Plasma antioxidant vitamins and carotenoids and age-related cataract.

OBJECTIVE: To investigate the relationships between plasma concentrations of antioxidant vitamins and carotenoids and nuclear, cortical, and posterior subcapsular cataracts in a group of elderly men and women. DESIGN: Cross-sectional survey. PARTICIPANTS: Three hundred seventy-two men and women, aged 66 to 75 years, born and still living in Sheffield, England. METHODS: The Lens Opacities Classification System (LOCS) III was used to grade nuclear, cortical, and posterior subcapsular lens opacities. Fasting blood samples were taken to assess plasma concentrations of vitamin C, vitamin E, alpha-carotene, beta-carotene, lycopene, lutein, zeaxanthin, and beta-cryptoxanthin. MAIN OUTCOME MEASURES: Logistic regression analyses of the associations between plasma vitamin concentrations and cataract subtype, adjusting for age, gender, and other risk factors. RESULTS: After adjustment for age, gender, and other risk factors, risk of nuclear cataract was lowest in people with the highest plasma concentrations of alpha-carotene (odds ratio [OR], 0.5; 95% confidence interval [CI], 0.3-0.9, P for trend 0.006) or beta-carotene (OR, 0.7; 95% CI, 0.4-1.4, P for trend 0.033). Risk of cortical cataract was lowest in people with the highest plasma concentrations of lycopene (OR, 0.4; 95% CI, 0.2-0.8, P for trend 0.003), and risk of posterior subcapsular cataract was lowest in those with higher concentrations of lutein (OR, 0.5; 95% CI, 0.2-1.0, P for trend 0.012). High plasma concentrations of vitamin C, vitamin E, or the carotenoids zeaxanthin and beta-cryptoxanthin were not associated with decreased risk. CONCLUSIONS: These findings suggest that a diet rich in carotenoids may protect against cataract development, but because they are based on observational data, they need to be confirmed in randomized controlled trials.     

Plasma lutein and zeaxanthin and other carotenoids as modifiable risk factors for age-related maculopathy and cataract: the POLA Study

PURPOSE: To assess the associations of plasma lutein and zeaxanthin and other carotenoids with the risk of age-related maculopathy (ARM) and cataract in the population-based Pathologies Oculaires Liées à l'Age (POLA) Study. METHODS: Retinal photographs were graded according to the international classification. ARM was defined by the presence of late ARM (neovascular ARM, geographic atrophy) and/or soft indistinct drusen (>125 microm) and/or soft distinct drusen (>125 microm) associated with pigmentary abnormalities. Cataract classification was based on a direct standardized lens examination at the slit lamp, according to Lens Opacities Classification System III. Plasma carotenoids were measured by high-performance liquid chromatography (HPLC), in 899 subjects of the cohort. RESULTS: After multivariate adjustment, the highest quintile of plasma zeaxanthin was significantly associated with reduced risk of ARM (OR=0.07; 95% CI: 0.01-0.58; P for trend=0.005), nuclear cataract (OR=0.23; 95% CI: 0.08-0.68; P for trend=0.003) and any cataract (OR=0.53; 95% CI: 0.31-0.89; P for trend=0.01). ARM was significantly associated with combined plasma lutein and zeaxanthin (OR=0.21; 95% CI: 0.05-0.79; P for trend=0.01), and tended to be associated with plasma lutein (OR=0.31; 95% CI: 0.09-1.07; P for trend=0.04), whereas cataract showed no such associations. Among other carotenoids, only beta-carotene showed a significant negative association with nuclear cataract, but not ARM. CONCLUSIONS: These results are strongly suggestive of a protective role of the xanthophylls, in particular zeaxanthin, for the protection against ARM and cataract.     

Neovascular age-related macular degeneration and its relationship to antioxidant intake

PURPOSE: Experimental and epidemiological studies suggest that low antioxidant intake may be associated with the occurrence of neovascular age-related macular degeneration (AMD). METHODS: We investigated this hypothesis further with a case-control study involving 72 case and 66 control patients attending the Ophthalmology Department of the University Hospital in Nijmegen. Data were collected by interview on antioxidant intake (i.e. in fruit and vegetables), cigarette smoking, sunlight exposure and familial predisposition. Antioxidant intake was calculated according to the method described in the Framingham Eye Study. Logistic regression analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI). RESULTS: The prevalence rate of AMD in patients with low antioxidant intake and low lutein intake (dichotomized at the median value) was about twice as high as that in patients with high intake: OR = 1.7, 95% CI (0.8-3.7), and OR = 2.4, 95% CI (1.1-5.1). Further specification of intake data into quartiles of antioxidant intake and lutein/zeaxanthine intake showed a clear dose-response relationship. CONCLUSION: The effect of dietary antioxidants upon macular health warrants preventive studies.     

