AREDS and macular degeneration
DEAR DR. ROACH: You should be aware that the AREDS2 vitamin supplement has not been shown to have any benefit in lowrisk age-related macular degeneration patients, and has been associated with lowering the risk of advance in only 25 per cent of moderateto high-risk AMD patients. As such, it should not be considered a treatment or preventative. The label on the bottle bears this statement: “This product is not intended to diagnose, treat, cure or prevent any disease.”
There also are some possible side effects. I have low-risk AMD and am currently taking this supplement with hopes that it might possibly help slow the progression as my AMD advances, since there is nothing else that can be done for it.
ANSWER: “AMD” is “age-related macular degeneration,” a disease that causes a loss of central vision necessary for detailed tasks like writing or sewing.
It comes when a part of the retina called the “macula,” with the highest concentration of rods and cones for fine visual detail, breaks down.
For dry AMD, the AREDS vitamins lowered the risk of progression to advanced AMD and risk of vision loss. Among all people in the study, about 31 per cent who took placebo progressed to advanced AMD, while 16 per cent of those who took the vitamins progressed.
Those with low risk were unlikely to progress at all: Only 1.5 per cent did, which makes it very difficult to prove that the vitamins are of use. It would take a very large study done for a very long time to do so.
I agree with you that there is a potential downside of vitamin treatment, but it is small, and even people with low-risk AMD might reduce their already-low risk of progression by taking the vitamins.
The label on the bottle is a legal phrase designed to reduce liability. However, I certainly prescribe these medications (AREDS or AREDS2 vitamins) for the very purpose of slowing progression of AMD, which to me sounds a lot like “treating or preventing disease.”
DEAR DR. ROACH: Do people over 70 have a harder time swallowing due to food feeling like it is stuck in their throat and cutting off air to breathe?
Can one actually pass out, fall backward with their eyes rolling back when this happens? I heard there is a procedure to stretch the throat that helps.
ANSWER: Older people can have several types of swallowing problems. Although some are relatively common, what you are describing is not normal and needs evaluation.
The word “dysphagia” is used to describe any kind of abnormal sensation related to swallowing, while “odynophagia” means “pain with swallowing.”
Swallowing problems often are broken down to those that relate to the mouth and pharynx (usually, difficulty starting a swallow is the presenting symptom) versus those that are in the esophagus (where the main symptom is food getting stuck).
Although obstruction of the airway is a dangerous, even life-threatening possibility in people with upper dysphagia, the case you describe sounds more like esophageal dysphagia, which would make passing out and being unable to breathe unlikely.
A short list of causes of esophageal dysphagia would include problems with the nerves to the esophagus and mechanical obstruction.
The major nerve problem is called achalasia, and it is less commonly diagnosed in people over 70. Most people find problems with both liquids and solids.
People whose problems are with solids only are more likely to have a blockage, such as a stricture, ring or web in the esophagus preventing food from going down.
While esophageal dilation is one possible treatment, there’s a long way to go before deciding what kind of treatment is necessary.
Speech and language pathologists are expert at making the diagnosis of many kinds of swallowing difficulties. A gastroenterologist is an expert in esophageal swallowing disorders, while head and neck surgeons are expert in upper swallowing problems.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth @med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803.