title: Oral docosahexaenoic acid in the prevention of exudative age-related macular degeneration: the Nutritional AMD Treatment 2 study.
abstract: OBJECTIVE
  To evaluate the efficacy of docosahexaenoic acid (DHA)-enriched oral supplementation in preventing exudative age-related macular degeneration (AMD).
  
  
  METHODS
  The Nutritional AMD Treatment 2 study was a randomized, placebo-controlled, double-blind, parallel, comparative study.
  
  
  METHODS
  Two hundred sixty-three patients 55 years of age or older and younger than 85 years with early lesions of age-related maculopathy and visual acuity better than 0.4 logarithm of minimum angle of resolution units in the study eye and neovascular AMD in the fellow eye.
  
  
  METHODS
  Patients were assigned randomly to receive either 840 mg/day DHA and 270 mg/day eicosapentaenoic acid (EPA) from fish oil capsules or the placebo (olive oil capsules) for 3 years.
  
  
  METHODS
  The primary outcome measure was time to occurrence of choroidal neovascularization (CNV) in the study eye. Secondary outcome measures in the study eye were: incidence of CNV developing in patients, changes in visual acuity, occurrence and progression of drusen, and changes in EPA plus DHA level in red blood cell membrane (RBCM).
  
  
  RESULTS
  Time to occurrence and incidence of CNV in the study eye were not significantly different between the DHA group (19.5±10.9 months and 28.4%, respectively) and the placebo group (18.7±10.6 months and 25.6%, respectively). In the DHA group, EPA plus DHA levels increased significantly in RBCM (+70%; P<0.001), suggesting that DHA easily penetrated cells, but this occurred unexpectedly also in the placebo group (+9%; P = 0.007). In the DHA-allocated group, patients steadily achieving the highest tertile of EPA plus DHA levels in RBCM had significantly lower risk (-68%; P = 0.047; hazard ratio, 0.32; 95% confidence interval, 0.10-0.99) of CNV developing over 3 years. No marked changes from baseline in best-corrected visual acuity, drusen progression, or geographic atrophy in the study eye were observed throughout the study in either group.
  
  
  CONCLUSIONS
  In patients with unilateral exudative AMD, 3 years of oral DHA-enriched supplementation had the same effect on CNV incidence in the second eye as did the placebo. However, RBCM fatty acid measurements revealed that CNV incidence was significantly reduced in DHA-supplemented patients showing a steadily high EPA plus DHA index over 3 years.
  
  
  BACKGROUND
  Proprietary or commercial disclosure may be found after the references.
authors: Ophthalmology Department, Hôpital Intercommunal de Créteil, University Paris Est Créteil, Créteil, France. eric.souied@chicreteil.fr
authors: Eric H
authors: EH
authors: Souied
authors: Cécile
authors: C
authors: Delcourt
authors: Giuseppe
authors: G
authors: Querques
authors: Ana
authors: A
authors: Bassols
authors: Bénédicte
authors: B
authors: Merle
authors: Alain
authors: A
authors: Zourdani
authors: Theodore
authors: T
authors: Smith
authors: Pascale
authors: P
authors: Benlian
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D002214:Capsules; D019587:Dietary Supplements; D004281:Docosahexaenoic Acids / Q000008:administration & dosage*; D004311:Double-Blind Method; D004338:Drug Combinations; D015118:Eicosapentaenoic Acid / Q000008:administration & dosage*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015593:Retinal Drusen / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy; D014792:Visual Acuity / Q000502:physiology; D014810:Vitamin E / Q000008:administration & dosage*; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy
chemical_list: D002214:Capsules; D004338:Drug Combinations; D008055:Lipids; D014810:Vitamin E; D004281:Docosahexaenoic Acids; D015118:Eicosapentaenoic Acid