Macular pigment optical density in a midwestern sample

Measurement of Macular Pigment Optical Density Using Two Different Heterochromatic Flicker Photometers

PURPOSE

To compare macular pigment optical density using two different heterochromatic flicker photometers.

METHODS

We measured macular pigment optical density in 121 healthy subjects using heterochromatic flicker photometry.

RESULTS

The mean (+/-SD) macular pigment optical density measured using the Maculometer was 0.394 (+/-0.170), and that using the Densitometer was 0.395 (+/-0.189). The difference in measurements on each instrument was influenced by age and macular pigment levels.

CONCLUSIONS

On average, there is no difference in measurements provided by these two instruments. The Maculometer tends to underestimate macular pigment in older subjects and/or those with higher macular pigment compared with the Densitometer.

Monthly Consistency of Macular Pigment Optical Density and Serum Concentrations of Lutein and Zeaxanthin

PURPOSE

This study was undertaken to assess serial month-to-month consistency of macular pigment (MP) optical density and serum concentrations of lutein (L) and zeaxanthin (Z). Four healthy subjects aged between 23 and 51 years volunteered to participate in this study.

METHODS

MP optical density (measured psychophysically using heterochromatic flicker photometry [HFP]), and serum concentrations of L and Z (quantified using high-performance liquid chromatography [HPLC]), were recorded every month for 24 consecutive months.

RESULTS

Mean MP optical density (+/-SD) was 0.361 (0.086) and 0.369 (0.074) for right and left eyes, respectively. There was no statistically significant seasonal variation in MP optical density for the group (two-way ANOVA: p>0.05). Serum concentrations of L and Z demonstrated a statistically significant subject-season interaction effect (two-way ANOVA: p<0.01). Serial serum concentrations of L and Z were positively correlated within all four subjects (r=0.370 to 0.786), and significantly so for three subjects (p<0.05). There was no obvious relationship, synchronous or lagged, between serum concentrations of L (or Z) and MP optical density (r=-0.036 to 0.368).

CONCLUSIONS

MP optical density was relatively stable for all subjects over the 24-month period. Fluctuations in serum concentrations of L and Z, in the absence of dietary modification or supplementation, are associated with stable MP optical density.

Macular zeaxanthins and lutein -- a review of dietary sources and bioavailability and some relationships with macular pigment optical density and age-related macular disease

The retina is unique in the human body in containing three xanthophyll carotenoids; 3R,3'R-zeaxanthin, meso-zeaxanthin (MZ) and lutein. Humans consume 1 to 3 mg lutein per d and the lutein:zeaxanthin ratio in the diet is about 5:1.Xanthophyll pigments occur widely in vegetables and fruits but MZ is found in only a few foods such as the shrimp carapace and fish skin. In spite of the amounts of the different xanthophylls in the diet, zeaxanthin and MZ occur in approximately equal amounts in the eye, and their combined concentration can exceed that of lutein. In the present review the bioavailablity of zeaxanthin and lutein is assessed using the plasma xanthophyll response to dietary intervention. A number of studies have used single and mixed sources of the pure xanthophylls to achieve steady-state plasma responses. Mostly these have been with lutein and zeaxanthin but two using MZ are also described. Responses following the intervention with the pure xanthophylls are compared with those following food intervention. Vegetables are the richest source of dietary lutein and several vegetable-feeding studies are discussed. Intervention studies with eggs, which are a good source of zeaxanthin, suggest that the xanthophyll carotenoids in egg yolk may be more bioavailable than those in other foods and are described separately. MZ has been a component of a xanthophyll supplement added to chicken feed in Mexico in the last 10 years. Egg consumption in Mexico is approximately one egg/person per d and the potential contribution of this food source of MZ to Mexican dietary intakes is described. Very limited information from human feeding studies of MZ-containing supplements suggests that MZ is less well absorbed than zeaxanthin. However, MZ is unusual in the diet and not reported in the plasma. Thus plasma responses may not reflect true absorption if it takes MZ longer to equilibrate with body tissues than the other xanthophylls and competition with zeaxanthin may lower the relative concentrations of MZ in plasma. Lastly, the effects of long-term feeding with both pure and food sources of the xanthophyll pigments on macular pigment optical density is compared and the importance of previous dietary intake on the effects of intervention is discussed.

Associations between lutein, zeaxanthin, and age-related macular degeneration: an overview

Age-related macular degeneration, the leading cause of blindness in the elderly, is a degenerative condition of the macula characterized by death or dysfunction of the photoreceptors. With the aging population growing, the incidence of age-related macular degeneration is expected to increase. This raises concern about the future of visual dysfunction related falls and the resulting injuries in the elderly population. Lutein and zeaxanthin are macular pigments that may play a role in reducing the development and progression of age-related macular degeneration. Evidence is accumulating on the consumption of lutein and zeaxanthin (in whole food or supplemental form), the resulting concentrations in the serum, and tissue distribution throughout the body, particularly in the retina. Lutein and zeaxanthin intake increases serum concentrations which in turn increases macular pigment density. Existing literature focuses on factors affecting macular pigment density, functions of lutein and zeaxanthin as blue-light filters and antioxidants, and risk factors associated with age-related macular degeneration. Few studies have focused on the impact of dietary lutein and zeaxanthin on retinal function and the potential to preserve vision and prevent further degeneration. This presents an opportunity for further research to determine an effective dose that delays the progression of age-related macular degeneration.

