Marshall Leisa L, Roach J Michael
Mercer University College of Pharmacy, Atlanta, Georgia.
Consult Pharm. 2013 Nov;28(11):723-37. doi: 10.4140/TCP.n.2013.723.
Review the current recommendations for the prevention and treatment of age-related macular degeneration (AMD).
Articles indexed in PubMed (National Library of Medicine), the Cochrane Reviews and Trials, Dynamed, and Iowa Drug Information Service (IDIS) in the last 10 years using the key words macular degeneration, agerelated macular degeneration (AMD), AMD and treatment, AMD and prevention.
Sixty-nine published papers were reviewed, and criteria supporting the primary objective were used to identify useful resources.
The literature included practice guidelines, original research articles, review articles, product prescribing information, and supplement product information for the prevention and treatment of AMD.
AMD is a leading cause of visual impairment in older adults. At present there is no cure for advanced AMD, but intravitreal vascular endothelial growth factor inhibitors minimize and even reverse vision loss in patients with AMD of the neovascular type. In the Age-Related Eye Disease Study (AREDS), participants with intermediate AMD who received a supplement combination of vitamins C and E, beta-carotene, and zinc had a greater delay in progression to advanced AMD than those participants who received a portion of these supplements. In the second AREDS, AREDS2, the addition of lutein + zeaxanthin, docosahexaenoic acid (DHA) + eicosapentaenoic acid (EPA), or lutein + zeaxanthin and DHA + EPA to the complete AREDS formulation did not further reduce the risk of progression to advanced AMD. Subgroup analyses indicated that additional research with lutein + zeaxanthin supplementation is warranted as it was beneficial in participants with low dietary intake of lutein + zeaxanthin. A formulation without beta-carotene may be best for most patients, especially smokers or former smokers. Health care professionals will want to consider patient-specific information before recommending ocular health supplements.
回顾当前关于年龄相关性黄斑变性（AMD）预防和治疗的建议。
过去10年在PubMed（美国国立医学图书馆）、考克兰系统评价和试验库、Dynamed以及爱荷华药物信息服务（IDIS）中索引的文章，使用关键词黄斑变性、年龄相关性黄斑变性（AMD）、AMD与治疗、AMD与预防。
对69篇已发表论文进行了综述，并使用支持主要目标的标准来确定有用的资源。
文献包括AMD预防和治疗的实践指南、原创研究文章、综述文章、产品处方信息以及补充产品信息。
AMD是老年人视力损害的主要原因。目前晚期AMD无法治愈，但玻璃体内血管内皮生长因子抑制剂可使新生血管型AMD患者的视力丧失最小化甚至逆转。在年龄相关性眼病研究（AREDS）中，中度AMD参与者接受维生素C和E、β-胡萝卜素和锌的补充剂组合，与接受部分这些补充剂的参与者相比，进展为晚期AMD的延迟时间更长。在第二项AREDS（AREDS2）中，在完整的AREDS配方中添加叶黄素+玉米黄质、二十二碳六烯酸（DHA）+二十碳五烯酸（EPA），或叶黄素+玉米黄质以及DHA+EPA，并未进一步降低进展为晚期AMD的风险。亚组分析表明，有必要对补充叶黄素+玉米黄质进行更多研究，因为它对叶黄素+玉米黄质饮食摄入量低的参与者有益。不含β-胡萝卜素的配方可能对大多数患者最有利，尤其是吸烟者或既往吸烟者。医疗保健专业人员在推荐眼部健康补充剂之前，会希望考虑患者的具体信息。
