Risk factors for age-related maculopathy are associated with a relative lack of macular pigment

Macular pigment (MP) is composed of the two dietary carotenoids lutein (L) and zeaxanthin (Z), and is believed to protect against age-related maculopathy (ARM). This study was undertaken to investigate MP optical density with respect to risk factors for ARM, in 828 healthy subjects from an Irish population. MP optical density was measured psychophysically using heterochromatic flicker photometry, serum L and Z were quantified by HPLC, and dietary intake of L and Z was assessed using a validated food-frequency questionnaire. Clinical and personal details were also recorded, with particular attention directed towards risk factors for ARM. We report a statistically significant age-related decline in MP optical density (r2=0.082, p<0.01). Current and past smokers had lower average MP optical density than never smokers and this difference was statistically significant (p<0.01). Subjects with a confirmed family history of ARM had significantly lower levels of MP optical density than subjects with no known family history of disease (p<0.01). For each of these established risk factors, their statistically significant negative association with MP persisted after controlling for the other two, and also after controlling for other potentially confounding variables such as sex, cholesterol, dietary and serum L (p<0.01). In the absence of retinal pathology, and in advance of disease onset, the relative lack of MP seen in association with increasing age, tobacco use and family history of ARM supports the hypothesis that the enhanced risk that these variables represent for ARM may be attributable, at least in part, to a parallel deficiency of macular carotenoids.     

Measurement of macular pigment optical density among healthy Chinese people and patients with early-stage age-related macular degeneration

AIM: To measure the macular pigment optical density (MPOD) in healthy Chinese people and patients with early age-related macular degeneration (AMD). METHODS: Cross-sectional population based study. Demographic and lifestyle characteristics were ascertained by questionnaire. A food frequency questionnaire was completed for all participants. Participants underwent general physical and ophthalmic examinations and MPOD was measured by heterochromatic flicker photometry. Foveal architecture was measured by optical coherence tomography. RESULTS: MPOD of 225 participants (122 healthy and 103 early AMD) was 0.48±0.18. Patients with early AMD (0.52±0.19) tended to have higher MPOD levels than healthy people (0.47±0.17), but the difference was not statistically significant (P=0.06). Participants with carrot or corn oil intake every week tended to have higher levels of MPOD (P=0.002 and 0.008 respectively) while those with corn intake had relatively lower level of MPOD (P=0.01). MPOD increased with the center foveal thickness (P=0.01). CONCLUSION: Our findings show that there is no statistically significant association between MPOD and early AMD in the studied population. MPOD is related to center foveal thickness and diets would influence MPOD levels.     

Changes in macular pigment optical density and serum concentrations of its constituent carotenoids following supplemental lutein and zeaxanthin: the LUNA study

Macular pigment (MP), consisting of lutein (L) and zeaxanthin (Z), is believed to protect the retina from photo-oxidative damage. The current study investigates, in terms of MP optical density (MPOD) and serum concentrations of its constituent carotenoids, response to supplemental L and Z, and co-antioxidants. An intervention (I) group, consisting of 108 subjects (mean [+/-SD] age: 71.5 [+/-7.1] years), of which 92.6% exhibited features of age-related macular degeneration (AMD), received a daily supplement consisting of 12 mg L and 1 mg Z, both provided as ester 120 mg vitamin C, 17.6 mg vitamin E, 10 mg zinc, 40 microg selenium (Ocuvite Luteintrade mark) for a period of 6 months. MPOD was measured, by 2-wavelength autofluorescence (AF), on five occasions during the period of supplementation, and once again 3 months following discontinuation of the supplement. A control (C) group of 28 subjects (mean [+/-SD] age: 71.0 [+/-8.1] years), who received no dietary supplementation or modification, was examined at baseline and once again after a mean of 29.4 (+/-9.3) weeks. At baseline, mean (+/-SD) MPOD (at 0.5 degrees) was 0.504 (+/-0.197) and 0.525 (+/-0.189) in the I and C groups, respectively. There was a statistically significant increase in MPOD (at 0.5 degrees) for the I group (0.1 [+/-0.009]; p<0.0008), whereas no significant increase was seen in the C group (0.03 [+/-0.02]; p>0.05), over the period of supplementation. In order to classify supplemented subjects into quartiles, in terms of MPOD response, we calculated the difference between MPOD (at 0.5 degrees) at visit 6 and at baseline (visit 1). Quartile 1 (the "non-responder" quartile) displayed no increase in MPOD (at 0.5 degrees), in spite of rises seen in serum concentrations of L and Z. The three "responder" quartiles reached similar final plateaus of MPOD (at 0.5 degrees), reflected in final mean (+/-SEM) values of 0.59 (+/-0.04) optical density unit (ODU), 0.64 (+/-0.03) ODU and 0.64 (+/-0.03) ODU for quartiles 2, 3 and 4, respectively. Subjects with low baseline MPOD were more likely to exhibit a dramatic rise in MPOD, or to exhibit no rise in MPOD, in response to supplements than subjects with medium to high baseline MPOD values. Supplementation with 12 mg L and 1 mg Z, combined with co-antioxidants, resulted in an increase of MPOD at 0.5 degrees eccentricity in a majority of subjects, including those afflicted with AMD. However, there remains a substantial proportion of subjects for whom, in spite of rises in serum concentrations of L and Z in these subjects, MPOD augmentation in response to supplemental L, Z and co-antioxidants could not be detected over the study period, thus indicating that intestinal malabsorption of these carotenoids is not responsible for the lack of a macular response to such supplements. Further, our results suggest that saturable mechanisms play a role in the retinal capture and/or stabilisation of the macular carotenoids.     