[Lutein and antioxidants in the prevention of age-related macular degeneration]

Demographic developments in Europe and North America are causing an increase of age-related diseases. Age-related macular degeneration (AMD) is one of the leading causes of severe central visual acuity loss in elderly people and seems to be an economic problem, too. There is evidence that oxidative damage is an important factor for exacerbation of AMD. Macular pigment with its antioxidative effect may serve as"natural sunglasses" filtering the blue light acting as a possible source of photooxidative damage to the neurosensory retina. The macular pigment consists mostly of lutein and zeaxanthin. These micronutrients from the group of carotenoids, as is the case for vitamins (vitamins C, E, and beta-carotene), cannot be synthesized in mammals and that is the reason why the role of micronutrition or its supplementation and its correlation to AMD progression has been discussed for years. The results of currently published studies are often contradictory. At present there are no results from randomized controlled studies confirming that supplementation of lutein and zeaxanthin can reduce the risk for AMD. Several epidemiological studies investigating the impact of antioxidants and omega-3 fatty acids on the incidence of AMD provided conflicting results.Up to now, AREDS is the largest randomized controlled study investigating the effect of supplementation of antioxidants, zinc, and copper on the progression of AMD. AREDS showed a significant effect of this supplementation in some particular groups of patients with AMD. The supplementation of lutein and omega-3 fatty acids is not toxic but a positive effect has not been proven by randomized studies.

Macular pigment density and age-related maculopathy in the Carotenoids in Age-Related Eye Disease Study. An ancillary study of the women's health initiative

PURPOSE

To examine the association between intermediate age-related macular degeneration (AMD) and the optical density of macular pigment (MPOD), which is composed of lutein and zeaxanthin from the diet.

DESIGN

Cross-sectional cohort study.

PARTICIPANTS

We included 1698 of 2005 women ages 54 to 86 years and participating in the Carotenoids in Age-Related Eye Disease Study, an ancillary study of the Women's Health Initiative.

METHODS

The MPOD was measured noninvasively by heterochromatic flicker photometry. Fundus photographs were taken to document prevalent AMD.

MAIN OUTCOME MEASURES

Intermediate AMD (n = 305) and two subtypes-large drusen (n = 233) and pigmentary abnormalities (n = 157).

RESULTS

After adjusting for covariates, the odds ratio (OR) and 95% confidence interval (CI) for AMD among women in quintile (Q) 5 (n = 339) versus 1 (n = 340) for MPOD was 1.4 (0.9, 2.1). However, after excluding women with possible unstable diets and recent supplement use due to chronic disease history, associations reversed (OR Q2-5 vs. 1, 0.8; 95% CI, 0.5-1.2), but remained nonsignificant. Associations also differed between middle-aged (54-69 years) and older (> or =70 years) women (P-interaction = 0.09), but less so, after excluding women who were likely to have unstable diets: adjusted ORs (95% CI) were 0.5 (0.3-1.0; P = 0.08) for intermediate AMD among middle-aged women (n = 516) with MPOD in Q2 to Q5 versus 1 and 1.0 (0.5-2.0; P = 0.90) for older women (n = 422).

CONCLUSIONS

The MPOD is not cross-sectionally associated with AMD. The inconsistency of relationships across age groups and in subgroups of women who are likely to have more stable diets suggests that cross-sectional associations may be biased and highlights the need to study these relationships prospectively.

Macular pigment optical density in the elderly: findings in a large biracial Midsouth population sample

PURPOSE

To report the macular pigment optical density (MPOD) findings at 0.5 degrees of eccentricity from the fovea in elderly subjects participating in ARMA, a study of aging and age-related maculopathy (ARM) ancillary to the Health, Aging, and Body Composition (Health ABC) Study.

METHODS

MPOD was estimated with a heterochromatic flicker photometry (HFP) method in a large biracial population sample of normal 79.1 +/- 3.2-year-old adults living in the Midsouth (n = 222; 52% female; 23% black, 34% users of lutein-containing supplements). Within a modified testing protocol, subjects identified the lowest and the highest target intensity at which the flicker sensation disappeared, and the exact middle of this "no-flicker zone" was interpolated by the examiner.

