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Seddon JM, De D, Rosner B. The role of nutritional factors in transitioning between early, mid, and late stages of age-related macular degeneration: prospective longitudinal analysis. Am J Clin Nutr 2024; 120:1387-1398. [PMID: 39181206 PMCID: PMC11619796 DOI: 10.1016/j.ajcnut.2024.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 08/15/2024] [Accepted: 08/19/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Transitions between different stages of age-related macular degeneration (AMD) are not completely captured by traditional survival models with an end point of advanced AMD. OBJECTIVES This study aimed to explore the transitions from early and intermediate AMD to higher non-advanced and advanced stages and determine the contributions of nutritional factors to these outcomes. METHODS Eyes with early or intermediate AMD at baseline, classified according to the Age-Related Eye Disease Study severity scale, were included in this prospective longitudinal analysis. Foods and the biologically active nutrients associated with AMD [green leafy vegetables, fish, lutein/zeaxanthin (LZ), and ω-3 (n-3) fatty acids] were determined by a baseline food frequency questionnaire. Progression was defined as eyes transitioning to higher severity groups including non-advanced and advanced stages over 5 years, confirmed at 2 consecutive visits. Cox proportional hazards models for foods and nutrients were analyzed adjusting for demographics, lifestyle, baseline macular status, a family history of AMD, caloric intake, and genetic risk. RESULTS Among 2697 eyes, 616 (23%) progressed to higher severity groups. In the food group model, higher intake of green leafy vegetables reduced incidence of transitions {hazard ratio [HR] (≥2.7 servings/wk compared with none): 0.75; 95% confidence interval [CI]: 0.59, 0.96; P = 0.02}. Higher fish intake was also protective [HR (≥ two 4-ounce servings/wk compared with <2): 0.79; 95% CI: 0.65, 0.95; P = 0.01]. In the nutrient model, LZ intake was protective [HR (≥2 mg/d compared with <2): 0.76; 95% CI: 0.60, 0.96; P = 0.02]. Higher intake of ω-3 fatty acids also tended to be beneficial [HR (≥0.7 g/wk compared with <0.7): 0.85; 95% CI: 0.71, 1.01; P = 0.06]. CONCLUSIONS Increased consumption of green leafy vegetables, LZ, and fish nutritionally rich in ω-3 fatty acids during the initial stages of AMD may reduce rates of progression to higher severity of this debilitating disease. This trial was registered at clinicaltrials.gov as NCT00594672.
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Affiliation(s)
- Johanna M Seddon
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States.
| | - Dikha De
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Bernard Rosner
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Boston, MA, United States
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Wang Y, Gao S, Cao F, Yang H, Lei F, Hou S. Ocular immune-related diseases: molecular mechanisms and therapy. MedComm (Beijing) 2024; 5:e70021. [PMID: 39611043 PMCID: PMC11604294 DOI: 10.1002/mco2.70021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 10/05/2024] [Accepted: 10/31/2024] [Indexed: 11/30/2024] Open
Abstract
Ocular immune-related diseases, represent a spectrum of conditions driven by immune system dysregulation, include but not limit to uveitis, diabetic retinopathy, age-related macular degeneration, Graves' ophthalmopathy, etc. The molecular and cellular mechanisms underlying these diseases are typically dysfunctioned immune responses targeting ocular tissues, resulting in inflammation and tissue damage. Recent advances have further elucidated the pivotal role of different immune responses in the development, progression, as well as management of various ocular immune diseases. However, there is currently a relative lack of connection between the cellular mechanisms and treatments of several immune-related ocular diseases. In this review, we discuss recent findings related to the immunopathogenesis of above-mentioned diseases. In particular, we summarize the different types of immune cells, inflammatory mediators, and associated signaling pathways that are involved in the pathophysiology of above-mentioned ophthalmopathies. Furthermore, we also discuss the future directions of utilizing anti-inflammatory regime in the management of these diseases. This will facilitate a better understanding of the pathogenesis of immune-related ocular diseases and provide new insights for future treatment approaches.
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Affiliation(s)
- Yakun Wang
- The First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Beijing Institute of OphthalmologyBeijing Tongren Eye CenterBeijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Capital Medical UniversityBeijingChina
| | - Shangze Gao
- Beijing Institute of OphthalmologyBeijing Tongren Eye CenterBeijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Capital Medical UniversityBeijingChina
| | - Fan Cao
- Beijing Institute of OphthalmologyBeijing Tongren Eye CenterBeijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Capital Medical UniversityBeijingChina
| | - Hui Yang
- Beijing Institute of OphthalmologyBeijing Tongren Eye CenterBeijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Capital Medical UniversityBeijingChina
| | - Fengyang Lei
- Beijing Institute of OphthalmologyBeijing Tongren Eye CenterBeijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Capital Medical UniversityBeijingChina
| | - Shengping Hou
- Beijing Institute of OphthalmologyBeijing Tongren Eye CenterBeijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Capital Medical UniversityBeijingChina
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Sbai O, Torrisi F, Fabrizio FP, Rabbeni G, Perrone L. Effect of the Mediterranean Diet (MeDi) on the Progression of Retinal Disease: A Narrative Review. Nutrients 2024; 16:3169. [PMID: 39339769 PMCID: PMC11434766 DOI: 10.3390/nu16183169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 09/10/2024] [Accepted: 09/11/2024] [Indexed: 09/30/2024] Open
Abstract
Worldwide, the number of individuals suffering from visual impairment, as well as those affected by blindness, is about 600 million and it will further increase in the coming decades. These diseases also seriously affect the quality of life in working-age individuals. Beyond the characterization of metabolic, genetic, and environmental factors related to ocular pathologies, it is important to verify how lifestyle may participate in the induction of the molecular pathways underlying these diseases. On the other hand, scientific studies are also contributing to investigations as to whether lifestyle could intervene in modulating pathophysiological cellular responses, including the production of metabolites and neurohormonal factors, through the intake of natural compounds capable of interfering with molecular mechanisms that lead to ocular diseases. Nutraceuticals are promising in ameliorating pathophysiological complications of ocular disease such as inflammation and neurodegeneration. Moreover, it is important to characterize the nutritional patterns and/or natural compounds that may be beneficial against certain ocular diseases. The adherence to the Mediterranean diet (MeDi) is proposed as a promising intervention for the prevention and amelioration of several eye diseases. Several characteristic compounds and micronutrients of MeDi, including vitamins, carotenoids, flavonoids, and omega-3 fatty acids, are proposed as adjuvants against several ocular diseases. In this review, we focus on studies that analyze the effects of MeDi in ameliorating diabetic retinopathy, macular degeneration, and glaucoma. The analysis of knowledge in this field is requested in order to provide direction on recommendations for nutritional interventions aimed to prevent and ameliorate ocular diseases.
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Affiliation(s)
- Oualid Sbai
- Laboratory of Transmission, Control and Immunobiology of Infections (LTCII), LR11IPT02, Institut Pasteur de Tunis, Tunis 1068, Tunisia
| | - Filippo Torrisi
- Faculty of Medicine and Surgery, University KORE of Enna, 94100 Enna, Italy
| | | | - Graziella Rabbeni
- Faculty of Medicine and Surgery, University KORE of Enna, 94100 Enna, Italy
| | - Lorena Perrone
- Faculty of Medicine and Surgery, University KORE of Enna, 94100 Enna, Italy
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4
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Boopathiraj N, Wagner IV, Dorairaj SK, Miller DD, Stewart MW. Recent Updates on the Diagnosis and Management of Age-Related Macular Degeneration. Mayo Clin Proc Innov Qual Outcomes 2024; 8:364-374. [PMID: 39036487 PMCID: PMC11259890 DOI: 10.1016/j.mayocpiqo.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in the Western world, with a higher prevalence among Europeans and North Americans than that in Africans, Hispanics, and Asians. Advanced AMD is categorized as atrophic (dry) or exudative (wet/neovascular age-related macular degeneration [nAMD]). Dry AMD is characterized by progressive geographic atrophy of the retinal pigment epithelium and outer retinal layers, whereas nAMD is characterized by new vessels that invade the subretinal and/or subretinal pigment epithelium spaces. Existing treatments delay the onset of advanced AMD and reverses vision loss for a couple of years before atrophy usually decreases central visual acuity. We searched PubMed and Medline databases from January 1, 1980, to December 1, 2023, using the following search terms: macular degeneration, choroidal neovascularization, geographic atrophy, drusen, age-related maculopathy, AMD, ARMD, and anti-VEGF. Relevant articles in English (or English translations) were retrieved and reviewed. Bibliographies of the identified manuscripts were also reviewed to identify relevant studies. Age-related macular degeneration most commonly affects people older than 55 years. Visual prognosis varies, with advanced lesions (nAMD and geographic atrophy) leading to rapid, progressive loss of central vision and contrast sensitivity. Although AMD is not a life-threatening disease, reduced vision profoundly compromises quality of life and necessitates living assistance for many patients. Over the past 2 decades, advances in prevention (vitamin supplementation) and therapy (antivascular endothelial growth factor and complement inhibitor drugs) have reduced vision loss and blindness. Further research is needed to decrease the incidence of blindness in patients with advanced disease.
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Affiliation(s)
| | | | - Syril K. Dorairaj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Jacksonville, FL
| | - Darby D. Miller
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Jacksonville, FL
| | - Michael W. Stewart
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Jacksonville, FL
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Bejarano E, Domenech-Bendaña A, Avila-Portillo N, Rowan S, Edirisinghe S, Taylor A. Glycative stress as a cause of macular degeneration. Prog Retin Eye Res 2024; 101:101260. [PMID: 38521386 DOI: 10.1016/j.preteyeres.2024.101260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
People are living longer and rates of age-related diseases such as age-related macular degeneration (AMD) are accelerating, placing enormous burdens on patients and health care systems. The quality of carbohydrate foods consumed by an individual impacts health. The glycemic index (GI) is a kinetic measure of the rate at which glucose arrives in the blood stream after consuming various carbohydrates. Consuming diets that favor slowly digested carbohydrates releases sugar into the bloodstream gradually after consuming a meal (low glycemic index). This is associated with reduced risk for major age-related diseases including AMD, cardiovascular disease, and diabetes. In comparison, consuming the same amounts of different carbohydrates in higher GI diets, releases glucose into the blood rapidly, causing glycative stress as well as accumulation of advanced glycation end products (AGEs). Such AGEs are cytotoxic by virtue of their forming abnormal proteins and protein aggregates, as well as inhibiting proteolytic and other protective pathways that might otherwise selectively recognize and remove toxic species. Using in vitro and animal models of glycative stress, we observed that consuming higher GI diets perturbs metabolism and the microbiome, resulting in a shift to more lipid-rich metabolomic profiles. Interactions between aging, diet, eye phenotypes and physiology were observed. A large body of laboratory animal and human clinical epidemiologic data indicates that consuming lower GI diets, or lower glycemia diets, is protective against features of early AMD (AMDf) in mice and AMD prevalence or AMD progression in humans. Drugs may be optimized to diminish the ravages of higher glycemic diets. Human trials are indicated to determine if AMD progression can be retarded using lower GI diets. Here we summarized the current knowledge regarding the pathological role of glycative stress in retinal dysfunction and how dietary strategies might diminish retinal disease.
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Affiliation(s)
- Eloy Bejarano
- Department of Biomedical Sciences, School of Health Sciences and Veterinary School, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - Alicia Domenech-Bendaña
- Department of Biomedical Sciences, School of Health Sciences and Veterinary School, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | | | - Sheldon Rowan
- JM USDA Human Nutrition Research Center on Aging at Tufts University, United States
| | - Sachini Edirisinghe
- Tufts University Friedman School of Nutrition Science and Policy, United States
| | - Allen Taylor
- Tufts University Friedman School of Nutrition Science and Policy, United States.
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Brito M, Sorbier C, Mignet N, Boudy V, Borchard G, Vacher G. Understanding the Impact of Polyunsaturated Fatty Acids on Age-Related Macular Degeneration: A Review. Int J Mol Sci 2024; 25:4099. [PMID: 38612907 PMCID: PMC11012607 DOI: 10.3390/ijms25074099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
Age-related Macular Degeneration (AMD) is a multifactorial ocular pathology that destroys the photoreceptors of the macula. Two forms are distinguished, dry and wet AMD, with different pathophysiological mechanisms. Although treatments were shown to be effective in wet AMD, they remain a heavy burden for patients and caregivers, resulting in a lack of patient compliance. For dry AMD, no real effective treatment is available in Europe. It is, therefore, essential to look for new approaches. Recently, the use of long-chain and very long-chain polyunsaturated fatty acids was identified as an interesting new therapeutic alternative. Indeed, the levels of these fatty acids, core components of photoreceptors, are significantly decreased in AMD patients. To better understand this pathology and to evaluate the efficacy of various molecules, in vitro and in vivo models reproducing the mechanisms of both types of AMD were developed. This article reviews the anatomy and the physiological aging of the retina and summarizes the clinical aspects, pathophysiological mechanisms of AMD and potential treatment strategies. In vitro and in vivo models of AMD are also presented. Finally, this manuscript focuses on the application of omega-3 fatty acids for the prevention and treatment of both types of AMD.
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Affiliation(s)
- Maëlis Brito
- Unither Développement Bordeaux, Avenue Toussaint Catros, 33185 Le Haillan, France
- Université Paris Cité, CNRS, INSERM, UTCBS, Unité de Technologies Chimiques et Biologiques pour la Santé, F-75006 Paris, France
- Département de Recherche et Développement (DRDP), Agence Générale des Equipements et Produits de Santé (AGEPS), Assistance Publique Hôpitaux de Paris (AP-HP), 7 Rue du Fer-à-Moulin, 75005 Paris, France
- Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), School of Pharmaceutical Sciences, University of Geneva, Rue Michel-Servet 1, 1206 Geneva, Switzerland
| | - Capucine Sorbier
- Unither Développement Bordeaux, Avenue Toussaint Catros, 33185 Le Haillan, France
| | - Nathalie Mignet
- Université Paris Cité, CNRS, INSERM, UTCBS, Unité de Technologies Chimiques et Biologiques pour la Santé, F-75006 Paris, France
| | - Vincent Boudy
- Université Paris Cité, CNRS, INSERM, UTCBS, Unité de Technologies Chimiques et Biologiques pour la Santé, F-75006 Paris, France
- Département de Recherche et Développement (DRDP), Agence Générale des Equipements et Produits de Santé (AGEPS), Assistance Publique Hôpitaux de Paris (AP-HP), 7 Rue du Fer-à-Moulin, 75005 Paris, France
| | - Gerrit Borchard
- Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), School of Pharmaceutical Sciences, University of Geneva, Rue Michel-Servet 1, 1206 Geneva, Switzerland
| | - Gaëlle Vacher
- Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), School of Pharmaceutical Sciences, University of Geneva, Rue Michel-Servet 1, 1206 Geneva, Switzerland
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7
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Sesso HD, Rautiainen S, Park SJ, Kim E, Lee IM, Glynn RJ, Buring JE, Christen WG. Intake of Blueberries, Anthocyanins, and Risk of Eye Disease in Women. J Nutr 2024; 154:1404-1413. [PMID: 38432561 PMCID: PMC11007733 DOI: 10.1016/j.tjnut.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/12/2024] [Accepted: 02/27/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Blueberries and anthocyanins, their key bioactive component, may improve eye health. However, few long-term studies have examined blueberries and anthocyanins with cataract and age-related macular degeneration (AMD). OBJECTIVES To investigate the prospective association between blueberry and anthocyanin intake with incident cataract, total AMD, and visually significant AMD among middle-aged and older women. METHODS A total of 36,653 and 35,402 women initially free of AMD and cataract, respectively, aged ≥45 y from the Women's Health Study provided semiquantitative food frequency questionnaire data on blueberry intake categorized as none, 1-3 servings/mo, 1 serving/wk, or ≥2 servings/wk, plus a combined category of ≥1 serving/wk. Total anthocyanin intake and major subclasses were energy-adjusted and categorized into quintiles. Self-reported risk factors of eye disease were adjusted in multivariable hazard ratios (HRs) (95% confidence intervals [CIs]) of confirmed cataract, AMD, and visually significant AMD with mean follow-up of 11 y. RESULTS Among the participants, 10.5% consumed ≥1 serving/wk of blueberries, with mean total anthocyanin intake of 11.2 mg/d. Compared to no blueberry intake, women consuming 1-3 servings/mo, 1 serving/wk, and ≥2 servings/wk had corresponding multivariable HRs of total AMD of 0.90 (95% CI: 0.73, 1.11), 0.71 (95% CI: 0.50, 1.00), and 0.36 (95% CI: 0.14, 0.93) (Ptrend = 0.011); those consuming ≥1 servings/wk had an HR of 0.68 (95% CI: 0.47, 0.98). A similar magnitude of HRs were found for visually significant AMD (Ptrend = 0.012) but not for cataract. There were no significant associations between increasing total anthocyanin quintiles and total and visually significant AMD, but there was a modest inverse association with cataract (Ptrend = 0.022), driven by a 10% reduction in cataract in the upper 2 quintiles. CONCLUSIONS Greater blueberry intake significantly reduced total AMD, but not visually significant AMD or cataract. However, the magnitude of effect for visually significant AMD was similar to total AMD. There was a modest but significant inverse association between dietary anthocyanin intake with cataract but not AMD.
