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.     

Macular thickness mapping in exudative age-related macular degeneration

PURPOSE: To report the feasibility of retinal thickness mapping for evaluating thickness differences in retinal areas with and without leakage shown by fluorescein angiography for patients who have age-related macular degeneration with choroidal neovascularization. METHODS: A custom-built version of the retinal thickness analyzer was used for thickness mapping. Retinal thickness was defined as the separation between vitreoretinal and pigment epithelium-choroid interfaces. Imaging was performed in 1 eye of 10 patients with the clinical diagnoses of age-related macular degeneration and choroidal neovascularization. Patients either had never undergone photodynamic therapy at the time of measurement (untreated) or had received one or more photodynamic therapy treatments (treated). Average retinal thicknesses in selected areas with and without the presence of leakage shown by fluorescein angiography were calculated and compared statistically. RESULTS: Retinal thickness (mean +/- SD) in areas with leakage (315 +/- 54 microm) was significantly greater than that in areas without leakage (280 +/- 28 microm) (P = 0.03). In untreated patients, areas with leakage (345 +/- 45 microm) were significantly thicker than areas without leakage (289 +/- 23 microm) (P = 0.02). In treated patients, retinal thickness in areas with leakage (271 +/- 33 microm) and without leakage (267 +/- 34 microm) was similar. CONCLUSION: Retinal thickness mapping may prove to be useful as an adjunct to fluorescein angiography to monitor choroidal neovascularization and its treatment.     

Macular pigment and risk for age-related macular degeneration in subjects from a Northern European population

PURPOSE: Age and advanced disease in the fellow eye are the two most important risk factors for age-related macular degeneration (AMD). In this study, the authors investigated the relationship between these variables and the optical density of macular pigment (MP) in a group of subjects from a northern European population. METHODS: The optical density of MP was measured psychophysically in 46 subjects ranging in age from 21 to 81 years with healthy maculae and in 9 healthy eyes known to be at high-risk of AMD because of advanced disease in the fellow eye. Each eye in the latter group was matched with a control eye on the basis of variables believed to be associated with the optical density of MP (iris color, gender, smoking habits, age, and lens density). RESULTS: There was an age-related decline in the optical density of macular pigment among volunteers with no ocular disease (right eye: r(2) = 0.29, P = 0.0006; left eye: r(2) = 0.29, P < 0.0001). Healthy eyes predisposed to AMD had significantly less MP than healthy eyes at no such risk (Wilcoxon's signed rank test: P = 0.015). CONCLUSIONS: The two most important risk factors for AMD are associated with a relative absence of MP. These findings are consistent with the hypothesis that supplemental lutein and zeaxanthin may delay, avert, or modify the course of this disease.     

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.     

Macular function in eyes with early age-related macular degeneration with or without contralateral late age-related macular degeneration

PURPOSE: To evaluate psychophysical and electrophysiologic responses in eyes with early age-related macular degeneration (AMD) without a decrease in visual acuity and with or without late AMD in the fellow eye. METHODS: Fifteen patients (mean age: 67.9 +/- 7.20 years) with early AMD in both eyes (AMD1 group, 15 eyes) and 15 patients (mean age: 71.40 +/- 7.06 years) with early AMD in one eye and late AMD in the fellow eye (AMD2 group, 15 eyes) were enrolled. They were compared to 15 age-similar normal control subjects. LogMAR visual acuity (VA), macular sensitivity by MP-1 microperimetry, and multifocal electroretinograms (mfERG) were assessed in control, AMD1, and AMD2 eyes. mfERG response amplitude density (RAD, nV/deg2) of the N1-P1 component of first order binary kernels was measured. RESULTS: When compared to controls, AMD1 and AMD2 eyes showed a significant (analysis of variance, P < 0.01) decrease in MP-1 microperimetry assessed in the 0-2.5 and 2.5-5 degrees of the macula, significantly correlated (Pearson test, P < 0.01) to the corresponding significant decrease (P < 0.01) in mfERG N1-P1 RADs assessed in the 0-2.5 and 2.5-5 degrees. In AMD1 and AMD2 eyes, VA and mfERG N1-P1 RADs assessed in the 5-20 degrees were similar (P > 0.01) to controls. VA, MP-1, and mfERG values were not significantly different in AMD1 and AMD2 eyes. CONCLUSION: In eyes with early AMD there is a dysfunction of preganglionic elements in the central 0-5 retinal degrees detectable by mfERG or MP-1 microperimetry. This impairment is not further influenced by the presence of late AMD in the fellow eye.     

