommended levels of vitamin C, vitamin E, and zinc were designated AREDS-like supplements, and those that contained reduced amounts of beta carotene and included lutein were designated AREDS plus lutein supplements. This study was approved by the ethics committee of the Keio University School of Medicine.
Of the 163 patients with AMD who completed our questionnaire, 159 gave valid answers (119 male, 40 female; all ethnic Japanese; age range, 50-95 years; mean age, 73.9 years). Oral supplements of any type were used by 90 participants (56.6%); 23 used an AREDS-like supplement and 35 used an AREDS plus lutein supplement. Among the 139 candidates eligible for an AREDS supplement judged by the modified AREDS classification system based on fundus findings2 (Table), 48 (34.5%) used an AREDS-related supplement under their ophthalmologists' instruction; 17 used an AREDS-like supplement and 31 used an AREDS plus lutein supplement. Ninety-one participants (65.5%) had not used a supplement (Table), of whom 61 (43.9%) had not been given any instruction.
All of the 6 retinal specialists and 11 of the 12 non–retinal-specialized ophthalmologists considered AREDS-like supplements effective. All of the retinal specialists and 10 non–retinal-specialized ophthalmologists instructed their patients based on AREDS. However, 5 retinal specialists and 3 of the others included some additional information.
Overall, 56.6% of the participants in this study were taking supplements, which is lower than the proportion reported in the United States (93%).2
Surprisingly, all of the candidates who used the supplements were instructed to do so by ophthalmologists, suggesting that the patients' main source of information about supplements was their ophthalmologists. In this study, only 34.5% of the candidates used AREDS-related supplements, which is far lower than in the previous report in the United States (67%). This was in contrast to the high level of adherence among the candidates (48 of 78 participants [61.5%]; no significant difference according to age or sex). It should be noted that the instruction rate of the ophthalmologists was more critical than the adherence rate of the patients for taking supplements. Interestingly, AREDS plus lutein supplements were used more often than AREDS-like supplements in this study, in contrast to a US-based study.2 A recent survey in a Japanese cohort reporting the protective association of the serum levels of carotenoids with AMD3 and studies in animal models showing the tissue-protecting effects of lutein as a blue-light filter and antioxidant4,5 may have promoted the use of AREDS plus lutein supplements.
The ophthalmologists did not always recommend supplements in accordance with AREDS. Some ophthalmologists were not completely confident that the AREDS results are applicable to Japanese or other Asian patients with AMD because of the differences in the clinical features of Asian and white patients with AMD.2,6
The increased incidence of AMD and the resulting vision loss are now serious issues. Preventive therapy is important for both patients' personal health and their continued contributions to society. Reliable evidence based on a randomized controlled trial is still needed for ophthalmologists to appropriately instruct patients' use of supplements to prevent the progress of AMD in Japan.
Correspondence: Dr Ozawa, Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan (firstname.lastname@example.org).
Financial Disclosure: None reported.
Funding/Support: Dr Ozawa has received grant support from Wakasa Seikatsu Co, Ltd, and Drs Sasaki and Ozawa have received support from the Ministry of Education, Culture, Sports, Science, and Technology in Japan.