Macular Carotenoid Supplementation in Subjects with Atypical Spatial Profiles of Macular Pigment

This study was designed to investigate the impact of macular carotenoid supplementation on the spatial profile of macular pigment (MP) in subjects where the profile does not exhibit the typical central peak (i.e. peaked MP at foveal epicentre). Thirty one healthy subjects with such atypical MP spatial profiles were assigned to one of three intervention groups: Group 1: (n = 10), 20 mg/day lutein (L), 2 mg/day zeaxanthin (Z); Group 2: (n = 10), 10 mg/day meso-zeaxanthin (MZ), 10 mg/day L, 2 mg/day Z; Group 3: (n = 10), 17 mg/day MZ, 3 mg/day L, 2 mg/day Z. Subjects were instructed to take one capsule daily over an 8-week period. MP at 0.25°, 0.5°, 1°, 1.75° and 3° was measured using customized-heterochromatic flicker photometry at baseline, four weeks and 8 weeks. Over the study period, we report no statistically significant increase in MP at any eccentricity in Group 1 (p \u3e 0.05, for all eccentricities). There was a trend towards an increase in MP at all eccentricities in Group 2, with a significant increase found at 0.25° and 0.50° (p = 0.000 and p = 0.016, respectively). There was a statistically significant increase evident in MP at 0.25° in Group 3 (p = 0.005), but at no other eccentricity (p \u3e 0.05, for all other). We report that the typical central peak of MP can be realised in subjects with atypical spatial profiles, following supplementation with a preparation containing all three macular carotenoids, but not with a supplement lacking MZ. The implications of our findings, in terms of visual performance and/or a (photo)-protective effect, warrant additional study

Visual Performance, and it\u27s Response to Intervention, in Subjects with Age-Related Macular Degeneration.

Abstract Objectives: 1. To explore visual performance status through a range of psychophysical methods beyond corrected distance visual acuity (CDVA), in subjects with age-related macular degeneration (AMD). 2. To investigate the effects on these visual performance parameters in subjects with neovascular age-related macular degeneration (nv-AMD) and in subjects with early AMD undergoing anti-VEGF (vascular endothelial growth factor) therapy and macular carotenoid supplementation, respectively. 3. To understand the role of a supplement containing meso-zeaxanthin (MZ; the third, and currently least explored, macular carotenoid) on the augmentation of macular pigment (MP), on visual performance and on disease progression (graded according to the AREDS [Age-Related Eye Disease Study] criteria), in subjects with early AMD. 4. To explore the impact of macular carotenoid supplementation on vision in subjects presenting with atypical macular pigment optical density (MPOD) spatial profiles at baseline. Outcomes: This study has shown that CDVA is not the most appropriate measure of visual function and does not reflect retinal morphology in cases of early AMD or in cases of nv-AMD. Retinotopic ocular sensitivity (ROS), however, appears to be a more reflective measure of disease severity, where it correlates well with AMD-severity grade (in cases of early AMD) and also with mean foveal thickness (MFT; in cases of nv-AMD). In eyes with nv-AMD undergoing monthly intravitreal ranibizumab injections, there have been demonstrable improvements in a range of parameters of visual function, namely, contrast sensitivity (CS), glare disability (GD), and ROS but no significant change in CDVA, despite a reduction in MFT. MP can be augmented, and CS enhanced, in subjects with early AMD who receive supplemental macular carotenoids. Subjects with low baseline central MPOD had the greatest increases in MPOD and the greatest improvements in CS, when compared with subjects with medium or high baseline MPOD, suggesting that the 4 optimisation of CS (and putatively visual performance in general) is somewhat dependent on central MP levels. The literature review has concluded that supplementation with the macular carotenoids offers the best means of fortifying the antioxidant defenses of the macula, thus putatively reducing the risk of AMD and/or its progression, and of optimising visual performance. Conclusions: The findings of this work suggest the incorporation of tests, complimentary to CDVA, such as CS, GD, and particularly ROS, when attempting to understand disease severity in cases of AMD. In terms of monitoring change over time, the results of this study do seem to indicate that measures of ROS may be particularly useful in monitoring subjects with nv-AMD, while measures of CS and GD may be more apt in monitoring change in subjects with early AMD. Macular carotenoid supplementation can enhance visual performance in subjects with early AMD

AN OBSERVATIONAL STUDY ON THE EFFICACY AND SAFETY FOR THE COMBINATION OF LUTEIN, VITAMIN C, ZEAXANTHIN, ZINC, COPPER, AND VITAMIN E IN INDIAN PATIENTS OF AGE-RELATED MACULAR DEGENERATION (AMD).

