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CME Released: 5/6/2008
Valid for credit through: 5/6/2009, 11:59 PM EST
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May 6, 2008 — Treatment with vitamin E was not associated with reduced risk for age-related cataracts in healthy women, according to the results of a study reported in the May issue of Ophthalmology.
"Evidence from cross-sectional and case-control studies generally supports a beneficial effect for vitamin E in cataract, but the results of prospective studies have been mixed," write William G. Christen, ScD, from Brigham and Women's Hospital, Harvard Medical School, in Boston, Massachusetts, and colleagues. "The conduct of the Women's Health Study...offered a unique opportunity to investigate the occurrence of age-related cataract in a large trial of vitamin E use."
In this randomized, double-masked, placebo-controlled trial, 39,876 apparently healthy female health professionals aged 45 years or older were randomly assigned to receive either 600 IU natural-source vitamin E or placebo on alternate days. Follow-up for presence of cataract was for an average of 9.7 years. The primary endpoint was age-related cataract, defined as an incident, age-related lens opacity associated with a reduction in best-corrected visual acuity to 20/30 or worse, based on self-report and confirmed by medical record review.
The incidence of cataract was not significantly different between the vitamin E and placebo groups (1159 vs 1217 cases; relative risk [RR], 0.96; 95% confidence interval [CI], 0.88 - 1.04). Subgroup analyses showed no significant effects of vitamin E on the incidence of nuclear (1056 vs 1127 cases; RR, 0.94; 95% CI, 0.87 - 1.02), cortical (426 vs 461 cases; RR, 0.93; 95% CI, 0.81 - 1.06), or posterior subcapsular (357 vs 359 cases; RR, 1.00; 95% CI, 0.86 - 1.16) cataract.
Findings were similar for extraction of cataract and cataract subtypes. Baseline categories of age, cigarette smoking, multivitamin use, or several other possible risk factors for cataract did not appear to change the lack of effect of vitamin E on cataract.
Potential limitations of this trial include insufficient dosage or duration of treatment, subjects aged 45 years and older, bias in ascertainment of the cataract end points, confounding by other factors, and poor compliance.
"These data from a large trial of apparently healthy female health professionals with 9.7 years of treatment and follow-up indicate that 600 IU natural-source vitamin E taken every other day provides no benefit for age-related cataract or subtypes," the study authors write. "Whether long-term treatment with other antioxidant nutrients, or various combinations of nutrients, can be of benefit in delaying cataract onset or progression remains to be determined in other completed and ongoing trials."
This study was supported by the National Institutes of Health, Bethesda, Maryland.
Ophthalmology. 2008;115:822-829.
At this time, age-related cataract is the leading cause of visual impairment in the United States. It affects an estimated 20.5 million people in the United States aged 40 years and older. Age-related cataracts are believed to be caused by oxidative mechanisms; therefore, antioxidants such as vitamin E have been postulated to delay cataract onset and progression. Evidence from cross-sectional and case-control studies supports a beneficial effect for vitamin E in cataract; however, prospective studies have been mixed.
The aim of this study was to investigate whether vitamin E supplementation decreases the risk for age-related cataract in women.
