Cited by 3,285Retinal Diseases and TreatmentsAntioxidant Activity and Oxidative StressRetinal Imaging and Analysis

The DOI matches its Crossref record; 58 of the 61 references it cites were found in a registry or an index; none of the 18 sources its claims cite is checked for support yet.

A Randomized, Placebo-Controlled, Clinical Trial of High-Dose Supplementation With Vitamins C and E, Beta Carotene, and Zinc for Age-Related Macular Degeneration and Vision Loss: AREDS Report No. 8

Open access
Age-Related Eye Disease Study Research Group·2001·Archives of Ophthalmology

Abstract

BACKGROUND: Observational and experimental data suggest that antioxidant and/or zinc supplements may delay progression of age-related macular degeneration (AMD) and vision loss. OBJECTIVE: To evaluate the effect of high-dose vitamins C and E, beta carotene, and zinc supplements on AMD progression and visual acuity. DESIGN: The Age-Related Eye Disease Study, an 11-center double-masked clinical trial, enrolled participants in an AMD trial if they had extensive small drusen, intermediate drusen, large drusen, noncentral geographic atrophy, or pigment abnormalities in 1 or both eyes, or advanced AMD or vision loss due to AMD in 1 eye. At least 1 eye had best-corrected visual acuity of 20/32 or better. Participants were randomly assigned to receive daily oral tablets containing: (1) antioxidants (vitamin C, 500 mg; vitamin E, 400 IU; and beta carotene, 15 mg); (2) zinc, 80 mg, as zinc oxide and copper, 2 mg, as cupric oxide; (3) antioxidants plus zinc; or (4) placebo. MAIN OUTCOME MEASURES: (1) Photographic assessment of progression to or treatment for advanced AMD and (2) at least moderate visual acuity loss from baseline (> or =15 letters). Primary analyses used repeated-measures logistic regression with a significance level of.01, unadjusted for covariates. Serum level measurements, medical histories, and mortality rates were used for safety monitoring. RESULTS: Average follow-up of the 3640 enrolled study participants, aged 55-80 years, was 6.3 years, with 2.4% lost to follow-up. Comparison with placebo demonstrated a statistically significant odds reduction for the development of advanced AMD with antioxidants plus zinc (odds ratio [OR], 0.72; 99% confidence interval [CI], 0.52-0.98). The ORs for zinc alone and antioxidants alone are 0.75 (99% CI, 0.55-1.03) and 0.80 (99% CI, 0.59-1.09), respectively. Participants with extensive small drusen, nonextensive intermediate size drusen, or pigment abnormalities had only a 1.3% 5-year probability of progression to advanced AMD. Odds reduction estimates increased when these 1063 participants were excluded (antioxidants plus zinc: OR, 0.66; 99% CI, 0.47-0.91; zinc: OR, 0.71; 99% CI, 0.52-0.99; antioxidants: OR, 0.76; 99% CI, 0.55-1.05). Both zinc and antioxidants plus zinc significantly reduced the odds of developing advanced AMD in this higher-risk group. The only statistically significant reduction in rates of at least moderate visual acuity loss occurred in persons assigned to receive antioxidants plus zinc (OR, 0.73; 99% CI, 0.54-0.99). No statistically significant serious adverse effect was associated with any of the formulations. CONCLUSIONS: Persons older than 55 years should have dilated eye examinations to determine their risk of developing advanced AMD. Those with extensive intermediate size drusen, at least 1 large druse, noncentral geographic atrophy in 1 or both eyes, or advanced AMD or vision loss due to AMD in 1 eye, and without contraindications such as smoking, should consider taking a supplement of antioxidants plus zinc such as that used in this study.

Overview

Integrity signals

Registry

Crossref · 10.1001/archopht.119.10.1417

Cites

58 of 58 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

92 Own result · 36 Own method · 13 Own interpretation · 9 No basis given · 4 Sources not found · 4 No full text of the sources · 4 Not checked yet

Show all 107 claims

  • It may state two separate claims as one. 38
  • Probably not a substantial claim. 22
55 of 55
  • The authors state this as an assumption.