The macular xanthophylls

The macular pigments are predominantly composed of three carotenoids: lutein, zeaxanthin, and meso-zeaxanthin. These carotenoids are concentrated and distributed in a selective manner. The properties of these pigments are further explored along with their methods of uptake, stabilization, and storage. The dual nature of these pigments as filters and antioxidants are elaborated upon in relation to their protective effects upon the macula, specifically in age-related macular degeneration. Evidence suggests that increased levels of macular pigment are correlated with a decreased risk of age-related macular degeneration. Many have sought to exploit this therapeutic relation. Studies reveal that oral supplementation with lutein and zeaxanthin can increase the levels of macular pigments in the retina and plasma. The effects of such supplementation on actual ocular function have yet to be fully addressed. New and standardized methods of assessing macular pigment density are discussed and future areas of research to further our understanding of macular xanthophylls as they pertain to age-related macular degeneration are highlighted.     

Dietary and lifestyle risk factors associated with age-related macular degeneration: A hospital based study

Aim:

To establish the frequency, associations and risk factors for age-related macular degeneration (AMD) in hospital population of South India.

Materials and Methods:

In this cross-sectional hospital based study, 3549 subjects (2090 men and 1459 women) above 45 years of age were screened randomly for AMD. Participants underwent ocular evaluation and were interviewed for lifestyle variables and dietary intake of carotenoids by structured food frequency questionnaire. AMD was defined according to the international classifications and grading system.

Results:

Either form of AMD was detected in 77 (2.2%) participants. Of which, early and late AMD was present in 63 (1.8%) and 14 (0.4%) subjects, respectively. Binary logistic analysis showed that the incidence of AMD was significantly higher with increasing age (Odds ratio [OR] 1.17; 95% CI 1.13-1.22) and diabetes (OR 3.97; 95% CI 2.11-7.46). However, AMD was significant among heavy cigarette smokers (OR 5.58; 95% CI 0.88-7.51) and alcoholics (OR 4.85; 95% CI 2.45-12.22). Dietary lutein/zeaxanthin (L/Z) and β-carotene intake were associated (P < 0.001) with the reduction in risk for AMD, with an OR of 0.38 and 0.65, respectively.

Conclusions:

Higher dietary intake of carotenoids, especially L/Z, was associated with lower risk for AMD. Risk of AMD is higher with increasing age and was prevalent among subjects with diabetes. Cessation of smoking and alcohol may reduce the risk of AMD in this population.     

Nutritional supplementation in age-related macular degeneration

PURPOSE OF REVIEW: This review assesses the current status of the knowledge of the role of nutrition in age-related macular degeneration - a leading cause of vision loss in the persons with European ancestry. RECENT FINDINGS: We will evaluate the different nutritional factors and both observational and interventional studies used to assess the association of nutrition with age-related macular degeneration. Persons with intermediate risk of age-related macular degeneration or advanced age-related macular degeneration in one eye are recommended to take the formulation proven in the Age-Related Eye Disease Study (AREDS) to be successful in preventing the development of advanced age-related macular degeneration by 25%. The formulation consists of vitamins C, E, beta-carotene and zinc. In addition, observational data suggest that high dietary intake of macular xanthophylls lutein and zeaxanthin are associated with a lower risk of advanced age-related macular degeneration. Similarly, long-chain polyunsaturated fatty acids derived from fish consumption are also associated with a decreased risk of advanced age-related macular degeneration. SUMMARY: Persons with intermediate age-related macular degeneration or advanced age-related macular degeneration (neovascular or central geographic atrophy) in one eye should consider taking the AREDS-type supplements. Further evaluation of nutritional factors, specifically, lutein/zeaxanthin and omega-3 fatty acids will be tested in a multicenter controlled, randomized trial - the Age-Related Eye Disease Study 2 (AREDS2).     