Macular pigment optical density in wet age-related macular degeneration among Indians

PurposeTo estimate the value of macular pigment optical density (MPOD) in adult south Indian population with wet age-related macular degeneration (AMD).MethodsA total of 33 patients with wet AMD and 29 age-matched controls >50 years of age underwent MPOD measurement with the macular densitometer. The patients were also tested for their dietary intake of carotenoids, smoking history, and lifetime UV exposure.ResultsThe mean MPOD values in the Indian population with wet AMD was 0.23 (95% CI: 0.18-0.29) vs control was 0.43 (95% CI: 0.37-0.49), P<0.0001, at 0.5° eccentricity. Ex-smokers had a lower MPOD than non-smokers (0.16 (0.09-0.23) vs 0.28 (0.22-0.34), P=0.026) and the lowest level of carotenoids intake had 48% lower MPOD than the highest level (0.14 (0.08-0.21) vs 0.33 (0.24-0.43), P=0.012). There was no significant age-related decline or gender variation in MPOD.ConclusionThis study establishes the MPOD in adult Indian population with wet AMD, with a lack of macular pigment in association with wet AMD.     

Dietary lutein, zeaxanthin, and fats and the progression of age-related macular degeneration

BACKGROUND: To estimate the effect of dietary intake of lutein and zeaxanthin (L/Z) and fats on the progression of age-related macular degeneration (AMD). METHODS: Two hundred and fifty-four subjects identified with early age-related macular degeneration (AMD) were re-examined to determine 7-year AMD progression. Intakes of L/Z and fatty acids were estimated from food frequency questionnaires. Progression was defined by 3 different definitions, 2 quantitative and 1 qualitative, which varied in the stringency of the change required for the AMD to be deemed to have progressed. Covariates included age, smoking, AMD family history, source study, and follow-up duration. RESULTS: Energy-adjusted L/Z intake as a continuous variable was associated with AMD progression in the worse affected eye when defined by the most stringent criterion (odds ratio [OR] = 2.65, 95% confidence interval [CI] 1.13-6.22, p = 0.02). Similar associations were observed for the 2 other progression definitions (p = 0.18 and p = 0.13). Energy-adjusted omega-3 fatty acid intake modelled as a quintile median was associated with AMD progression only in the side-by-side assessment (OR = 2.56, 95% CI 1.11-5.91, p = 0.03), with borderline significance in the other 2 definitions (p = 0.05 and p = 0.08). No association of AMD progression was observed with the intake of either total fat or other subgroups: saturated, polyunsaturated, or monounsaturated fats; trans fatty acids; or omega-6 fatty acids. INTERPRETATION: The findings of the study are counterintuitive, suggesting that increased intakes of dietary L/Z and omega-3 fatty acids are associated with progression of AMD. These results may indicate that too much of a good thing might be harmful. It is possible that in this study participants adopted a more healthy diet, having been aware of their AMD status at the beginning of the study. This healthy diet was then reflected in the dietary questionnaire completed at the end of study. However, this explanation may not adequately explain why those whose AMD had progressed, on the basis of fundus signs and not symptoms such as visual acuity decline, adopted a healthier lifestyle more aggressively than those without progression.     

