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Kulbay M, Wu KY, Nirwal GK, Bélanger P, Tran SD. The Role of Reactive Oxygen Species in Age-Related Macular Degeneration: A Comprehensive Review of Antioxidant Therapies. Biomedicines 2024; 12:1579. [PMID: 39062152 PMCID: PMC11274723 DOI: 10.3390/biomedicines12071579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/26/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
This review article delves into the intricate roles of reactive oxygen species (ROS) in the pathogenesis of age-related macular degeneration (AMD). It presents a detailed analysis of the oxidative stress mechanisms that contribute to the development and progression of these diseases. The review systematically explores the dual nature of ROS in ocular physiology and pathology, underscoring their essential roles in cellular signaling and detrimental effects when in excess. In the context of AMD, the focus is on the oxidative impairment in the retinal pigment epithelium and Bruch's membrane, culminating in the deterioration of macular health. Central to this review is the evaluation of various antioxidant strategies in the prevention and management of AMD. It encompasses a wide spectrum of antioxidants, ranging from dietary nutrients like vitamins C and E, lutein, and zeaxanthin to pharmacological agents with antioxidative properties. The review also addresses novel therapeutic approaches, including gene therapy and nanotechnology-based delivery systems, aiming to enhance antioxidant defense mechanisms in ocular tissues. The article concludes by synthesizing current research findings, clinical trial data, and meta-analyses to provide evidence-based recommendations. It underscores the need for further research to optimize antioxidant therapies, considering individual patient factors and disease stages. This comprehensive review thus serves as a valuable resource for clinicians, researchers, and healthcare professionals in ophthalmology, offering insights into the potential of antioxidants in mitigating the burden of AMD.
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Affiliation(s)
- Merve Kulbay
- Department of Ophthalmology & Visual Sciences, McGill University, Montréal, QC H4A 3S5, Canada;
| | - Kevin Y. Wu
- Division of Ophthalmology, Department of Surgery, University of Sherbrooke, Sherbrooke, QC J1H 5N4, Canada; (K.Y.W.)
| | - Gurleen K. Nirwal
- Department of Zoology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Paul Bélanger
- Division of Ophthalmology, Department of Surgery, University of Sherbrooke, Sherbrooke, QC J1H 5N4, Canada; (K.Y.W.)
| | - Simon D. Tran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC H3A 1G1, Canada
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Bruns Y, Junker B, Boehringer D, Framme C, Pielen A. Comparison of Macular Pigment Optical Density in Glaucoma Patients and Healthy Subjects - A Prospective Diagnostic Study. Clin Ophthalmol 2020; 14:1011-1017. [PMID: 32308361 PMCID: PMC7140904 DOI: 10.2147/opth.s224259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 02/27/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the relationship between macular pigment optical density (MPOD) and glaucoma. Methods Forty-three patients with an established glaucoma diagnosis (25 females, 18 males, mean age 70 (range 34–84)) and 43 healthy controls (28 females, 15 males, mean age 62 (range 30–87)) were included in this prospective diagnostic case-control study. All subjects underwent detailed eye examination including ophthalmoscopy, best-corrected visual acuity, biomicroscopy, measurement of the axial length of the eye, objective refraction, lens status, central foveal thickness on spectral-domain optical coherence tomography (SD-OCT). In all glaucoma patients, a visual field assessment and a measurement of the retinal nerve fibre layer (RNFL) on SD-OCT were done. MPOD was determined using the macula pigment module of the Spectralis HRA+OCT (Heidelberg Engineering GmbH, Heidelberg, Germany) at 0.51°, 1.02° and 1.99° retinal eccentricity using two-wavelength autofluorescence imaging. Results In the glaucoma group, the median of the visual field mean defect was 5.1 db (quartiles 3.0 and 13.5) and the mean RNFL-thickness global was 65.9 µm (SD ± 16.1). Median MPOD measured at 0.51°, 1.02° and 1.99° retinal eccentricity in the glaucoma group was 0.42 DU, 0.34 DU and 0.13 DU, in the control group 0.40 DU, 0.35 DU and 0.12 DU respectively. There was no statistically significant difference of median MPOD between glaucomatous and control eyes (p=0.510, 0.735, 0.481). No significant relation between MPOD at 1.02 retinal eccentricity and the presence of glare symptoms was found (p=0.948). However, age seems to correlate with median MPOD measured at 1.02 retinal eccentricity (p=0.017). Conclusion There was no evidence for lower MPOD levels in our glaucoma patients; lower MPOD was not related to the presence of glare symptoms. However there seems to be a positive correlation between age and MPOD at 1.02° retinal eccentricity. To further investigate the relation between glare reported by glaucoma patients and glare disability linked to lower MPOD levels, additional studies are necessary that include both detailed inquiry of the quality of glare and a glare quantification and precise analysis of MPOD levels in glaucoma patients.