Relation between size at birth and risk of age-related macular degeneration

PURPOSE: To determine whether poor fetal growth, as determined by size at birth, is associated with increased risk of age-related macular degeneration. METHODS: A total of 660 men and women born in Sheffield, United Kingdom, between 1922 and 1930 and whose size at birth was available were traced and invited to take part in the study. Of these, 392 attended for ophthalmic examination. Age-related macular degeneration in these volunteers was determined by the Wisconsin Age-Related Maculopathy Grading System. RESULTS: The mean birth weight of subjects with macular degeneration (early or late) was heavier than that of those without (7.6 lb vs. 7.3 lb, respectively; P = 0.03). After adjustment for age, gender, and risk factors for macular degeneration, a significantly increased risk of macular degeneration was found in subjects with higher birth weight (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1-2.0 for each SD [1 lb, 5 oz] increase in birth weight). Other parameters describing size at birth showed a weaker relation or no relation with macular degeneration, but one of the measures of fetal proportion (head circumference-to-birth weight ratio) was significantly associated with risk of macular degeneration. Subjects with macular degeneration had a significantly lower head circumference-to-birth weight ratio than did those without (11.2 vs. 12.0 respectively, P = 0.01). CONCLUSIONS: The finding that age-related macular degeneration was associated with increased rather than decreased birth weight was unexpected. Failure of the developing fetus's normal brain-sparing mechanism is a possible explanation for our finding of a lower head circumference-to-birth weight ratio among subjects with macular degeneration.     

Macular pigment: new clinical methods of detection and the role of carotenoids in age-related macular degeneration.

Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in people over the age of 65. The Age-Related Eye Disease Study (AREDS) suggests antioxidants may delay the advance of age-related macular degeneration. The macular pigments zeaxanthin and lutein may serve as antioxidants as well as blue filter to protect the retina. In this review, the general characteristics of macular pigment are described. The nutritional value of zeaxanthin/lutein and methods to assess macular pigment are discussed. Several emerging instruments to assess macular pigment, including heterochromatic flickering photometer, motion detection photometer, fundus reflectance spectroscope, Raman spectrometer, and autofluorescence spectrometry, are introduced and reviewed. Optometrists should be aware that they may play a role to assess and monitor the risk of AMD. There is an opportunity to incorporate measurement of macular pigment in optometric practice.     

Family history and age-related maculopathy: The Blue Mountains Eye Study

Purpose: To assess the associations between stages of age-related maculopathy (ARM) and reported family history of this eye disease. Methods: A cross-sectional study of 3654 subjects from a defined geographical area west of Sydney (NSW, Australia) identified subjects with late age-related macular degeneration (AMD) and early ARM from masked detailed grading of retinal photographs. Interviewer-administered questionnaires provided data on family history of ARM. Logistic regression was used to assess associations, adjusting for other known risk factors. Results: A family history of ARM was significantly associated with both late AMD (odds ratio (OR) 3.92; 95% confidence interval (CI) 1.34-11.46) and early ARM (OR 2.17; 95% CI 1.04-4.55). The association was highest for neovascular AMD. Conclusions: These findings provide persuasive evidence that a stated family history of ARM is an important risk factor for ARM.     

Depressive symptoms and age-related macular degeneration in older people: the cardiovascular health study

PURPOSE: To examine the association between age-related macular degeneration (AMD) and depressive symptoms. METHODS: Population-based, cross-sectional study. A total of 2,194 persons aged 69-97 years were included in the current analyses. During the 1997-1998 examination, retinal photography from one randomly selected eye was graded for presence of early and late AMD using a modified Wisconsin AMD by Grading System. Depressive symptoms were assessed via a modified version of the Centers for Epidemiologic Studies Depression (CES-D) scale annually from 1989 through 1997-1998. Depressive symptoms were defined as a CES-D score of >9 (top quartile of CES-D score) at the 1997-1998 examination. RESULTS: There were 338 (15.6%) individuals with early AMD and 29 (1.3%) with late AMD. Among them, 368 (16.8%) persons had depressive symptoms at the 1997-1998 examination. Depressive symptoms were not associated with early AMD (multivariable adjusted odds ratio [OR]: 0.97; 95% confidence intervals [CI]: 0.69-1.36) or late AMD (OR: 1.15; 95% CI: 0.38-3.46). Including persons using anti-depressive medications did not alter these associations (OR: 0.98; 95% CI: 0.74-1.32 for early AMD and OR: 0.97; 95% CI: 0.35-2.67 for late AMD). There was no association in multinomial logistic regression models of increasing quartiles of the CES-D scores with early or late AMD status. CONCLUSIONS: Our study did not find an association between early AMD and depressive symptoms in older people.     

