Items which should not routinely be prescribed in primary care - lutein and antioxidants by all Sub-ICB Locations

The supplements lutein and antioxidants (e.g. vitamin A, C, E and zinc) are sometimes recommended for age-related macular degeneration (AMD). A variety of supplements are available to purchase in health food stores and other outlets where they are promoted to assist with ‘eye health’.

Two Cochrane reviews have been conducted on this topic:

1. Antioxidant vitamin and mineral supplements for preventing age-related macular degeneration. The authors conclude: 'There is accumulating evidence that taking vitamin E or beta-carotene supplements will not prevent or delay the onset of AMD. There is no evidence with respect to other antioxidant supplements, such as vitamin C, lutein and zeaxanthin, or any of the commonly marketed multivitamin combinations'.
2. Antioxidant vitamin and mineral supplements for slowing the progression of age-related macular degeneration. The authors conclude: 'People with AMD may experience delay in progression of the disease with antioxidant vitamin and mineral supplementation. This finding is drawn from one large trial conducted in a relatively well-nourished American population. The generalisability of these findings to other populations is not known'.

PrescQIPP CIC has issued a bulletin that did not find evidence to support prescribing of lutein and antioxidants routinely on the NHS.

NICE guidance on AMD includes a recommendation for research on the effectiveness and cost-effectiveness of lutein and antioxidants, which is currently a gap in the research.