Dietary Carotenoids, Vitamins A, C, and E, and Advanced Age-Related Macular Degeneration

Johanna M. Seddon, MD; Umed A. Ajani, MBBS; Robert D. Sperduto, MD; Rita Hiller, MS; Norman Blair, MD; Thomas C. Burton, MD; Marilyn D. Farber, PhD; Evangelos S. Gragoudas, MD; Julia Haller, MD; Dayton D. Miller, PhD; Lawrence A. Yannuzzi, MD; Walter Willett, MD; for the Eye Disease Case-Control Study Group

Objective: To evaluate the relationships between dietary intake of carotenoids and vitamins A, C, and E and the risk of neovascular age-related macular degeneration (AMD), the leading cause of irreversible blindness among adults.

Design: The multicenter Eye Disease Case-Control Study.

Setting: Five ophthalmology centers in the United States.

Patients: A total of 356 case subjects who were diagnosed with the advanced stage of age-related macular degeneration within 1 year prior to their enrollment, aged 55 to 80 years, and residing near a participating clinical center.  The 520 control subjects were from the same geographic areas as the case subjects, had other ocular diseases, and were frequency matched to cases according to age and sex.

Main Outcome Measures: The relative risk for age related macular degeneration was estimated according to dietary indicators of antioxidant status, controlling for smoking and other risk factors, by using multiple logistic-regression analyses.

Results: A higher dietary intake of carotenoids was associated with a lower risk for age-related macular degeneration.  Adjusting for other risk factors for age-related macular degeneration, we found that those in the highest quintile of carotenoid intake had a 43% lower risk for age-related macular degeneration compared with those in the lowest quintile (odds ratio, 0.57; 95% confidence interval, 0.35 to 0.92; P for trend=.02).  Among the specific carotenoids, lutein and zeaxanthin, which are primarily obtained from dark green, leafy vegetables, were most strongly associated with a reduced risk for age-related macular degeneration (P for trend=.01).  Several food items rich in carotenoids were inversely associated with age-related macular degeneration.  In particular, a higher frequency of intake of spinach or collard greens was associated with a substantially lower risk for age-related macular degeneration (P for trend <.001).   The intake of preformed vitamin A (retinol) was not appreciably related to age-related macular degeneration.  Neither vitamin E nor total vitamin C consumption was associated with a statistically significant reduced risk of age-related macular degeneration, although a possibly lower risk for age-related macular degeneration was suggested among those with higher intake of vitamin C, particularly from foods.

Conclusion: Increasing the consumption of foods rich in certain carotenoids, in particular dark green, leafy vegetables, may decrease the risk of developing advanced or exudative age-related macular degeneration, the most visually disabling form of macular degeneration among older people.  These findings support the need for further studies of this relationship.