    There is no interaction between the antioxidant formulation and the zinc formulation.

    “Sequential monitoring of end points assumed no interaction between the antioxidant formulation and the zinc formulation, so that only main effects were analyzed.”
  • The paper relies on this without support.

    Visual acuity loss of at least 15 letters is a clinically meaningful outcome for AMD.

    “at least a 15-letter decrease in the visual acuity score between baseline and each follow-up visit (equivalent to at least a doubling of the initial visual angle)”
  • The paper relies on this without support.

    The examining ophthalmologist's attribution of visual acuity events to macular degeneration is accurate.

    “only 13 of these events (7%) were thought by the examining ophthalmologist to be primarily related to macular degeneration.”
  • The paper relies on this without support.

    Serum levels of antioxidants and zinc reflect adherence to study medication.

    “These results indicate a definite serum response to each study ingredient.”
  • The paper relies on this without support.

    The 400-IU dose of vitamin E is about 13 times the RDA and the dose of zinc as zinc oxide is about 5 times the RDA.

    “The 400-IU dose of vitamin E is about 13 times the RDA and the dose of zinc as zinc oxide is about 5 times the RDA.”
  • The paper relies on this without support.

    AREDS participants were relatively well-nourished compared with the general population.

    “The AREDS participants were relatively well-nourished compared with the general population”
  • The paper relies on this without support.

    Most cases of advanced AMD are identified with long-term follow-up.

    “Most cases are identified with long-term follow-up”
7 of 7

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1 of 1

Citations

Cites

Show all 61 references

Research works printed but not linked: 2

  1. [9]9. Fine SL, Berger JW, Maguire MG, Ho AC. Drug therapy: age-related macular de- generation. N Engl J Med. 2000;342:483-492.
  2. [47]47. Taylor HR, Tikellis G, Robman LD, McCarty CA, McNeil JJ. Vitamin E supple- mentation and age-related maculopathy [ARVO abstract]. Invest Ophthalmol Vis Sci. 2001;42:S311. Abstract No. 1676.

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Metadata

Authors
Age-Related Eye Disease Study Research Group
Corresponding author
Age-Related Eye Disease Study Research Group
Venue
Archives of Ophthalmology
Published
2001-10-01
Volume
119
Issue
10
Pages
1417
ISSN
0003-9950 (ISSN-L)
OpenAlex
W2598520882
Cited by
3,285
References
61
Citations by year
2026: 101 · 2025: 106 · 2024: 102 · 2023: 99 · 2022: 129 · 2021: 155 · 2020: 147 · 2019: 105 · 2018: 125 · 2017: 127 · 2016: 118 · 2015: 164 · 2014: 170 · 2013: 154 · 2012: 176
FWCI
90.03
Type
journal article
Language
en
Open access
Locations
  • Archives of Ophthalmology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • University of Wisconsin-Madison
  • Wake Forest University
  • University of Washington
  • Georgetown University
  • Università degli Studi di Parma
  • National Institutes of Health (1z01ey000394-01, Z01 EY000394)
  • Centers for Disease Control and Prevention
  • National Eye Institute (Z01 EY000394-03)
  • National Cancer Institute
  • NIH Clinical Center
Topics
  • Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
  • Health Sciences › Medicine › Biochemistry (medical) › Antioxidant Activity and Oxidative Stress
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
Keywords
age-related macular degeneration, vitamin C, vitamin E, beta-carotene, zinc supplementation, antioxidants, visual acuity loss, drusen, geographic atrophy, AMD progression, blindness prevention, AREDS, dietary supplements, serum zinc, copper supplementation, macular pigment optical density, retinal pigment epithelium, macular pigment
MeSH terms
Aged, Aged, 80 and over, Antioxidants, Ascorbic Acid, Double-Blind Method, Drug Evaluation, Drug Therapy, Combination, Female, Follow-Up Studies, Humans, Macular Degeneration, Male, Middle Aged, Prospective Studies, Risk Factors, Vision Disorders, Visual Acuity, Vitamin E, Zinc, Disease Progression, beta Carotene, Dietary Supplements

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