Damien Luviano, MD
<ul><li>#1 reason people over age 65 loose vision </li></ul>Damien Luviano, MD, FACS
<ul><li>March 14 in the  Archives of Ophthalmology </li></ul><ul><li>The women were US healthcare professionals 45 years o...
<ul><li>Salisbury Eye Evaluation (SEE) Study participants </li></ul><ul><li>A random sample of 2520 Salisbury, Maryland, r...
<ul><li>December 13 in the  Archives of Ophthalmology.   </li></ul><ul><li>The study sample consisted of 1313 women, aged ...
<ul><li>Age Related Eye Disease Study </li></ul><ul><li>The formulations included: </li></ul><ul><li>vitamin C (500 mg); <...
<ul><li>STUDY GROUPS </li></ul><ul><li>Original AREDS formulation </li></ul><ul><li>vitamin E (400 International Units [IU...
<ul><li>Direct association   between the homocysteine level in the blood and risk of AMD 16 - 23   and from the demonstrat...
<ul><li>The sample size was 1313 women, of whom 1287 without AMD were analyzed. </li></ul><ul><li>In women older than 75 y...
<ul><li>#1 reason in the world for blindness </li></ul><ul><li>#1 surgery performed in the United States </li></ul><ul><li...
<ul><li>Four thousand five hundred ninety individuals with at least one natural lens and photographic follow-up (median, 6...
<ul><ul><li>November 8 issue of  Archives of Ophthalmology </li></ul></ul><ul><ul><li>Study participants were male physici...
<ul><li>The formulations included: </li></ul><ul><li>vitamin C (500 mg); </li></ul><ul><li>vitamin E (400 International Un...
<ul><li>Number one reason patients age 25-65 loose vision </li></ul><ul><li>Number one reason patients loose kidney functi...
<ul><li>232,007 met inclusion criteria for this study. </li></ul><ul><li>14,130 cases of diabetes were diagnosed after 200...
<ul><ul><li>AREDS Vitamins any brand for Age related macular Degeneration patients who do not smoke </li></ul></ul><ul><ul...
<ul><li>Ask Questions </li></ul><ul><ul><li>HealthTap.com </li></ul></ul><ul><li>Read Articles </li></ul><ul><ul><li>WebMD...
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Multivitamins and the Eye

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Supplement vitamins do they help your eyes? Do they prevent blindness

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Multivitamins and the Eye

  1. 1. Damien Luviano, MD
  2. 2. <ul><li>#1 reason people over age 65 loose vision </li></ul>Damien Luviano, MD, FACS
  3. 3. <ul><li>March 14 in the Archives of Ophthalmology </li></ul><ul><li>The women were US healthcare professionals 45 years or older in 1993 who did not have a baseline history of cardiovascular disease or cancer and who were then assigned to aspirin, vitamin E, both, or neither </li></ul><ul><li>Among 38,022 women who completed the baseline food frequency questionnaire without a prior diagnosis of AMD, there were 235 cases of AMD at 10 years of follow-up. </li></ul><ul><li>Included were participants of the Women's Health Study, a randomized trial of low-dose aspirin and vitamin E for the primary prevention of cardiovascular disease and cancer. </li></ul><ul><li>Higher intakes of DHA and EPA are associated with 36% to 38% lower risk for AMD. </li></ul><ul><li>Consumption of tuna and dark fish at least once per week vs intake of less than once per month is associated with a lower risk for AMD. </li></ul><ul><li>CME : http://www.medscape.org/viewarticle/739316 </li></ul>Damien Luviano, MD, FACS
  4. 4. <ul><li>Salisbury Eye Evaluation (SEE) Study participants </li></ul><ul><li>A random sample of 2520 Salisbury, Maryland, residents aged 65 to 84 years. </li></ul><ul><li>There was no relationship of AMD with intake of crab and oysters combined, each of which has high levels of zinc. </li></ul><ul><li>Those with advanced AMD (CNV or GA) were significantly less likely to consume fish/shellfish high in omega-3 fatty acids </li></ul><ul><li>These data support a protective effect of fish/shellfish intake against advanced AMD. </li></ul><ul><li>Source: http://www.ophsource.org/periodicals/ophtha/article/S0161-6420(10)00377-5/abstract </li></ul><ul><li>CME: N/A </li></ul>Damien Luviano, MD, FACS
  5. 5. <ul><li>December 13 in the Archives of Ophthalmology. </li></ul><ul><li>The study sample consisted of 1313 women, aged 55 to 74 years, enrolled in CAREDS </li></ul><ul><li>The goal of the study was to evaluate the associations between lifestyle behaviors of diet, smoking, and physical activity with subsequent AMD prevalence </li></ul><ul><li>However, the combination of 3 healthy behaviors (healthy diet, physical activity, and not smoking) was associated with 71% lower odds for AMD vs having high-risk scores </li></ul><ul><li>CME : http://www.medscape.org/viewarticle/734537 </li></ul>Damien Luviano, MD, FACS
