The Proctor award honors outstanding research in the basic or clinical sciences. This year’s Proctor awardee, Dr. Emily Chew, delved into the discovery of nutrition in advanced AMD prevention in her talk entitled “The epidemic of age-related macular degeneration: therapeutic strategies towards prevention.”
Dr. Emily Chew opened by recounting her Chinese upbringing where her mom would say “Goji berries are good for the eyes,” and her dad always encouraged her to “eat fish for brain food before an exam”. Little did she know, this advice would be a foreshadowing to a major focus of her career. After finishing medical school and ophthalmology residency training in the University of Toronto, Dr. Chew joined the National Eye Institute (NEI). Her career evolved over the years into her current position as the director of epidemiology and clinical applications at the NEI. Dr. Chew highlighted how AMD is the leading cause of blindness in high-income countries, and its prevalence increases with age. In 2050, the number of people over age 60 years old is expected to double. And while the incidence of advanced AMD is decreasing in the present, the increase in the older population over the years will make AMD prevention ever more important.
Dr. Chew recounted how early epidemiological studies suggested nutrition may be important in AMD prevention. Indeed, individuals who consumed healthy Mediterranean diets were found to be protected against advanced AMD. Furthermore, individuals who had fish twice a week were found to have 31% decreased progression to geographic atrophy. These and other such associations motivated the AREDS study, which identified a combination of nutrients that together resulted in a 25% reduction in progression to advanced AMD at 5 years and was particularly important for reducing progression to neovascular AMD. These findings have persisted in the 10-year followups.
Further work in the AREDS2 study, a large randomized clinical trial of 4,203 people followed for 10 years, identified that omega 3 fatty acids and the combination of lutein/zeaxanthin are associated with a reduced progression to advanced AMD and reduction in neovascular AMD. The study also identified that beta carotene increases risk of lung cancer by 1.82, thus resulting in the removal of beta carotene in the current AREDS2 formula. Recent analyses suggest GA growth is also slowed with AREDS2.
Dr. Chew then shifted to the latest advancements and future directions in AMD prevention. She highlighted the need to take a multi-omic perspective to elucidate the response to AREDS2 in the aging retina – combining genomics, transcriptomics, methylomics, proteomics, and metabolomics to improve prevention of AMD. Dr. Chew highlighted the potential for artificial intelligence in enabling our understanding of the pathophysiology of AMD. She finished by underscoring a crucial point that remains to be tackled – the prevention of early AMD itself. In her words, our focus should be “prevention, prevention, prevention.”
In summary, Dr. Chew’s talk presented an overview of the past epidemiologic and clinical trials which focused on nutritional prevention of AMD – “food is medicine,” as she puts it. With her story going from goji berries and fish to AREDS2, she highlighted the path from epidemiologic observation to therapeutics. Moving forward, Dr. Chew highlighted the current potential for multi-omic work in combination with machine learning for further discovery and prevention of early AMD – a task to be tackled in this new era of big data.