The role of macular pigment assessment in clinical practice: a review

This review compares the results of studies that have investigated the impact of lutein and zeaxanthin supplementation on macular pigment optical density (MPOD) with those that have investigated the reliability of techniques used to measure macular pigment optical density. The review will focus on studies that have used heterochromatic flicker photometry for measurement of macular pigment optical density, as this is the only technique that is currently available commercially to clinicians. We identified articles that reported on supplementation with lutein and/or zeaxanthin and/or meso‐zeaxanthin on macular pigment optical density measurement techniques published in peer‐reviewed journals, through a multi‐staged, systematic approach. Twenty‐four studies have investigated the repeatability of MPOD measurements using heterochromatic flicker photometry. Of these, 10 studies provided a coefficient of repeatability or data from which the coefficient could be calculated, with a range in values of 0.06 to 0.58. The lowest coefficient of repeatability assessed on naïve subjects alone was 0.08. These values tell us that, at best, changes greater than 0.08 can be considered clinically significant and at worst, only changes greater than 0.58 can be considered clinically significant. Six studies assessed the effect of supplementation with up to 20 mg/day lutein on macular pigment optical density measured using heterochromatic flicker photometry and the mean increase in macular pigment optical density ranged from 0.025 to 0.09. It seems reasonable to conclude that the chance of eliciting an increase in macular pigment optical density during six months of daily supplementation with between 10 and 20 mg lutein that is of sufficient magnitude to be detected by using heterochromatic flicker photometry on an individual basis is small. Commercially available heterochromatic flicker photometers for macular pigment optical density assessment in the clinical environment appear to demonstrate particularly poor coefficient of repeatability values. Clinicians should exercise caution when considering the purchase of these instruments for potential monitoring of macular pigment optical density in response to supplementation in individual patients.     

Association of macular pigment optical density with risk factors for wet age-related macular degeneration in the Indian population

Purpose

To investigate macular pigment optical density (MPOD) in patients with and without wet age-related macular degeneration (AMD) and to elucidate the association between MPOD and the risk factors for AMD in an Indian population.

Methods

Thirty-three subjects with wet AMD and 29 controls above 50 years old underwent MPOD measurement with the ‘Macular Densitometer''. The subjects were also tested for their smoking history, lifetime ultraviolet (UV) exposure, dietary intake of carotenoids, and body mass index (BMI).

Results

Smokers had a higher risk for AMD than the non-smokers (P=0.032) and a lower MPOD level than non-smokers (mean (95% CI)) (0.16 (0.09–0.23) vs 0.28 (0.22–0.34), adjusted P=0.026). Subjects with lowest UV exposure had higher MPOD than those with the highest (0.46 (0.38–0.54) vs 0.17 (0.01–0.33), P=0.01). MPOD was significantly lower among those with the lowest quartile of dietary intake of carotenoids (0.14 (0.08–0.21) vs 0.25 (0.13–0.36), P=0.012). Smoking, obesity, and UV index showed an inverse association with the MPOD. Low MPOD, smoking, and UV exposure had 5.11 (1.73–15.08), 3.54 (1.08–11.57), and 5.24 (1.06–25.96) odds for AMD, respectively, whereas higher dietary intake of carotenoids showed a protective effect for AMD.

Conclusion

We found an inverse association between wet AMD and MPOD. Among the established risk factors of wet AMD, we found an inverse association of smoking, UV index, and obesity with MPOD, whereas a positive association was found between dietary intake of carotenoids and MPOD.     

The utility of using customized heterochromatic flicker photometry (cHFP) to measure macular pigment in patients with age-related macular degeneration

The purpose of this study was to assess the utility and validity of using customized heterochromatic flicker photometry (cHFP) to measure macular pigment optical density (MPOD) in patients with intermediate stages of age-related macular degeneration (AMD). The measurement procedure was optimized to accommodate individual differences in temporal vision related to age, disease, or other factors. The validity criteria were based on the similarity of the spectral absorption curves to ex vivo curves of lutein and zeaxanthin and the similarity of spatial density profiles to those measured in subjects without retinal disease. Macular pigment optical density (MPOD) spatial profiles were measured with an LED-based macular densitometer; spectral absorption curves were measured with a 3-channel Maxwellian view system including a monochromator. All patients were characterized via clinical exams and all but 2 subjects from whom data were obtained had masked grading of color fundus photographs using the Wisconsin Age-Related Maculopathy Grading System. Most of the patients were in AREDS category 2 (27%) or 3 (57%). Patients with visual acuity as poor as 20/80 were included, and could perform the task as long as they could see the stimulus. Eighty-one percent of the patients screened were able to perform the cHFP task, and data were obtained from 30 AMD patients. Spatial profiles of MPOD were measured in 19 subjects who could see the stimulus at all tested loci. These profiles were highly similar to those that have been measured with HFP in subjects without retinal disease. The average shape of the spectral absorption curves for the AMD subjects corresponded well to an ex vivo template. These data support both the utility and validity of the cHFP method for measuring MPOD in subjects with intermediate stages of AMD. The ability to measure the retinal response to nutritional intervention is of practical importance for monitoring patients being supplemented with lutein and zeaxanthin in hopes of retarding visual loss and/or disease progression.     

