Grand Rounds

Do Vitamin Supplements Inhibit Macular Degeneration?

BACKGROUND AND PURPOSE:

It is still unknown whether a diet rich in antioxidant vitamins (carotenoids, vitamins C, and E) or minerals (selenium and zinc) makes one less likely to develop age-related macular degeneration (AMD)
Evans et al. (Chochrane Database Syst Rev, 2017) sought to determine whether AMD development could be prevented by taking antioxidant vitamin and/or mineral supplements

Systematic Review and meta-analysis
Search of multiple databases
Selection Criteria: RCTs comparing antioxidant vitamin and/or mineral supplement vs control

5 low-risk of bias RCTs comparing vitamin or mineral supplement to control were included, with data from 76,756 individuals
- Follow-up ranged from 4 to 10 years
Vitamin E:
- Showed no evidence of preventing AMD development (risk ratio (RR) 0.97, 95% confidence interval (CI) 0.90 to 1.06; high-certainty evidence)
- Could increase risk of late AMD compared to placebo (RR 1.22, 95% CI 0.89 to 1.67; moderate-certainty evidence)
- Low-certainty evidence of excess hemorrhagic strokes in vitamin E group
Beta-carotene:
- Did not prevent any AMD (RR 1.00, 95% CI 0.88 to 1.14; high-certainty evidence) nor impact late AMD
- Was associated with increased risk for lung cancer among smokers
- Could increase risk of lung cancer among people exposed to asbestos
Vitamin C:
- Did not prevent any AMD (RR 0.96, 95% CI 0.79 to 1.18; high-certainty evidence) nor impact late AMD
- There was moderate-certainty evidence that multivitamins may increase risk of AMD (RR 1.21, 95% CI 1.02 to 1.43)
- Correlated to a possible increased risk of skin rashes

Taking vitamin E, beta-carotene supplements, vitamin C, or multivitamin will not prevent or delay the onset of AMD
Lutein and zeaxanthin, other supplements, have not been studied
Vitamin supplements may have harmful effects and AMD-related benefits are not clear

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