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Affiliation(s)
- Howard D Sesso
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
| | - Susanne Rautiainen
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sarah Jaehwa Park
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Eunjung Kim
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - I-Min Lee
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Robert J Glynn
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Julie E Buring
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - William G Christen
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
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Angelia M, Amelia YS, Pratama KG. Mediterranean diet as a modifiable risk factor for age-related macular degeneration: A systematic review and meta-analysis. Tzu Chi Med J 2024; 36:223-230. [PMID: 38645781 PMCID: PMC11025595 DOI: 10.4103/tcmj.tcmj_153_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/23/2023] [Accepted: 08/31/2023] [Indexed: 04/23/2024] Open
Abstract
Objectives Age-related macular degeneration (AMD) is a chronic and degenerative disease of the retina that leads to irreversible blindness. There is no proven effective treatment for early AMD and advanced AMD. Mediterranean diet (MD) has been linked to reducing the risk or delaying the progression of AMD. Therefore, in this study, we aim to investigate the potential of MD as a modifiable risk factor for AMD. Materials and Methods A systematic search was performed in three databases: PubMed, EBSCO host, and Proquest. We search for studies that determine the association of MD in AMD. Then, we pooled the data for meta-analysis. Results Eight studies were included in our systematic review. Seven studies were included for meta-analysis. Subjects with medium-high (hazard ratio [HR] 0.82; 95% confidence interval [CI]: 0.75-0.90) adherence to the MD showed a reduced risk of developing AMD. Moreover, medium adherence AMD shows a significant and inverse relationship with the progression to advanced AMD (HR: 0.87; 95% CI: 0.81-0.93). Although it is still inconsistent, the reduction appears stronger for geographic atrophy than for neovascular AMD. Conclusion Adhering to the MD, particularly at a medium to high level, appears to confer a protective effect against AMD. The sub-analysis demonstrates even that there is a protective effect associated with moderate adherence against advanced AMD. The presence of considerable heterogeneity within the results warrants cautious interpretation. Further research is needed to enhance our understanding.
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Affiliation(s)
- Maria Angelia
- School of Medicine and Health Sciences, Atma Jaya University Catholic of Indonesia, Jakarta, Indonesia
| | - Yufilia Suci Amelia
- School of Medicine and Health Sciences, Atma Jaya University Catholic of Indonesia, Jakarta, Indonesia
| | - Kevin Gracia Pratama
- School of Medicine and Health Sciences, Atma Jaya University Catholic of Indonesia, Jakarta, Indonesia
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Koçyiğit E, Gövez NE, Arslan S, Ağagündüz D. A narrative review on dietary components and patterns and age-related macular degeneration. Nutr Res Rev 2024:1-28. [PMID: 38221852 DOI: 10.1017/s0954422424000015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Age-related macular degeneration (AMD) is one of the most prevalent eye diseases among the ageing population worldwide. It is a leading cause of blindness in individuals over 55, particularly in industrialised Western countries. The prevalence of AMD increases with age, and genetic factors and environmental influences are believed to contribute to its development. Among the environmental factors, diet plays a significant role in AMD. This review explores the association between dietary components, dietary patterns and AMD. Various nutrients, non-nutrient substances and dietary models that have the potential to counteract oxidative stress and inflammation, which are underlying mechanisms of AMD, are discussed. Consuming fruits, vegetables, fish and seafood, whole grains, olive oil, nuts and low-glycaemic-index foods has been highlighted as beneficial for reducing the risk of AMD. Adhering to the Mediterranean diet, which encompasses these elements, can be recommended as a dietary pattern for AMD. Furthermore, the modulation of the gut microbiota through dietary interventions and probiotics has shown promise in managing AMD.
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Affiliation(s)
- Emine Koçyiğit
- Department of Nutrition and Dietetics, Ordu University, Ordu, Türkiye
| | - Nazlıcan Erdoğan Gövez
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Ankara, Türkiye
| | - Sabriye Arslan
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Ankara, Türkiye
| | - Duygu Ağagündüz
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Ankara, Türkiye
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Barreto P, Farinha C, Coimbra R, Cachulo ML, Melo JB, Lechanteur Y, Hoyng CB, Cunha-Vaz J, Silva R. Interaction between genetics and the adherence to the Mediterranean diet: the risk for age-related macular degeneration. Coimbra Eye Study Report 8. EYE AND VISION (LONDON, ENGLAND) 2023; 10:38. [PMID: 37580831 PMCID: PMC10424352 DOI: 10.1186/s40662-023-00355-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 07/25/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Age-related macular degeneration (AMD) is a multifactorial degenerative disease of the macula. Different factors, environmental, genetic and lifestyle, contribute to its onset and progression. However, how they interconnect to promote the disease, or its progression, is still unclear. With this work, we aim to assess the interaction of the genetic risk for AMD and the adherence to the Mediterranean diet in the Coimbra Eye Study. METHODS Enrolled subjects (n = 612) underwent ophthalmological exams and answered a food questionnaire. Adherence to the Mediterranean diet was assessed with mediSCORE. An overall value was calculated for each participant, ranging from 0 to 9, using the sum of 9 food groups, and a cut off value of ≥ 6 was considered high adherence. Rotterdam Classification was used for grading. Participants' genotyping was performed in collaboration with The European Eye Epidemiology Consortium. The genetic risk score (GRS) was calculated for each participant considering the number of alleles at each variant and their effect size. Interaction was assessed with additive and multiplicative models, adjusted for age, sex, physical exercise, and smoking. RESULTS The AMD risk was reduced by 60% in subjects with high adherence to the Mediterranean diet compared to subjects with low adherence to the Mediterranean diet. Combined effects of having low adherence to the Mediterranean diet and high GRS led to almost a 5-fold increase in the risk for AMD, compared to low GRS and high adherence to the Mediterranean diet. The multiplicative scale suggested a multiplicative interaction, although not statistically significant [odds ratio (OR) = 1.111, 95% CI 0.346-3.569, P = 0.859]. The additive model showed a causal positive effect of the interaction of GRS and adherence to the Mediterranean diet: relative excess risk due to interaction (RERI) = 150.9%, (95% CI: - 0.414 to 3.432, P = 0.062), attributable proportion due to interaction (AP) = 0.326 (95% CI: - 0.074 to 0.726, P = 0.055) and synergy index (SI) = 1.713 (95% CI: 0.098-3.329, P = 0.019). High GRS people benefited from adhering to the Mediterranean diet with a 60% risk reduction. For low-GRS subjects, a risk reduction was also seen, but not significantly. CONCLUSIONS Genetics and Mediterranean diet interact to protect against AMD, proving there is an interplay between genetics and environmental factors. TRIAL REGISTRATION The AMD Incidence (NCT02748824) and Lifestyle and Food Habits Questionnaire in the Portuguese Population Aged 55 or More (NCT01715870) studies are registered at www. CLINICALTRIALS gov . Five-year Incidence of Age-related Macular Degeneration in the Central Region of Portugal (AMD IncidencePT); NCT02748824: date of registration: 22/04/16. Lifestyle and Food Habits Questionnaire in the Portuguese Population Aged 55 or More; NCT01715870: date of registration: 29/10/12.
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Affiliation(s)
- Patrícia Barreto
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal.
- Univ Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Coimbra, Portugal.
- Univ Coimbra, Centre for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal.
| | - Cláudia Farinha
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
- Univ Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Coimbra, Portugal
- Univ Coimbra, Centre for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Rita Coimbra
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | - Maria Luz Cachulo
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Joana Barbosa Melo
- Univ Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Coimbra, Portugal
- Univ Coimbra, Centre for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal
- Cytogenetics and Genomics Laboratory, Clinical Academic Center of Coimbra (CACC), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Univ Coimbra, Center of Investigation in Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, Coimbra, Portugal
| | - Yara Lechanteur
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carel B Hoyng
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - José Cunha-Vaz
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | - Rufino Silva
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
- Univ Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Coimbra, Portugal
- Univ Coimbra, Centre for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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11
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Wu Y, Xie Y, Yuan Y, Xiong R, Hu Y, Ning K, Ha J, Wang W, Han X, He M. The Mediterranean Diet and Age-Related Eye Diseases: A Systematic Review. Nutrients 2023; 15:2043. [PMID: 37432187 PMCID: PMC10181476 DOI: 10.3390/nu15092043] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 07/12/2023] Open
Abstract
The Mediterranean diet (MD) is a healthy diet pattern that can prevent chronic age-related diseases, especially age-related eye diseases (AREDs) including cataract, glaucoma, age-related macular degeneration (AMD), diabetic retinopathy (DR) and dry eye syndrome (DES). In this study, we systematically reviewed studies in the literature that had reported associations between adherence to the MD and the five above-mentioned AREDs. Randomized controlled trials as well as prospective and retrospective observational studies were included; 1164 studies were identified, of which 1, 2, 9, 2 and 4 studies met our eligibility criteria for cataract, glaucoma, AMD, DR, and DES, respectively. According to these studies, higher MD adherence was associated with reduced risks of incident DR, incident AMD and progression to late AMD, but whether early and neovascular AMD could be alleviated remained to be debated. The results regarding the effects of the MD on DES were mixed, with three studies reporting an associations between MD and decreased severity or incidence of DES, whereas one study reported the opposite. No significant associations were observed between the MD and cataract or glaucoma. Generally, convincing evidence suggested a protective effect of the MD against AMD and DR. However, the evidence for cataract, glaucoma, and DES was less conclusive, and high-quality studies are needed for comprehensive evaluations of the potential benefits of MD on these eye diseases.
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Affiliation(s)
- Yi Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China; (Y.W.); (Y.Y.); (R.X.); (M.H.)
| | - Ye Xie
- Zhongshan Medical School, Sun Yat-sen University, Guangzhou 510080, China; (Y.X.); (Y.H.)
| | - Yixiong Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China; (Y.W.); (Y.Y.); (R.X.); (M.H.)
| | - Ruilin Xiong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China; (Y.W.); (Y.Y.); (R.X.); (M.H.)
| | - Yuxin Hu
- Zhongshan Medical School, Sun Yat-sen University, Guangzhou 510080, China; (Y.X.); (Y.H.)
| | - Kang Ning
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China;
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in Southern China, Guangzhou 510060, China
| | - Jason Ha
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC 3002, Australia;
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China; (Y.W.); (Y.Y.); (R.X.); (M.H.)
| | - Xiaotong Han
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China; (Y.W.); (Y.Y.); (R.X.); (M.H.)
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China; (Y.W.); (Y.Y.); (R.X.); (M.H.)
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC 3002, Australia;
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, VIC 3010, Australia
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12
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Blue Light Exposure: Ocular Hazards and Prevention-A Narrative Review. Ophthalmol Ther 2023; 12:755-788. [PMID: 36808601 PMCID: PMC9938358 DOI: 10.1007/s40123-023-00675-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/01/2023] [Indexed: 02/21/2023] Open
Abstract
INTRODUCTION Exposure to blue light has seriously increased in our environment since the arrival of light emitting diodes (LEDs) and, in recent years, the proliferation of digital devices rich in blue light. This raises some questions about its potential deleterious effects on eye health. The aim of this narrative review is to provide an update on the ocular effects of blue light and to discuss the efficiency of methods of protection and prevention against potential blue light-induced ocular injury. METHODS The search of relevant English articles was conducted in PubMed, Medline, and Google Scholar databases until December 2022. RESULTS Blue light exposure provokes photochemical reactions in most eye tissues, in particular the cornea, the lens, and the retina. In vitro and in vivo studies have shown that certain exposures to blue light (depending on the wavelength or intensity) can cause temporary or permanent damage to some structures of the eye, especially the retina. However, currently, there is no evidence that screen use and LEDs in normal use are deleterious to the human retina. Regarding protection, there is currently no evidence of a beneficial effect of blue blocking lenses for the prevention of eye diseases, in particular age-related macular degeneration (AMD). In humans, macular pigments (composed of lutein and zeaxanthin) represent a natural protection by filtering blue light, and can be increased through increased intake from foods or food supplements. These nutrients are associated with lower risk for AMD and cataract. Antioxidants such as vitamins C, E, or zinc might also contribute to the prevention of photochemical ocular damage by preventing oxidative stress. CONCLUSION Currently, there is no evidence that LEDs in normal use at domestic intensity levels or in screen devices are retinotoxic to the human eye. However, the potential toxicity of long-term cumulative exposure and the dose-response effect are currently unknown.
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13
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Guymer RH, Campbell TG. Age-related macular degeneration. Lancet 2023; 401:1459-1472. [PMID: 36996856 DOI: 10.1016/s0140-6736(22)02609-5] [Citation(s) in RCA: 102] [Impact Index Per Article: 102.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 11/22/2022] [Accepted: 11/30/2022] [Indexed: 04/01/2023]
Abstract
Age-related macular degeneration is an increasingly important public health issue due to ageing populations and increased longevity. Age-related macular degeneration affects individuals older than 55 years and threatens high-acuity central vision required for important tasks such as reading, driving, and recognising faces. Advances in retinal imaging have identified biomarkers of progression to late age-related macular degeneration. New treatments for neovascular age-related macular degeneration offer potentially longer-lasting effects, and progress is being made towards a treatment for atrophic late age-related macular degeneration. An effective intervention to slow progression in the earlier stages of disease, or to prevent late age-related macular degeneration development remains elusive, and our understanding of underlying mechanistic pathways continues to evolve.
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Affiliation(s)
- Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia; Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, VIC, Australia
| | - Thomas G Campbell
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia; Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, VIC, Australia; Department of Ophthalmology, Sunshine Coast University Hospital, Sunshine Coast, QLD, Australia.
