159
3.3.2 Key points:
Several studies support the benefits of regular dietary fish
and omega-3 PUFA intakes on the risk of AMD, especially
in individuals with lower omega-6 to omega-3 ratios.
Other studies have also suggested that higher vegetable fat
and trans unsaturated fatty acid intakes increase the preva-
lence of late AMD, while omega-3 fatty acids and olive
oil were associated with a reduced prevalence of early and
late AMD.
3.4 Preventive treatment pyramid
Indications for AMD prevention are based on the risk
factors and disease stages described in AREDS report
no. 18
(11)
.
Therefore, a treatment “pyramid” may be defined for indi-
viduals over 50 years of age:
Stage 0
(zero factors): annual observation
Stage 1-2
(one-two factors, drusen < 125 + pigment
abnormality): DHA +/- Lutein
Stage 3
(three factors): antioxidants + zinc (AREDS report
no. 8)
Stage 4
(four or more factors): antioxidants + DHA
Based on AREDS data, individuals over 50-55 should
be subject to dilated eye examinations to determine their
risk of developing advanced AMD. Patients with exten-
sive intermediate-size drusen, at least 1 large drusen, non-
central GA in 1 or both eyes, advanced AMD or vision
loss due to AMD in 1 eye, and without contraindications
such as smoking, should consider taking an antioxidant
and zinc supplement, such as those used in this study
(62)
.
prevalence of AMD in a cohort of 6734 Australian par-
ticipants aged 58-69.
The corresponding results showed that a higher dietary
intake of trans unsaturated fats was associated with
an increased prevalence of late AMD. Comparing the
highest and lowest trans fat intake quartiles, the OR
for late AMD was 1.76 (95% CI: 0.92-3.37; p = 0.02),
whereas a higher intake of omega-3 fatty acids was
inversely associated with early AMD (OR for highest
quartile vs. lowest quartile: 0.85; 95% CI: 0.71-1.02;
p = 0.03).
The prevalence of late AMD was lower for olive oil
intakes equal to or higher than 100 mL/week vs. less
than 1 mL/week (OR: 0.48; 95% CI: 0.22-1.04; P =
0.03). No significant associations were found between
fish, total fat, butter and margarine intakes and
AMD
(60)
.
More recently, in 2009, the
SanGiovanni AREDS
Group
investigated the relationship between dietary
omega-3 LCPUFA intake and progression to advanced
AMD in 1837 AREDS participants with a moderate
risk for developing sight-threatening AMD (1211 par-
ticipants in category 3a and 626 participants in cat-
egory 4a).
It was observed that participants reporting the highest
baseline omega-3 LCPUFA intakes were approximately
30% less likely to develop advanced AMD by the end
of the 12-year follow-up period than those reporting
the lowest omega-3 LC-PUFA intakes. Results for
CGA and NV AMD were similar; the corresponding
multivariate odds ratios were 0.65 (95% CI: 0.45-0.92;
p ≤ 0.02) and 0.68 (95% CI: 0.49-0.94; p ≤ 0.02)
(61)
.
Preventive AMD Treatments
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