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Jaggi D, Solberg Y, Dysli C, Lincke J, Habra O, Wyss A, Wolf S, Zinkernagel M. Fluorescence lifetime imaging ophthalmoscopy and the influence of oral lutein/zeaxanthin supplementation on macular pigment (FLOS) - A pilot study. Clin Nutr ESPEN 2023; 56:127-134. [PMID: 37344061 DOI: 10.1016/j.clnesp.2023.05.009] [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: 09/10/2022] [Revised: 04/24/2023] [Accepted: 05/12/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND & AIMS Oral lutein (L) and zeaxanthin (Z) supplementation enhances macular pigment optical density (MPOD) and plays a protective role in the development of age-related macular degeneration (AMD). Fluorescence lifetime imaging ophthalmoscopy (FLIO) is a novel in vivo retinal imaging method that has been shown to correlate to classical MPOD measurements and might contribute to a metabolic mapping of the retina in the future. Our aim was to show that oral supplementation of L and Z affects the FLIO signal in a positive way in patients with AMD. METHODS This was a prospective, single center, open label cohort study. Patients with early and intermediate AMD received oral L and Z supplementation during three months, and were observed for another three months after therapy termination. All visits included measurements of clinical parameters, serum L and Z concentration, MPOD measurements using heterochromatic flicker photometry, dual wavelength autofluorescence imaging, and FLIO. Correlation analysis between FLIO and MPOD were performed. RESULTS Twenty-one patients completed the follow up period. Serum L and Z concentrations significantly increased during supplementation (mean difference 244.8 ng/ml; 95% CI: 81.26-419.9, and 77.1 ng/ml; 95% CI: 5.3-52.0, respectively). Mean MPOD units significantly increased (mean difference 0.06; 95% CI: 0.02-0.09; at 0.5°, 202; 95% CI: 58-345; at 2°, 1033; 95% CI: 288-1668; at 9° of eccentricity, respectively) after three months of supplementation with macular xanthophylls, which included L and Z. Median FLIO lifetimes in the foveal center significantly decreased from 277.3 ps (interquartile range 230.2-339.1) to 261.0 ps (interquartile range 231.4-334.4, p = 0.027). All parameters returned to near-normal values after termination of the nutritional supplementation. A significant negative correlation was found between FLIO and MPOD (r2 = 0.57, p < 0.0001). CONCLUSIONS FLIO is able to detect subtle changes in MPOD after L and Z supplementation in patients with early and intermediate AMD. Our findings confirm the previous described negative correlation between FLIO and MPOD. Macular xanthophylls seem to contribute to short foveal lifetimes. This study is registered at ClinicalTrials.gov (identifier number NCT04761341).
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Affiliation(s)
- Damian Jaggi
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of BioMedical Research, University of Bern, Bern, Switzerland.
| | - Yasmin Solberg
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of BioMedical Research, University of Bern, Bern, Switzerland.
| | - Chantal Dysli
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of BioMedical Research, University of Bern, Bern, Switzerland.
| | - Joel Lincke
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of BioMedical Research, University of Bern, Bern, Switzerland.
| | - Oussama Habra
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of BioMedical Research, University of Bern, Bern, Switzerland.
| | - Adrian Wyss
- DSM Nutritional Products Ltd. R&D Human Nutrition and Care, CH-4303 Kaiseraugst, Switzerland.
| | - Sebastian Wolf
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of BioMedical Research, University of Bern, Bern, Switzerland.
| | - Martin Zinkernagel
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of BioMedical Research, University of Bern, Bern, Switzerland.
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Schweitzer D, Haueisen J, Klemm M. Suppression of natural lens fluorescence in fundus autofluorescence measurements: review of hardware solutions. BIOMEDICAL OPTICS EXPRESS 2022; 13:5151-5170. [PMID: 36425615 PMCID: PMC9664869 DOI: 10.1364/boe.462559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 06/16/2023]
Abstract
Fluorescence lifetime imaging ophthalmoscopy (FLIO), a technique for investigating metabolic changes in the eye ground, can reveal the first signs of diseases related to metabolism. The fluorescence of the natural lens overlies the fundus fluorescence. Although the influence of natural lens fluorescence can be somewhat decreased with mathematical models, excluding this influence during the measurement by using hardware enables more exact estimation of the fundus fluorescence. Here, we analyze four 1-photon excitation hardware solutions to suppress the influence of natural lens fluorescence: aperture stop separation, confocal scanning laser ophthalmoscopy, combined confocal scanning laser ophthalmoscopy and aperture stop separation, and dual point confocal scanning laser ophthalmoscopy. The effect of each principle is demonstrated in examples. The best suppression is provided by the dual point principle, realized with a confocal scanning laser ophthalmoscope. In this case, in addition to the fluorescence of the whole eye, the fluorescence of the anterior part of the eye is detected from a non-excited spot of the fundus. The intensity and time-resolved fluorescence spectral data of the fundus are derived through the subtraction of the simultaneously measured fluorescence of the excited and non-excited spots. Advantages of future 2-photon fluorescence excitation are also discussed. This study provides the first quantitative evaluation of hardware principles to suppress the fluorescence of the natural lens during measurements of fundus autofluorescence.
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Affiliation(s)
- D. Schweitzer
- Department of Ophthalmology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - J. Haueisen
- Institute of Biomedical Engineering and Informatics, POB 100565, 98694 Ilmenau, Germany
| | - M. Klemm
- Institute of Biomedical Engineering and Informatics, POB 100565, 98694 Ilmenau, Germany
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