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14
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Lynn SA, Soubigou F, Dewing JM, Smith A, Ballingall J, Sass T, Nica I, Watkins C, Gupta B, Almuhtaseb H, Lash SC, Yuen HM, Cree A, Newman TA, Lotery AJ, Ratnayaka JA. An Exploratory Study Provides Insights into MMP9 and Aβ Levels in the Vitreous and Blood across Different Ages and in a Subset of AMD Patients. Int J Mol Sci 2022; 23:14603. [PMID: 36498929 PMCID: PMC9736887 DOI: 10.3390/ijms232314603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
Matrix metalloproteinase-9 (MMP9) and total amyloid-beta (Aβ) are prospective biomarkers of ocular ageing and retinopathy. These were quantified by ELISA in the vitreous and blood from controls (n = 55) and in a subset of age-related macular degeneration (AMD) patients (n = 12) for insights and possible additional links between the ocular and systemic compartments. Vitreous MMP9 levels in control and AMD groups were 932.5 ± 240.9 pg/mL and 813.7 ± 157.6 pg/mL, whilst serum levels were 2228 ± 193 pg/mL and 2386.8 ± 449.4 pg/mL, respectively. Vitreous Aβ in control and AMD groups were 1173.5 ± 117.1 pg/mL and 1275.6 ± 332.9 pg/mL, whilst plasma Aβ were 574.3 ± 104.8 pg/mL and 542.2 ± 139.9 pg/mL, respectively. MMP9 and Aβ showed variable levels across the lifecourse, indicating no correlation to each other or with age nor AMD status, though the smaller AMD cohort was a limiting factor. Aβ and MMP9 levels in the vitreous and blood were unrelated to mean arterial pressure. Smoking, another modifiable risk, showed no association with vitreous Aβ. However, smoking may be linked with vitreous (p = 0.004) and serum (p = 0.005) MMP9 levels in control and AMD groups, though this did not reach our elevated (p = 0.001) significance. A bioinformatics analysis revealed promising MMP9 and APP/Aβ partners for further scrutiny, many of which are already linked with retinopathy.
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Affiliation(s)
- Savannah A. Lynn
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP806, Tremona Road, Southampton SO16 6YD, UK
| | - Flavie Soubigou
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP806, Tremona Road, Southampton SO16 6YD, UK
| | - Jennifer M. Dewing
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP806, Tremona Road, Southampton SO16 6YD, UK
| | - Amanda Smith
- Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Joanna Ballingall
- Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Thea Sass
- Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Isabela Nica
- Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Catrin Watkins
- Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Bhaskar Gupta
- Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Hussein Almuhtaseb
- Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Stephen C. Lash
- Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Ho Ming Yuen
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, MP 801, Tremona Road, Southampton SO16 6YD, UK
| | - Angela Cree
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP806, Tremona Road, Southampton SO16 6YD, UK
| | - Tracey A. Newman
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP806, Tremona Road, Southampton SO16 6YD, UK
| | - Andrew J. Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP806, Tremona Road, Southampton SO16 6YD, UK
- Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - J. Arjuna Ratnayaka
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP806, Tremona Road, Southampton SO16 6YD, UK
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15
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Dave S, Binns A, Vinuela-Navarro V, Callaghan T. What Advice Is Currently Given to Patients with Age-Related Macular Degeneration (AMD) by Eyecare Practitioners, and How Effective Is It at Bringing about a Change in Lifestyle? A Systematic Review. Nutrients 2022; 14:4652. [PMID: 36364912 PMCID: PMC9658969 DOI: 10.3390/nu14214652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 07/09/2024] Open
Abstract
There is currently no treatment for early/intermediate Age-related Macular Degeneration (AMD) but Eye Care Professionals (ECPs) are recommended to advise patients about modifiable lifestyle factors, including dietary changes, that can slow disease progression. The aim of this review was to understand advice currently given to patients with AMD by ECPs and to evaluate evidence regarding patient compliance. A systematic review was conducted of literature published in electronic databases: CINAHL, MEDLINE, PsycINFO, PyscARTICLES, EMBASE, AMED. Methods followed PRISMA guidelines (PROSPERO registration number: CRD42020223724). Twenty-four reports were eligible for inclusion, 12 focused on ECP experience, 7 on patient experience, and 6 on impact of advice (one paper reported on the ECP and patient experience). Studies reported that a substantial proportion of patients did not recall receiving lifestyle modification advice from their ECP (57.95%, range 2-95% across patient based studies). Practitioners were most likely to provide advice about nutritional supplements (80%, range 67-93% across ECP studies), and least likely about smoking (44%, range 28-71% across ECP studies), however supplements advised did not always comply with evidence-based guidelines. The main reason for patients not following lifestyle advice was lack of provision by the ECP (54.5%, range 21-94% across studies on the impact of advice). The review highlighted a need for more studies to understand patient preferences for receiving advice and research on ECP perceived barriers to advice provision.
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Affiliation(s)
- Sonali Dave
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, University of London, Northampton Square, London EC1V 0HB, UK
| | - Alison Binns
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, University of London, Northampton Square, London EC1V 0HB, UK
| | - Valldeflors Vinuela-Navarro
- Department of Optics and Optometry, Universitat Politècnica de Catalunya, Carrer Violinista Vellsolà, 37, 08222 Terrassa, Spain
| | - Tamsin Callaghan
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, University of London, Northampton Square, London EC1V 0HB, UK
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16
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Choi EY, Kim M, Lee CS, Byeon SH, Kim SS, Lee M. Intermittent Fasting Is Associated With a Decreased Risk of Age-Related Macular Degeneration. Am J Ophthalmol 2022; 243:1-9. [PMID: 35809657 DOI: 10.1016/j.ajo.2022.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/15/2022] [Accepted: 06/22/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To investigate the association between intermittent fasting and age-related macular degeneration (AMD) in the general older adult population. DESIGN A cross-sectional study using a population-based, government-led survey data, Korean National Health and Nutrition Examination Survey (KNHANES). METHODS A total of 4504 individuals aged ≥55 years with comprehensive data including meal frequency and fundus photography were selected using the KNHANES 2015-2018 database. Participants were divided into 2 groups based on breakfast frequency per week; intermittent fasting (nearly 0 time/week) and nonfasting (5-7 times/week) groups. Multiple logistic regression analysis was performed to determine the risk factors for AMD identified by fundus photography. RESULTS AMD was identified in 25.1% of total participants. The intermittent fasting group had a decreased risk of AMD compared with the nonfasting group (adjusted odds ratio [aOR] 0.413, 95% CI 0.203-0.841), especially in individuals with a younger age (<70 years, aOR 0.357, 95% CI 0.153-0.833), obesity (aOR 0.663, 95% CI 0.424-1.037), and urban residence (aOR 0.437, 95% CI 0.248-0.769). Increased age (aOR 1.058, 95% CI 1.041-1.076) and serum high-density lipoprotein levels (aOR 1.011, 95% CI 1.002-1.021) were also independent risk factors for AMD. CONCLUSIONS Using the population-based survey data, we demonstrated that intermittent fasting by skipping breakfast was significantly associated with a reduced risk of AMD in a representative older adult population, especially in individuals with age <70 years, obesity, and urban residence.
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Affiliation(s)
- Eun Young Choi
- Department of Ophthalmology, Gangnam Severance Hospital, Institute of Vision Research (E.Y.C., M.K.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Kim
- Department of Ophthalmology, Gangnam Severance Hospital, Institute of Vision Research (E.Y.C., M.K.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, Severance Eye Hospital, Institute of Vision Research (C.S.L., S.H.B., S.S.K.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Severance Eye Hospital, Institute of Vision Research (C.S.L., S.H.B., S.S.K.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Severance Eye Hospital, Institute of Vision Research (C.S.L., S.H.B., S.S.K.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Minyoung Lee
- Department of Internal Medicine (M.L.), Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Endocrine Research (M.L.), Yonsei University College of Medicine, Seoul, Republic of Korea.
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17
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García-Layana A, López-Gálvez M, García-Arumí J, Arias L, Gea-Sánchez A, Marín-Méndez JJ, Sayar-Beristain O, Sedano-Gil G, Aslam TM, Minnella AM, Ibáñez IL, de Dios Hernández JM, Seddon JM. A Screening Tool for Self-Evaluation of Risk for Age-Related Macular Degeneration: Validation in a Spanish Population. Transl Vis Sci Technol 2022; 11:23. [PMID: 35749108 PMCID: PMC9234358 DOI: 10.1167/tvst.11.6.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose The objectives of this study were the creation and validation of a screening tool for age-related macular degeneration (AMD) for routine assessment by primary care physicians, ophthalmologists, other healthcare professionals, and the general population. Methods A simple, self-administered questionnaire (Simplified Théa AMD Risk-Assessment Scale [STARS] version 4.0) which included well-established risk factors for AMD, such as family history, smoking, and dietary factors, was administered to patients during ophthalmology visits. A fundus examination was performed to determine presence of large soft drusen, pigmentary abnormalities, or late AMD. Based on data from the questionnaire and the clinical examination, predictive models were developed to estimate probability of the Age-Related Eye Disease Study (AREDS) score (categorized as low risk/high risk). The models were evaluated by area under the receiving operating characteristic curve analysis. Results A total of 3854 subjects completed the questionnaire and underwent a fundus examination. Early/intermediate and late AMD were detected in 15.9% and 23.8% of the patients, respectively. A predictive model was developed with training, validation, and test datasets. The model in the test set had an area under the curve of 0.745 (95% confidence interval [CI] = 0.705-0.784), a positive predictive value of 0.500 (95% CI = 0.449-0.557), and a negative predictive value of 0.810 (95% CI = 0.770-0.844). Conclusions The STARS questionnaire version 4.0 and the model identify patients at high risk of developing late AMD. Translational Relevance The screening instrument described could be useful to evaluate the risk of late AMD in patients >55 years without having an eye examination, which could lead to more timely referrals and encourage lifestyle changes.
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Affiliation(s)
- Alfredo García-Layana
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain,Navarra Institute for Health Research, IdiSNA, Pamplona, Spain,Red Temática de Investigación Cooperativa Sanitaria en Enfermedades Oculares (Oftared), Instituto de Salud Carlos III, Madrid, Spain
| | - Maribel López-Gálvez
- Red Temática de Investigación Cooperativa Sanitaria en Enfermedades Oculares (Oftared), Instituto de Salud Carlos III, Madrid, Spain,Retina Group, IOBA, Campus Miguel Delibes, Valladolid, Spain,Grupo de Ingeniería Biomédica, Universidad de Valladolid, Campus Miguel Delibes. Valladolid, Spain,Department of Ophthalmology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - José García-Arumí
- Department of Ophthalmology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Luis Arias
- Department of Ophthalmology, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Alfredo Gea-Sánchez
- Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
| | | | | | | | - Tariq M. Aslam
- School of Pharmacy and Optometry, University of Manchester and Manchester Royal Eye Hospital, Manchester, UK
| | - Angelo M. Minnella
- UOC Oculistica, Università Cattolica del S. Cuore, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Isabel López Ibáñez
- Department of Family and Community Medicine, Centro de Salud Nápoles y Sicilia, Valencia, Spain
| | | | - Johanna M. Seddon
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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18
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Keeling E, Lynn SA, Koh YM, Scott JA, Kendall A, Gatherer M, Page A, Cagampang FR, Lotery AJ, Ratnayaka JA. A High Fat "Western-style" Diet Induces AMD-Like Features in Wildtype Mice. Mol Nutr Food Res 2022; 66:e2100823. [PMID: 35306732 PMCID: PMC9287010 DOI: 10.1002/mnfr.202100823] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 03/01/2022] [Indexed: 12/20/2022]
Abstract
Scope The intake of a “Western‐style” diet rich in fats is linked with developing retinopathies including age‐related macular degeneration (AMD). Wildtype mice are given a high fat diet (HFD) to determine how unhealthy foods can bring about retinal degeneration. Methods and results Following weaning, female C57BL/6 mice are maintained on standard chow (7% kcal fat, n = 29) or a HFD (45% kcal fat, n = 27) for 12 months. Animals were sacrificed following electroretinography (ERG) and their eyes analyzed by histology, confocal immunofluorescence, and transmission electron microscopy. HFD mice become obese, but showed normal retinal function compared to chow‐fed controls. However, diminished β3tubulin labeling of retinal cross‐sections indicated fewer/damaged neuronal processes in the inner plexiform layer. AMD‐linked proteins clusterin and TIMP3 accumulated in the retinal pigment epithelium (RPE) and Bruch's membrane (BrM). Neutral lipids also deposited in the outer retinae of HFD mice. Ultrastructural analysis revealed disorganized photoreceptor outer segments, collapsed/misaligned RPE microvilli, vacuoles, convoluted basolateral RPE infolds and BrM changes. Basal laminar‐like deposits were also present alongside abnormal choroidal endothelial cells. Conclusions We show that prolonged exposure to an unhealthy “Western‐style” diet alone can recapitulate early‐intermediate AMD‐like features in wildtype mice, highlighting the importance of diet and nutrition in the etiology of sight‐loss.
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Affiliation(s)
- Eloise Keeling
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP806, Tremona Road, Southampton, SO16 6YD, UK
| | - Savannah A Lynn
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP806, Tremona Road, Southampton, SO16 6YD, UK
| | - Yen Min Koh
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP806, Tremona Road, Southampton, SO16 6YD, UK
| | - Jenny A Scott
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP806, Tremona Road, Southampton, SO16 6YD, UK
| | - Aaron Kendall
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP806, Tremona Road, Southampton, SO16 6YD, UK
| | - Maureen Gatherer
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP806, Tremona Road, Southampton, SO16 6YD, UK
| | - Anton Page
- Biomedical Imaging Unit, University of Southampton, MP12, Tremona Road, Southampton, SO16 6YD, UK
| | - Felino R Cagampang
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Andrew J Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP806, Tremona Road, Southampton, SO16 6YD, UK.,Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - J Arjuna Ratnayaka
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP806, Tremona Road, Southampton, SO16 6YD, UK
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Gastaldello A, Giampieri F, Quiles JL, Navarro-Hortal MD, Aparicio S, García Villena E, Tutusaus Pifarre K, De Giuseppe R, Grosso G, Cianciosi D, Forbes-Hernández TY, Nabavi SM, Battino M. Adherence to the Mediterranean-Style Eating Pattern and Macular Degeneration: A Systematic Review of Observational Studies. Nutrients 2022; 14:nu14102028. [PMID: 35631175 PMCID: PMC9144566 DOI: 10.3390/nu14102028] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/01/2022] [Accepted: 05/10/2022] [Indexed: 02/01/2023] Open
Abstract
Age-related macular degeneration (AMD) is a serious degenerative disease affecting the eyes, and is the main cause of severe vision loss among people >55 years of age in developed countries. Its onset and progression have been associated with several genetic and lifestyle factors, with diet appearing to play a pivotal role in the latter. In particular, dietary eating patterns rich in plant foods have been shown to lower the risk of developing the disease, and to decrease the odds of progressing to more advanced stages in individuals already burdened with early AMD. We systematically reviewed the literature to analyse the relationship between the adherence to a Mediterranean diet, a mainly plant-based dietary pattern, and the onset/progression of AMD. Eight human observational studies were analysed. Despite some differences, they consistently indicate that higher adherence to a Mediterranean eating pattern lowers the odds of developing AMD and decreases the risk of progression to more advanced stages of the disease, establishing the way for preventative measures emphasizing dietary patterns rich in plant-foods.
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Affiliation(s)
- Annalisa Gastaldello
- Research Group on Foods, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, 39011 Santander, Spain; (A.G.); (J.L.Q.); (S.A.); (E.G.V.); (K.T.P.)
| | - Francesca Giampieri
- Research Group on Foods, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, 39011 Santander, Spain; (A.G.); (J.L.Q.); (S.A.); (E.G.V.); (K.T.P.)
- Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah 80200, Saudi Arabia
- Correspondence: (F.G.); (M.B.)
| | - José L. Quiles
- Research Group on Foods, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, 39011 Santander, Spain; (A.G.); (J.L.Q.); (S.A.); (E.G.V.); (K.T.P.)
- Department of Physiology, Institute of Nutrition and Food Technology “José Mataix”, Biomedical Research Centre, University of Granada, 18100 Granada, Spain; (M.D.N.-H.); (T.Y.F.-H.)
| | - María D. Navarro-Hortal
- Department of Physiology, Institute of Nutrition and Food Technology “José Mataix”, Biomedical Research Centre, University of Granada, 18100 Granada, Spain; (M.D.N.-H.); (T.Y.F.-H.)
| | - Silvia Aparicio
- Research Group on Foods, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, 39011 Santander, Spain; (A.G.); (J.L.Q.); (S.A.); (E.G.V.); (K.T.P.)
- Faculdade de Ciências Sociais e Humanas, Universidade Internacional do Cuanza Bairro Kaluanda, Cuito EN 250, Bié, Angola
| | - Eduardo García Villena
- Research Group on Foods, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, 39011 Santander, Spain; (A.G.); (J.L.Q.); (S.A.); (E.G.V.); (K.T.P.)
- Department de Salud, Universidad Internacional Iberoamericana Campeche, Campeche 24560, Mexico
| | - Kilian Tutusaus Pifarre
- Research Group on Foods, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, 39011 Santander, Spain; (A.G.); (J.L.Q.); (S.A.); (E.G.V.); (K.T.P.)
- Department de Salud, Universidad Internacional Iberoamericana Campeche, Campeche 24560, Mexico
| | - Rachele De Giuseppe
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Giuseppe Grosso
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95124 Catania, Italy;
| | - Danila Cianciosi
- Department of Clinical Sciences, Polytechnic University of Marche, 60131 Ancona, Italy;
| | - Tamara Y. Forbes-Hernández
- Department of Physiology, Institute of Nutrition and Food Technology “José Mataix”, Biomedical Research Centre, University of Granada, 18100 Granada, Spain; (M.D.N.-H.); (T.Y.F.-H.)
| | - Seyed M. Nabavi
- Applied Biotechnology Research Center, Baqiyatallah University of Medical Sciences, Tehran 1435916471, Iran;
| | - Maurizio Battino
- Research Group on Foods, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, 39011 Santander, Spain; (A.G.); (J.L.Q.); (S.A.); (E.G.V.); (K.T.P.)
- Department of Clinical Sciences, Polytechnic University of Marche, 60131 Ancona, Italy;
- International Joint Research Laboratory of Intelligent Agriculture and Agri-Products Processing, Jiangsu University, Zhenjiang 212013, China
- Correspondence: (F.G.); (M.B.)
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20
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Sasaki M, Miyagawa N, Harada S, Tsubota K, Takebayashi T, Nishiwaki Y, Kawasaki R. Dietary Patterns and Their Associations with Intermediate Age-Related Macular Degeneration in a Japanese Population. J Clin Med 2022; 11:jcm11061617. [PMID: 35329943 PMCID: PMC8955354 DOI: 10.3390/jcm11061617] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 11/22/2022] Open
Abstract
This population-based cross-sectional study investigated the influence of dietary patterns on age-related macular degeneration (AMD) in a Japanese population. The Tsuruoka Metabolomics Cohort Study enrolled a general population aged 35–74 years from among participants in annual health check-up programs in Tsuruoka City, Japan. Eating habits were assessed using a food frequency questionnaire. Principal component analysis was used to identify dietary patterns among food items. The association between quartiles of scores for each dietary pattern and intermediate AMD was assessed using multivariate logistic regression models. Of 3433 participants, 415 had intermediate AMD. We identified four principal components comprising the Vegetable-rich pattern, Varied staple food pattern, Animal-rich pattern, and Seafood-rich pattern. After adjusting for potential confounders, higher Varied staple food diet scores were associated with a lower prevalence of intermediate AMD (fourth vs. first quartile) (OR, 0.63; 95% confidence interval [CI], 0.46–0.86). A significant trend of decreasing ORs for intermediate AMD associated with increasing Varied staple food diet scores was noted (p for trend = 0.002). There was no significant association between the other dietary patterns and intermediate AMD. In a Japanese population, individuals with a dietary pattern score high in the Varied staple food pattern had a lower prevalence of intermediate AMD.
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Affiliation(s)
- Mariko Sasaki
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan;
- Department of Ophthalmology, Tachikawa Hospital, Tokyo 190-8531, Japan
- National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo 152-8902, Japan
- Correspondence:
| | - Naoko Miyagawa
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo 160-8582, Japan; (N.M.); (S.H.); (T.T.)
| | - Sei Harada
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo 160-8582, Japan; (N.M.); (S.H.); (T.T.)
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan;
| | - Toru Takebayashi
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo 160-8582, Japan; (N.M.); (S.H.); (T.T.)
| | - Yuji Nishiwaki
- Department of Environmental and Occupational Health, Toho University, Tokyo 143-8540, Japan;
| | - Ryo Kawasaki
- Department of Vision Informatics (Topcon), Osaka University Graduate School of Medicine, Osaka 565-0871, Japan;
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21
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Di Carlo E, Augustin AJ. Prevention of the Onset of Age-Related Macular Degeneration. J Clin Med 2021; 10:jcm10153297. [PMID: 34362080 PMCID: PMC8348883 DOI: 10.3390/jcm10153297] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 12/12/2022] Open
Abstract
Age-related macular degeneration (AMD) represents the leading cause of irreversible blindness in elderly people, mostly after the age of 65. The progressive deterioration of visual function in patients affected by AMD has a significant impact on quality of life and has also high social costs. The current therapeutic options are only partially able to slow down the natural course of the disease, without being capable of stopping its progression. Therefore, better understanding of the possibilities to prevent the onset of the disease is needed. In this regard, a central role is played by the identification of risk factors, which might participate to the development of the disease. Among these, the most researched are dietary risk factors, lifestyle, and light exposure. Many studies showed that a higher dietary intake of nutrients, such as lutein, zeaxanthin, beta carotene, omega-3 fatty acids and zinc, reduced the risk of early AMD. Regarding lifestyle habits, the association between smoking and AMD is currently accepted. Finally, retinal damage caused by ultraviolet rays and blue light is also worthy of attention. The scope of this review is to summarize the present knowledge focusing on the measures to adopt in order to prevent the onset of AMD.
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22
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Fleckenstein M, Keenan TDL, Guymer RH, Chakravarthy U, Schmitz-Valckenberg S, Klaver CC, Wong WT, Chew EY. Age-related macular degeneration. Nat Rev Dis Primers 2021; 7:31. [PMID: 33958600 DOI: 10.1038/s41572-021-00265-2] [Citation(s) in RCA: 423] [Impact Index Per Article: 141.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 02/07/2023]
Abstract
Age-related macular degeneration (AMD) is the leading cause of legal blindness in the industrialized world. AMD is characterized by accumulation of extracellular deposits, namely drusen, along with progressive degeneration of photoreceptors and adjacent tissues. AMD is a multifactorial disease encompassing a complex interplay between ageing, environmental risk factors and genetic susceptibility. Chronic inflammation, lipid deposition, oxidative stress and impaired extracellular matrix maintenance are strongly implicated in AMD pathogenesis. However, the exact interactions of pathophysiological events that culminate in drusen formation and the associated degeneration processes remain to be elucidated. Despite tremendous advances in clinical care and in unravelling pathophysiological mechanisms, the unmet medical need related to AMD remains substantial. Although there have been major breakthroughs in the treatment of exudative AMD, no efficacious treatment is yet available to prevent progressive irreversible photoreceptor degeneration, which leads to central vision loss. Compelling progress in high-resolution retinal imaging has enabled refined phenotyping of AMD in vivo. These insights, in combination with clinicopathological and genetic correlations, have underscored the heterogeneity of AMD. Hence, our current understanding promotes the view that AMD represents a disease spectrum comprising distinct phenotypes with different mechanisms of pathogenesis. Hence, tailoring therapeutics to specific phenotypes and stages may, in the future, be the key to preventing irreversible vision loss.
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Affiliation(s)
- Monika Fleckenstein
- Department of Ophthalmology and Visual Science, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA.
| | - Tiarnán D L Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Melbourne, VIC, Australia
- Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia
| | - Usha Chakravarthy
- Department of Ophthalmology, Centre for Public Health, Queen's University of Belfast, Belfast, UK
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology and Visual Science, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Caroline C Klaver
- Department of Ophthalmology, Erasmus MC, Rotterdam, Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands
- Department of Ophthalmology, Radboud Medical Center, Nijmegen, Netherlands
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Wai T Wong
- Section on Neuron-Glia Interactions in Retinal Disease, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA.
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23
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Pugazhendhi A, Hubbell M, Jairam P, Ambati B. Neovascular Macular Degeneration: A Review of Etiology, Risk Factors, and Recent Advances in Research and Therapy. Int J Mol Sci 2021; 22:1170. [PMID: 33504013 PMCID: PMC7866170 DOI: 10.3390/ijms22031170] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/11/2021] [Accepted: 01/19/2021] [Indexed: 12/14/2022] Open
Abstract
Neovascular age-related macular degeneration (exudative or wet AMD) is a prevalent, progressive retinal degenerative macular disease that is characterized by neovascularization of the choroid, mainly affecting the elderly population causing gradual vision impairment. Risk factors such as age, race, genetics, iris color, smoking, drinking, BMI, and diet all play a part in nvAMD's progression, with anti-vascular endothelial growth factor (anti-VEGF) therapy being the mainstay of treatment. Current therapeutic advancements slow the progression of the disease but do not cure or reverse its course. Newer therapies such as gene therapies, Rho-kinase inhibitors, and levodopa offer potential new targets for treatment.
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Affiliation(s)
- Arunbalaji Pugazhendhi
- Knights Campus for Accelerating Scientific Impact, University of Oregon, Eugene, OR 97403, USA; (A.P.); (M.H.)
| | - Margaret Hubbell
- Knights Campus for Accelerating Scientific Impact, University of Oregon, Eugene, OR 97403, USA; (A.P.); (M.H.)
| | - Pooja Jairam
- Vagelos College of Physicians & Surgeons, Columbia Irving Medical Center, Columbia University, New York, NY 10032, USA;
| | - Balamurali Ambati
- Knights Campus for Accelerating Scientific Impact, University of Oregon, Eugene, OR 97403, USA; (A.P.); (M.H.)
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24
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Age-Related Macular Degeneration: Epidemiology and Clinical Aspects. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1256:1-31. [PMID: 33847996 DOI: 10.1007/978-3-030-66014-7_1] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Age-related macular degeneration (AMD) is a degenerative disease of the human retina affecting individuals over the age of 55 years. This heterogeneous condition arises from a complex interplay between age, genetics, and environmental factors including smoking and diet. It is the leading cause of blindness in industrialized countries. Worldwide, the number of people with AMD is predicted to increase from 196 million in 2020 to 288 million by 2040. By this time, Asia is predicted to have the largest number of people with the disease. Distinct patterns of AMD prevalence and phenotype are seen between geographical areas that are not explained fully by disparities in population structures. AMD is classified into early, intermediate, and late stages. The early and intermediate stages, when visual symptoms are typically absent or mild, are characterized by macular deposits (drusen) and pigmentary abnormalities. Through risk prediction calculators, grading these features helps predict the risk of progression to late AMD. Late AMD is divided into neovascular and atrophic forms, though these can coexist. The defining lesions are macular neovascularization and geographic atrophy, respectively. At this stage, visual symptoms are often severe and irreversible, and can comprise profoundly decreased central vision in both eyes. For these reasons, the condition has major implications for individuals and society, as affected individuals may experience substantially decreased quality of life and independence. Recent advances in retinal imaging have led to the recognition of an expanded set of AMD phenotypes, including reticular pseudodrusen, nonexudative macular neovascularization, and subtypes of atrophy. These developments may lead to refinements in current classification systems.
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25
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Colijn JM, Meester-Smoor M, Verzijden T, de Breuk A, Silva R, Merle BMJ, Cougnard-Grégoire A, Hoyng CB, Fauser S, Coolen A, Creuzot-Garcher C, Hense HW, Ueffing M, Delcourt C, den Hollander AI, Klaver CCW. Genetic Risk, Lifestyle, and Age-Related Macular Degeneration in Europe: The EYE-RISK Consortium. Ophthalmology 2020; 128:1039-1049. [PMID: 33253757 DOI: 10.1016/j.ophtha.2020.11.024] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 11/17/2020] [Accepted: 11/23/2020] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Age-related macular degeneration (AMD) is a common multifactorial disease in the elderly with a prominent genetic basis. Many risk variants have been identified, but the interpretation remains challenging. We investigated the genetic distribution of AMD-associated risk variants in a large European consortium, calculated attributable and pathway-specific genetic risks, and assessed the influence of lifestyle on genetic outcomes. DESIGN Pooled analysis of cross-sectional data from the European Eye Epidemiology Consortium. PARTICIPANTS Seventeen thousand one hundred seventy-four individuals 45 years of age or older participating in 6 population-based cohort studies, 2 clinic-based studies, and 1 case-control study. METHODS Age-related macular degeneration was diagnosed and graded based on fundus photographs. Data on genetics, lifestyle, and diet were harmonized. Minor allele frequencies and population-attributable fraction (PAF) were calculated. A total genetic risk score (GRS) and pathway-specific risk scores (complement, lipid, extra-cellular matrix, other) were constructed based on the dosage of SNPs and conditional β values; a lifestyle score was constructed based on smoking and diet. MAIN OUTCOME MEASURES Intermediate and late AMD. RESULTS The risk variants with the largest difference between late AMD patients and control participants and the highest PAFs were located in ARMS2 (rs3750846) and CHF (rs570618 and rs10922109). Combining all genetic variants, the total genetic risk score ranged from -3.50 to 4.63 and increased with AMD severity. Of the late AMD patients, 1581 of 1777 (89%) showed a positive total GRS. The complement pathway and ARMS2 were by far the most prominent genetic pathways contributing to late AMD (positive GRS, 90% of patients with late disease), but risk in 3 pathways was most frequent (35% of patients with late disease). Lifestyle was a strong determinant of the outcome in each genetic risk category; unfavorable lifestyle increased the risk of late AMD at least 2-fold. CONCLUSIONS Genetic risk variants contribute to late AMD in most patients. However, lifestyle factors have a strong influence on the outcome of genetic risk and should be a strong focus in patient management. Genetic risks in ARMS2 and the complement pathway are present in most late AMD patients but are mostly combined with risks in other pathways.
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Affiliation(s)
- Johanna M Colijn
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Magda Meester-Smoor
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Timo Verzijden
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Anita de Breuk
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rufino Silva
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Department of Ophthalmology, Coimbra Hospital and University Center, Coimbra, Portugal; Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Benedicte M J Merle
- Team LEHA, Bordeaux Population Health Research Center, Inserm, Université de Bordeaux, Bordeaux, France
| | - Audrey Cougnard-Grégoire
- Team LEHA, Bordeaux Population Health Research Center, Inserm, Université de Bordeaux, Bordeaux, France
| | - Carel B Hoyng
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sascha Fauser
- Department of Ophthalmology, University Hospital Cologne, Cologne, Germany; Hoffmann-La Roche AG, Basel, Switzerland
| | - Anthonius Coolen
- Randall Division of Cellular and Molecular Biophysics, King's College London, London, United Kingdom; Department of Mathematics, King's College London, London, United Kingdom
| | - Catherine Creuzot-Garcher
- Department of Ophthalmology, University Hospital, Eye and Nutrition Research Group, INRAe, Dijon, France
| | - Hans-Werner Hense
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Marius Ueffing
- Centre for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
| | - Cecile Delcourt
- Team LEHA, Bordeaux Population Health Research Center, Inserm, Université de Bordeaux, Bordeaux, France
| | - Anneke I den Hollander
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland.
