Centrum use and progression of age-related cataract in the Age-Related Eye Disease Study: a propensity score approach. AREDS report No. 21

Abstract

Purpose: To evaluate the effect of the multivitamin Centrum on the development and progression of age-related lens opacities.

Design: Clinic-based prospective cohort study.

Participants: Four thousand five hundred ninety individuals with at least one natural lens and photographic follow-up (median, 6.3 years) were assessed for development or progression of lens opacities.

Main outcome measures: Progression of "any" lens opacity or type-specific opacity was ascertained from lens photographs taken at baseline and at annual visits beginning at year 2.

Methods: The Age-Related Eye Disease Study (AREDS) showed no statistically significant effect of a high-dose antioxidant formulation on progression of lens opacities. Centrum also was provided to approximately two thirds of the study participants. Because Centrum use was elective, a logistic regression model of baseline characteristics was used to generate a propensity score for Centrum use. Repeated-measures logistic regression, adjusted for propensity score and other covariates, was used to evaluate associations of Centrum use and lens opacity.

Results: Centrum use, adjusted for propensity score and other covariates, was associated with a reduction in "any" lens opacity progression (odds ratio [OR] = 0.84, 95% confidence interval [CI] = 0.72-0.98, P = 0.025). Results for individual lens opacity types suggested that Centrum use was protective for nuclear opacity events (OR = 0.75, 95% CI = 0.61-0.91, P = 0.004).

Conclusion: Observational data from the AREDS and other studies suggest that use of a multivitamin may delay the progression of lens opacities. A National Eye Institute-sponsored clinical trial scheduled for completion in 2007 will provide additional data on Centrum use and cataract development.

Figure 1

Examples of lens opacity progression in Age-Related Eye Disease Study (AREDS) participants. Nuclear opacity graded from slit-lamp photographs (model SL-6E, Topcon Corp., Tokyo, Japan) increased from 2.0 U (equal to AREDS standard photograph 3) at baseline (A) to 3.9 U (approaching standard photograph 5) at the 5-year visit (B). Cortical opacity within 5 mm of the lens center graded from retroillumination photographs (Neitz Instruments Co., Ltd., Tokyo, Japan) increased from 6% at baseline (C) to 45% at the 6-year visit (D). Posterior subcapsular opacity within 5 mm of the lens center increased from 6% at baseline (E) to 22% at the 5-year visit (F). Reproduced with permission from Archives of Ophthalmology (2001;119:1444). Copyright © 2001, American Medical Association. All rights reserved.