1. Guidelines for Appropriate Use of Vitamins, Minerals, and Nutrients for Risk Reduction of Age Related Eye Disease Eric A. Johnson MS2, Bruce Gaynes OD, PharmD Loyola University Medical Center, Department of Ophthalmology, Maywood, IL References Objective Methods ResultsConclusion Eleven multivitamins were evaluated, including ten Centrum products and one multivitamin used at Hines VA, in Maywood, IL. These were crossed with 13 total eye supplements (four PreserVision, two Occuvite, five ICaps, and two I-Vite). To determine vitamin and nutrient exposure levels with use of dietary supplements intended specifically as a means to reduce the risk of macular degeneration when intake is combined with additional multivitamin and nutrient dietary products used for general supplementation. Evidence-based study evaluating the potential toxicity resulting from the combination of different Centrum Multivitamins or Hines VA multivitamins with available AREDS and AREDS 2 supplements. The brands analyzed include PreserVision, Ocuvite, ICaps, and I-Vite. Total daily values of each multivitamin were added to total daily values of each eye vitamin in order to evaluate the total daily intake for patients taking a multivitamin along with their AREDS supplement. These totals were then compared against the recommended daily allowance and tolerable upper intake limit to evaluate the possible toxicity that may result. Values measured include the percentage intake of the recommended daily allowance (RDA) and tolerable upper intake limit (UL). These values help to determine the level of toxicity being reached by supplement users. Different combinations of vitamins proved to reach levels that far surpass those recommended for daily intake. Beta carotene levels were found to be as high as 32,140 IU, which is 1071% the RDA for men, 1378% the RDA for women, and 321% the tolerable upper intake limit. Similar results can be seen with the other vitamins and minerals analyzed in this study. When used in conjunction with other vitamin products, patients requiring vitamin eye supplements should consider discontinuing the intake of other multivitamin formulations or supplement with single vitamin formulation products to reduce risk of unnecessary duplication in vitamin and nutrient exposure. Careful examination of vitamin labeling can help guide informed decisions on selection of appropriate individual vitamin and nutrient products to avoid overdosage and potent 1. Age-related Eye Disease Study Research Group. (2001). A randomized, placebo- controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degenration and vision loss: AREDS report no. 8. Arch Ophthalmol, 119(10), 1417-1436 2. Milton, R. C., Sperduto, R. D., Clemons, T. E., & Ferris 3rd, F. L. (2006). Centrum use and progression of age-related cataract in the Age-Related Eye Disease Study: a propensity score approach. AREDS report No. 21.Ophthalmology, 113(8), 1264-1270. 3. Nutrient Recommendations: Dietary Reference Intakes. (2011). Retrieved July 5, 2013, from http://ods.od.nih.gov/Health_Information/Diet ary_Reference_Intakes.aspx 4. Schultz, Neil. Daily Multivitamin & Eye Care Vitamin Toxicity [PowerPoint slides]. Retrieved from Hines VA Eye Clinic. 5.Vitamins & Minerals. Retrieved July 3, 2013, from http://www.centrum.ca/learn/vitamins- minerals. Richard A. Perritt Charitable Foundation Illinois Society for the Prevention of Blindness Edward Hines Jr. VA Hospital Acknowledgements Design Outcome Measures RDAs and IUs Vitamins Studied Examples of Combinations above UIs and Potential Toxicities Figure A. Figure B. Figure C. As seen in figures A and B, the combination of supplements leads to toxic levels of Vitamin A, far above the tolerable upper intake level. These levels can lead to increased intracranial pressure, dizziness, nausea, vomiting, skin irritation, and joint pain. Zinc is also seen to surpass the tolerable upper intake level in figures A, B, and C. Acute effects of high zinc intake include nausea, vomiting, loss of appetite, abdominal cramps, diarrhea, and headaches.