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26
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Blasiak J, Pawlowska E, Sobczuk A, Szczepanska J, Kaarniranta K. The Aging Stress Response and Its Implication for AMD Pathogenesis. Int J Mol Sci 2020; 21:ijms21228840. [PMID: 33266495 PMCID: PMC7700335 DOI: 10.3390/ijms21228840] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/12/2020] [Accepted: 11/20/2020] [Indexed: 02/07/2023] Open
Abstract
Aging induces several stress response pathways to counterbalance detrimental changes associated with this process. These pathways include nutrient signaling, proteostasis, mitochondrial quality control and DNA damage response. At the cellular level, these pathways are controlled by evolutionarily conserved signaling molecules, such as 5’AMP-activated protein kinase (AMPK), mechanistic target of rapamycin (mTOR), insulin/insulin-like growth factor 1 (IGF-1) and sirtuins, including SIRT1. Peroxisome proliferation-activated receptor coactivator 1 alpha (PGC-1α), encoded by the PPARGC1A gene, playing an important role in antioxidant defense and mitochondrial biogenesis, may interact with these molecules influencing lifespan and general fitness. Perturbation in the aging stress response may lead to aging-related disorders, including age-related macular degeneration (AMD), the main reason for vision loss in the elderly. This is supported by studies showing an important role of disturbances in mitochondrial metabolism, DDR and autophagy in AMD pathogenesis. In addition, disturbed expression of PGC-1α was shown to associate with AMD. Therefore, the aging stress response may be critical for AMD pathogenesis, and further studies are needed to precisely determine mechanisms underlying its role in AMD. These studies can include research on retinal cells produced from pluripotent stem cells obtained from AMD donors with the mutations, either native or engineered, in the critical genes for the aging stress response, including AMPK, IGF1, MTOR, SIRT1 and PPARGC1A.
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Affiliation(s)
- Janusz Blasiak
- Department of Molecular Genetics, Faculty of Biology and Environmental Protection, University of Lodz, 90-236 Lodz, Poland
- Correspondence: ; Tel.: +48-426354334
| | - Elzbieta Pawlowska
- Department of Orthodontics, Medical University of Lodz, 92-216 Lodz, Poland;
| | - Anna Sobczuk
- Department of Gynaecology and Obstetrics, Medical University of Lodz, 93-338 Lodz, Poland;
| | - Joanna Szczepanska
- Department of Pediatric Dentistry, Medical University of Lodz, 92-216 Lodz, Poland;
| | - Kai Kaarniranta
- Department of Ophthalmology, University of Eastern Finland, 70211 Kuopio, Finland;
- Department of Ophthalmology, Kuopio University Hospital, 70211 Kuopio, Finland
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27
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Gocuk SA, Lee J, Keller PR, Ayton LN, Guymer RH, McKendrick AM, Downie LE. Clinical audit as an educative tool for optometrists: an intervention study in age‐related macular degeneration. Ophthalmic Physiol Opt 2020; 41:53-72. [DOI: 10.1111/opo.12754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/13/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Sena A Gocuk
- Department of Optometry and Vision Sciences The University of Melbourne Parkville Australia
| | - Ji‐hyun Lee
- Department of Optometry and Vision Sciences The University of Melbourne Parkville Australia
| | - Peter R Keller
- Department of Optometry and Vision Sciences The University of Melbourne Parkville Australia
| | - Lauren N Ayton
- Department of Optometry and Vision Sciences The University of Melbourne Parkville Australia
- Department of Surgery (Ophthalmology) The University of Melbourne Parkville Australia
- Centre for Eye Research Australia Royal Victorian Eye and Ear Hospital Melbourne Australia
| | - Robyn H Guymer
- Department of Surgery (Ophthalmology) The University of Melbourne Parkville Australia
- Centre for Eye Research Australia Royal Victorian Eye and Ear Hospital Melbourne Australia
| | - Allison M McKendrick
- Department of Optometry and Vision Sciences The University of Melbourne Parkville Australia
| | - Laura E Downie
- Department of Optometry and Vision Sciences The University of Melbourne Parkville Australia
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28
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Broadhead GK, Hong T, Bahrami B, Flood V, Liew G, Chang AA. Diet and risk of visual impairment: a review of dietary factors and risk of common causes of visual impairment. Nutr Rev 2020; 79:636-650. [PMID: 33051676 DOI: 10.1093/nutrit/nuaa100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Age-related macular degeneration, diabetic retinopathy, cataract, and glaucoma remain the leading causes of visual impairment in developed nations, resulting in a substantial treatment burden on sufferers and health care systems. Despite significant advances in diagnostic testing and therapeutics, population-based strategies to reduce the burden of these diseases remain limited. However, there is some evidence that these diseases may share overlapping risk factors, particularly in regard to dietary intake and antioxidant status, and it is thus possible that dietary modification may reduce both the prevalence and severity of these conditions. In particular, dietary intake of green leafy vegetables, hyperglycemia/glycemia index, and omega-3 fatty acid intake, as well as overall dietary patterns, may affect risk of one or more of these conditions. In this review, we analyse the evidence for dietary intake and the association with these conditions, and provide insights into possible modifications that may thus simultaneously reduce the risk of visual impairment from multiple causes, including improving dietary intake of green leafy vegetables and reducing dietary glycemic index, both of which have been associated with a decreased risk of multiple causes of visual impairment.
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Affiliation(s)
- Geoffrey K Broadhead
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia.,Sydney Institute of Vision Science, Sydney, NSW, Australia.,Sydney Institute of Vision Science, Sydney, NSW, Australia
| | - Thomas Hong
- Sydney Institute of Vision Science, Sydney, NSW, Australia
| | - Bobak Bahrami
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia.,Sydney Institute of Vision Science, Sydney, NSW, Australia.,Sydney Institute of Vision Science, Sydney, NSW, Australia
| | - Victoria Flood
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Western Sydney Local Health District, Sydney, NSW, Australia.,Westmead Hospital, Western Sydney Local Health District, Westmead, NSW, Australia
| | - Gerald Liew
- Centre for Vision Research, The Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Andrew A Chang
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia.,Sydney Institute of Vision Science, Sydney, NSW, Australia.,Sydney Institute of Vision Science, Sydney, NSW, Australia
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Tang D, Mitchell P, Liew G, Burlutsky G, Flood VM, Gopinath B. Telephone-Delivered Dietary Intervention in Patients with Age-Related Macular Degeneration: 3-Month Post-Intervention Findings of a Randomised Controlled Trial. Nutrients 2020; 12:E3083. [PMID: 33050401 PMCID: PMC7650817 DOI: 10.3390/nu12103083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/02/2020] [Accepted: 10/06/2020] [Indexed: 11/17/2022] Open
Abstract
There is an evidence-practice gap between the dietary recommendations for age-related macular degeneration (AMD) presented in the literature and those practiced by patients. This study reports on the 3-month post-intervention results of a randomised controlled trial (RCT) evaluating telephone-delivered counselling to improve dietary behaviours among AMD patients. A total of 155 AMD patients (57% female, aged 78 ± 8 years; control: 78, intervention: 77), primarily residing in New South Wales, Australia, were recruited. Participants completed a baseline questionnaire and a short dietary questionnaire (SDQ-AMD). The intervention included an evidence-based nutrition resource and four monthly calls with a dietitian. Immediately post-intervention, intervention participants repeated the SDQ-AMD and completed a feedback form. At 3 months post-intervention, both study arms repeated the SDQ-AMD. Statistical analyses included t-tests and McNemar's test. Intervention participants reported satisfaction with the tailored phone calls, nutrition resource and nutrition education provided. At 3 months post-intervention, there was no statistically significant difference between study arms in the proportion of participants meeting the dietary goals nor in intake (mean servings ± SE) of total vegetables (primary outcome) and other key food groups; however, there was a significantly higher intake of nuts (secondary outcome) (3.96 ± 0.51 vs. 2.71 ± 0.32; p = 0.04) among participants in the intervention versus control group. Within the intervention arm, there were also significant improvements in intakes of the following secondary outcomes: dark green leafy vegetables (0.99 ± 0.17 vs. 1.71 ± 0.22; p = 0.003) and legumes (0.69 ± 0.10 vs. 1.12 ± 0.16; p = 0.02) and intake of sweets and processed/prepared foods (8.31 ± 0.76 vs. 6.54 ± 0.58, p = 0.01). In summary, although there were few dietary differences between study arms at 3 months post-intervention, the intervention involving four monthly calls was acceptable and helpful to the participants. This type of intervention therefore has the potential to provide people with AMD the needed support for improving their nutrition knowledge and dietary practices, especially if continued over a longer period.
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Affiliation(s)
- Diana Tang
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Camperdown, NSW 2006, Australia; (P.M.); (G.L.); (G.B.); (B.G.)
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Camperdown, NSW 2006, Australia; (P.M.); (G.L.); (G.B.); (B.G.)
| | - Gerald Liew
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Camperdown, NSW 2006, Australia; (P.M.); (G.L.); (G.B.); (B.G.)
| | - George Burlutsky
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Camperdown, NSW 2006, Australia; (P.M.); (G.L.); (G.B.); (B.G.)
| | - Victoria M. Flood
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia;
- Western Sydney Local Health District, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Bamini Gopinath
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Camperdown, NSW 2006, Australia; (P.M.); (G.L.); (G.B.); (B.G.)
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Dietary Patterns, Carbohydrates, and Age-Related Eye Diseases. Nutrients 2020; 12:nu12092862. [PMID: 32962100 PMCID: PMC7551870 DOI: 10.3390/nu12092862] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 12/19/2022] Open
Abstract
Over a third of older adults in the U.S. experience significant vision loss, which decreases independence and is a biomarker of decreased health span. As the global aging population is expanding, it is imperative to uncover strategies to increase health span and reduce the economic burden of this age-related disease. While there are some treatments available for age-related vision loss, such as surgical removal of cataracts, many causes of vision loss, such as dry age-related macular degeneration (AMD), remain poorly understood and no treatments are currently available. Therefore, it is necessary to better understand the factors that contribute to disease progression for age-related vision loss and to uncover methods for disease prevention. One such factor is the effect of diet on ocular diseases. There are many reviews regarding micronutrients and their effect on eye health. Here, we discuss the impact of dietary patterns on the incidence and progression of age-related eye diseases, namely AMD, cataracts, diabetic retinopathy, and glaucoma. Then, we focus on the specific role of dietary carbohydrates, first by outlining the physiological effects of carbohydrates on the body and then how these changes translate into eye and age-related ocular diseases. Finally, we discuss future directions of nutrition research as it relates to aging and vision loss, with a discussion of caloric restriction, intermittent fasting, drug interventions, and emerging randomized clinical trials. This is a rich field with the capacity to improve life quality for millions of people so they may live with clear vision for longer and avoid the high cost of vision-saving surgeries.
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Dighe S, Zhao J, Steffen L, Mares JA, Meuer SM, Klein BEK, Klein R, Millen AE. Diet patterns and the incidence of age-related macular degeneration in the Atherosclerosis Risk in Communities (ARIC) study. Br J Ophthalmol 2020; 104:1070-1076. [PMID: 31810976 PMCID: PMC8218331 DOI: 10.1136/bjophthalmol-2019-314813] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/28/2019] [Accepted: 11/05/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss among the elderly. OBJECTIVE This study aimed to determine the association between dietary patterns and food groups (used to make them) with the 18-year incidence of AMD. METHODS ARIC (Atherosclerosis Risk in Communities) participants who showed change in AMD lesions between retinal photographs taken at visit 3 and visit 5 were graded side by side to determine incident AMD (any=144; early=117; late=27). A 66-line item food frequency questionnaire, administered at visit 1 and visit 3, was used to identify 29 food groups. Principal component analysis was used to derive dietary patterns from average food group servings. Logistic regression was used to estimate ORs and 95% CIs for incident AMD (any, early and late) by tertiles of dietary pattern scores, adjusted for age, race, education, total calories and smoking status. P-trend was estimated using continuous scores. RESULTS Western (unhealthy) and Prudent (healthy) dietary patterns were identified. No significant associations were observed between either dietary pattern and incident any or incident early AMD. However, a threefold higher incidence of late AMD was observed among participants with a Western pattern score above, as compared with below, the median (OR=3.44 (95% CI 1.33 to 8.87), p-trend=0.014). The risk of developing late AMD was decreased, but not statistically significant, among participants with a Prudent pattern score above, as compared with below, the median (OR=0.51 (95% CI 0.22 to 1.18), p-trend=0.054). CONCLUSIONS Diet patterns were not significantly associated with incident any or incident early AMD. However, consumption of a Western pattern diet may be a risk factor for development of late AMD.
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Affiliation(s)
- Shruti Dighe
- Department of Epidemiology and Environmental health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Jiwei Zhao
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Lyn Steffen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, Minneapolis, Minnesota, USA
| | - J A Mares
- Department of Ophthalmology and Visual Sciences, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Stacy M Meuer
- Department of Ophthalmology and Visual Sciences, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Barbara E K Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Amy E Millen
- Department of Epidemiology and Environmental health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York, USA
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Jones M, Whitton C, Tan AG, Holliday EG, Oldmeadow C, Flood VM, Sim X, Chai JF, Hamzah H, Klein R, Teo YY, Mitchell P, Wong TY, Tai ES, Van Dam RM, Attia J, Wang JJ. Exploring Factors Underlying Ethnic Difference in Age-related Macular Degeneration Prevalence. Ophthalmic Epidemiol 2020; 27:399-408. [PMID: 32511069 DOI: 10.1080/09286586.2020.1762229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIMS To assess contributions of dietary and genetic factors to ethnic differences in AMD prevalence. DESIGN Population-based analytical study. METHODS In the Blue Mountains Eye Study, Australia (European ancestry n = 2826) and Multi-Ethnic Cohort Study, Singapore (Asian ancestry, n = 1900), AMD was assessed from retinal photographs. Patterns of dietary composition and scores of the Alternative Healthy Eating Index were computed using food frequency questionnaire data. Genetic susceptibility to AMD was determined using either single nucleotide polymorphisms (SNPs) of the complement factor H and age-related maculopathy susceptibility 2 genes, or combined odds-weighted genetic risk scores of 24 AMD-associated SNPs. Associations of AMD with ethnicity, diet, and genetics were assessed using logistic regression. Six potential mediators covering genetic, diet and lifestyle factors were assessed for their contributions to AMD risk difference between the two samples using mediation analyses. RESULTS Age-standardized prevalence of any (early or late) AMD was higher in the European (16%) compared to Asian samples (9%, p < .01). Mean AMD-related genetic risk scores were also higher in European (33.3 ± 4.4) than Asian (Chinese) samples (31.7 ± 3.7, p < .001). In a model simultaneously adjusting for age, ethnicity, genetic susceptibility and Alternative Healthy Eating Index scores, only age and genetic susceptibility were significantly associated with AMD. Genetic risk scores contributed 19% of AMD risk difference between the two samples while intake of polyunsaturated fatty acids contributed 7.2%. CONCLUSION Genetic susceptibility to AMD was higher in European compared to Chinese samples and explained more of the AMD risk difference between the two samples than the dietary factors investigated.