黄斑色素密度与老年性黄斑变性的关系

黄斑色素主要包括叶黄素和玉米黄素,分布在整个视网膜上,以黄斑中心凹密度最高.现认为黄斑色素的功能减退与老年性黄斑变性(AMD)的病理生理改变一致,提高黄斑色素水平可降低AMD发生和发展的危险性.叶黄素和玉米黄素的补充治疗可能对AMD的防治有一定的作用.但其确切作用机制与临床应用价值亟待进一步探索.本文就黄斑色素的组成结构、分布、来源以及功能特点、检测方法及其与AMD的关系作一综述.     

年龄相关性黄斑变性黄斑部循环改变与脉络膜新生血管形成

目的探讨年龄相关性黄斑变性(age-relatedmaculardegeneration,AMD)黄斑部循环改变与脉络膜新生血管(choroidalneovascularization,CNV)形成的关系。方法对12例(24眼)首诊为萎缩型AMD,在随访中转变为渗出型AMD(16眼)的眼底荧光素血管造影(fundusfluorescenceangiography,FFA)及吲哚青绿血管造影(indocyaninegreenangiography,ICGA)图像进行回顾性分析,对比观察脉络膜循环变化。结果24只萎缩型AMD黄斑区脉络膜毛细血管层均有局限性灌注不良,16眼(67%)CNV在原脉络膜毛细血管灌注不良区域内生成。结论脉络膜灌注不良是CNV形成的主要原因。     

Spatial extent of pigment epithelial detachments in age-related macular degeneration.

OBJECTIVE: To quantify the spatial extent of pigment epithelial detachment (PED) associated with age-related macular degeneration (AMD) using a rapid, noninvasive method. DESIGN: Prospective, cross-sectional study. PARTICIPANTS: The authors tested 32 eyes of 21 patients (13 women and 8 men) with AMD 56 to 91 years of age (mean = 72.8 years). The authors retested seven eyes of six patients. INTERVENTION: Three-dimensional imaging and quantification of PED were performed in each subject using confocal infrared imaging (790 nm) with a Topographic Scanning System (TopSS). The data consisted of a series of 32 images within a 3-mm-depth range requiring 0.9 second. Three-dimensional calculations were made from the series. MAIN OUTCOME MEASURE: Height, diameter, area, volume, and slope of each PED were obtained with two calculation methods. The Ellipse Method used a graphics tool to draw elliptical borders circumscribing the region of interest in the image. The software automatically calculated the values for all parameters for the region inside the ellipse, with the retinal reference plane adjusted to match the height of the surrounding retina. The User-Defined Region Method differed in that the region of interest was drawn manually. RESULTS: PEDs were easily detected in all patients using the TopSS. Maximum height of all PEDs above the reference plane ranged from 0.204 to 1.818 mm (mean = 0.57 mm). The diameter was 0.501 to 5.151 mm (mean = 2.711 mm), area was 0.179 to 20.402 mm2 (mean = 6.585 mm2), and volume was 0.012 to 13.981 mm3 (mean = 2.173 mm3). Intraobserver variability was low, with correlations between first and second measurements for the first visit ranging from r = 0.906 to 0.997 for slope and diameter, respectively. CONCLUSIONS: Three-dimensional analysis with the TopSS provides objective outcome measures not obtainable with typical clinical methods such as fundus photography and angiography. Height and volume are crucial in determining whether neovascularization is worsening or persistent after photocoagulation. More longitudinal data are needed to determine whether tomographic data reduce the need for angiography. Unique to scanning laser tomography, exudative features were imaged at different depths.     

