An ideal ocular nutritional supplement?

Through the Smoke: An In-Depth Review on Cigarette Smoking and Its Impact on Ocular Health

Smoking is a widespread and pervasive habit, impacting health across various care settings, including acute care, subacute care, home-based care, and long-term care. Smoking is a serious global public health concern that has been related to many chronic diseases. However, the effect of smoking on eye disorders has been less studied. Cigarette smoke contains a complex mixture of harmful constituents, including nicotine and toxic chemicals, which permeate the bloodstream, affecting ocular tissues. The oxidative stress and inflammation induced by smoking are central to its detrimental effects on ocular health. Age-related macular degeneration (AMD), a leading cause of vision loss, exhibits a strong association with smoking. Research consistently demonstrates that smokers face a heightened risk of both early and advanced AMD. Cataracts, another prevalent ocular condition, develop earlier and progress more rapidly in smokers. The oxidative stress on the lens and reduced antioxidants among smokers contribute to the increased severity of cataracts. Moreover, the health of the eyes may be compromised by smoking-related chemicals that reduce blood flow and/or hasten thrombus formation in ocular capillaries thus increasing the chance of acquiring glaucoma, cataracts, AMD, and Graves' eye disease. Beyond individual health concerns, the societal implications of smoking on ocular health are substantial, including increased healthcare costs and diminished quality of life for affected individuals. Understanding the underlying mechanisms can provide insights into potential therapeutic interventions for preventing and managing smoking-related ocular damage. Given the global prevalence of smoking, raising awareness about the ocular risks associated with smoking is crucial for promoting eye health. The review underscores the urgent need for comprehensive anti-smoking initiatives and smoking cessation programs to alleviate the burden of ocular diseases associated with smoking.

Biomarkers of Pediatric Cataracts: A Proteomics Analysis of Aqueous Fluid

Cataracts are among the most common causes of childhood vision loss worldwide. This study seeks to identify differentially expressed proteins in the aqueous humor of pediatric cataract patients. Samples of aqueous humor were collected from pediatric and adult cataract patients and subjected to mass spectrometry-based proteomic analysis. Samples of pediatric cataracts were grouped by subtype and compared to adult samples. Differentially expressed proteins in each subtype were identified. Gene ontology analysis was performed using WikiPaths for each cataract subtype. Seven pediatric patients and ten adult patients were included in the study. Of the pediatric samples, all seven (100%) were male, three (43%) had traumatic cataracts, two (29%) had congenital cataracts, and two (29%) had posterior polar cataracts. Of the adult patients, seven (70%) were female and seven (70%) had predominantly nuclear sclerotic cataracts. A total of 128 proteins were upregulated in the pediatric samples, and 127 proteins were upregulated in the adult samples, with 75 proteins shared by both groups. Gene ontology analysis identified inflammatory and oxidative stress pathways as upregulated in pediatric cataracts. Inflammatory and oxidative stress mechanisms may be involved in pediatric cataract formation and warrant further investigation.

Potential Properties of Natural Nutraceuticals and Antioxidants in Age-Related Eye Disorders

Eye health is crucial, and the onset of diseases can reduce vision and affect the quality of life of patients. The main causes of progressive and irreversible vision loss include various pathologies, such as cataracts, ocular atrophy, corneal opacity, age-related macular degeneration, uncorrected refractive error, posterior capsular opacification, uveitis, glaucoma, diabetic retinopathy, retinal detachment, undetermined disease and other disorders involving oxidative stress and inflammation. The eyes are constantly exposed to the external environment and, for this reason, must be protected from damage from the outside. Many drugs, including cortisonics and antinflammatory drugs have widely been used to counteract eye disorders. However, recent advances have been obtained via supplementation with natural antioxidants and nutraceuticals for patients. In particular, evidence has accumulated that polyphenols (mostly deriving from Citrus Bergamia) represent a reliable source of antioxidants able to counteract oxidative stress accompanying early stages of eye diseases. Luteolin in particular has been found to protect photoreceptors, thereby improving vision in many disease states. Moreover, a consistent anti-inflammatory response was found to occur when curcumin is used alone or in combination with other nutraceuticals. Additionally, Coenzyme Q10 has been demonstrated to produce a consistent effect in reducing ocular pressure, thereby leading to protection in patients undergoing glaucoma. Finally, both grape seed extract, rich in anthocyanosides, and polynsatured fatty acids seem to contribute to the prevention of retinal disorders. Thus, a combination of nutraceuticals and antioxidants may represent the right solution for a multi-action activity in eye protection, in association with current drug therapies, and this will be of potential interest in early stages of eye disorders.

