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NEI Clinician Scientist Discusses Lifestyle and AMD

Featured speaker Emily Chew, M.D.
Featured speaker Emily Chew, M.D.
On September 21, AEVR’s Decade of Vision 2010-2020 Initiative hosted a Congressional briefing entitled Lifestyle and Age-related Macular Degeneration (AMD) during International Awareness Week (September 18-24) with co-sponsors AMD Alliance International, the Alliance for Aging Research, the Association for Research in Vision and Ophthalmology (ARVO), the European Vision Institute (EVI) and Lighthouse International. AMD is the leading cause of blindness and low vision in the United States and the developed world. Since AMD affects central vision, specifically the macula in the light-sensitive back of the eye called the retina, it severely alters a person’s ability to read and drive, impacting productivity, independence, and quality of life and adding greatly to cost burden. The National Institutes of Health’s (NIH) National Eye Institute (NEI) estimates that 15 million Americans have the disease, with 2 million cases diagnosed each year. One out of every four Americans in the fast-growing 64-74 year old population has the disease, making it a major public health problem.

Featured speaker clinician-scientist Emily Chew, M.D., NEI Deputy Clinical Director and Deputy Director of the Division of Epidemiology and Clinical Applications, described the two forms of AMD and their vision loss consequences —the “wet” form, where abnormal blood vessels develop under the retina that leak fluid and cause central vision loss, and the “dry” form, where protein deposits called “drusen” develop and the retina degenerates or slowly thins out, resulting in a slow progression to vision loss.

Dr. Chew identified the non-modifiable risk factors-that is, factors that individuals cannot control-for developing AMD as increasing age, family history, and ethnicity (more prevalent in a fair-skinned individual). Modifiable risk factors affected by lifestyle include cigarette smoking, high blood pressure, elevated cholesterol levels, increased body mass/obesity, sun exposure, and oxidative stress. She focused on the role of nutrition, as she has been involved in the NEI-funded Age-Related Eye Disease Study (AREDS) study, both AREDS1 and AREDS2, where she serves as study chair.

AREDS1 studied the impact of antioxidants and the trace element zinc on the development of advanced AMD and cataract in patients, as animal studies and human epidemiological studies suggested a link. AREDS1 found that individuals at high risk of developing advanced stages of AMD lowered their risk by about 25 percent when treated with a high dose combination of vitamin C, vitamin E, beta-carotene, and zinc (with copper). There were other dietary data from AREDS1 which suggested that individuals who ate fish or leafy green vegetables, such as spinach, kale and collard greens, had a reduced risk of the advanced form of AMD. Since such AREDS1 data were part of an “observational” evaluation and not a clinical trial, the results could have been affected by unknown factors that might influence the patient’s disease course, for example, persons with better economic or social status who may have better access to healthcare and may take better care of themselves. Consequently, in 2006, NEI decided to conduct AREDS2, a randomized clinical trial investigating the impact of high doses of xanthophylls (lutein and zeaxanthin found in leafy green vegetables, such as kale) and/or omega-3 polyunsaturated fatty acids (such as DHA and EPA found in fish) in further reducing AMD progression. Study results are expected in 2013.

Dr. Chew emphasized the public health impact of AREDS results to date. “If the 8 million Americans currently at high risk for AMD took the appropriate nutritional supplements, more than 300,000 could be saved from advanced AMD in the next five years.” She added that AREDS has been a breakthrough study in many ways, as its database is included in NIH’s database of Genotypes and Phenotypes (dbGaP) and is also being combined with data from tens of thousands of individuals from around the world under the NEI-funded International AMD Gene Consortium to better understand the genetic basis and progression of the disease. NEI’s leadership in basic and translational research into AMD has led NIH Director Francis Collins, M.D., Ph.D. to report to Congress that, “Twenty years ago, we could do little to prevent or treat AMD. Today, because of new treatments and procedures based in part on NIH research, 1.3 million Americans at risk for severe vision loss over the next five years can receive potentially sight-saving therapies.”

AEVR’s briefing featured an eye healthy luncheon, in which food items were identified for their nutritional content of zinc, antioxidants, omega-3 fatty acids, beta carotene, and lutein/zeaxanthin.

Louis Tutt, Executive Director of the Association for Education and Rehabilitation of the Blind and Visually Impaired, speaks with AEVR Executive Director James Jorkasky
Left to right: Louis Tutt, Executive Director of the Association for Education and Rehabilitation of the Blind and Visually Impaired, speaks with AEVR Executive Director James Jorkasky
Diego Sanchez of the office of Cong. Barney Frank (D-MA) with AEVR’s David Epstein
Left to right: Diego Sanchez of the office of Cong. Barney Frank (D-MA) with AEVR’s David Epstein
Debbie Zeldow and Lindsay Duvall Clarke from the Alliance for Aging Research, a briefing co-host
Left to right: Debbie Zeldow and Lindsay Duvall Clarke from the Alliance for Aging Research, a briefing co-host
Vision writer Elaine Richman with Mark Ackermann, President and CEO of Lighthouse International, a briefing co-host
Left to right: Vision writer Elaine Richman with Mark Ackermann, President and CEO of Lighthouse International, a briefing co-host