Background: Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in the elderly population, particularly those over the age of 65. The progressive decline in visual function experienced by individuals with AMD significantly impacts their daily lives and incurs their social activities and independence. This study aims to conduct a post-marketing investigation of a fixed-dose combination created for patients in India affected with AMD, evaluating its safety and efficiency. Material and Methods: In this research, a total of 450 participants were registered in the span of 10 months. The study was conducted at Anugrah Narayan Magadh Medical College, Gaya, Bihar. During the research, efficacy and safety assessments were conducted on every visit conducted after 3 months. The efficacy assessment involved the use of two parameters, namely vision-related quality of life (VRQOL) and vision impairment score, which were obtained by the administration of a Vision Impairment Questionnaire. Results: Assessing the patients with the help of vision impairment and VRQOL test, the following were the observations- For the VRQOL test, on the 2nd and the 3rd visit, the VRQOL increased by 19% and 33% that compared to the first assessment, this indicates a positive impact of the dosage administered. For the Vision impairment test, on visit 1 the percentage was 23% which further reduced to 15% by the second visit and 11% approx.  Conclusion: After the successful investigation, the combination of Vit C (250 mg), Cu (1 mg), Zn (40 mg), Lutein (5 mg), Vit E (200 IU), and Zeaxanthin (1 mg) per capsule was determined to be both effective and safe in treating age-related macular degeneration (AMD) in Indian patients. Recommendation: It is to consult an eye-care professional as soon as possible if vision changes and also continue to attend routine sight tests with an optometrist

Macular Pigment Optical Density Fluctuation as a Function of Pupillary Mydriasis: Methodological Considerations for Dual-Wavelength Autofluorescence

Macular pigment (MP), comprising the dietary carotenoids lutein, zeaxanthin and meso-zeaxanthin, is believed to benefit eye health and vision. Numerous clinical and research devices and techniques are currently available to facilitate MP optical density (MPOD) measurement. One of those techniques, dual-wavelength fundus autofluorescence (AF) is being increasingly used for measurement of MP in the eye. There is substantial methodological variation across the published studies that have employed this technique, including in relation to the use of mydriasis, the possible influence of which does not appear to have been addressed in the literature. This prospective cross-sectional study was designed to investigate the effect of mydriasis on MP measurement quality and MPOD values obtained with dual-wavelength AF using the Heidelberg Spectralis HRA+OCT device

Topical review: optometric considerations in sports vs. e-sports

Electronic sports (e-sports) have recently emerged to become a rapidly growing form of videogame competition, requiring gamers to spend many hours in front of a visual display. The nature of this new modality raises important considerations for ocular health, and visual and perceptual functioning, compared to traditional sports. In general, sports performance has been associated with open spaces, gross motor movement, and balance, while electronic sports require visual and attentional stamina at near distances with fine motor control. From an optometric viewpoint, visual perception is specific to both the sports modality and the environment where sports take place. In this topical review, we consider e-sport optometric factors such as screen time and digital eyestrain, visual skill demands, and perceptual cognitive skills such as visual attention. We compare training considerations for traditional sports and training in gaming platforms, with recommendations for future research in this growing modality. The goal of this review is to raise awareness of the various elements to consider when providing vision care to e-sport participants.Peer ReviewedPostprint (author's final draft

Phospholipid oxidation and carotenoid supplementation in Alzheimer’s disease patients

