Summary

There are various antioxidant/ mineral supplements available which are marketed on the basis of that they promote ocular health. None of these are actually licensed as medicinal products for use in the treatment of eye disease.

· There are a variety of randomised controlled trials that used various antioxidant eye supplements in the treatment of age-related macular degeneration but the results are generally difficult to interpret due to methodological flaws and inconsistent results.

· The landmark trial in this disease area is the AREDS. The results of this study suggest that a combination of zinc and antioxidants provides a modest beneficial effect on progression to advanced AMD, particularly in those with moderate or advanced signs of the disease at baseline. This group were also less likely to develop reduced vision. However these findings are based on a sub-group analysis of the main study.

· AREDS would appear to be the only one study that addresses the issue of safety. The antioxidant arms reported more yellowing of the skin and the zinc arms reported more anaemia. Therefore there are some concerns about adverse effects associated with the long-term administration of high dose vitamins and mineral supplementation.

· Of all the supplements available in the UK it would appear that only VisiVite Original and Ocuvite Preservision are equivalent or almost equivalent to the combination of constituents tested in AREDS.

· All of these products are however potentially prescribable at NHS expense but given that they are actually food supplements issues such as the need to obtain informed consent from the patient, product liability and the implications of prescribing responsibility remain unclear

· Currently there is little definitive evidence to help identify which, if any, groups of AMD patients will benefit from supplementation. There is no evidence to support the suggestion that people with early stages of the disease might benefit from supplementation.

· Similarly there is limited evidence to help inform decisions as to which product is the most suitable particularly in populations such as smokers.