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Affiliation(s)
- Mark Jones
- , Hunter Medical Research Institute , Newcastle, NSW, Australia
| | - Clare Whitton
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System , Singapore
| | - Ava G Tan
- Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney , Westmead, NSW, Australia
| | - Elizabeth G Holliday
- Centre for Clinical Epidemiology and Biostatistics, and School of Medicine and Public Health, University of Newcastle , Newcastle, NSW, Australia
| | - Christopher Oldmeadow
- , Hunter Medical Research Institute , Newcastle, NSW, Australia.,Centre for Clinical Epidemiology and Biostatistics, and School of Medicine and Public Health, University of Newcastle , Newcastle, NSW, Australia
| | - Victoria M Flood
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney , Sydney, NSW, Australia.,Westmead Hospital, Western Sydney Local Health District , Sydney, NSW, Australia
| | - Xueling Sim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System , Singapore
| | - Jin-Fang Chai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System , Singapore
| | - Haslina Hamzah
- Ocular Reading Centre, Singapore National Eye Centre , Singapore
| | - Ronald Klein
- Department of Ophthalmology & Visual Sciences, University of Wisconsin Medical School , Madison, Wisconsin, USA
| | - Yik-Ying Teo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System , Singapore
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney , Westmead, NSW, Australia
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Center , Singapore.,Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School , Singapore
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System , Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore , Singapore.,Cardiovascular and Metabolic Disease Signature Research Program, Duke-NUS Medical School , Singapore
| | - Rob M Van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System , Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore , Singapore.,Department of Nutrition, Harvard T.H. Chan School of Public Health , Boston, Massachusetts, USA
| | - John Attia
- , Hunter Medical Research Institute , Newcastle, NSW, Australia.,Centre for Clinical Epidemiology and Biostatistics, and School of Medicine and Public Health, University of Newcastle , Newcastle, NSW, Australia
| | - Jie Jin Wang
- Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney , Westmead, NSW, Australia.,Health Services and Systems Research, Duke-NUS Medical School , Singapore
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Merle BMJ, Rosner B, Seddon JM. Genetic Susceptibility, Diet Quality, and Two-Step Progression in Drusen Size. Invest Ophthalmol Vis Sci 2020; 61:17. [PMID: 32407518 PMCID: PMC7405620 DOI: 10.1167/iovs.61.5.17] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/27/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose To investigate the relationship of growth in drusen size with genetic susceptibility and adherence to the alternate Mediterranean diet. Methods Participants in this analysis had complete ocular, genetic, and dietary data with mean follow-up time of 10.2 years in the Age-Related Eye Disease database. Maximal drusen size was graded on an ordinal scale and two-step progression was determined. A genetic risk score using variants associated with advanced AMD and derived from a stepwise regression model yielded 11 variants in 8 genes. Adherence to the alternate Mediterranean diet was assessed using a nine-component score based on intake of vegetables, fruits, legumes, whole cereals, fish, meat, nuts, alcohol, and monounsaturated-to-saturated fatty acids ratio. Multivariate Cox proportional hazards models were used. Results Among 3023 eligible eyes, 19% had drusen growth. In the stepwise selection, common and rare risk alleles for CFH Y402H, CFH rs1410996, CFH R1210C, C3 R102G, C3 K155Q, and ARMS2/HTRA1, as well as VEGF-A, TIMP3, NPLOC4, and HSPH1 variants were significantly associated with 2-step progression in drusen size, and the C2 E318D protective allele conferred decreased risk, adjusting for other covariates. A higher genetic risk score conferred a higher risk (hazard ratio per 1-unit increase, 2.68; 95% confidence interval, 2.23-3.23; P < 0.001), and a medium/high adherence to alternate Mediterranean diet score (4-9) tended to lower risk (hazard ratio, 0.83; 95% confidence interval, 0.68-0.99; P = 0.049), adjusting for all covariates. Conclusions Genetic susceptibility was independently related to drusen growth. A Mediterranean-style diet with healthful nutrient-rich foods (fruits, vegetables, legumes and fish), may reduce enlargement of drusen, the hallmark of AMD.
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Affiliation(s)
- Bénédicte M. J. Merle
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, team LEHA, UMR 1219, Bordeaux, France
| | - Bernard Rosner
- Channing Division of Network Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts, United States
| | - Johanna M. Seddon
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, United States
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Keenan TD, Agrón E, Mares J, Clemons TE, van Asten F, Swaroop A, Chew EY. Adherence to the Mediterranean Diet and Progression to Late Age-Related Macular Degeneration in the Age-Related Eye Disease Studies 1 and 2. Ophthalmology 2020; 127:1515-1528. [PMID: 32348832 DOI: 10.1016/j.ophtha.2020.04.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To determine whether closer adherence to a Mediterranean diet (and its individual components) was associated with altered risk of progression to late age-related macular degeneration (AMD) and large drusen. Additional objectives were to assess interactions with AMD genotype. DESIGN Retrospective analysis of 2 controlled clinical trial cohorts: Age-Related Eye Disease Study (AREDS) and AREDS2. PARTICIPANTS Eyes with no late AMD at baseline in AREDS participants (n = 4255) and AREDS2 participants (n = 3611): total of 13 204 eyes (7756 participants). Mean age was 71 years (standard deviation, 6.6); 56.5% were female. METHODS Color fundus photographs were collected at annual study visits and graded centrally for late AMD. The modified Alternative Mediterranean Diet Index (aMedi) score was calculated for each participant from food frequency questionnaires. MAIN OUTCOME MEASURES Progression to late AMD, geographic atrophy (GA), and neovascular AMD; progression to large drusen. RESULTS Over a median follow-up of 10.2 years, of the 13 204 eyes, 34.0% progressed to late AMD. Hazard ratios (HRs) for progression in aMedi tertile 3 versus 1 were 0.78 (95% confidence interval [CI], 0.71-0.85, P < 0.0001) for late AMD, 0.71 (0.63-0.80, P < 0.0001) for GA, and 0.84 (0.75-0.95, P = 0.005) for neovascular AMD. For fish consumption, HRs for late AMD in quartile 4 versus 1 were 0.69 (0.58-0.82, P < 0.0001; AREDS) and 0.92 (0.78-1.07, P = 0.28; AREDS2). In AREDS, both aMedi and its fish component interacted with CFH rs10922109 for late AMD (P = 0.01 and P = 0.0005, respectively); higher aMedi and fish intake were each associated with decreased risk only in participants with protective alleles. In separate analyses (n = 5029 eyes of 3026 AREDS participants), the HR for progression to large drusen in aMedi tertile 3 versus 1 was 0.79 (0.68-0.93, P = 0.004). CONCLUSIONS Closer adherence to a Mediterranean-type diet was associated with lower risk of progression to late AMD and to large drusen. The signal was greater for GA than neovascular AMD. Fish intake contributed to this protective association. CFH genotype strongly influenced these relationships. These findings may help inform evidence-based dietary recommendations.
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Affiliation(s)
- Tiarnán D Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Elvira Agrón
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Julie Mares
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Freekje van Asten
- Neurobiology-Neurodegeneration & Repair Laboratory, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Anand Swaroop
- Neurobiology-Neurodegeneration & Repair Laboratory, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland.
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Rowan S, Jiang S, Chang ML, Volkin J, Cassalman C, Smith KM, Streeter MD, Spiegel DA, Moreira-Neto C, Rabbani N, Thornalley PJ, Smith DE, Waheed NK, Taylor A. A low glycemic diet protects disease-prone Nrf2-deficient mice against age-related macular degeneration. Free Radic Biol Med 2020; 150:75-86. [PMID: 32068111 PMCID: PMC7747150 DOI: 10.1016/j.freeradbiomed.2020.02.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/30/2020] [Accepted: 02/12/2020] [Indexed: 12/16/2022]
Abstract
Age-related macular degeneration (AMD) is a major blinding disease, affecting over 14% of the elderly. Risk for AMD is related to age, diet, environment, and genetics. Dietary modulation of AMD risk is a promising treatment modality, but requires appropriate animal models to demonstrate advantages of diet. Mice lacking the antioxidant transcription factor Nrf2 (Nfe2l2) develop age-related retinopathy relevant to human AMD. Here we evaluated the effect of consuming high glycemic (HG) or low glycemic (LG) diets until 18-months of age on development of features relevant to AMD in Nrf2-null mice. Nrf2-null mice that consumed HG diets developed atrophic AMD, characterized by photoreceptor degeneration, retinal pigment epithelium (RPE) atrophy and pigmentary abnormalities, basal laminar deposits, and loss of the choriocapillaris. In contrast, Nrf2-null-mice that consumed LG diets did not develop retinal disease phenotypes. Consumption of HG diets was associated with accumulation of advanced glycation end-products in the RPE and systemically, whereas consumption of the LG diet was associated with increased levels of anti-glycative and anti-oxidative detoxification machinery. Together our data indicate that the Nrf2-null HG mouse is a good model for atrophic AMD studies and that the LG diet can activate protective pathways to prevent AMD, even in a genetically predisposed animal.
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Affiliation(s)
- Sheldon Rowan
- Laboratory for Nutrition and Vision Research, JM-USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, 02111, USA; Friedman School of Nutrition and Science Policy, Tufts University, Boston, MA, 02111, USA; Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, 02111, USA.
| | - Shuhong Jiang
- Laboratory for Nutrition and Vision Research, JM-USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, 02111, USA; Inner Mongolia Autonomous Region People's Hospital, Hohhot, Inner Mongolia, 010017, China
| | - Min-Lee Chang
- Laboratory for Nutrition and Vision Research, JM-USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, 02111, USA
| | - Jonathan Volkin
- Laboratory for Nutrition and Vision Research, JM-USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, 02111, USA
| | - Christa Cassalman
- Department of Pathology and Laboratory Medicine, Tufts University School of Medicine, Boston, MA, 02111, USA
| | - Kelsey M Smith
- Laboratory for Nutrition and Vision Research, JM-USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, 02111, USA; Friedman School of Nutrition and Science Policy, Tufts University, Boston, MA, 02111, USA
| | | | - David A Spiegel
- Department of Chemistry, Yale University, New Haven, CT, 06520, USA
| | - Carlos Moreira-Neto
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, 02111, USA
| | - Naila Rabbani
- Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, University Hospital, Coventry, CV2 2DX, UK; Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Paul J Thornalley
- Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, University Hospital, Coventry, CV2 2DX, UK; Diabetes Research Center, Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Qatar Foundation, P.O. Box 34110, Doha, Qatar
| | - Donald E Smith
- Laboratory for Nutrition and Vision Research, JM-USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, 02111, USA
| | - Nadia K Waheed
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, 02111, USA
| | - Allen Taylor
- Laboratory for Nutrition and Vision Research, JM-USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, 02111, USA; Friedman School of Nutrition and Science Policy, Tufts University, Boston, MA, 02111, USA; Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, 02111, USA.
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Chakravarthy U, Bailey CC, Scanlon PH, McKibbin M, Khan RS, Mahmood S, Downey L, Dhingra N, Brand C, Brittain CJ, Willis JR, Venerus A, Muthutantri A, Cantrell RA. Progression from Early/Intermediate to Advanced Forms of Age-Related Macular Degeneration in a Large UK Cohort: Rates and Risk Factors. Ophthalmol Retina 2020; 4:662-672. [PMID: 32144084 DOI: 10.1016/j.oret.2020.01.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/10/2020] [Accepted: 01/14/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To estimate rates and risk factors for progression to geographic atrophy (GA) or choroidal neovascularization (CNV) among eyes diagnosed with early or intermediate age-related macular degeneration (AMD) in clinical practice. DESIGN Retrospective cohort analysis of a multicenter electronic medical record (EMR) database from the United Kingdom. PARTICIPANTS Patients aged 50 years or more with diagnosis of early/intermediate AMD in at least 1 eye (the study eye) and no evidence of CNV or GA in the study eye, from 10 clinical sites using the EMR. METHODS Anonymized data for 40 543 patients with a diagnosis of early/intermediate AMD were extracted between October 2000 and February 2016 from EMR database records held in the 10 sites. A sample of records randomly selected from each center was used to validate disease definitions. Records were analyzed by subgroup, based on the AMD status of the fellow eye. Multivariate Cox regression models identified other predictors of disease progression. MAIN OUTCOME MEASURES Progression rate (per 100 person-years) to GA or CNV in study eyes with early/intermediate AMD by fellow eye status and identified risk factors for progression. RESULTS Study eyes with early/intermediate AMD and a diagnosis of CNV in the fellow eye progressed to CNV fastest (at a rate of 15.2 per 100 person-years), and those with a diagnosis of GA in the fellow eye progressed to GA fastest (11.2 per 100 person-years), compared with the rates per 100 person-years of progression to CNV (3.2-11.9) or GA (2.0-7.8) in the other subgroups. In individuals with bilateral early/intermediate AMD, rates of progression to GA or CNV were 2.0 and 3.2 per 100 person-years, respectively. In the multivariate model, age, female sex, and cardiovascular disease were associated with an increased risk for progression to advanced AMD, whereas diabetes and glaucoma were associated with a decreased rate of progression (hazard ratios, 0.45 and 0.64, respectively). CONCLUSIONS Progression to GA or CNV was observed frequently in eyes with early/intermediate AMD, with the status of the fellow eye affecting the rate of progression. Novel associations with risk factors were observed and require replication in other cohorts.
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Affiliation(s)
- Usha Chakravarthy
- Queen's University of Belfast Royal Victoria Hospital, Belfast, Ireland.
| | - Clare C Bailey
- University Hospitals Bristol National Health Service Foundation Trust, Bristol, United Kingdom
| | - Peter H Scanlon
- Gloucestershire Hospitals National Health Service Foundation Trust, Cheltenham, United Kingdom
| | - Martin McKibbin
- Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
| | - Rehna S Khan
- Calderdale and Huddersfield National Health Service Foundation Trust, Huddersfield, West Yorkshire, United Kingdom
| | - Sajjad Mahmood
- Central Manchester University Hospitals National Health Service Foundation Trust, Manchester, United Kingdom
| | - Louise Downey
- Hull and East Yorkshire Hospitals National Health Service Trust, Hull, United Kingdom
| | - Narendra Dhingra
- Mid Yorkshire Hospitals National Health Service Trust, Wakefield, United Kingdom
| | - Christopher Brand
- Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
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Subhi Y, Krogh Nielsen M, Molbech CR, Oishi A, Singh A, Nissen MH, Sørensen TL. Polypoidal Choroidal Vasculopathy Associate With Diminished Regulatory T Cells That Are Polarized Into a T Helper 2-Like Phenotype. Invest Ophthalmol Vis Sci 2019; 60:2583-2590. [PMID: 31219532 DOI: 10.1167/iovs.19-26882] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate possible roles of T helper (Th) cells, regulatory T cells (Tregs), and the recently mapped Th-like Tregs in patients with polypoidal choroidal vasculopathy (PCV). Methods In this prospective case-control study, we obtained fresh venous blood from patients with PCV (n = 24), age-matched healthy controls (n = 32), and patients with neovascular AMD (n = 45). All participants underwent a comprehensive ocular examination including fluorescein and indocyanine green angiography for where retinal disease was suspected. Using flow cytometry, we identified Th subsets, Tregs, and Th-like Tregs. Plasma samples were stored at -80°C to investigate plasma cytokines of interest. Results Compared to healthy controls, patients with PCV had lower percentages of Tregs (8.7% ± 2.8% vs. 7.3% ± 1.7%, P = 0.027), which were significantly more Th2-like polarized (42.6% ± 13.3% vs. 50.5% ± 13.0%, P = 0.029). These changes differed from that observed in neovascular AMD, which compared to healthy controls had fewer Th1/Th17 cells (3.6% ± 2.7% vs. 2.4% ± 2.5%, P = 0.049), comparable Treg levels, and no distinct polarization of Th-like Tregs. Because of these findings, we measured plasma IL-4 and IL-33 levels. Plasma IL-33 in patients with PCV (median 0.30 pg/mL) was twice as high compared to healthy controls (median 0.16 pg/mL; P = 0.037). Conclusions PCV associate with diminished Tregs that are polarized more into a Th2-like phenotype. This is correlated to IL-33 levels, which we also find increased in patients with PCV. Our findings suggest a possible role for Th2-like Tregs and IL-33 in PCV.