  6. 6. <ul><li>Age Related Eye Disease Study </li></ul><ul><li>The formulations included: </li></ul><ul><li>vitamin C (500 mg); </li></ul><ul><li>vitamin E (400 International Units [IU]); </li></ul><ul><li>beta-carotene (15 mg); </li></ul><ul><li>zinc (80 mg of zinc oxide); and </li></ul><ul><li>copper (2 mg of cupric oxide). </li></ul><ul><li>CME: http://www.medscape.org/viewarticle/578905_2 </li></ul><ul><li>moderate reduction in the risk of developing advanced AMD over a median of 6.3 years of follow-up in persons at high risk. [7] </li></ul><ul><li>Specifically, the risk for progression was reduced by 25% for the entire study population (Categories 2-4) </li></ul><ul><li>and 34% for the population of patients with Categories 3 or 4 AMD. </li></ul><ul><li>The overall risk for moderate vision loss (decrease of 15 or more letters on the logarithmic chart compared with baseline) was reduced by 19% at 5 years. </li></ul><ul><li>For persons with early AMD, however, the AREDS-type supplements did not prevent progression from Category 2 to Category 3 </li></ul><ul><li>During the course of AREDS, supplementation of beta-carotene was demonstrated to increase the risk for lung cancer and its associated mortality in smokers. [8,9] </li></ul><ul><li>Currently, the AREDS formulation is not recommended for smokers. </li></ul><ul><li>AREDS does NOT affect development or progression of cataract </li></ul><ul><li>analyses from AREDS and other studies using similar doses of vitamin E showed that there was no increased risk for mortality. [16] Analyses of 5-year mortality rates in AREDS also demonstrated no increased risk in those participants randomized to high-dose antioxidant vitamins and zinc </li></ul>Damien Luviano, MD, FACS
  7. 7. <ul><li>STUDY GROUPS </li></ul><ul><li>Original AREDS formulation </li></ul><ul><li>vitamin E (400 International Units [IU]) beta-carotene (15 mg); zinc (80 mg of zinc oxide); and copper (2 mg of cupric oxide). </li></ul><ul><li>minus beta-carotene; </li></ul><ul><li>with 40 mg of zinc </li></ul><ul><li>without beta-carotene and with 40 mg zinc </li></ul><ul><li>plus Xannthophylls (lutein at 10 mg/day + zeaxanthin at 2 mg/day) </li></ul><ul><li>Plus omega-3 LCPUFAs, DHA 350 mg, and eicosapentaenoic acid (EPA) 650 mg </li></ul><ul><li>CME: http://www.medscape.org/viewarticle/578905_4 </li></ul><ul><li>Approximately 4000 participants aged 50-85 years with either bilateral large drusen or large drusen in one eye and advanced AMD in the fellow eye are currently enrolled </li></ul><ul><li>The primary objective of AREDS2 is to determine whether oral supplementation with macular xanthophylls (lutein at 10 mg/day + zeaxanthin at 2 mg/day) and/or omega-3 LCPUFAs, DHA 350 mg, and eicosapentaenoic acid (EPA) 650 mg, will decrease the risk for progression to advanced AMD. </li></ul><ul><li>AREDS2 will also study the effects of these nutritional supplements on moderate vision loss and on the development of cataracts. </li></ul><ul><li>Patients who are smokers should avoid taking beta-carotene </li></ul><ul><li>At the conclusion of AREDS2, which is not expected Until 2012 at least, we will have more data to address the effects of vitamins, minerals, and omega-3 LCPUFAs for the therapy of AMD </li></ul>Damien Luviano, MD, FACS
  8. 8. <ul><li>Direct association between the homocysteine level in the blood and risk of AMD 16 - 23 and from the demonstration in intervention studies that treatment with folic acid and B vitamin supplements could lower homocysteine levels </li></ul><ul><li>objective was to examine the incidence of AMD in a trial of combined folic acid, pyridoxine hydrochloride (vitamin B 6 ), and cyanocobalamin (vitamin B 12 ) therapy. </li></ul><ul><li>(2.5 mg/d), pyridoxine hydrochloride (50 mg/d), and cyanocobalamin (1 mg/d) vs Placebo </li></ul><ul><li>5442 female health care professionals 40 years or older with preexisting cardiovascular disease or 3 or more cardiovascular disease risk factors </li></ul><ul><li>After an average of 7.3 years of treatment and follow-up </li></ul><ul><li>statistically significant 35% to 40% decreased risk of AMD. The beneficial effect of treatment began to emerge at approximately 2 years of follow-up and persisted throughout the trial. </li></ul><ul><li>Source: http://archinte.ama-assn.org/cgi/content/full/169/4/335#IOI80186F2 </li></ul>Damien Luviano, MD, FACS