Serum levels of macular carotenoids in relation to age-related maculopathy

Background It has been hypothesized that the macular carotenoids, lutein and zeaxanthin, may protect against age-related maculopathy. We evaluated the association between blood concentrations of lutein (L) and zeaxanthin (Z) and age-related maculopathy (ARM) in a case-control analysis of the baseline examination of the Muenster Ageing and Retina Study (MARS). Methods Of the 1060 participants aged 59–82 years at baseline, 910 (85.9%) with bilateral gradable fundus photographs and complete data for the carotenoids and potential confounders were included. The Rotterdam classification system was used for definition of ARM stages. Multivariate linear regression methods were applied to model the relationship between macular carotenoids and the presence of ARM. Results The participants’ mean age was 70.9+5.5 years, 59.9% were female, 20.8% had a normal bilateral fundus, and 48.5% showed signs of early ARM (uni- or bilateral) and 30.7% of late ARM (in at least one eye). In study participants with L and/or Z supplementation (15.6%), the median serum levels for L (Z) were approximately 2 times (1.5 times) higher than in subjects with no supplementation. After exclusion of subjects with L and/or Z supplementation, no statistically significant bivariate relationship was observed between the serum levels of L or Z and the presence of ARM. Multivariate regression models, adjusting for age, gender, smoking, body-mass index, and HDL-cholesterol blood levels, produced adjusted mean serum levels of 0.124, 0.112, and 0.131 μg/ml for L and 0.019, 0.020, and 0.022 μg/ml for Z in subjects with normal fundus, early ARM, and late ARM, respectively. Conclusion In this large study, the serum concentrations of L and Z were not related to the prevalence of ARM. However, the large proportion of study participants taking L and/or Z supplementation may have affected these results.     

Foveal slope measurements in subjects with high-risk of age-related macular degeneration

Background:

Recent reports indicated that the slope of the foveal depression influences the macular pigment (MP) spatial profile. MP has been shown to confer possible protection against age-related macular degeneration (ARMD) because of its antioxidant properties.

Aims:

To study the configuration of foveal slope and the foveal thickness in fellow eyes of subjects with unilateral neovascular ARMD.

Settings and design:

Case-control series.

Materials and Methods:

The study population consisted of 30 cases aged >50, who had unilateral choroidal neovascular membrane (CNVM) or disciform scar in the fellow eye and 29 controls aged >50, who had no sign of ARMD in the either eye. Using spectral-domain optical coherence tomography, foveal thickness at different locations including the central subfield foveal thickness (CSFT) was noted. The foveal slopes were calculated in the six radial scans (between 0.25° and 1° retinal eccentricity) as well as the 3D scan.

Results:

Cases had a significantly higher CSFT when compared to controls (215.1 ± 36.19 μ vs. 193.0 ± 17.38 μ, P = 0.004). On the 3D scan, the cases had shallower superior (cases 1.32 ± 0.32 vs. controls 1.45 ± 0.13, P = 0.04) and temporal slopes (cases 1.27 ± 0.21 vs. controls 1.39 ± 0.12, P = 0.01) in comparison to the controls.

Conclusions:

We noted a shallower superior and temporal foveal slope and a higher CSFT in the fellow eyes of subjects with a unilateral neovascular ARMD. Prospective studies observing the development of CNVM in subjects with altered foveal slope might provide more information on this optical coherence tomography finding.     