Depressive Symptoms and Age-Related Macular Degeneration in Older People: The Cardiovascular Health Study

Purpose: To examine the association between age-related macular degeneration (AMD) and depressive symptoms. Methods: Population-based, cross-sectional study. A total of 2,194 persons aged 69–97 years were included in the current analyses. During the 1997–1998 examination, retinal photography from one randomly selected eye was graded for presence of early and late AMD using a modified Wisconsin AMD by Grading System. Depressive symptoms were assessed via a modified version of the Centers for Epidemiologic Studies Depression (CES-D) scale annually from 1989 through 1997–1998. Depressive symptoms were defined as a CES-D score of > 9 (top quartile of CES-D score) at the 1997–1998 examination. Results: There were 338 (15.6%) individuals with early AMD and 29 (1.3%) with late AMD. Among them, 368 (16.8%) persons had depressive symptoms at the 1997–1998 examination. Depressive symptoms were not associated with early AMD (multivariable adjusted odds ratio [OR]: 0.97; 95% confidence intervals [CI]: 0.69–1.36) or late AMD (OR: 1.15; 95% CI: 0.38–3.46). Including persons using anti-depressive medications did not alter these associations (OR: 0.98; 95% CI: 0.74–1.32 for early AMD and OR: 0.97; 95% CI: 0.35–2.67 for late AMD). There was no association in multinomial logistic regression models of increasing quartiles of the CES-D scores with early or late AMD status. Conclusions: Our study did not find an association between early AMD and depressive symptoms in older people.     

Glutathione S-transferase M1, T1, and P1 gene polymorphism in exudative age-related macular degeneration: a preliminary report

PURPOSE: To elucidate whether the gene polymorphisms of glutathione S-transferase (GST) M1, T1, and P1 are associated with the development of exudative age-related macular degeneration. METHODS: The authors genotyped 35 white patients with exudative age-related macular degeneration and 159 healthy controls. Genomic DNA from peripheral blood was examined using polymerase chain reaction and defined for the genetic polymorphisms of GST. RESULTS: No association was observed between GSTM1, GSTT1, and GSTP1 polymorphisms and age-related macular degeneration risk (p>0.05). The frequencies of the combination of the GSTM1 (null) and GSTP1 (mutant), GSTM1 (null), and GSTT1 (null) genotype polymorphisms in patients with exudative age-related macular degeneration differed greatly from those of the control group (p=0.001 OR [95% CI]: 7.70 [2.28-25.98] and p=0.007 OR [95% CI]: 3.88 [1.51-10.02], respectively). CONCLUSIONS: The present study suggests that the GSTM1 (null) and GSTT1 (null), GSTM1 (null), and GSTP1 (mutant) combinations may be a genetic risk factor for the development of exudative age-related macular degeneration. However, the potential role of GST polymorphisms as a marker of susceptibility to age-related macular degeneration needs further studies in a larger number of patients.     

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.     

Ligand-binding characterization of xanthophyll carotenoids to solubilized membrane proteins derived from human retina

The macula of the human retina contains extraordinarily high concentrations of lutein and zeaxanthin, xanthophyll carotenoids that appear to play an important role in protecting against age-related macular degeneration, the leading cause of blindness among the elderly. It is likely that the uptake and stabilization of these carotenoids is mediated by specific xanthophyll-binding proteins. In order to purify and characterize such a binding protein, a carotenoid-rich membrane fraction derived from human macula or peripheral retina was prepared by homogenization, differential centrifugation, and detergent solubilization. Further purification was carried out using ion-exchange chromatography and gel-filtration chromatography coupled with continuous photodiode-array monitoring for endogenously associated xanthophyll carotenoids. The most highly purified preparations contained two major protein bands at 25 and 55 kDa that consistently co-eluted with endogenous lutein and zeaxanthin. The visible absorbance spectrum of the binding protein preparation closely matches the spectral absorbance of the human macular pigment, and it is bathochromically shifted about 10 nm from the spectrum of lutein and zeaxanthin dissolved in organic solvents. Binding of exogenously added lutein and zeaxanthin is saturable and specific with an apparent Kd of approximately 1 microM. Canthaxanthin and beta-carotene exhibit no significant binding activity to solubilized retinal membrane proteins when assayed under identical conditions. Other potential mammalian xanthophyll-binding proteins such as albumin, tubulin, lactoglobulin and serum lipoproteins possess only weak non-specific binding affinity for carotenoids when assayed under the same stringent binding conditions. This investigation provides the first direct evidence for the existence of specific xanthophyll-binding protein(s) in the vertebrate retina and macula. The possible roles of xanthophyll-binding proteins in normal macular function and in the pathogenesis of age-related macular degeneration remain to be elucidated.     