RESULTS

An MPOD estimate was obtained successfully in 82% of the participants. The mean MPOD in our sample was 0.34 +/- 0.21 (SD). The interocular correlation was high (Pearson's r = 0.82). Compared with lutein supplement users, mean MPOD was 21% lower in nonusers (P = 0.013). MPOD was also 41% lower in blacks than in whites (P = 0.0002), even after adjustment for lutein supplement use. There were no differences in MPOD by gender, iris color, or history of smoking.

CONCLUSIONS

Older adults in the Midsouth appear to have average MPOD and interocular correlation comparable to those in previous studies. Lutein supplement use and white race correlated with higher MPOD. No evidence of an age-related decline in MPOD was seen in the sample. The HFP method for the measurement of MPOD is feasible in epidemiologic investigations of the elderly, the group at highest risk of ARM.

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.

The selective retention of lutein, meso-zeaxanthin and zeaxanthin in the retina of chicks fed a xanthophyll-free diet

Lutein and zeaxanthin are pigmented oxygenated carotenoids, or xanthophylls, derived from plants and concentrated in the retina of primates and birds. We investigated the transport, distribution and depletion of lutein and zeaxanthin in the plasma and tissues of newly hatched chicks fed xanthophyll-free diets. One-day-old Leghorn chicks were randomly divided into two groups. A control group was fed a diet containing lutein and zeaxanthin (5.2 and 1.7 mg/kg diet, respectively) for 28 days. An experimental group was fed a diet containing no lutein and zeaxanthin for 28 days. Plasma and tissues were analyzed for lutein and zeaxanthin at 28 days (control) and on days 1, 14 and 28 (experimental). At hatching, lutein and zeaxanthin were the predominant carotenoids present in the blood and tissues. As indicated by their similar mass contents, there was complete transfer of these carotenoids from egg yolk to chick. Lutein and zeaxanthin concentrations in the plasma and tissues of chicks fed the xanthophyll-free diet decreased rapidly to almost zero (with a depletion time of seven days [t(1/2)]). In contrast, the retina retained its initial concentrations of lutein and zeaxanthin similar to the control group. meso-Zeaxanthin and cis-zeaxanthin were identified only in the retina. The retina concentrated zeaxanthin over lutein. Lutein and zeaxanthin were selectively retained in the retinas of chicks fed a xanthophyll-free diet. In contrast, the plasma and other tissues lost up to 90% of their original content of xanthophylls. These data emphasize the relative stability of lutein and zeaxanthin in the cone-rich retina where they are present as esters in oil droplets. The tissue depletion suggests the need for a regular dietary intake of lutein and zeaxanthin because of rapid depletion in the body. It is clear that these xanthophylls may have an essential role in the cone-rich retina of the chick as evidenced by their selective retention.

Xanthophyll accumulation in the human retina during supplementation with lutein or zeaxanthin – the LUXEA (LUtein Xanthophyll Eye Accumulation) study

The xanthophylls lutein (L) and zeaxanthin (Z) form the macular pigment with the highest density in the macula lutea. We investigated Macular Pigment Optical Density (MPOD) responses to supplementation with identically formulated (Actilease) L or Z (OPTISHARP) or L+Z over 6-12 months using doses of 10 or 20mg/day. MPOD as well as blue light sensitivity in fovea and parafovea were measured monthly by heterochromatic flicker photometry. Average xanthophyll plasma concentrations, analysed monthly by HPLC, increased up to 27-fold. MPOD increased by 15% upon L or L+Z supplementation. Supplementation of Z alone produced similar pigment accumulation in fovea and parafovea, which confounded MPOD measurements. After correction for this, a 14% MPOD increase resulted for Z. Thus, during supplementation with xanthophylls, L is predominantly deposited in the fovea while Z deposition appears to cover a wider retinal area. This may be relevant to health and disease of the retina.

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.

Predictors of optical density of lutein and zeaxanthin in retinas of older women in the Carotenoids in Age-Related Eye Disease Study, an ancillary study of the Women's Health Initiative

BACKGROUND

Lifestyle, diet, and physical and health predictors of xanthophyll carotenoids in the retina are poorly understood.

OBJECTIVE

We aimed to investigate the predictors of the density of lutein and zeaxanthin in the macula of the retina.

DESIGN

Macular pigment optical density (MPOD) was measured by heterochromatic flicker photometry. Relations to dietary lutein and zeaxanthin and to other predictors were measured in 1698 women aged 53-86 y. The women were members of observational study cohorts of the Women's Health Initiative at Iowa City, IA, Madison, WI, or Portland, OR, and participated in the Carotenoids in Age-Related Eye Disease Study (2001-2004).

RESULTS

MPOD at 0.5 degrees from the foveal center was 30% higher in women in the highest quintile for lutein and zeaxanthin intake [x (+/-SD): 0.40 +/- 0.21] than in women in the lowest quintile (0.31 +/- 0.21) and 20% higher after adjustment for other predictors. Dietary intake of lutein, zeaxanthin, fiber, and polyunsaturated fatty acids (% of energy) together explained 3% of the variability in MPOD. Higher waist circumference and diabetes, which are related to lower MPOD, together with study site explained an additional 5% of variation. The total explained variability increased to 12% when lutein and zexanthin concentrations obtained from the serum, which were collected 4-7 y earlier, were added to the model.