The genetics of age-related macular degeneration: a review of progress to date

Age-related macular degeneration (AMD) is the leading cause of vision loss and blindness among older adults in the USA and throughout the developed world. Etiological research suggests that AMD is a complex disease, caused by the actions and interactions of multiple genes and environmental factors. Familial aggregation studies, twin studies, and segregation analyses have provided strong evidence for the heritability of AMD, and linkage and association studies have been conducted to localize the disease-causing genes. Whole genome linkage scans have implicated nearly every chromosome in the human genome, with the most replicated signals residing on 1q25-31 and 10q26. Association studies have identified a major risk variant within the complement factor H gene (CFH), and recent reports suggest that PLEKHA1/LOC387715 and the BF/C2 regions may be major risk loci for AMD as well. Several other genes have had at least one positive association finding and deserve further exploration. Among these, apolipoprotein E (APOE) may be a minor risk locus. Additional genes will likely be identified, and future studies should explore the potential interactions of these genes with other genes as well as environmental factors.     

The association between macular pigment optical density and CFH, ARMS2, C2/BF, and C3 genotype

Age-related macular degeneration (AMD) is the most common cause of blindness in older people in developed countries, and risk for this condition may be classified as genetic or environmental, with an interaction between such factors predisposing to this disease. This study investigated the relationship between AMD risk genes, macular pigment optical density (MPOD), which may protect against AMD, and serum concentrations of the macular carotenoids, lutein (L) and zeaxanthin (Z). This was a cross-sectional study of 302 healthy adult subjects. Dietary intake of L and Z was assessed by food frequency questionnaire, and MPOD was measured by customized heterochromatic flicker photometry. We also calculated MPOD Area as the area of MP under the spatial profile curve, to reflect MP across the macula. Serum L and Z were measured by HPLC. Genotyping of tag SNPs in the genes CFH, ARMS2, C3, C2 and BF was undertaken with multiplex polymerase chain reaction (PCR) and primer extension methodology (ABI Snapshot, ABI Warrington UK) on DNA extracted from peripheral blood. The mean ± SD (range) age of the subjects in this study was 48 ± 11 (21–66) years. There was a statistically significant association between CFH genotype and family history of AMD, with subjects having two non-risk CFH haplotypes (n = 35), or one non-risk and one protective CFH haplotype (n = 33), being significantly more likely to have a negative family history of AMD (Pearson Chi square: p = 0.001). There was no significant association between the AMD risk genes investigated and either MPOD (One way ANOVA: p > 0.05) or serum concentrations of L or Z (One way ANOVA: p > 0.05, for both). Subjects who were homozygous for risk alleles of both CFH and ARMS2 (n = 4) had significantly lower MPOD at 0.5° and 1° retinal eccentricity (Independent samples t test: p < 0.05) and lower MPOD Area which approached statistical significance (Independent samples t test: p = 0.058), compared to other subjects (n = 291). In conclusion, this study did not detect an association between individual AMD risk genotypes and the putatively protective MP, or serum concentrations of its constituent carotenoids. However, the combination of homozygous risk alleles at both CFH and ARMS2 loci was associated with significantly lower MPOD centrally, despite comparable serum concentrations of the macular carotenoids. These findings suggest that the maculae of subjects at very high genetic risk of AMD represent a hostile environment for accumulation and/or stabilization of MP.     

Association between complement factor I gene polymorphisms and the risk of age-related macular degeneration: a Meta-analysis of literature

AIM: To systematically review the association between complement factors I (CFI) polymorphisms and age-related macular degeneration (AMD) and to explore whether CFI polymorphisms are associated with AMD. METHODS: Meta-analysis of articles published from 1995 to January 2015 of articles involved with AMD and polymorphisms of the CFI gene. Eligible data were pooled in a Meta-analysis, analyzing using STATA software (version 12.0), Review Manager (version 5.2) and different models based on the heterogeneity of effect sizes. Egger’s test, Begg’s rank correlation methods were used to evaluate for publication bias. RESULTS: Thirteen articles were eligible, describing two loci polymorphisms of the CFI gene (of which 12 articles focus on rs10033900T>C and 3 articles focus on rs2285714C>T). For rs10033900T>C, the results of our study revealed that having a mutant allele C, TC, CC and TC+CC was associated with a decreased risk of AMD in all population groups studied (C versus T models, OR=0.84, 95%CI: 0.72-0.99, P=0.04; TC versus TT models OR=0.89, 95%CI: 0.88-0.99, P=0.04; CC versus TT models, OR=0.76, 95%CI: 0.60-0.98, P=0.03; TC+CC versus TT models, OR=0.81, 95%CI:0.65-0.99, P=0.04). We found that C allele were related to lower AMD risk in the Caucasian population by subgroup analysis, but there was no association with AMD under the allele and genotypes comparison in Asian studies. For rs2285714 C>T, the TC, TT genotypes contributed to a higher risk of AMD, compared with the CC carriers and TC+CC (OR=1.34, 95%CI: 1.09-1.63, P=0.004; OR=1.50, 95%CI: 1.25-1.80, P<0.0001). CONCLUSION: This Meta-analysis suggests that CFI rs10033900T>C and rs2285714C>T polymorphisms may contribute to AMD.     

