[Primary and secondary prophylaxis of AMD by antioxidants: current risk-benefit data]

Supplementation of antioxidants is widely used in industrialized countries. Their popularity is based on the idea that antioxidants may avoid harmful effects caused by reactive oxygen species and in this way provide a primary and/or secondary prophylaxis against age-related diseases. AREDS was the first study that could prove a secondary prophylactic effect of antioxidants and zinc in patients with AMD. The published recommendations of the AREDS study and their transfer into practical ophthalmological care need a critical review. On the background of the original AREDS data it seems that the recommendation for supplementation includes too many AMD patients. The risks and potential side effect of the AREDS medication should always be critically considered. Currently available data do not provide evidence for an effective primary prophylaxis of AMD by the supplementation of antioxidants. Data on a positive effects of vitamin E supplementation are insignificant, but can be characterized as borderline. A paradigmatic change seems to develop in the present scientific discussion concerning the use of antioxidants, especially on the background of data from extensive meta-analyses which seem to indicate an increase of mortality risks in patients with antioxidant supplementation.