  9. 9. <ul><li>The sample size was 1313 women, of whom 1287 without AMD were analyzed. </li></ul><ul><li>In women older than 75 years, there is an increased risk for early AMD, with higher vitamin D levels reflecting higher mortality and mortality bias in this age group. </li></ul><ul><li>Among women younger than 75 years, there is a lower risk for early AMD with higher vitamin D levels, with a threshold effect at 38 nmol/L serum 25(OH)D. </li></ul><ul><li>The authors concluded that vitamin D levels of 38 nmol/L and higher in women younger than 75 years were associated with reduced risk for early AMD. </li></ul><ul><li>CME: http://www.medscape.org/viewarticle/740922?src=cmemp </li></ul>Damien Luviano, MD, FACS
  10. 10. <ul><li>#1 reason in the world for blindness </li></ul><ul><li>#1 surgery performed in the United States </li></ul><ul><li>#1 eye surgery performed in the United States </li></ul>Damien Luviano, MD, FACS
  11. 11. <ul><li>Four thousand five hundred ninety individuals with at least one natural lens and photographic follow-up (median, 6.3 years) were assessed for development or progression of lens opacities. </li></ul><ul><li>Observational data from the AREDS and other studies suggest that use of a multivitamin may delay the progression of lens opacities. </li></ul><ul><li>Source: http://www.ncbi.nlm.nih.gov/pubmed/16877067 </li></ul>Damien Luviano, MD, FACS
  12. 12. <ul><ul><li>November 8 issue of Archives of Ophthalmology </li></ul></ul><ul><ul><li>Study participants were male physicians age 50 years or older. </li></ul></ul><ul><ul><li>11,545 men provided data for study analysis. The mean age of participants was 62 years, and nearly 60% of subjects had never smoked cigarettes </li></ul></ul><ul><ul><li>Neither vitamin C nor vitamin E supplements were more effective than placebo in the prevention of cataract in the current study of male physicians. </li></ul></ul><ul><ul><li>CME: http://www.medscape.org/viewarticle/732166 </li></ul></ul>Damien Luviano, MD, FACS
  13. 13. <ul><li>The formulations included: </li></ul><ul><li>vitamin C (500 mg); </li></ul><ul><li>vitamin E (400 International Units [IU]); </li></ul><ul><li>beta-carotene (15 mg); </li></ul><ul><li>zinc (80 mg of zinc oxide); and </li></ul><ul><li>copper (2 mg of cupric oxide). </li></ul><ul><li>CME: http://www.medscape.org/viewarticle/578905_2 </li></ul><ul><li>moderate reduction in the risk of developing advanced AMD over a median of 6.3 years of follow-up in persons at high risk. [7] </li></ul><ul><li>Currently, the AREDS formulation is not recommended for smokers. </li></ul><ul><li>AREDS does NOT affect development or progression of cataract </li></ul>Damien Luviano, MD, FACS
  14. 14. <ul><li>Number one reason patients age 25-65 loose vision </li></ul><ul><li>Number one reason patients loose kidney function </li></ul><ul><li>Number one reason patients loose limbs </li></ul>Damien Luviano, MD, FACS
  15. 15. <ul><li>232,007 met inclusion criteria for this study. </li></ul><ul><li>14,130 cases of diabetes were diagnosed after 2000. </li></ul><ul><li>Of the 232,007 participants, 72,577 (53.6%) of men and 62,296 (64.5%) of women took multivitamin supplements. </li></ul><ul><li>In older persons, multivitamin use is not associated with a reduced risk for diabetes. </li></ul><ul><li>In older persons, intake of vitamin C and calcium supplements is associated with a reduced risk for diabetes, although further research is needed to confirm the association. </li></ul><ul><li>CME http://www.medscape.org/viewarticle/731777 </li></ul>Damien Luviano, MD, FACS
  16. 16. <ul><ul><li>AREDS Vitamins any brand for Age related macular Degeneration patients who do not smoke </li></ul></ul><ul><ul><li>PCP to consider Centrum multivitamins for any patient to delay the onset of cataract formation </li></ul></ul><ul><ul><li>Omega-3 in the form of dark fish for patients who are at risk for macular degeneration such as family history, women, light colored eyes </li></ul></ul><ul><ul><li>Folic acid, pyridoxine hydrochloride (vitamin B 6 ), and cyanocobalamin (vitamin B 12 ) therapy </li></ul></ul><ul><li>Exercise is good for macular degeneration </li></ul><ul><ul><li>Smoking is bad for macular degeneration </li></ul></ul><ul><li>Multiple life changes prolong life and improve health of all organs including the eyes and sight </li></ul>Damien Luviano, MD, FACS
  17. 17. <ul><li>Ask Questions </li></ul><ul><ul><li>HealthTap.com </li></ul></ul><ul><li>Read Articles </li></ul><ul><ul><li>WebMD.com </li></ul></ul><ul><ul><li>Medscape.com </li></ul></ul><ul><li>View Presentations </li></ul><ul><ul><li>Slideshare.com </li></ul></ul><ul><li>Physician Ratings </li></ul><ul><ul><li>Avvo.com </li></ul></ul><ul><li>Statistics and information </li></ul><ul><ul><li>CDC.gov </li></ul></ul><ul><li>Find Board Certified Physicians </li></ul><ul><ul><li>certificationmatters.org/ </li></ul></ul>Damien Luviano, MD, FACS

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