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Affiliation(s)
- Yousif Subhi
- Clinical Eye Research Division, Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark.,Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Marie Krogh Nielsen
- Clinical Eye Research Division, Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark.,Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Christopher Rue Molbech
- Clinical Eye Research Division, Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark.,Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Akio Oishi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Amardeep Singh
- Clinical Eye Research Division, Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark.,Department of Ophthalmology, Skåne University Hospital Malmö-Lund, Lund, Sweden
| | - Mogens Holst Nissen
- Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.,Eye Research Unit, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Torben Lykke Sørensen
- Clinical Eye Research Division, Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark.,Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
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Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, Ying GS. Age-Related Macular Degeneration Preferred Practice Pattern®. Ophthalmology 2019; 127:P1-P65. [PMID: 31757502 DOI: 10.1016/j.ophtha.2019.09.024] [Citation(s) in RCA: 186] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
| | | | - Steven T Bailey
- Casey Eye Institute, Oregon Health & Science University, Portland, OR
| | - Amani Fawzi
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - G Atma Vemulakonda
- Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA
| | - Gui-Shuang Ying
- Center for Preventative Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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39
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Keeling E, Chatelet DS, Johnston DA, Page A, Tumbarello DA, Lotery AJ, Ratnayaka JA. Oxidative Stress and Dysfunctional Intracellular Traffic Linked to an Unhealthy Diet Results in Impaired Cargo Transport in the Retinal Pigment Epithelium (RPE). Mol Nutr Food Res 2019; 63:e1800951. [PMID: 30835933 DOI: 10.1002/mnfr.201800951] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/18/2019] [Indexed: 12/19/2022]
Abstract
SCOPE Oxidative stress and dysregulated intracellular trafficking are associated with an unhealthy diet which underlies pathology. Here, these effects on photoreceptor outer segment (POS) trafficking in the retinal pigment epithelium (RPE), a major pathway of disease underlying irreversible sight-loss, are studied. METHODS AND RESULTS POS trafficking is studied in ARPE-19 cells using an algorithm-based quantification of confocal-immunofluorescence data supported by ultrastructural studies. It is shown that although POS are tightly regulated and trafficked via Rab5, Rab7 vesicles, LAMP1/2 lysosomes and LC3b-autophagosomes, there is also a considerable degree of variation and flexibility in this process. Treatment with H2 O2 and bafilomycin A1 reveals that oxidative stress and dysregulated autophagy target intracellular compartments and trafficking in strikingly different ways. These effects appear limited to POS-containing vesicles, suggesting a cargo-specific effect. CONCLUSION The findings offer insights into how RPE cells cope with stress, and how mechanisms influencing POS transport/degradation can have different outcomes in the senescent retina. These shed new light on cellular processes underlying retinopathies such as age-related macular degeneration. The discoveries reveal how diet and nutrition can cause fundamental alterations at a cellular level, thus contributing to a better understanding of the diet-disease axis.
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Affiliation(s)
- Eloise Keeling
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP806, Tremona Road, SO16 6YD, UK
| | - David S Chatelet
- Biomedical Imaging Unit, University of Southampton, MP12, Tremona Road, SO16 6YD, UK
| | - David A Johnston
- Biomedical Imaging Unit, University of Southampton, MP12, Tremona Road, SO16 6YD, UK
| | - Anton Page
- Biomedical Imaging Unit, University of Southampton, MP12, Tremona Road, SO16 6YD, UK
| | - David A Tumbarello
- Biological Sciences, Faculty of Natural & Environmental Sciences, University of Southampton, Life Sciences Building 85, SO17 1BJ, UK
| | - Andrew J Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP806, Tremona Road, SO16 6YD, UK
- Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - J Arjuna Ratnayaka
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP806, Tremona Road, SO16 6YD, UK
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40
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Gilbert R, Peto T, Lengyel I, Emri E. Zinc Nutrition and Inflammation in the Aging Retina. Mol Nutr Food Res 2019; 63:e1801049. [PMID: 31148351 DOI: 10.1002/mnfr.201801049] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 04/18/2019] [Indexed: 12/16/2022]
Abstract
Zinc is an essential nutrient for human health. It plays key roles in maintaining protein structure and stability, serves as catalytic factor for many enzymes, and regulates diverse fundamental cellular processes. Zinc is important in affecting signal transduction and, in particular, in the development and integrity of the immune system, where it affects both innate and adaptive immune responses. The eye, especially the retina-choroid complex, has an unusually high concentration of zinc compared to other tissues. The highest amount of zinc is concentrated in the retinal pigment epithelium (RPE) (RPE-choroid, 292 ± 98.5 µg g-1 dry tissue), followed by the retina (123 ± 62.2 µg g-1 dry tissue). The interplay between zinc and inflammation has been explored in other parts of the body but, so far, has not been extensively researched in the eye. Several lines of evidence suggest that ocular zinc concentration decreases with age, especially in the context of age-related disease. Thus, a hypothesis that retinal function could be modulated by zinc nutrition is proposed, and subsequently trialled clinically. In this review, the distribution and the potential role of zinc in the retina-choroid complex is outlined, especially in relation to inflammation and immunity, and the clinical studies to date are summarized.
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Affiliation(s)
- Rosie Gilbert
- Moorfields Eye Hospital NHS Foundation Trust, City Road, London, EC1V 2PD, UK.,UCL Institute of Ophthalmology, Bath Street, London, EC1V 2EL, UK
| | - Tunde Peto
- School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Ireland
| | - Imre Lengyel
- UCL Institute of Ophthalmology, Bath Street, London, EC1V 2EL, UK.,School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Ireland
| | - Eszter Emri
- School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Ireland
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41
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Hogg RE, Woodside JV. Mediterranean Diet and Age-Related Macular Degeneration: Is It Time to Attempt Dietary Modification? Ophthalmology 2019; 126:391-392. [PMID: 30803514 DOI: 10.1016/j.ophtha.2018.09.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 09/20/2018] [Accepted: 09/24/2018] [Indexed: 10/27/2022] Open
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Tang D, Mitchell P, Flood V, Kifley A, Hayes A, Liew G, Gopinath B. Dietary intervention in patients with age-related macular degeneration: protocol for a randomised controlled trial. BMJ Open 2019; 9:e024774. [PMID: 30782917 PMCID: PMC6377551 DOI: 10.1136/bmjopen-2018-024774] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Age-related macular degeneration (AMD) is a leading cause of blindness. After smoking, nutrition is the key modifiable factor in reducing AMD incidence and progression, and no other preventative treatments are currently available. At present, there is an evidence-practice gap of dietary recommendations made by eye care practitioners and those actually practised by patients with AMD. To address this gap, a telephone-delivered dietary intervention tailored to patients with AMD will be piloted. The study aims to improve dietary intake and behaviours in patients with AMD. This type of nutrition-focused healthcare is currently not considered in the long-term management of AMD and represents the first empirical evaluation of a telephone-supported application encouraging adherence to dietary recommendations for AMD. METHODS AND ANALYSIS 140 participants with AMD will be recruited for this randomised controlled trial. Those lacking English fluency; unwilling to engage in the intervention or provide informed consent were excluded. Following the completion of the baseline questionnaire, participants will be randomised into one of two arms: intervention or wait-list control (70 each in the intervention and control groups). Intervention participants will receive a detailed mail-delivered workbook containing information on healthy eating behaviours that promote optimal macular health, as well as scheduled phone calls over 4 months from an accredited practising dietitian. Descriptive statistics and multivariate stepwise linear regressions analyses will be used to summarise and determine the changes in dietary intakes, respectively. Economic analysis will be conducted to determine intervention feasibility and possibility of a large-scale rollout. ETHICS AND DISSEMINATION The study was approved by the University of Sydney Human Research Ethics Committee (HREC) (Reference: HREC 2018/219). Study findings will be disseminated via presentations at national/international conferences and peer-reviewed journal articles. TRIAL REGISTRATION NUMBER ACTRN12618000527268; Pre-results.
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Affiliation(s)
- Diana Tang
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Victoria Flood
- Western Sydney Local Health District, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Health Sciences, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Annette Kifley
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Alison Hayes
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Gerald Liew
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Bamini Gopinath
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
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43
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Bejarano E, Taylor A. Too sweet: Problems of protein glycation in the eye. Exp Eye Res 2019; 178:255-262. [PMID: 30145354 PMCID: PMC8351608 DOI: 10.1016/j.exer.2018.08.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/03/2018] [Accepted: 08/22/2018] [Indexed: 01/06/2023]
Abstract
Laboratory and epidemiological data indicate that high blood sugar levels and/or consuming high glycemia diets are linked to multiple age-related diseases, including age-related macular degeneration, cataract, Parkinson's disease, Alzheimer's disease, diabetic retinopathy, and, apparently glaucoma. High concentrations of blood sugar and perturbations of the systems that regulate blood sugar lead to the accumulation of advanced-glycation end products (AGEs). AGEs are toxic compounds that are formed from the combination of sugars and their metabolites with biomolecules in a non-enzymatic biochemical reaction called glycation. In vitro and in vivo data indicate that high sugar consumption is associated with accumulation of AGEs in a variety of human tissues. Hyperglycemia, along with an oxidative environment and limited cell proliferation in many ocular tissues, encourages formation and precludes dilution of AGEs and associated damage by cell division. These circumstances make many eye tissues vulnerable to glycation-derived damage. Here, we summarize research regarding glycation-induced ocular tissue dysfunction and its contribution to the onset and development of eye disorders. We also discuss how management of carbohydrate nutrition may provide a low-cost way to ameliorate the progression of AGEs-related diseases, including age related macular degeneration and some cataracts, as they do for cardiovascular disease and diabetes.
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Affiliation(s)
- Eloy Bejarano
- Laboratory for Nutrition and Vision Research, USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington St, Boston, MA, 02111, USA.
| | - Allen Taylor
- Laboratory for Nutrition and Vision Research, USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington St, Boston, MA, 02111, USA.
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44
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Raimundo M, Mira F, Cachulo MDL, Barreto P, Ribeiro L, Farinha C, Laíns I, Nunes S, Alves D, Figueira J, Merle BMJ, Delcourt C, Santos L, Silva R. Adherence to a Mediterranean diet, lifestyle and age-related macular degeneration: the Coimbra Eye Study - report 3. Acta Ophthalmol 2018; 96:e926-e932. [PMID: 30218481 DOI: 10.1111/aos.13775] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 03/06/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE To characterize the lifestyle and nutritional risk profile associated with the Mediterranean diet in a Portuguese population with and without age-related macular degeneration (AMD). METHODS Nested case-control study (n = 883) within the Coimbra Eye Study, including 434 subjects with AMD and 449 age- and sex-matched subjects without AMD. All enrolled subjects underwent a full risk assessment, including lifestyle-related risk factors and a thorough food frequency questionnaire. This allowed us to build an adherence score to the Mediterranean diet (mediSCORE, range 0-9) constructed from individual food intakes. Food intake was also further analysed by conversion to micronutrient consumption. RESULTS Our results suggest that physical activity has a protective role in AMD [p = 0.018 after multivariate adjustment, OR: 0.69 (0.51-0.93)]. High (mediSCORE ≥6) was also found to be protective [p = 0.041, OR: 0.62 (95% CI: 0.38-0.97)]. Food group analysis unveiled a specific protective role for increased fruits consumption (p = 0.029). Finally, micronutrient analysis revealed a protective role associated with increased consumption of caffeine, fibres, beta-carotene, vitamin C and vitamin E (p < 0.05). CONCLUSION High mediSCORE appears to confer protection against the development of AMD in a Mediterranean population. This effect is driven by increased consumption of fruits and some antioxidant micronutrients, which emerged as statistically significant protective factors. Further studies are required to establish dietary recommendations with clinical application.
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Affiliation(s)
- Miguel Raimundo
- Ophthalmology Department; Coimbra University Hospital Centre (CHUC); Coimbra Portugal
| | - Filipe Mira
- Faculty of Medicine; Institute for Biomedical Imaging and Life Sciences; University of Coimbra (FMUC-IBILI); Coimbra Portugal
| | - Maria da Luz Cachulo
- Ophthalmology Department; Coimbra University Hospital Centre (CHUC); Coimbra Portugal
- Faculty of Medicine; Institute for Biomedical Imaging and Life Sciences; University of Coimbra (FMUC-IBILI); Coimbra Portugal
- Association for Innovation and Biomedical Research on Light and Image (AIBILI); Coimbra Portugal
| | - Patrícia Barreto
- Association for Innovation and Biomedical Research on Light and Image (AIBILI); Coimbra Portugal
| | - Luísa Ribeiro
- Association for Innovation and Biomedical Research on Light and Image (AIBILI); Coimbra Portugal
| | - Cláudia Farinha
- Ophthalmology Department; Coimbra University Hospital Centre (CHUC); Coimbra Portugal
- Association for Innovation and Biomedical Research on Light and Image (AIBILI); Coimbra Portugal
| | - Inês Laíns
- Ophthalmology Department; Coimbra University Hospital Centre (CHUC); Coimbra Portugal
- Massachusetts Eye and Ear Infirmary; Harvard Medical School; Boston MA USA
| | - Sandrina Nunes
- Association for Innovation and Biomedical Research on Light and Image (AIBILI); Coimbra Portugal
| | - Dalila Alves
- Association for Innovation and Biomedical Research on Light and Image (AIBILI); Coimbra Portugal
| | - João Figueira
- Ophthalmology Department; Coimbra University Hospital Centre (CHUC); Coimbra Portugal
- Faculty of Medicine; Institute for Biomedical Imaging and Life Sciences; University of Coimbra (FMUC-IBILI); Coimbra Portugal
- Association for Innovation and Biomedical Research on Light and Image (AIBILI); Coimbra Portugal
| | - Bénédicte MJ Merle
- Inserm, Bordeaux Population Health Research Center; Team LEHA; UMR 1219; University of Bordeaux; Bordeaux France
| | - Cécile Delcourt
- Inserm, Bordeaux Population Health Research Center; Team LEHA; UMR 1219; University of Bordeaux; Bordeaux France
| | - Lèlita Santos
- Faculty of Medicine; Institute for Biomedical Imaging and Life Sciences; University of Coimbra (FMUC-IBILI); Coimbra Portugal
- Internal Medicine; Coimbra University Hospital Centre; Coimbra Portugal
| | - Rufino Silva
- Ophthalmology Department; Coimbra University Hospital Centre (CHUC); Coimbra Portugal
- Faculty of Medicine; Institute for Biomedical Imaging and Life Sciences; University of Coimbra (FMUC-IBILI); Coimbra Portugal
- Association for Innovation and Biomedical Research on Light and Image (AIBILI); Coimbra Portugal
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45
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Affiliation(s)
- Daniel J Rader
- From Departments of Genetics, Medicine, and Pediatrics and Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
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46
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Merle BMJ, Colijn JM, Cougnard-Grégoire A, de Koning-Backus APM, Delyfer MN, Kiefte-de Jong JC, Meester-Smoor M, Féart C, Verzijden T, Samieri C, Franco OH, Korobelnik JF, Klaver CCW, Delcourt C. Mediterranean Diet and Incidence of Advanced Age-Related Macular Degeneration: The EYE-RISK Consortium. Ophthalmology 2018; 126:381-390. [PMID: 30114418 DOI: 10.1016/j.ophtha.2018.08.006] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/31/2018] [Accepted: 08/06/2018] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To investigate associations of adherence to the Mediterranean diet (MeDi) with incidence of advanced age-related macular degeneration (AMD; the symptomatic form of AMD) in 2 European population-based prospective cohorts. DESIGN Prospective cohort study of the Rotterdam Study I (RS-I) and the Antioxydants, Lipides Essentiels, Nutrition et Maladies Oculaires (Alienor) Study populations. PARTICIPANTS Four thousand four hundred forty-six participants 55 years of age or older from the RS-I (The Netherlands) and 550 French adults 73 years of age or older from the Alienor Study with complete ophthalmologic and dietary data were included in the present study. METHODS Examinations were performed approximately every 5 years over a 21-year period (1990-2011) in RS-I and every 2 years over a 4-year period (2006-2012) in the Alienor Study. Adherence to the MeDi was evaluated using a 9-component score based on intake of vegetables, fruits, legumes, cereals, fish, meat, dairy products, alcohol, and the monounsaturated-to-saturated fatty acids ratio. Associations of incidence of AMD with MeDi were estimated using multivariate Cox proportional hazard models. MAIN OUTCOMES MEASURES Incidence of advanced AMD based on retinal fundus photographs. RESULTS Among the 4996 included participants, 155 demonstrated advanced incident AMD (117 from the RS-I and 38 from the Alienor Study). The mean follow-up time was 9.9 years (range, 0.6-21.7 years) in the RS-I and 4.1 years (range, 2.5-5.0 years) in the Alienor Study. Pooling data for both the RS-I and Alienor Study, participants with a high (range, 6-9) MeDi score showed a significantly reduced risk for incident advanced AMD compared with participants with a low (range, 0-3) MeDi score in the fully adjusted Cox model (hazard ratio, 0.59; 95% confidence interval, 0.37-0.95; P = 0.04 for trend). CONCLUSIONS Pooling data from the RS-I and Alienor Study, higher adherence to the MeDi was associated with a 41% reduced risk of incident advanced AMD. These findings support the role of a diet rich in healthful nutrient-rich foods such as fruits, vegetables, legumes, and fish in the prevention of AMD.