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Affiliation(s)
- Yannick Bruns
- University Eye Hospital, Hannover Medical School, Hannover 30625, Germany
| | - Bernd Junker
- University Eye Hospital, Hannover Medical School, Hannover 30625, Germany
| | - Daniel Boehringer
- Clinic for Ophthalmology, University of Freiburg Faculty of Medicine, Freiburg 79106, Germany
| | - Carsten Framme
- University Eye Hospital, Hannover Medical School, Hannover 30625, Germany
| | - Amelie Pielen
- University Eye Hospital, Hannover Medical School, Hannover 30625, Germany
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Abstract
Retinal carotenoids are dietary nutrients that uniquely protect the eye from light damage and various retinal pathologies. Their antioxidative properties protect the eye from many retinal diseases, such as age-related macular degeneration. As many retinal diseases are accompanied by low carotenoid levels, accurate noninvasive assessment of carotenoid status can help ophthalmologists identify the patients most likely to benefit from carotenoid supplementation. This review focuses on the different methods available to assess carotenoid status and highlights disease-related changes and potential nutritional interventions.
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Affiliation(s)
- Lydia Sauer
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA;, ,
| | - Binxing Li
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA;, ,
| | - Paul S. Bernstein
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA;, ,
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Conrady CD, Bell JP, Besch BM, Gorusupudi A, Farnsworth K, Ermakov I, Sharifzadeh M, Ermakova M, Gellermann W, Bernstein PS. Correlations Between Macular, Skin, and Serum Carotenoids. Invest Ophthalmol Vis Sci 2017; 58:3616-3627. [PMID: 28728169 PMCID: PMC5520678 DOI: 10.1167/iovs.17-21818] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Ocular and systemic measurement and imaging of the macular carotenoids lutein and zeaxanthin have been employed extensively as potential biomarkers of AMD risk. In this study, we systematically compare dual wavelength retinal autofluorescence imaging (AFI) of macular pigment with skin resonance Raman spectroscopy (RRS) and serum carotenoid levels in a clinic-based population. Methods Eighty-eight patients were recruited from retina and general ophthalmology practices from a tertiary referral center and excluded only if they did not have all three modalities tested, had a diagnosis of macular telangiectasia (MacTel) or Stargardt disease, or had poor AFI image quality. Skin, macular, and serum carotenoid levels were measured by RRS, AFI, and HPLC, respectively. Results Skin RRS measurements and serum zeaxanthin concentrations correlated most strongly with AFI macular pigment volume under the curve (MPVUC) measurements up to 9° eccentricity relative to MPVUC or rotationally averaged macular pigment optical density (MPOD) measurements at smaller eccentricities. These measurements were reproducible and not significantly affected by cataracts. We also found that these techniques could readily identify subjects taking oral carotenoid-containing supplements. Conclusions Larger macular pigment volume AFI and skin RRS measurements are noninvasive, objective, and reliable methods to assess ocular and systemic carotenoid levels. They are an attractive alternative to psychophysical and optical methods that measure MPOD at a limited number of eccentricities. Consequently, skin RRS and MPVUC at 9° are both reasonable biomarkers of macular carotenoid status that could be readily adapted to research and clinical settings.