Plasma and macular responses to lutein supplement in subjects with and without age-related maculopathy: a pilot study

There is a growing body of evidence which suggests that macular pigment (MP), which is entirely of dietary origin, protects against age-related maculopathy. We evaluated the effect of a daily 20 mg lutein ester (equivalent of 10 mg/day free lutein) supplement in patients with early age-related maculopathy (ARM), in terms of macular pigment optical density (MPOD) and plasma concentrations of lutein. MPOD was measured using a flicker photometric technique in seven ARM sufferers and six age-matched controls over a period of supplementation which lasted 18-20 weeks. Plasma lutein increased from a mean (SD) baseline concentration of 182 (127)ng ml(-1) to a peak of 1077 (165)ng ml(-1) in ARM patients, and from 152 (57) to 1110 (605)ng ml(-1) in control subjects. Mean MPOD had increased significantly from baseline of 0.24 to a peak of 0.31 in ARM sufferers. This mean increment of 0.07 was the same for the age-matched controls (baseline: 0.20; peak: 0.27). The augmentation of MP, and plasma concentrations of lutein, following supplementation in subjects with ARM provides the first evidence the disease is not associated with intestinal malabsorption of the relevant macular carotenoids, and that a diseased macula can accumulate and stabilise lutein and/or zeaxanthin. Furthermore, these results suggest that the beneficial effects of lutein supplementation, if any, may be extended to subjects with established ARM.     

Effect of dietary zeaxanthin on tissue distribution of zeaxanthin and lutein in quail

PURPOSE: The xanthophyll carotenoids (lutein and zeaxanthin) are hypothesized to delay progression of age-related macular degeneration. The quail has a cone-dominant retina that accumulates carotenoids. The purpose of these experiments was to characterize the carotenoid composition of retina, serum, liver, and fat in quail and to determine whether dietary enrichment with zeaxanthin alters zeaxanthin or lutein concentrations in these tissues. METHODS: Quail were fed for 6 months with a commercial turkey diet (T group; n = 8), carotenoid-deficient diet (C- group; n = 8), or a carotenoid-deficient diet supplemented with 35 mg 3R,3'R-zeaxanthin per kilogram of food, (Z+ group; n = 8). Zeaxanthin was derived from Sphingobacterium multivorum (basonym Flavobacterium). Carotenoids in serum, retina, liver, and fat were analyzed by HPLC. RESULTS: As in the primate fovea, the retina accumulated zeaxanthin, lutein, and cryptoxanthin, and preferentially absorbed zeaxanthin (P < 0.005). In contrast, lutein was preferentially absorbed by liver (P < 0.01) and fat (P < 0.0001). In supplemented females, zeaxanthin increased approximately 4-fold in retina, and 74-, 63- and 22-fold in serum, liver, and fat, respectively. In males, zeaxanthin was elevated approximately 3-fold in retina, and 42-, 17-, and 12-fold in serum, liver, and fat, respectively. Birds fed the Z+ diet absorbed a higher fraction of dietary lutein into serum, but lutein was reduced in the retina (P < 0.05). CONCLUSIONS: Xanthophyll profiles in quail mimic those in primates. Dietary supplements of zeaxanthin effectively increased zeaxanthin concentrations in serum, retina, liver, and fat. The robust response to zeaxanthin supplementation identifies the quail as an animal model for exploration of factors regulating delivery of dietary carotenoids to the retina.     

Resonance Raman measurement of macular carotenoids in normal subjects and in age-related macular degeneration patients