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Affiliation(s)
- Bénédicte M J Merle
- Team LEHA, Bordeaux Population Health Research Center, Inserm, Université de Bordeaux, Bordeaux, France.
| | - Johanna M Colijn
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Audrey Cougnard-Grégoire
- Team LEHA, Bordeaux Population Health Research Center, Inserm, Université de Bordeaux, Bordeaux, France
| | - Alexandra P M de Koning-Backus
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marie-Noëlle Delyfer
- Team LEHA, Bordeaux Population Health Research Center, Inserm, Université de Bordeaux, Bordeaux, France; Service d'Ophtalmologie, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | | | - Magda Meester-Smoor
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Catherine Féart
- Team LEHA, Bordeaux Population Health Research Center, Inserm, Université de Bordeaux, Bordeaux, France
| | - Timo Verzijden
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Cécilia Samieri
- Team LEHA, Bordeaux Population Health Research Center, Inserm, Université de Bordeaux, Bordeaux, France
| | - Oscar H Franco
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jean-François Korobelnik
- Team LEHA, Bordeaux Population Health Research Center, Inserm, Université de Bordeaux, Bordeaux, France; Service d'Ophtalmologie, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cécile Delcourt
- Team LEHA, Bordeaux Population Health Research Center, Inserm, Université de Bordeaux, Bordeaux, France
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Chapman NA, Jacobs RJ, Braakhuis AJ. Role of diet and food intake in age-related macular degeneration: a systematic review. Clin Exp Ophthalmol 2018; 47:106-127. [PMID: 29927057 DOI: 10.1111/ceo.13343] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/13/2018] [Indexed: 01/05/2023]
Abstract
A systematic literature review was conducted to evaluate the role of diet and food intake in age-related macular degeneration (AMD). Eighteen high-quality studies were identified. Adherence to a Mediterranean diet had decreased risk of AMD progression. An Oriental diet pattern had decreased association with AMD prevalence, whereas a Western diet pattern had increased association with AMD prevalence. High consumption of vegetables rich in carotenoids and fatty fish containing omega-3 fatty acids was beneficial for those at risk of AMD. Vegetable oils and animal fats containing omega-6 fatty acids, and red/processed meat should be consumed minimally to reduce the risk of AMD progression. High glycaemic index diets and alcohol consumption of greater than two drinks a day had increased association with AMD. As the quality of diet and food intake had a vital role in AMD, the provision of appropriate nutritional advice to those at risk of AMD is recommended.
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Affiliation(s)
- Naoko A Chapman
- School of Optometry and Vision Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Robert J Jacobs
- School of Optometry and Vision Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Andrea J Braakhuis
- Department of Nutrition, School of Medical Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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48
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Food groups and risk of age-related macular degeneration: a systematic review with meta-analysis. Eur J Nutr 2018; 58:2123-2143. [DOI: 10.1007/s00394-018-1771-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/28/2018] [Indexed: 01/10/2023]
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49
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van Leeuwen EM, Emri E, Merle BMJ, Colijn JM, Kersten E, Cougnard-Gregoire A, Dammeier S, Meester-Smoor M, Pool FM, de Jong EK, Delcourt C, Rodrigez-Bocanegra E, Biarnés M, Luthert PJ, Ueffing M, Klaver CCW, Nogoceke E, den Hollander AI, Lengyel I. A new perspective on lipid research in age-related macular degeneration. Prog Retin Eye Res 2018; 67:56-86. [PMID: 29729972 DOI: 10.1016/j.preteyeres.2018.04.006] [Citation(s) in RCA: 159] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/25/2018] [Accepted: 04/30/2018] [Indexed: 12/15/2022]
Abstract
There is an urgency to find new treatment strategies that could prevent or delay the onset or progression of AMD. Different classes of lipids and lipoproteins metabolism genes have been associated with AMD in a multiple ways, but despite the ever-increasing knowledge base, we still do not understand fully how circulating lipids or local lipid metabolism contribute to AMD. It is essential to clarify whether dietary lipids, systemic or local lipoprotein metabolismtrafficking of lipids in the retina should be targeted in the disease. In this article, we critically evaluate what has been reported in the literature and identify new directions needed to bring about a significant advance in our understanding of the role for lipids in AMD. This may help to develop potential new treatment strategies through targeting the lipid homeostasis.
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Affiliation(s)
- Elisabeth M van Leeuwen
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eszter Emri
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
| | - Benedicte M J Merle
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team LEHA, UMR 1219, F-33000, Bordeaux, France
| | - Johanna M Colijn
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eveline Kersten
- Department of Ophthalmology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Audrey Cougnard-Gregoire
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team LEHA, UMR 1219, F-33000, Bordeaux, France
| | - Sascha Dammeier
- Centre for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Germany
| | - Magda Meester-Smoor
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Eiko K de Jong
- Department of Ophthalmology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Cécile Delcourt
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team LEHA, UMR 1219, F-33000, Bordeaux, France
| | | | | | | | - Marius Ueffing
- Centre for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Germany
| | - Caroline C W Klaver
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Ophthalmology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Everson Nogoceke
- Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Anneke I den Hollander
- Department of Ophthalmology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands; Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Imre Lengyel
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom.
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50
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Douillard A, Picot MC, Delcourt C, Defoort-Dhellemmes S, Marzouka NAD, Lacroux A, Zanlonghi X, Drumare I, Jozefowicz E, Bocquet B, Baudoin C, Perez-Roustit S, Arsène S, Gissot V, Devin F, Arndt C, Wolff B, Mauget-Faÿsse M, Quaranta M, Mura T, Deplanque D, Oubraham H, Cohen SY, Gastaud P, Zambrowski O, Creuzot-Garcher C, Saïd SM, Sahel JA, Souied E, Milazzo S, Garavito RB, Kalatzis V, Puech B, Hamel C, Audo I, Meunier I. Dietary, environmental, and genetic risk factors of Extensive Macular Atrophy with Pseudodrusen, a severe bilateral macular atrophy of middle-aged patients. Sci Rep 2018; 8:6840. [PMID: 29717154 PMCID: PMC5931512 DOI: 10.1038/s41598-018-25003-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 04/09/2018] [Indexed: 12/13/2022] Open
Abstract
EMAP (Extensive Macular Atrophy with Pseudodrusen) is a maculopathy we recently described that shares pseudodrusen and geographic atrophy with Age-related Macular Disease (AMD). EMAP differs from AMD by an earlier age of onset (50-55 years) and a characteristic natural history comprising a night blindness followed by a severe visual loss. In a prospective case-control study, ten referral centers included 115 EMAP (70 women, 45 men) patients and 345 matched controls to appraise dietary, environmental, and genetic risk factors. The incidence of EMAP (mean 2.95/1.106) was lower in Provence-Côte d’Azur with a Mediterranean diet (1.9/1.106), and higher in regions with intensive farming or industrialized activities (5 to 20/1.106). EMAP patients reported toxic exposure during professional activities (OR 2.29). The frequencies of common AMD complement factor risk alleles were comparable in EMAP. By contrast, only one EMAP patient had a rare AMD variant. This study suggests that EMAP could be a neurodegenerative disorder caused by lifelong toxic exposure and that it is associated with a chronic inflammation and abnormal complement pathway regulation. This leads to diffuse subretinal deposits with rod dysfunction and cone apoptosis around the age of 50 with characteristic extensive macular atrophy and paving stones in the far peripheral retina.
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Affiliation(s)
- Aymeric Douillard
- CHRU Montpellier, Clinical Investigation Center (CIC) & Clinical Research and Epidemiology Unit (URCE), Montpellier, France.,INSERM, CIC 1411, Montpellier, France
| | - Marie-Christine Picot
- CHRU Montpellier, Clinical Investigation Center (CIC) & Clinical Research and Epidemiology Unit (URCE), Montpellier, France.,INSERM, CIC 1411, Montpellier, France
| | - Cécile Delcourt
- University of Bordeaux, ISPED, F-33000, Bordeaux, France.,Inserm, U1219 - Bordeaux Population Health Research Center, F-33000, Bordeaux, France
| | - Sabine Defoort-Dhellemmes
- Service d'Exploration de la Vision et Neuro-ophtalmologie, Hôpital Robert Salengro, CHU de Lille, France
| | - Nour Al-Dain Marzouka
- Centre de Référence Maladies Sensorielles Génétiques, Hôpital Gui de Chauliac, University of Montpellier, Institute for Neurosciences of Montpellier INSERM U1051, Montpellier, France
| | - Annie Lacroux
- Centre de Référence Maladies Sensorielles Génétiques, Hôpital Gui de Chauliac, University of Montpellier, Institute for Neurosciences of Montpellier INSERM U1051, Montpellier, France
| | | | - Isabelle Drumare
- Service d'Exploration de la Vision et Neuro-ophtalmologie, Hôpital Robert Salengro, CHU de Lille, France
| | - Elsa Jozefowicz
- University Lille, Inserm, CHU Lille, CIC 1403 - Centre d'investigation clinique, F-59000, Lille, France
| | - Béatrice Bocquet
- Centre de Référence Maladies Sensorielles Génétiques, Hôpital Gui de Chauliac, University of Montpellier, Institute for Neurosciences of Montpellier INSERM U1051, Montpellier, France
| | - Corinne Baudoin
- Centre de Référence Maladies Sensorielles Génétiques, Hôpital Gui de Chauliac, University of Montpellier, Institute for Neurosciences of Montpellier INSERM U1051, Montpellier, France
| | - Sarah Perez-Roustit
- Centre de Référence Maladies Sensorielles Génétiques, Hôpital Gui de Chauliac, University of Montpellier, Institute for Neurosciences of Montpellier INSERM U1051, Montpellier, France
| | - Sophie Arsène
- Eye Clinic, Hôpital de Tours, CHRU de Tours, Tours, France
| | - Valérie Gissot
- Inserm 1415, Centre d'investigation clinique, CHRU de Tours, Tours, France
| | - François Devin
- Eye Clinic, Centre Paradis, Monticelli, Marseille, France
| | - Carl Arndt
- Eye Clinic, Hôpital Robert Debré, CHRU de Reims, France
| | - Benjamin Wolff
- Eye Clinic, Maison Rouge, Strasbourg, France.,Fondation Adolphe de Rothschild, 25 rue Manin, 75019, Paris, France
| | | | | | - Thibault Mura
- CHRU Montpellier, Clinical Investigation Center (CIC) & Clinical Research and Epidemiology Unit (URCE), Montpellier, France
| | - Dominique Deplanque
- University Lille, Inserm, CHU Lille, CIC 1403 - Centre d'investigation clinique, F-59000, Lille, France
| | | | - Salomon Yves Cohen
- Eye Clinic, Hôpital Intercommunal, Créteil, France.,Centre d'Imagerie Laser, Rue Antoine Bourdelle, Paris, France
| | - Pierre Gastaud
- Eye Clinic, Hôpital Saint Roch, CHU de Nice, Nice, France
| | | | - Catherine Creuzot-Garcher
- Eye Clinic, Hôpital Universitaire de Dijon and Eye nutrition and signaling group, INRA, Dijon, France
| | - Saddek Mohand Saïd
- Sorbonne Université, UPMC Univ Paris 06, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, 75012, Paris, France.,CHNO des Quinze-Vingts, DHU Sight Restore, INSERM-DHOS CIC1423, 28 rue de Charenton, 75012, Paris, France
| | - José-Alain Sahel
- Fondation Adolphe de Rothschild, 25 rue Manin, 75019, Paris, France.,Sorbonne Université, UPMC Univ Paris 06, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, 75012, Paris, France.,CHNO des Quinze-Vingts, DHU Sight Restore, INSERM-DHOS CIC1423, 28 rue de Charenton, 75012, Paris, France.,Institute of Ophthalmology, University College of London, London, EC1V 9EL, UK.,Académie des Sciences, Institut de France, Paris, France
| | - Eric Souied
- Eye Clinic, Hôpital Intercommunal, Créteil, France
| | - Solange Milazzo
- Department of Ophtalmology, Amiens University Hospital, Paris, France
| | | | - Vasiliki Kalatzis
- Centre de Référence Maladies Sensorielles Génétiques, Hôpital Gui de Chauliac, University of Montpellier, Institute for Neurosciences of Montpellier INSERM U1051, Montpellier, France
| | - Bernard Puech
- Service d'Exploration de la Vision et Neuro-ophtalmologie, Hôpital Robert Salengro, CHU de Lille, France
| | - Christian Hamel
- Centre de Référence Maladies Sensorielles Génétiques, Hôpital Gui de Chauliac, University of Montpellier, Institute for Neurosciences of Montpellier INSERM U1051, Montpellier, France
| | - Isabelle Audo
- Sorbonne Université, UPMC Univ Paris 06, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, 75012, Paris, France.,CHNO des Quinze-Vingts, DHU Sight Restore, INSERM-DHOS CIC1423, 28 rue de Charenton, 75012, Paris, France.,Institute of Ophthalmology, University College of London, London, EC1V 9EL, UK
| | - Isabelle Meunier
- Centre de Référence Maladies Sensorielles Génétiques, Hôpital Gui de Chauliac, University of Montpellier, Institute for Neurosciences of Montpellier INSERM U1051, Montpellier, France.
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