CONCLUSIONS

MPOD is directly related to dietary intake of lutein and zeaxanthin but even more strongly to serum concentrations, which may reflect unmeasured physical and medical factors that influence the uptake, distribution, and utilization of lutein and zeaxanthin. Higher abdominal body fat and diabetes are related to lower MPOD. Unknown predictors of retinal carotenoids remain.

Spinach cultigen variation for tissue carotenoid concentrations influences human serum carotenoid levels and macular pigment optical density following a 12-week dietary intervention

Increasing intakes of carotenoid-rich plant foods can increase serum carotenoid concentrations and macular pigment optical density (MPOD) in most, but not all, individuals. Research objectives for this study were to (1) characterize tissue lutein (L) and beta-carotene (BC) concentrations in carotenoid-rich spinach (Spinacia oleracea L.) cultigens and (2) determine serum carotenoid and MPOD responses in human subjects consuming spinach cultigens differing in tissue L and BC concentrations. Thirteen spinach cultigens were evaluated for carotenoid accumulations over two consecutive growing seasons. "Springer" (8.4 and 6.5 mg/100 g of fresh mass for L and BC, respectively) and "Spinner" (12.1 and 9.2 mg/100 g of fresh mass for L and BC, respectively) spinach cultigens were selected for a dietary intervention study and represented low- and high-L concentrations. The high-L ("Spinner") and low-L ("Springer" ) spinach treatment groups consisted of 10 subject volunteers ingesting five 50-g spinach servings/week during a 12-week intervention. Average serum L concentrations increased by 22% (P = 0.07) from baseline (0.233 micromol/L) to 12 weeks (0.297 micromol/L) for subjects consuming low-L spinach. Subjects consuming high-L spinach showed increases of 33% (P = 0.04) in serum L from baseline (0.202 micromol/L) to 12 weeks (0.300 micromol/L). Average MPOD did not change for the low-L treatment group; however, subjects in the high-L group demonstrated increases (P = 0.02) in MPOD at the 30' eccentricity between baseline (0.343) and 12 weeks (0.374). This study demonstrates that serum carotenoid and MPOD are determined by L concentrations present in the spinach matrix. Results emphasize the role of cultigen selection among vegetable crops in determining phytochemical effects on human health.

In vivo macular pigment measurements: a comparison of resonance Raman spectroscopy and heterochromatic flicker photometry

AIM

To investigate whether two methods of measuring macular pigment-namely, heterochromatic flicker photometry (HFP) and resonance Raman spectroscopy (RRS)--yield comparable data.

METHODS

Macular pigment was measured using HFP and RRS in the right eye of 107 participants aged 20-79 years. Correlations between methods were sought and regression models generated. RRS was recorded as Raman counts and HFP as macular pigment optical density (MPOD). The average of the top three of five Raman counts was compared with MPOD obtained at 0.5 degrees eccentricity, and an integrated measure (spatial profile; MPODsp) computed from four stimulus sizes on HFP.

RESULTS

The coefficient of variation was 12.0% for MPODsp and 13.5% for Raman counts. MPODsp exhibited significant correlations with Raman counts (r = 0.260, p = 0.012), whereas MPOD at 0.5 degrees did not correlate significantly (r = 0.163, p = 0.118). MPODsp was not significantly correlated with age (p = 0.062), whereas MPOD at 0.5 degrees was positively correlated (p = 0.011). Raman counts showed a significant decrease with age (p = 0.002) and were significantly lower when pupil size was smaller (p = 0.015).

CONCLUSIONS

Despite a statistically significant correlation, the correlations were weak, with those in excess of 90% of the variance between MPODsp and Raman counts remaining unexplained, meriting further research.

Bimodal spatial distribution of macular pigment: evidence of a gender relationship

The spatial distribution of the optical density of the human macular pigment measured by two-wavelength autofluorescence imaging exhibits in over half of the subjects an annulus of higher density superimposed on a central exponential-like distribution. This annulus is located at about 0.7 degrees from the fovea. Women have broader distributions than men, and they are more likely to exhibit this bimodal distribution. Maxwell's spot reported by subjects matches the measured distribution of their pigment. Evidence that the shape of the foveal depression may be gender related leads us to hypothesize that differences in macular pigment distribution are related to anatomical differences in the shape of the foveal depression.

Jahreszeitliche Schwankungen und Einfluss der Ernährung auf die makuläre Pigmentdichte

PURPOSE

We have previously reported on measuring macular pigment density (MPD) with a scanning laser ophthalmoscope (HRA, Heidelberg Engineering, Heidelberg, Germany). This study war undertaken to evaluate the variation of MPD over a period of 1 year in healthy subjects.