Comparison of macular pigment in patients with age‐related macular degeneration and healthy control subjects – a study using spectral fundus reflectance

Purpose: Previous studies have reported an age‐dependent decline of macular pigment optical density (MPOD) as well as a relative lack of MPOD in age‐related macular degeneration (AMD). Results are, however, strongly dependent on the technique used. In this study, we investigated the age dependence of MPOD using spectral fundus reflectance. In addition, we hypothesized that patients with AMD have a reduced MPOD as compared to healthy controls. Methods: A total of 85 healthy subjects and 96 patients with AMD were included in this study. The healthy control subjects showed a wide range of ages (mean, 51.6 years; range, 21–79 years). Patients with AMD were significantly older (mean, 71.2 years; range, 50–89 years). Spectral fundus reflectance of the fovea was measured in a 2.3° detection field with a custom built fundus reflectometer. Calculation of MPOD was based on a previously published fundus reflectance model. Results: Patients with AMD showed a reduced MPOD (0.35 ± 0.12) as compared to the healthy control group (0.39 ± 0.12, p = 0.013 between groups). No age dependence of MPOD (r = ?0.14, p = 0.19) was found in the healthy control group. In the AMD group, however, MPOD declined with age (r = ?0.24, p = 0.019). Conclusions: This study indicates that MPOD is reduced in patients with AMD. In addition, the data of this study indicate that MPOD is age dependent in AMD patients, but not in healthy controls. Taken together with data indicating that lutein supplementation increases MPOD, this provides a rationale for supplementation of the macular pigments in patients with AMD, although long‐term clinical outcome data are lacking.     

Cataract surgery in patients with age-related maculopathy: preoperative diagnosis and postoperative visual acuity

PURPOSE: To report the reliability in detecting age-related maculopathy (ARM) lesions before cataract surgery and postoperative visual acuity (VA) in cataract surgery patients with ARM. METHODS: Medical records of surgical patients in a large public hospital, west of Sydney, were reviewed retrospectively. Detection of ARM lesions was compared before and after surgery to determine sensitivity and specificity of preoperative diagnoses. Postoperative VA was assessed 4 weeks after surgery. RESULTS: Data were available for 721/784 eyes (92.0%) of 656 patients aged 60 years or older. ARM lesions were detected in 98 eyes (13.6%) before and 92 eyes (12.8%) after surgery. Sensitivities for detecting late ARM lesions, soft drusen and retinal pigment epithelium abnormalities preoperatively were 100%, 94% and 69%, respectively. Corresponding specificities were 100%, 100% and 77%, respectively. Postoperative VA achieved or remained 6/12 or better in 81.6% of eyes. CONCLUSION: A high sensitivity and specificity in detecting late ARM lesions and soft drusen preoperatively, and a good postoperative VA outcome is achievable in patients with preoperative early ARM lesions.     

Macular pigment and serum zeaxanthin levels with Goji berry supplement in early age-related macular degeneration