Phenotypic variation of retinal pigment epithelium in age-related macular degeneration.

PURPOSE: To determine whether retinal pigment epithelium (RPE) in eyes with age-related macular degeneration (ARMD) express vimentin and alpha smooth muscle actin (alphaSMA), two cytoskeletal proteins associated with phenotypic variation in culture. METHODS: Six eyes with late ARMD and three age-matched control eyes were preserved in buffered 4% paraformaldehyde and cryosectioned at 10 microm. Stages of RPE morphology and pigmentation were assessed by the Alabama Age-Related Macular Degeneration Grading System. Vimentin, alphaSMA, and glial fibrillary acidic protein (GFAP) expression was detected by indirect immunofluorescence. These results were compared with regional variations in disease severity. RESULTS: RPE changes in ARMD included acquired expression of vimentin, but alphaSMA-positive cells were rare. GFAP expression increased in Müller cells in the neural retina in association with RPE changes and photoreceptor degeneration. CONCLUSIONS: The initial stages of RPE changes in eyes with ARMD mimic those reported for cultured RPE cells. The absence of alphaSMA-positive cells in regions of RPE atrophy suggests that RPE are lost rather than persist in a dedifferentiated state.     

Macular pigment density and aging, assessed in the normal elderly and those with cataracts and age-related macular degeneration

PURPOSE: Increasing evidence has linked retinal lutein and zeaxanthin (termed macular pigment, MP) to the risk of age-related macular degeneration (AMD). Currently, however, studies differ regarding the question of whether MP declines with age or age has an effect in patient populations being assessed. This study assessed MP across the lifespan with an emphasis on assessing MP in a cross-section of elderly including those with lenticular or age-related macular degeneration, or both. DESIGN: Prospective, observational, cross-sectional study. METHODS: SETTING: Institution. STUDY POPULATION: Cross-sectional study of normal, cataractous, and AMD subjects tested in Indianapolis, Indiana, including 390 subjects, 22 with cataracts and 59 with age-related macular degeneration. OBSERVATIONAL PROCEDURE: MP density was measured with a one-degree diameter test field at 460 nm using a psychophysical method based on heterochromatic flicker photometry. MAIN OUTCOME MEASURES: MP optical density. RESULTS: MP does not appear to change as a function of age (r = +.04) when examining subjects across the lifespan (from 18-88 years). There was a slight tendency (slope = -.0027, r = -.11) for MP to decline when only the elderly subjects were considered, but this trend was not significant (P < .12) for any of the groups considered (normal, cataractous, or AMD). CONCLUSIONS: MP does not change significantly with age, even when elderly subjects with cataracts and AMD are considered. Using heterochromic flicker photometry, elderly subjects display a full range of MP density that is similar to young subjects.     

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.     

Macular translocation with retinotomy and retinal rotation for exudative age-related macular degeneration.

PURPOSE: To determine the effectiveness of macular translocation with retinotomy and retinal rotation in exudative age-related macular degeneration. METHODS: After written informed consent was obtained, 20 patients underwent macular translocation. We created a 180-degree retinotomy superior, inferior, and temporal to the macula near the equator. The hinged retinal flap was rotated superiorly or inferiorly to place the center of the fovea over an area of healthy retinal pigment epithelium. The retina was flattened under silicone oil and laser photocoagulation was placed. RESULTS: The fovea was moved 425 to 1,700 microm (965+/-262 microm) superiorly or inferiorly. Follow-up time was 2 to 12 months (median 8 months). Complications included macular pucker (3 eyes), subfoveal hemorrhage (2 eyes), macular hole (1 eye), and progression of cataract in phakic eyes (3 eyes). Thirteen of 20 eyes showed various degrees of proliferative vitreoretinopathy with epiretinal membrane formation over the inferior peripheral retina with the inferior retinal detachment stabilized by the silicone oil. One eye progressed to phthisis bulbi. Initial visual acuity ranged from 20/80 to 20/800 (median 20/150) and final visual acuity ranged from light perception to 20/200 (median 20/1000). CONCLUSION: The fovea can be moved up to 1,700 microm with retinotomy and retinal rotation; however, there is a high rate of complications. Proliferative vitreoretinopathy is the major complication of this technique and is probably related to the extensive retinotomy and subretinal irrigation inherent in the technique. Other techniques such as scleral shortening may have fewer complications.     

