Are Eye Vitamins Safe to Stop in Hospice Patients? - OnePoint Patient Care

Are Eye Vitamins Safe to Stop in Hospice Patients?

Generally speaking, the use of vitamins at end of life is not beneficial. Still, hospice patients with age-related macular degeneration (AMD) might be reluctant to stop taking their eye vitamins out of fear of going blind during their final months of life. AMD is a degenerative disease that damages the macula (the central portion of the retina) in adults 50 and older.1-3 It’s often asymptomatic until its later stages where central vision acuity decreases, meaning it’s difficult for these individuals to see faces, read, drive, or complete basic tasks. It’s estimated that around 15% of patients would eventually become legally blind if they lived long enough for the disease to run its course.1,2

A 2001 trial reported that the AREDS eye vitamin formula (a combination of high-dose vitamin C, vitamin E, beta-carotene, zinc oxide and cupric oxide) reduced the risk of progression to late stage AMD by about 25% with a number needed to treat (NNT) of 33, meaning 33 patients would need to be treated over 5 years to prevent one patient from developing vision loss (figure 1).4,5 These findings were considered somewhat controversial because there was difficulty replicating them, though a reformulated product, AREDS 2, later demonstrated similar benefit.5

Figure 1: AREDS Number Needed to Treat (NNT)

Physician-directed supplementation with AREDS or similar formulas is reasonable for otherwise healthy adults with AMD. However, it makes little sense for hospice patients and can be safely deprescribed in this population.

Written by: OnePoint Patient Care Clinical Team

Joseph Solien, PharmD, BCGP, BCPP – Vice President of Clinical Services

Melissa Corak, PharmD, BCGP – Senior Clinical Pharmacist

John Corrigan, PharmD, BCGP – Clinical Pharmacist

 

References

  1. Vavvas D. Age-related macular degeneration. UpToDate. Updated February 21, 2024. Accessed March 15, 2024. Link
  2. Evans JR, Lawrenson JG. Antioxidant vitamin and mineral supplements for slowing the progression of age-related macular degeneration. Cochrane Database of Systematic Reviews. 2023;9. Art. No.:CD000254. doi:Link
  3. Boyd K. What is Macular Degeneration? American Academy of Ophthalmology. November 13, 2023. Accessed March 15,2024. Link
  4. Kansagara D, Gleitsman K, Gillingham M, et al. Nutritional Supplements for Age-related Macular Degeneration: A systematic Review. US Department of Veterans Affairs. January 2012. Accessed March 27,2024. Link
  5. AREDS / AREDS2 Frequently Asked Questions. National Eye Institute. Updated November 19, 2020. Accessed March 27, 2024. Link