The Age-Related Eye Disease Study (AREDS) was initially conceived as a long
-term multicenter, prospective study of the clinical course of age-related
macular degeneration (AMD) and age-related cataract. Data on progression ra
tes and risk factors from the study will increase understanding of the clin
ical course of both conditions, generate hypotheses about etiology, and aid
in the design of clinical trials of potential interventions. In addition t
o collecting natural history data, AREDS includes a clinical trial of high-
dose vitamin and mineral supplements for AMD and a clinical trial of high-d
ose vitamin supplements for cataract. The clinical trials were initiated la
rgely because of the widespread public use in the United States of commerci
ally available pharmacologic doses of vitamins and minerals to treat these
two eye conditions and the absence of definitive studies on the safety and
efficacy of their use. Important design issues for the clinical trials incl
ude: defining cataract and AMD, estimating event rates, determining the typ
e and dosage of vitamins and minerals to be tested for each condition, and
identifying the parameters necessary for monitoring safety and efficacy. Th
is paper describes the AREDS design, including the study rationale and oper
ational structure, and the approach adopted to combine, for two diseases, c
linical trials with a natural history study. (C) Elsevier Science Inc. 1999
.