PURPOSE: Dietary carotenoids lutein and zeaxanthin may play a protective role against visual loss from age-related macular degeneration (AMD) through antioxidant and light screening mechanisms. We used a novel noninvasive objective method to quantify lutein and zeaxanthin in the human macula using resonance Raman spectroscopy and compared macular pigment levels in AMD and normal subjects. DESIGN: Observational study of an ophthalmology clinic-based population. PARTICIPANTS AND CONTROLS: Ninety-three AMD eyes from 63 patients and 220 normal eyes from 138 subjects. METHODS: Macular carotenoid levels were quantified by illuminating the macula with a low-power argon laser spot and measuring Raman backscattered light using a spectrograph. This technique is sensitive, specific, and repeatable even in subjects with significant macular pathologic features. MAIN OUTCOME MEASURE: Raman signal intensity at 1525 cm(-1) generated by the carbon-carbon double-bond vibrations of lutein and zeaxanthin. RESULTS: Carotenoid Raman signal intensity declined with age in normal eyes (P < 0.001). Average levels of lutein and zeaxanthin were 32% lower in AMD eyes versus normal elderly control eyes as long as the subjects were not consuming high-dose lutein supplements (P = 0.001). Patients who had begun to consume supplements containing high doses of lutein (> or =4 mg/day) regularly after their initial diagnosis of AMD had average macular pigment levels that were in the normal range (P = 0.829) and that were significantly higher than in AMD patients not consuming these supplements (P = 0.038). CONCLUSIONS: These findings are consistent with the hypothesis that low levels of lutein and zeaxanthin in the human macula may represent a pathogenic risk factor for the development of AMD. Resonance Raman measurement of macular carotenoid pigments could play an important role in facilitating large-scale prospective clinical studies of lutein and zeaxanthin protection against AMD, and this technology may someday prove useful in the early detection of individuals at risk for visual loss from AMD.     

Diabetes, hyperglycemia, and age-related maculopathy. The Beaver Dam Eye Study.

PURPOSE: The purpose of this study is to examine the association among hyperglycemia, diabetes status, and age-related maculopathy in a population-based study of people between the ages of 43 and 86 years who lived in Beaver Dam, Wisconsin between 1988 and 1990. METHODS: Age-related maculopathy was determined from stereoscopic fundus photographs. RESULTS: In the nondiabetic group (n = 4291), no relationship was found between glycosylated hemoglobin and any signs of age-related maculopathy. Diabetes status was not associated with early age-related maculopathy. People 75 years of age or older with diabetes (n = 85) had a higher frequency of exudative macular degeneration (9.4%) than those without (4.7%) but had similar frequencies of pure geographic atrophy (3.8% for those with diabetes and 3.4% for those without diabetes). The relative risk of exudative macular degeneration in men with diabetes who were 75 years of age or older compared with those who did not have diabetes was 10.2 (95% confidence interval [CI]: 2.4, 43.7); for females it was 1.1 (95% CI: 0.4, 3.0). CONCLUSION: These data suggest that diabetes is not related to early age-related maculopathy or geographic atrophy. The relationship of exudative macular degeneration to diabetes in older men, but not women, may be a result of chance. Further longitudinal study of this observation is needed.     

叶黄素和玉米黄质治疗年龄相关性黄斑变性的多焦视网膜电图变化观察

目的 应用多焦视网膜电图(multifocal electroretinography,mfERC)评价叶黄素(lutein)和玉米黄质(zeaxanthin)治疗年龄相关性黄斑变性(age-related macular degeneration,ARMD)的视网膜功能变化情况.方法 ARMD患者6例9只眼在接受叶黄素和玉米黄质治疗前及治疗后100d分别对各患眼5个环状视网膜区域进行b波反应密度的测量比较.记录以黄斑中心凹为中心呈同心圆排列的5个环区,自内至外分别是1环(2.18度),2环(7.46度),3环(12.36度),4环(19.66度)和5环(29.75度)的b波反应振幅密度,应用EPi Info统计软件中两个独立样本的t检验进行统计学分析.结果 9只眼ARMD患者治疗前后mf-ERG b波反应振幅密度比较,1,2,3,4,5环各环的振幅密度均明显提高,与治疗前相比差异具有统计学意义(P<0.05).结论 mf-ERG 显示叶黄素和玉米黄质治疗能有效提高ARMD患者mf-ERG的b波反应振幅密度,改善患眼视网膜光感受器功能.     

Macular pigment: a review of current knowledge

The existence of the macula lutea of the human retina has been known for more than 200 years. It is established that the xanthophylls lutein and zeaxanthin are responsible for the yellow color. The effect of macular photopigments on blue-light filtration and color perception is well established. It has been postulated that the pigment might serve to reduce chromatic aberration and to improve visual acuity. The antioxidant capabilities of these xanthophylls combined with their ability to trap short-wavelength light may serve to protect the outer retina, retinal pigment epithelium, and choriocapillaris from oxidative damage. Current ideas on the pathophysiology of age-related macular degeneration may be compatible with the proposed function of lutein and zeaxanthin. This review will summarize our knowledge about macular pigment regarding current efforts in research and the epidemiology of age-related eye disease.