MILITARY PHARMACY AND MEDICINE

© Military Pharmacy and Medicine • 2012 • 4 • 7 – 16supplements, albeit selected, have no optimumconditions for absorption. This accounts for thesuperiority of comprehensive natural nutritionover the intake of selected substances containedin dietary supplements, which do not have tobe (and, in fact are not) fully absorbed from thegastrointestinal tract. A separate issue relates tothe substances being delivered just where theyare needed, which is a problem not less importantfrom the standpoint of efficacy and expectedresults, and providently passed over in silence bythe producers or suppliers of dietary supplements.However, some individuals may, for various reasons,including the fact that preparation of appropriatemeal requires time and effort, while swallowinga capsule “solves the problem”, may preferready-made dietary supplements. Therefore, thedietary supplements must also be included in ourconsiderations.Dietary supplements and the efficacyof AMD prophylaxis/treatmentFrom the medical standpoint, the issue as statedin the heading is of primary importance for awide group of mature population at risk of discomfortsassociated with the developing orpotential AMD. As mentioned before, pathogenesisof the disease is still unknown, which makesit impossible to both early diagnose the developingpathology and to efficiently treat it usingappropriate medications.Jerzy Z. Nowak: Age-related macular degeneration (AMD): a critical appraisal …first registered drug for the treatment of neovascularAMD [23].However, when starting the treatment of CNV, oneshould keep in mind, that:1) the use of anti-VEGF medications will be efficaciousonly in VEGF-dependent neovascularization (luckily,in a large group of patients CNV is started froma VEGF-dependent process; however, a blockade,particularly a prolonged blockade of this angiogenicpathway may lead to spontaneous switch to anotherangiogenic pathway, which may depend on PDGF,FGF, CEP, or other factors; also possible is that a non-VEGF-dependent mechanism of neovascularization isactivated first – in this case, the CNV process will berefractory to anti-VEGF medications); and2) fighting neovascularization is a symptomatictreatment , as the AMD pathology continues todevelop despite pharmacological inhibition ofneovascularization and/or elimination of alreadyformed pathological vessels using verteporfin-basedphotodynamic therapy (PDT).How should one therefore manage AMD, particularlythe dry (atrophic) form of AMD? Thereare no appropriate drugs or reliable diagnosticmethods for early stages of the disease. Whatremains is only physician’s intuition and knowledge,and prophylactic rather than therapeuticactions. Since the diet has been discussed above,let’s focus on dietary supplements.This does not pertain to the neovascular form of AMD,originating from choroidal neovascularization andconsidered by many researchers, including the authorof this article, to be a serious complication of advancedAMD. This form, or more precisely, the dynamic neovascularizationthat accompanies AMD, may currentlybe treated pharmacologically using agents thatneutralize the main proangiogenic factor, i.e. thevascular endothelial growth factor (VEGF). Followingagents are available: monoclonal anti-VEGF-Aantibodies (Avastin – bevacizumab, Lucentis – ranibizumab),the recently registered soluble decoy receptorfor the factors of the VEGF-A family, VEGF-B andplacenta growth factor – PlGF (Eylea – aflibercept),as well as the less commonly at present used modifiedpegylated aptamer, an oligonucleotide strongly andselectively binding the VEGF-A 165protein, thus inhibitingits activity (Macugen – pegaptanib sodium) – thehttp://military.isl-journals.comThe dietary supplements or, more precisely, “ophthalmic”supplements, as their trade names oftenrefer, either explicitly or implicitly, to the eye orthe retina, include ophthalmic antioxidant preparations(OAPs) and preparations containingPUFA-ω3. Recently, a trend is observed to combinethe active ingredients so that one capsule/tablet containsboth macular pigments (lutein ± zeaxanthin),microelements, and PUFA-ω3. Thus, the capsulesbecome ever bigger in size, making them hard toswallow without plenty of water.This, however, is not as important as the qualitativeand quantitative composition of the offeredproducts/ingredients. This may be completelyarbitrary, including specific substances (suchas lutein and zeaxanthin, vitamins, metal salts)and less precisely defined ingredients such asplant extracts with presumed antioxidative7