METHOD

We used autofluorescence images recorded with a HRA to evaluate MPD with a 2 degrees circle centered on the fovea. Healthy subjects were included in the study and MPD measurements were repeated every 2 months over a period of 1 year.

RESULTS

We included a total of 30 healthy subjects aged 19-34 years (mean: 23+/-2 years). Mean MPD at time point 1 was 0.215+/-0.056 density units (DU), at time point 2 0.235+/-0.051 DU, at time point 3 0.218+/-0.055 DU, at time point 4 0.228+/-0.057 DU, at time point 5 0.225+/-0.053 DU, and at time point 6 0.203+/-0.050 DU. The statistical analysis revealed no significant variation of MPD over the follow-up period of 1 year.

CONCLUSION

This study demonstrates that MPD shows no variation over a period of 1 year in healthy subjects.

Macular pigment optical density in a Chinese sample

PURPOSE

Extensive efforts have been devoted to determining the macular pigment optical density (MPOD) in Caucasian subjects. Unfortunately, no such data in ethnic groups with naturally dark irises are currently available. In this study, we report the values in a sample of Chinese subjects.

METHODS

The MPOD was measured psychophysically using a densitometer at 0.25 degrees , 0.50 degrees , 1.00 degrees , and 2.00 degrees eccentricity from the foveal center in 92 Chinese subjects.

RESULTS

The spatial profile for the averaged MPOD was approximately exponential in form and showed a decline with age (r = -0.23). Subjects aged below 60 years had significantly higher averaged MPOD than those aged 60 years or above. Significant gender differences, in favor of males, were also found in the middle-age groups.

CONCLUSIONS

Our study reports for the first time the MPOD in a Chinese population. Baseline information on MPOD would aid future research in preventive measures against age-related macular degeneration.

On the age dependency of the macular pigment optical density

Macular pigment may protect against age related macular degeneration (AMD), because of its capability to absorb blue light and scavenge free radicals. Since age is the major risk factor in AMD, a fundamental question to be answered is the possible age dependence of the macular pigment optical density (MPOD) in normal healthy subjects. In this study we used five methods to study a possible age effect: heterochromatic flickerphotometry, two setups for fundus reflectance spectroscopy, a Scanning Laser Ophthalmoscope (SLO) for obtaining reflectance, and the same SLO for autofluorescence maps. MPOD was determined from the reflected light by a full spectral analysis. We also used a new, directional analysis of the reflected light to estimate MPOD. The latter avoids the disturbing influence of stray-light. Digital subtraction at two wavelengths of log reflectance and digital subtraction of log autofluorescence obtained with the SLO provided MPOD maps. Together, all methods of measuring and of analysis provided seven MPOD estimates per subject. A total of 53 subjects, aged 19-76 years, completed all five measurements (and thus seven analyses). An additional 81 subjects, aged 18-70 years, were measured with one setup for fundus reflectance spectroscopy (and thus only two analyses). We could not find any association with age with all the objective techniques. Only MPOD values obtained with heterochromatic flickerphotometry showed a small, but significant decrease with age. This decrease was caused by an increase in the parafoveal data, suggesting that the central MPOD is unchanged with age. The bivariate correlation coefficients between all methods were significant (all p<0.001).

Assessment of the validity of in vivo methods of measuring human macular pigment optical density

PURPOSE

As a result of the putative protective role of lutein and zeaxanthin at the site of the retina (macular pigment [MP]), interest in the noninvasive measurement of these retinal carotenoids is increasing. In principle, any method used to measure MP in vivo should provide spectral absorption curves that match extinction spectra of MP measured ex vivo.

METHODS

In this article, we assess published spectral curves with respect to this criterion.

RESULTS AND DISCUSSION

Variation in derived MP measures resulting from methodological differences between techniques is noted and discussed.

Diet and Serum Carotenoid Concentrations Affect Macular Pigment Optical Density in Adults 45 Years and Older

The dietary carotenoids lutein (L) and zeaxanthin (Z) are the principal components of macular pigment (MP). Protection of the central retina by MP is suggested, but data are limited. Dietary practices and serum carotenoid concentrations were investigated in 98 adults, 45-73 y old, in relation to MP. Macular pigment optical density (MPOD) was measured at 4 loci: 10 min (10', 30 min (30'), 60 min (60'), and 120 min (120') retinal eccentricity. Serum L + Z concentrations in fasting subjects were correlated with MPOD: 10' (r = 0.29, P = 0.008), 30' (r = 0.342, P = 0.0006), and 60' (r = 0.73, P = 0.001) eccentricity. Dietary L + Z was positively correlated with MPOD: 10' (r = 0.24, P = 0.02), 30' (r = 0.237, P = 0.02), 60' (r = 0.27, P = 0.009), and 120' (r = 0.25, P = 0.02) eccentricity. The lowest fruit and vegetable consumers had lower MPOD at 30' (P = 0.01), 60' (P = 0.03), and 120' (P = 0.006) eccentricity compared with the highest consumers. Based on age quartiles (45-49 y), (50-55 y), (56-61 y), and (62-74 y), the youngest and oldest had higher MPOD than those 56-61 y at 60' (P < 0.05). Compared with those with a BMI (kg/m(2)) >/= 27, those with a BMI < 27 had higher serum concentrations of beta-carotene (P = 0.002), and higher MPOD at 60' (P = 0.04) and 120' (P = 0.01). These findings suggest that carotenoid-rich diets and serum carotenoids positively contribute to MP status.