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Affiliation(s)
- Christopher D Conrady
- Department of Ophthalmology and Visual Sciences, Moran Eye Center, Salt Lake City, Utah, United States
| | - James P Bell
- Department of Ophthalmology and Visual Sciences, Moran Eye Center, Salt Lake City, Utah, United States
| | - Brian M Besch
- Department of Ophthalmology and Visual Sciences, Moran Eye Center, Salt Lake City, Utah, United States
| | - Aruna Gorusupudi
- Department of Ophthalmology and Visual Sciences, Moran Eye Center, Salt Lake City, Utah, United States
| | - Kelliann Farnsworth
- Department of Ophthalmology and Visual Sciences, Moran Eye Center, Salt Lake City, Utah, United States
| | - Igor Ermakov
- Image Technologies Corporation, Salt Lake City, Utah, United States
| | | | - Maia Ermakova
- Image Technologies Corporation, Salt Lake City, Utah, United States
| | - Werner Gellermann
- Department of Ophthalmology and Visual Sciences, Moran Eye Center, Salt Lake City, Utah, United States 2Image Technologies Corporation, Salt Lake City, Utah, United States
| | - Paul S Bernstein
- Department of Ophthalmology and Visual Sciences, Moran Eye Center, Salt Lake City, Utah, United States
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Broadhead GK, Grigg JR, Chang AA, McCluskey P. Dietary modification and supplementation for the treatment of age-related macular degeneration. Nutr Rev 2015; 73:448-62. [PMID: 26081455 DOI: 10.1093/nutrit/nuv005] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Age-related macular degeneration (AMD) causes a significant proportion of visual loss in the developed world. Currently, little is known about its pathogenesis, and treatment options are limited. Dietary intake is one of the few modifiable risk factors for this condition. The best-validated therapies remain oral antioxidant supplements based on those investigated in the Age-Related Eye Disease Study (AREDS) and the recently completed Age-Related Eye Disease Study 2 (AREDS2). In this review, current dietary guidelines related to AMD, along with the underlying evidence to support them, are presented in conjunction with current treatment recommendations. Both AREDS and AREDS2 are discussed, as are avenues for further research, including supplementation with vitamin D and saffron. Despite the considerable disease burden of atrophic AMD, few effective therapies are available to treat it, and further research is required.
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Affiliation(s)
- Geoffrey K Broadhead
- G.K. Broadhead, J. Grigg, A.A Chang, and P. McCluskey are with the Save Sight Institute, Department of Ophthalmology, The University of Sydney, Sydney, New South Wales, 2000, Australia. G.K. Broadhead and A.A Chang are with the Sydney Institute of Vision Science, Sydney, New South Wales, 2000, Australia.
| | - John R Grigg
- G.K. Broadhead, J. Grigg, A.A Chang, and P. McCluskey are with the Save Sight Institute, Department of Ophthalmology, The University of Sydney, Sydney, New South Wales, 2000, Australia. G.K. Broadhead and A.A Chang are with the Sydney Institute of Vision Science, Sydney, New South Wales, 2000, Australia
| | - Andrew A Chang
- G.K. Broadhead, J. Grigg, A.A Chang, and P. McCluskey are with the Save Sight Institute, Department of Ophthalmology, The University of Sydney, Sydney, New South Wales, 2000, Australia. G.K. Broadhead and A.A Chang are with the Sydney Institute of Vision Science, Sydney, New South Wales, 2000, Australia
| | - Peter McCluskey
- G.K. Broadhead, J. Grigg, A.A Chang, and P. McCluskey are with the Save Sight Institute, Department of Ophthalmology, The University of Sydney, Sydney, New South Wales, 2000, Australia. G.K. Broadhead and A.A Chang are with the Sydney Institute of Vision Science, Sydney, New South Wales, 2000, Australia
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The use of heterochromatic flicker photometry to determine macular pigment optical density in a healthy Australian population. Graefes Arch Clin Exp Ophthalmol 2014; 252:417-21. [PMID: 24390399 DOI: 10.1007/s00417-013-2554-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/03/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To establish the normal macular pigment density (MPOD) in a healthy adult Australian sample using heterochromatic flicker photometry (HFP). METHODS Macular pigment density was measured using heterochromatic flicker photometry in a total of 201 subjects ranging in age from 21 to 84 years with healthy macula. Fifty-seven of the healthy subjects also completed a food-frequency dietary questionnaire. Best-corrected visual acuity (BCVA) was measured using logMAR, chart and macular morphological profiles were assessed using high-resolution integrated Fourier-domain optical coherence tomography (OCT). RESULTS The average MPOD value was 0.41 ± 0.20 (range 0.07-0.79). There was no statistically significant difference between values in the left and right eye, with good interocular agreement (0.41 vs 0.40, r = 0.893, p < 0.01). Age significantly predicted MPOD score (R (2) = 0.07, p < 0.05). A subgroup analysis of patients who completed the dietary questionnaire revealed a close correlation between higher diet scores and higher MPOD (r = 0.720 p = 0.031). There was no effect of smoking, gender, or iris colour on MPOD values. There was no significant correlation between BCVA, macular OCT profiles, and MPOD. CONCLUSION Given that MPOD values are potentially affected by geographical variation, we have determined a mean MPOD value for healthy subjects in a population south of the equator, providing a reference point for future studies on Caucasian samples.
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Igras E, Loughman J, Ratzlaff M, O'Caoimh R, O'Brien C. Evidence of lower macular pigment optical density in chronic open angle glaucoma. Br J Ophthalmol 2013; 97:994-8. [DOI: 10.1136/bjophthalmol-2013-303153] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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