Nutrition Effects on Ocular Diseases in the Aging Eye
Nutrition Effects on Ocular Diseases in the Aging Eye
复制标题
DOI：
10.1167/iovs.13-12914
复制
发表时间：
2013-12-01
影响因子：
4.4
通讯作者：
Chew, Emily Y.
中科院分区：
文献类型：
--
作者：
Chew, Emily Y.
目的。我们回顾了营养补充剂治疗年龄相关性白内障和年龄相关性黄斑变性（AMD）的临床试验数据，以确定未来的研究和治疗方向。方法。提交并审查了对照临床试验的数据，以寻找进一步研究白内障和 AMD 治疗的潜在机会。结果。每日服用多种维生素/矿物质的两项试验表明，核性白内障的进展有所减少，但会增加后囊下白内障的风险。对于 AMD，年龄相关眼病研究 (AREDS) 配方（维生素 C、E、β-胡萝卜素、锌和铜）可在 5 年内将进展为晚期 AMD 的风险降低 25%。由于 β-胡萝卜素与前吸烟者肺癌增加有关，因此叶黄素/玉米黄质可以替代 β-胡萝卜素，并提供超越 AREDS 配方效果的有益效果的增量增加。此外，一项 B 族维生素随机临床试验证明，维生素 B 复合物对 AMD 具有有益作用。结论。未来的评估可能包括对治疗白内障和 AMD 进展的营养物质进行额外评估。适度减少将产生重大影响，因为受这两种主要失明原因影响的人数预计在未来十年内将增加一倍。一个重要的步骤是开发替代结果以提高临床试验的效率。需要更详细的表型分析，尤其是 AMD 的表型分析，因为它似乎不是一种疾病，而是一组疾病。基因型-表型分析可能有助于确定 AMD 中重要的通路。
PURPOSE. We reviewed the data from the clinical trials of nutritional supplements for the treatment of age-related cataract and age-related macular degeneration (AMD) to determine future directions of research and treatment.METHODS. Data from the controlled clinical trials are presented and reviewed for potential opportunities for further research into the treatment of cataracts and AMD.RESULTS. Two trials using daily multivitamins/minerals demonstrated a reduction in the progression of nuclear cataract, but increased the risk of posterior subcapsular cataract. For AMD, the Age-Related Eye Disease Study (AREDS) formulation (vitamins C, E, beta-carotene, zinc, and copper) reduced the risk of progression to advanced AMD by 25% at 5 years. Because beta-carotene is associated with increased lung cancer in former smokers, lutein/zeaxanthin could replace beta-carotene and provide an incremental increase in the beneficial effects beyond the effects of the AREDS formulation. In addition, a randomized clinical trial of B vitamins demonstrated a beneficial effect for AMD with the vitamin B complex.CONCLUSIONS. Future evaluation may include additional assessments of nutrients for the treatment of progression of cataract and AMD. A modest reduction would have significant impact as the numbers of persons affected with these two leading causes of blindness are projected to double in the next decade. An important step would be to develop surrogate outcomes to increase efficiency in clinical trials. More detailed phenotyping, especially of AMD, is required as it appears to be not one disease, but a group of diseases. Genotype-phenotype analyses may help to target pathways that are important in AMD.