Future pharmacological treatment options for nonexudative and exudative age-related macular degeneration

Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in the industrialised world. Within the past decade, researchers have introduced many promising prevention and treatment options in an attempt to minimise the central vision loss imparted from AMD. Based on large-scale, randomised, prospective, placebo-controlled trials, a specially formulated combination of the antioxidants vitamin C, vitamin E, beta-carotene, copper and zinc is the only proven means of AMD prophylaxis. Thermal laser photocoagulation and photodynamic therapy with verteporfin are the only standard treatment options. However, efficacy is limited and treatment is only applicable to a minority of AMD patients. Thus, alternative pharmacological interventions are in all phases of clinical development. Researchers are guardedly optimistic that these advances may change the entire approach to AMD management in the near future. This review article will detail the currently accepted treatment options, as well as describe several of the more promising investigational pharmacological approaches to AMD.

Absorption of the eye lens and macular pigment derived from the reflectance of cone photoreceptors

We measured the amplitude of the directional component of the bleached fundus reflectance, the so-called optical Stiles-Crawford effect, as a function of wavelength. The directional reflectance originates from within the outer segments of the photoreceptors. Thus only two anterior absorbers are of importance: macular pigment and the crystalline lens. Analysis of spectra obtained in pseudophakes established that the cone photoreceptors act as spectrally neutral reflectors. The reflectance spectra, expressed in density units, resembled the macular pigment density spectrum. Studying age effects in the lens of normal subjects resulted in a description of the optical density of the lens in terms of a "young" and an "aged" template. The young template represents the pigment O-beta-glucoside of 3-hydroxykynurenine, which dominates the light absorption in young eyes and decreases with age. The aged template represents the pigments accumulating in the lens with age. The total optical density increased with age, but it was lower in the wavelength region 500-650 nm than was previously assumed on the basis of psychophysical studies. Analysis of the spectra also provided precise individual estimates of the optical density of macular pigment. Finally, we observed a decrease in the photoreceptor reflectivity with age, possibly reflecting a degradation of the photoreceptors.

Macular pigment optical density in young Chinese adults

PURPOSE

The purpose of this study was to determine the macular pigment optical density (MPOD) in a group of Chinese subjects using a simple customized light emitting diode-based device.

METHODS

Heterochromatic flicker photometry was used in this study. With a 1 degrees diameter circular test stimulus, MPOD was estimated by comparing the relative sensitivities to a blue light, against a green reference, between foveal and parafoveal 4 degrees temporal locations. Fixed alternating frequencies were used. Repeatability was determined on a small group of subjects. A further group of 67 young healthy subjects provided data for MPOD norms.

RESULTS

All results were corrected to the common MPOD reference wavelength of 460 nm. The group-averaged MPOD was 0.48 (S.D. 0.23). We found no gender difference in MPOD. The coefficient of variability was 7.2-8.0% and the coefficient of repeatability was 0.12.

CONCLUSIONS

The MPOD of Chinese subjects did not differ greatly from the reported MPOD in white subjects.

Macular pigment optical density and its relationship with serum and dietary levels of lutein and zeaxanthin

Observational evidence is accumulating that the onset of age-related maculopathy, the leading cause of legal blindness in the Western World, could be delayed, or even averted, with antioxidant supplements. Lutein (L) and zeaxanthin (Z) are two hydroxy-carotenoids with antioxidant activity which accumulate at the macula, where they are collectively known as macular pigment (MP). It has been shown that MP is entirely of dietary origin, and that L and Z levels in serum, diet, and retina correlate. However, the nature of the relationships between L and Z in foodstuffs, blood, and macula is confounded by many variables including processes which influence digestion, absorption, and transport of the compounds in question, and accumulation and stabilization of the carotenoids in the tissues. If macular pigment is protective for age-related maculopathy, a clear understanding of the mechanisms whereby L and Z arrive at the target tissue (retina) from their source (foodstuff) is essential. In this paper, we review the literature germane to this growing area of interest.

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.

