Tissue Recovery

Background  Observational epidemiologic studies indicate a direct association between homocysteine co ncentration in the blood and the risk of age-related macular degeneration (AMD), but randomized trial data to examine the effect of therapy to lower homocysteine levels in AMD are lacking. Our objective was to examine the incidence of AMD in a trial of co mbined folic acid, pyridoxine hydrochloride (vitamin B 6), and cyano co balamin (vitamin B 12) therapy.

Methods  We co nducted a randomized, double-blind, placebo- co ntrolled trial including 5442 female health care professionals 40 years or older with preexisting cardiovascular disease or 3 or more cardiovascular disease risk factors. A total of 5205 of these women did not have a diagnosis of AMD at baseline and were included in this analysis. Participants were randomly assigned to receive a co mbination of folic acid (2.5 mg/d), pyridoxine hydrochloride (50 mg/d), and cyano co balamin (1 mg/d) or placebo. Our main out co me measures included total AMD, defined as a self-report documented by medical re co rd evidence of an initial diagnosis after randomization, and visually significant AMD, defined as co nfirmed incident AMD with visual acuity of 20/30 or worse attributable to this co ndition.

Results  After an average of 7.3 years of treatment and follow-up, there were 55 cases of AMD in the co mbination treatment group and 82 in the placebo group (relative risk, 0.66; 95% co nfidence interval, 0.47-0.93 [P = .02]). For visually significant AMD, there were 26 cases in the co mbination treatment group and 44 in the placebo group (relative risk, 0.59; 95% co nfidence interval, 0.36-0.95 [P = .03]).

Conclusions  These randomized trial data from a large co hort of women at high risk of cardiovascular disease indicate that daily supplementation with folic acid, pyridoxine, and cyano co balamin may reduce the risk of AMD.