AIM: To evaluate the efficacy of Goji berry supplementation on improving macular pigment, serum zeaxanthin levels and visual acuity in patients with early age-related macular degeneration (AMD). METHODS: A total of 114 patients (aged from 51 to 92y, mean age 69.53±8.41y) with early AMD were enrolled in our prospective, randomized controlled study. The included patients were assigned randomly to the Goji group (n=57) with 25 g of Goji berries supplementation per day for 90d and the control group (n=57) with their normal diet for 90d. Macular pigment optical density (MPOD) was measured using heterochromatic flicker photometry (HFP). The levels of serum lutein (L)/zeaxanthin (Z) were analyzed using high-performance liquid chromatography (HPLC). MPOD, serum L/Z levels and best corrected visual acuity (BCVA) were recorded at baseline and 90d. RESULTS: In the Goji group, there were no statistically significant differences in the serum L levels between the baseline (0.199±0.149 μmol/mL) and 90d (0.203±0.181 μmol/mL) (t=-0.186, P=0.850); however the serum Z levels were increased at 90d (0.101±0.087 μmol/mL) compared with those at the baseline (0.029±0.032 μmol/mL) (t=6.412, P<0.001). Patients treated with Goji berry for 90d showed an elevated MPOD (0.877±0.202 DU) from the baseline (0.731±0.205 DU) (t=-4.741, P=0.000). In contrast to the control group, the serum Z levels and MPOD were higher in the Goji group at 90d (both P<0.05). At 90d, patients with Goji berry supplementation had a relative decrease in BCVA (0.21±0.18 logMAR) compared with the baseline (0.27±0.20) (t=2.397, P=0.020). CONCLUSION: Overall, daily supplementation with Goji berry for 90d improves MPOD by increasing serum Z levels rather than serum L levels in early AMD patients. Goji berry may be an effective therapeutic intervention for preventing the progression of early AMD.     

自噬及其与干性年龄相关性黄斑变性发病的相关性

年龄相关性黄斑变性(age-related macular degeneration,AMD)是老年人首要致盲眼病,发病率呈不断上升趋势.而干性AMD占85％ ～ 90％,其病因尚未完全阐明.自噬是指细胞中需要降解的蛋白质和细胞器等成分被包裹,并最终运送到溶酶体降解的过程,是清除细胞内受损蛋白及细胞器的主要途径,对维持细胞内环境稳态至关重要.多项研究显示自噬失调与AMD目前所知的主要发病机制,即氧化应激、炎症及视网膜色素上皮细胞代谢障碍密切相关,为从自噬方面探索AMD治疗方案提供一些思路和方向.     

Low dose radiation for subfoveal choroidal neovascularization in age-related macular degeneration. A pilot study

The aim of our pilot study was to test the effect of low dose radiation on classic and occult subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (AMD). The posterior pole of the afflicted eye of 12 patients was irradiated with 5 Gray (Gy), and that of 34 patients with 8 Gy. The radiotherapy was done by a linear accelerator (6 MV X-rays) during 4 consecutive days with daily doses of 1.25 Gy and 2 Gy respectively. At the time of treatment, and 6 weeks, 6 months and 1 year after, a simultaneous fluorescein and ICG angiography of both eyes were carried out, and the distance visual acuity was measured. In none of the cases were we able to note a reduction in the subfoveal membrane's size. With regards to the visual acuity, the evolution was slightly better than the spontaneous courses described in existing literature. Further prospective randomized studies with higher dose radiation are necessary in order to determine the significance of radiotherapy in the treatment of this pathology.     

Visual function following transpupillary thermotherapy with adjusted laser parameters for the treatment of exudative age-related macular degeneration: a pilot study

PURPOSE: To evaluate the efficacy of transpupillary thermotherapy (TTT) using adjusted laser parameters for the treatment of choroidal neovascularization (CNV) secondary to age-related macular degeneration. METHODS: TTT was performed on patients with CNV using a diode laser (810 nm) for 60 s in a subthreshold manner. Power settings were varied between 460 and 1200 mW, depending on lesion size, presence of pigment epithelial detachment and the amount of fundal pigmentation and subretinal fluid. LogMAR visual acuity, contrast sensitivity (Pelli-Robson) and metamorphopsia (Amsler chart) were assessed prior to and 6 months following treatment. Subjects also self-administered the National Eye Institute 25-Item Visual Function Questionnaire. RESULTS: Thirty occult/minimally classic and eight predominantly classic membranes were treated with TTT. At 6 months, absence or significant reduction of fluorescein leakage was observed in 20 (53%) patients. Stabilization of vision (loss of less than 15 letters) was observed in 25/30 (83%) eyes with occult/minimally classic CNV and 5/8 (63%) eyes with predominantly classic CNV. Improvement of contrast sensitivity was noted in 15 (35%) eyes, in 10 (26%) eyes it remained unchanged and in 13 (34%) eyes it deteriorated. There was no statistically significant effect of TTT on the National Eye Institute 25-Item Visual Function Questionnaire composite or subscale scores. CONCLUSIONS: TTT using adjusted parameters depending on fundal characteristics appears to be effective in stabilizing subjective and objective visual ability in a considerable number of patients with subfoveal CNV due to age-related macular degeneration. Larger-scale studies are required to confirm the benefit of this technique as opposed to the natural history of occult CNV.