Current and Future Treatment Options for Nonexudative and Exudative Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is the leading cause of irreversible visual loss in the industrialised world. Although relatively simple to diagnose through direct visualisation augmented with rapid sequence fluorescein angiography, treatment has presented a far greater challenge because the true aetiology of AMD is largely unknown. Within the past decade, researchers have introduced many new, potentially promising treatment and prevention options in an attempt to minimise the damage imparted from AMD. They capitalise on many of the theoretical and known factors contributing to AMD progression. A high-dose of an orally administered combination of the antioxidants ascorbic acid (vitamin C), tocopherol (vitamin E) and beta-carotene, in addition to copper and zinc, is the only widely accepted preventive therapy. Thermal laser photocoagulation and verteporfin photodynamic therapy are the only standard treatment options available based on large scale, randomised, prospective, placebo-controlled trials; however, efficacy is limited and only a minority of patients who present with AMD are eligible for these treatments. Many other preventive and treatment options are in all phases of clinical studies and expected to change the entire approach to AMD management in the near future. For example, alternative antioxidants, drusen ablation, apheresis and HMG-CoA reductase inhibitors have shown promise in some studies by preventing or slowing the progression of certain forms of AMD. In addition, alternative photodynamic therapies, low-intensity laser, antiangiogenic medications, radiation treatment and surgery have demonstrated the ability, albeit to differing degrees, to inhibit or possibly even reverse the severe vision loss often associated with AMD characterised by choroidal neovascularisation.

Biologic mechanisms of the protective role of lutein and zeaxanthin in the eye

The macular region of the primate retina is yellow in color due to the presence of the macular pigment, composed of two dietary xanthophylls, lutein and zeaxanthin, and another xanthophyll, meso-zeaxanthin. The latter is presumably formed from either lutein or zeaxanthin in the retina. By absorbing blue-light, the macular pigment protects the underlying photoreceptor cell layer from light damage, possibly initiated by the formation of reactive oxygen species during a photosensitized reaction. There is ample epidemiological evidence that the amount of macular pigment is inversely associated with the incidence of age-related macular degeneration, an irreversible process that is the major cause of blindness in the elderly. The macular pigment can be increased in primates by either increasing the intake of foods that are rich in lutein and zeaxanthin, such as dark-green leafy vegetables, or by supplementation with lutein or zeaxanthin. Although increasing the intake of lutein or zeaxanthin might prove to be protective against the development of age-related macular degeneration, a causative relationship has yet to be experimentally demonstrated.

Macular pigment density and distribution: comparison of fundus autofluorescence with minimum motion photometry

Macular pigment (MP) distribution profiles were measured for 18 subjects using a Moreland anomaloscope modified for motion photometry. The total amount of MP within the central 7 degrees was estimated from the distribution profile by numerical integration. Fundus autofluorescence images were obtained for eight of these subjects using a scanning laser ophthalmoscope. Peak optical density of MP increased with the total amount present, but the correlation was weakened by inter-subject differences in MP distribution. The mean MP distribution derived from mean grey-scale profiles of fundus autofluorescence images correlated closely with that obtained psychophysically (r=0.96). Autofluorescence imaging provides a fast non-invasive method for assessing MP in vivo.

Age, lens transmittance, and the possible effects of light on melatonin suppression

Recently it has been suggested that a previously undetected, rhodopsin-based, visual pigment, located in some retinal ganglion cells and having a peak sensitivity around 460 nm, may be responsible for light-induced melatonin suppression and, perhaps, maintenance of the circadian rhythm. Using data from the literature, it is shown that, as absorption in the crystalline lens for shorter visible wavelengths increases substantially with age, while the pupil diameter tends to decrease, the effective retinal exposure received under the same ambient lighting conditions by the pigment is almost 10 times lower in an old, as compared with a young, eye. Interestingly, replacement of the old crystalline lens by an intraocular implant restores the exposure to youthful levels. The possible effects of these changes with age on circadian rhythms are discussed.

A portable instrument for measuring macular pigment with central fixation

PURPOSE

To evaluate the reliability and validity of a portable instrument for measuring macular pigment optical density.

METHODS

The instrument is small, uses light emitting diodes as light sources and the principles of heterochromatic flicker photometry of comparing foveal and extra-foveal minimum flicker matches. It uses central fixation for the extra-foveal matches, which subjects found easier than eccentric fixation. Subjects with healthy eyes used the instrument to measure their pigment density in a number of eye clinics.

RESULTS

The mean pigment density in 124 eyes in 124 individuals was 0.41 +/- 0.16 (mean +/- SD), there was no significant change with age but the density was less in females, those with light irides, smokers, subjects on diets low in precursor carotenoids and in those exposed to several hours of daylight every day or who used sun beds.

CONCLUSIONS

The portable instrument gave valid and reliable data that confirmed published values for macular pigment. It was convenient to use in the clinic and has potential as a screening tool.