Alzheimer's disease (AD) is a progressive, neurodegenerative disease, characterised by decline of memory, cognitive function and changes in behaviour. Generic markers of lipid peroxidation are increased in AD, therefore reactive oxygen species have been suggested to be involved in the aetiology of cognitive decline. Carotenoids are depleted in AD serum, therefore we have compared serum lipid oxidation between AD and age-matched control subjects before and after carotenoid supplementation. The novel oxidised phospholipid biomarker 1-palmitoyl-2-(5'-oxo-valeroyl)-sn-glycero-3-phosphocholine (POVPC) was analysed using electrospray ionization tandem mass spectrometry (MS) with multiple reaction monitoring (MRM), 8-isoprostane (IsoP) was measured by ELISA and ferric reducing antioxidant potential (FRAP) was measured by a colorimetric assay. AD patients (n=21) and healthy age-matched control subjects (n=16) were supplemented with either Macushield™ (10 mg meso-zeaxanthin, 10 mg lutein, 2 mg zeaxanthin) or placebo (sunflower oil) for six months. The MRM-MS method determined serum POVPC sensitively (from 10 µl serum) and reproducibly (CV=7.9%). At baseline, AD subjects had higher serum POVPC compared to age-matched controls, (p=0.017) and cognitive function was correlated inversely with POVPC (r=−0.37; p=0.04). After six months of carotenoid intervention, serum POVPC was not different in AD patients compared to healthy controls. However, POVPC was significantly higher in control subjects after six months of carotenoid intervention compared to their baseline (p=0.03). Serum IsoP concentration was unrelated to disease or supplementation. Serum FRAP was significantly lower in AD than healthy controls but was unchanged by carotenoid intervention (p=0.003). In conclusion, serum POVPC is higher in AD patients compared to control subjects, is not reduced by carotenoid supplementation and correlates with cognitive function

Effects of lutein and docosahexaenoic Acid supplementation on macular pigment optical density in a randomized controlled trial

We studied the macular pigment ocular density (MPOD) in patients with early age macular degeneration (AMD) before and 1 year after nutritional supplementation with lutein and docosahexaenoic acid (DHA). Forty-four patients with AMD were randomly divided into two groups that received placebo (n = 21) or a nutritional supplement (n = 23, 12 mg of lutein and 280 mg of DHA daily). Heterochromatic flicker photometry was used to determine the MPOD. At baseline, the MPOD in AMD patients with placebo was 0.286 ± 0.017 meanwhile in AMD patients with supplementation it was 0.291 ± 0.016. One year later, the mean MPOD had increased by 0.059 in the placebo group and by 0.162 in patients receiving lutein and DHA. This difference between groups was significant (p < 0.05). Lutein and DHA supplementation is effective in increasing the MPOD and may aid in prevention of age related macular degeneration

Predictors of macular pigment and contrast threshold in Spanish healthy normolipemic subjects (45–65 years) with habitual food intake.

Introduction The dietary carotenoids lutein (L) and zeaxanthin (Z) are transported in the bloodstream by lipoproteins, sequestered by adipose tissue, and eventually captured in the retina where they constitute macular pigment. There are no L&Z dietary intake recommendations nor desired blood/tissue concentrations for the Spanish general population. Our aim was to assess the correlation of L&Z habitual dietary intake (excluding food supplements), resulting serum concentrations and lipid profile with macular pigment optical density (MPOD) as well as the contrast sensitivity (CT), as visual outcome in normolipemic subjects (n = 101) aged 45–65. Methods MPOD was measured by heterochromatic flicker photometry, serum L&Z by HPLC, the dietary intake by a 3-day food records and CT using the CGT-1000-Contrast-Glaretester at six stimulus sizes, with and without glare. Results Lutein and zeaxanthin concentrations (median) in serum: 0.361 and 0.078 μmol/L, in dietary intake: 1.1 mg L+Z/day. MPOD: 0.34du. L+Z intake correlates with their serum concentrations (rho = 0.333, p = 0.001), which in turn correlates with MPOD (rho = 0.229, p = 0.000) and with fruit and vegetable consumption (rho = 0.202, p = 0.001), but not with lutein+zeaxanthin dietary intake. MPOD correlated with CT, with and without glare (rho ranges: -0.135, 0.160 and -0.121, –0.205, respectively). MPOD predictors: serum L+Z, L+Z/HDL-cholesterol (β-coeficient: -0.91±0.2, 95%CI: -1.3,-0.5) and HDL-cholesterol (R2 = 15.9%). CT predictors: MPOD, mainly at medium and smaller visual angles (corresponding to spatial frequencies for which sensitivity declines with age) and gender (β-coefficients ranges: -0.95,-0.39 and -0.13,-0.39, respectively). Conclusion A higher MPOD is associated with a lower ratio of L+Z/HDL-cholesterol and with a lower CT (higher contrast sensitivity). The HDL-cholesterol would also act indirectly on the CT improving the visual function.post-print1201 K