Case Study: AM is a 74-year-old man looking to purchase vitamins for eye health. He recently saw his ophthalmologist and was given a diagnosis of macular degeneration in his left eye. AM was advised to start taking antioxidant vitamins because he has been having trouble seeing fine details when reading and watching television. He appears confused by all the available OTC supplements. AM wants to know whether PreserVision ARED (vitamins A [beta carotene], C, and E; zinc and copper) is a suitable choice for him. You review his profile and see that he has a history of erectile dysfunction, hypertension, osteoarthritis, and tobacco abuse. AM takes amlodipine 10 mg daily, lisinopril 20 mg daily, and sildenafil 50 mg as needed prior to sexual activity. He has no known drug allergies.


Should the pharmacist recommend this product for AM?


Answer: 
OTC antioxidant vitamins and minerals are recommended for those with advanced or intermediate macular degeneration in at least 1 eye. Findings from the AREDS study show that high doses of vitamins C, E, and beta carotene, along with zinc and copper, slow progression of macular degeneration by 25%.1 Because of the concern that beta carotene increases the risk of lung cancer in smokers, lutein and zeaxanthin are substituted for beta carotene in some formulations and appear to be safe alternatives. The pharmacist should therefore instruct AM to purchase a beta carotene-free formation, not the one he selected, because he is an active smoker. The pharmacist should also help identify and compare the ingredients list on different product labels. Options for AM include ICaps, Ocuvite Adult 50+, and PreserVision AREDS 2. AM should also be encouraged to quit smoking because smoking is a modifiable risk factor for macular degeneration.


Reference
Age-related Eye Disease Study Research Group. 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. Arch Ophthalmol. 2001;119(10):1417-1436. doi: 10.1001/archopht.119.10.1417.