The body of evidence to support a protective role for lutein and zeaxanthin in delaying chronic disease. Overview

Recent evidence introduces the possibility that lutein and zeaxanthin may protect against the development of the two common eye diseases of aging, cataract and macular degeneration. This potential and the lack of other effective means to slow the progression of macular degeneration have fueled high public interest in the health benefits of lutein and zeaxanthin and the proliferation of supplements containing them on pharmacy shelves. An understanding of the biologic consequences of limiting or supplementing with these carotenoids is only beginning to emerge. Some epidemiologic evidence supports a role in eye disease and, to a lesser extent, cancer and cardiovascular disease. However, the overall body of evidence is insufficient to conclude that increasing levels of lutein and zeaxanthin, specifically, will confer an important health benefit. Future advances in scientific research are required to gain a better understanding of the biologic mechanisms of their possible role in preventing disease. Additional research is also required to understand the effect of their consumption, independent of other nutrients in fruits and vegetables, on human health. The newly advanced ability to measure levels of lutein and zeaxanthin in the retina in vivo creates a unique opportunity to contribute some of this needed evidence.

In vivo assessment of retinal carotenoids: macular pigment detection techniques and their impact on monitoring pigment status

Of the many carotenoids found within human tissue, only the carotenoids within the human retina can be assessed noninvasively at present. Such assessment should eventually provide a more complete understanding of the functional role of retinal lutein (L) and zeaxanthin (Z) (termed macular pigment, MP) in human vision. The emerging data allow for some initial observations. For example, there appears to be wide variation (>factor of 10) in the concentration of MP. Although MP levels have been recorded from nondetectable to 1.20 OD (optical density), the "average" levels, relative to what is possible, appear low. This may be due in part to the low average dietary intake of L and Z in the typical U.S. diet. Nonetheless, individual differences in MP may also be influenced by nondietary factors such as genetics, demographics and lifestyle characteristics. Some evidence indicates that the MP carotenoids may protect the retina and lens, and could improve vision through some optical mechanisms. Consequently, efforts to determine typical MP levels and the factors that influence individual differences in MP density should be continued.

Macular pigment: influences on visual acuity and visibility

There is increasing evidence that the macular pigment (MP) carotenoids lutein (L) and zeaxanthin (Z) protect the retina and lens from age-related loss. As a result, the use of L and Z supplements has increased dramatically in recent years. An increasing number of reports have suggested that L and Z supplementation (and increased MP density) are related to improved visual performance in normal subjects and patients with retinal and lenticular disease. These improvements in vision could be due either to changes in the underlying biology and/or optical changes. The optical mechanisms, i.e., preferential absorption of short-wave light, underlying these putative improvements in vision, however, have not been properly evaluated. Two major hypotheses are discussed. The acuity hypothesis posits that MP could improve visual function by reducing the effects of chromatic aberration. The visibility hypothesis is based on the idea that MP may improve vision through the atmosphere by preferentially absorbing blue haze (short-wave dominant air light that produces a veiling luminance when viewing objects at a distance).

The spatial distribution of macular pigment in humans

PURPOSE

To estimate the distributions in width as well as in density of macular pigment (MP) in humans at different ages, imaging fundus reflectometry was employed as a tool to reach our aim.

METHODS

Imaging fundus reflectometry was used to measure the macular pigment distribution in human eyes with a modified fundus camera to which a cooled CCD camera was attached. The fundus images were taken at 460 nm and 560 nm after the retina was light-adapted to completely bleach rhodopsin. The density of macular pigment was estimated using a model described in the text. The variation in density with retinal eccentricity was fit to Gaussian distribution. The width of MP in retinal eccentricity was estimated by 95% covering area of the distribution profile. A total of 54 normal people served as subjects. They were divided into three groups with ages of 24.8 +/- 2.6 years (N = 24), 40.2 +/- 8.3 years (N = 13) and 67.5 +/- 7.1 years (N = 17) respectively. Statistical t-tests were employed to evaluate the differences in MP density, the half width of MP distributed (HWMPD) in retina with respect to age between the groups. Linear regression was also applied to reveal the relationships of HWMPD distribution with respect to age.

RESULTS

The results indicate that the average MP densities are 0.23 +/- 0.08, 0.22 +/- 0.06 and 0.23 +/- 0.06 density unit (DU) for the young to old age groups. The average MP density is 0.23 +/- 0.07. No statistical significant difference is found in the peak MP density between the groups (all p > 0.05). This result pretty agrees with the data that obtained from others by using optical methods. For the young to old age groups, the average estimated HWMPD are 2.6 degrees +/- 0.5 degrees, 3.1 degrees +/- 0.5 degrees and 4.1 degrees +/- 0.6 degrees respectively. The differences between loci of HWMPD in the three groups are statistically significant with p = 0.0059, p < 0.0001 and p = 0.0001 for young vs. mid-age, young vs. old and mid-age vs. old respectively. Linear regressions for the HWMPD vs. age (r = 0.734, p < 0.001) implies that the macular pigment can gradually accumulate and spread out to the periphery of retina through our life span with an increase rate of approximately 0.03 degrees /year.

CONCLUSIONS

The accumulation of MP is reflected by the broader area in the macula lutea due to age, but no significant change is observed in peak density. The cause of the extension in the macular area with respect to age is unknown.