Macular translocation for subfoveal choroidal neovascularization in age-related macular degeneration: a prospective study.

PURPOSE: To conduct a prospective study of macular translocation in patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration. METHODS: In 10 eyes of 10 patients with subfoveal choroidal neovascularization and best-corrected visual acuity ranging from 20/50 to 20/800 (median, 20/111), the fovea was relocated by means of scleral imbrication, intentional retinal detachment with small posterior retinotomies, and partial fluid-air exchange. In two eyes, the choroidal neovascular membranes were removed at the time of macular translocation; in seven eyes they were photocoagulated in the postoperative period; and in one eye the membrane was removed during reoperation to unfold a macular fold. RESULTS: All 10 eyes were followed up for 6 months. The median postoperative foveal displacement was 1286 microm (range, 114 to 1,919 microm). In three eyes (30%), a foveal fold formed postoperatively requiring reoperation, with one of these eyes requiring a second reoperation for a rhegmatogenous retinal detachment. Best-corrected visual acuity improved in four eyes (median, 10.5 letters) and decreased in six eyes (median, 14.5 letters). The median change in visual acuity was a decrease of 5 letters. The final best-corrected visual acuity was 20/80 in two eyes, 20/126 in one eye, 20/160 in four eyes, 20/200 in one eye, 20/250 in one eye, and 20/640 in one eye. CONCLUSIONS: Our initial experience with limited macular translocation suggests that this surgical technique is unpredictable. However, in patients with subfoveal choroidal neovascularization from age-related macular degeneration, it offers the potential for improving visual function and may be associated with less loss of vision than the disease itself, if allowed to progress. Further refinements in surgical indications and technique are needed to make this procedure safer, more predictable, and more beneficial.     

眼科辅助检查在年龄相关性黄斑变性中的应用

随着人口老龄化的不断加剧,年龄相关性黄斑变性的发病率不断增加,致盲率也随之增加,因此对年龄相关性黄斑变性的早期诊断、治疗至关重要。目前对年龄相关性黄斑变性的检查方法众多,比如眼底血管造影、相干光断层扫描(OCT)、视野检查、多焦视网膜电图等。近些年许多新兴的检查手段也不断涌现并且逐步应用于临床诊断,比如OCT血流成像技术(OCTA)等。这些检查方法均有其独特的优势,同时也存在相应的局限性。本文将对这些现有的检查方法进行综述。     

Computerized detection and measurement of drusen in age-related macular degeneration.

BACKGROUND AND OBJECTIVE: The authors used a drusen detection algorithm to quantitate drusen on digitized images and determined its precision and accuracy. PATIENTS AND METHODS: Fundus images from 349 participants in the Age-Related Eye Disease Study trial were digitized and analyzed with the Drusen Analyzer (IRIDEX Corporation, Mountain View, CA). The size, number, and area of the drusen in two macular regions were computed by two readers using an interactive approach. Measurements were compared to data generated by reading center methods. RESULTS: For the Analyzer, inter-observer agreement was 0.79 (SE = 0.02) and 0.86 (SE = 0.01) (kappa statistic). Intra-observer precision was 0.835 and 0.880 (Spearman coefficients). Categorical agreement (weighted kappa) between the Analyzer and reading center results for the two regions was (0.76, 0.58) and (0.68, 0.68) for readers A and B. The time required to quantitate an image using the Analyzer was 105 +/- 52 and 218 +/- 102 seconds for the two regions, respectively. CONCLUSIONS: Quantitative detection of drusen can be performed reproducibly and efficiently. Comparisons to more labor intensive reading center techniques suggest that the results are similar but that the algorithm is more sensitive and precise.