Lutein/zeaxanthin for the treatment of age-related cataract: AREDS2 randomized trial report no. 4

Age-Related Eye Disease Study 2 (AREDS2) Research Group, Emily Y Chew, John Paul SanGiovanni, Frederick L Ferris, Wai T Wong, Elvira Agron, Traci E Clemons, Robert Sperduto, Ronald Danis, Suresh R Chandra, Barbara A Blodi, Amitha Domalpally, Michael J Elman, Andrew N Antoszyk, Alan J Ruby, David Orth, Susan B Bressler, Gary E Fish, George B Hubbard, Michael L Klein, Thomas R Friberg, Philip J Rosenfeld, Cynthia A Toth, Paul Bernstein, Emily Y Chew, John Paul SanGiovanni, Frederick L Ferris, Wai T Wong, Elvira Agron, Traci E Clemons, Robert Sperduto, Ronald Danis, Suresh R Chandra, Barbara A Blodi, Amitha Domalpally, Michael J Elman, Andrew N Antoszyk, Alan J Ruby, David Orth, Susan B Bressler, Gary E Fish, George B Hubbard, Michael L Klein, Thomas R Friberg, Philip J Rosenfeld, Cynthia A Toth, Paul Bernstein, Age-Related Eye Disease Study 2 (AREDS2) Research Group, Emily Y Chew, John Paul SanGiovanni, Frederick L Ferris, Wai T Wong, Elvira Agron, Traci E Clemons, Robert Sperduto, Ronald Danis, Suresh R Chandra, Barbara A Blodi, Amitha Domalpally, Michael J Elman, Andrew N Antoszyk, Alan J Ruby, David Orth, Susan B Bressler, Gary E Fish, George B Hubbard, Michael L Klein, Thomas R Friberg, Philip J Rosenfeld, Cynthia A Toth, Paul Bernstein, Emily Y Chew, John Paul SanGiovanni, Frederick L Ferris, Wai T Wong, Elvira Agron, Traci E Clemons, Robert Sperduto, Ronald Danis, Suresh R Chandra, Barbara A Blodi, Amitha Domalpally, Michael J Elman, Andrew N Antoszyk, Alan J Ruby, David Orth, Susan B Bressler, Gary E Fish, George B Hubbard, Michael L Klein, Thomas R Friberg, Philip J Rosenfeld, Cynthia A Toth, Paul Bernstein

Abstract

Importance: Age-related cataract is a leading cause of visual impairment in the United States. The prevalence of age-related cataract is increasing, with an estimated 30.1 million Americans likely to be affected by 2020.

Objective: To determine whether daily oral supplementation with lutein/zeaxanthin affects the risk for cataract surgery.

Design, setting, and patients: The Age-Related Eye Disease Study 2 (AREDS2), a multicenter, double-masked clinical trial, enrolled 4203 participants, aged 50 to 85 years, at risk for progression to advanced age-related macular degeneration.

Interventions: Participants were randomly assigned to daily placebo; lutein/zeaxanthin, 10mg/2mg; omega-3 long-chain polyunsaturated fatty acids, 1 g; or a combination to evaluate the effects on the primary outcome of progression to advanced age-related macular degeneration.

Main outcomes and measures: Cataract surgery was documented at annual study examination with the presence of pseudophakia or aphakia, or reported during telephone calls at 6-month intervals between study visits. Annual best-corrected visual acuity testing was performed. A secondary outcome of AREDS2 was to evaluate the effects of lutein/zeaxanthin on the subsequent need for cataract surgery.

Results: A total of 3159 AREDS2 participants were phakic in at least 1 eye and 1389 of 6027 study eyes underwent cataract surgery during the study, with median follow-up of 4.7 years. The 5-year probability of progression to cataract surgery in the no lutein/zeaxanthin group was 24%. For lutein/zeaxanthin vs no lutein/zeaxanthin, the hazard ratios for progression to cataract surgery was 0.96 (95% CI, 0.84-1.10; P = .54). For participants in the lowest quintile of dietary intake of lutein/zeaxanthin, the hazard ratio comparing lutein/zeaxanthin vs no lutein/zeaxanthin for progression to cataract surgery was 0.68 (95% CI, 0.48-0.96; P = .03). The hazard ratio for 3 or more lines of vision loss was 1.03 (95% CI, 0.93-1.13; P = .61 for lutein/zeaxanthin vs no lutein/zeaxanthin).

Conclusions and relevance: Daily supplementation with lutein/zeaxanthin had no statistically significant overall effect on rates of cataract surgery or vision loss.

Trial registration: clinicaltrials.gov Identifier: NCT00345176.