Successful Phakic Intraocular Lens Implantation with the Usage of Topical Ascorbic Acid in Patient with Reduced Corneal Endothelial Cell Density

We aimed to describe the use of topical ascorbic acid (AA) in a patient with reduced endothelial cells density (ECD) who was scheduled for phakic intraocular lens (pIOL) implantation. A 28-year-old woman presenting with dry eye and reduced ECD would like to have her high myopia (spherical equivalence >−15.0 D) corrected. The procedure of laser refractive surgery or even pIOL was not indicated for the reduced ECD of 1865/mm2 in the right eye and 2188/mm2 in the left eye, as well as level 3 dry eye. Fortunately, the ECD increased to 3144/mm2 in the right eye and 2538/mm2 in the left eye after topical AA was prescribed for one year preoperatively and one month postoperatively, with concomitant improvement of dry eye to level 1. Finally, bilateral pIOL implantation was performed smoothly and no sign of corneal decompensation was found postoperatively. Three months postoperatively, the ECD showed a satisfactory level of 2983/mm2 in the right eye and 3003/mm2 in the left eye. In conclusion, topical AA instillation might increase and maintain the density of central human corneal endothelial cells (HCECs) even after pIOL implantation.

Non-drug interventions in glaucoma: Putative roles for lifestyle, diet and nutritional supplements

Glaucoma is a major ocular neurodegenerative disease characterized by progressive retinal ganglion cells degeneration and sight loss. Current treatment options have been limited to reducing intraocular pressure (IOP), known as the leading risk factor for this disease; however, glaucoma can develop even with low or normal IOP and progress despite controlling IOP values. Lifestyle, dietary habits, and supplementation may influence some of the risk factors and pathophysiological mechanisms underlying glaucoma development and progression; thus, the role of this complementary and alternative medicine in glaucoma has received great interest from both patients and ophthalmologists. We provide a summary of the current evidence concerning the relationship between lifestyle, dietary habits, and effects of supplements on the incidence and progression of glaucoma and their targets and associated mechanisms. The data suggest the existence of a therapeutic potential that needs to be further explored with both preclinical and rigorous clinical studies.

Effects of a New Combination of Natural Extracts on Glaucoma-Related Retinal Degeneration

BACKGROUND

Glaucoma is currently the leading cause of irreversible blindness; it is a neuropathy characterized by structural alterations of the optic nerve, leading to visual impairments. The aim of this work is to develop a new oral formulation able to counteract the early changes connected to glaucomatous degeneration. The composition is based on gastrodin and vitamin D3 combined with vitamin C, blackcurrant, and lycopene.

METHODS

Cells and tissues of the retina were used to study biological mechanisms involved in glaucoma, to slow down the progression of the disease. Experiments mimicking the conditions of glaucoma were carried out to examine the etiology of retinal degeneration.

RESULTS

Our results show a significant ability to restore glaucoma-induced damage, by counteracting ROS production and promoting cell survival by inhibiting apoptosis. These effects were confirmed by the intracellular mechanism that was activated following administration of the compound, either before or after the glaucoma induction. In particular, the main results were obtained as a preventive action of glaucoma, showing a beneficial action on all selected markers, both on cells and on eyecup preparations. It is therefore possible to hypothesize both the preventive and therapeutic use of this formulation, in the presence of risk factors, and due to its ability to inhibit the apoptotic cycle and to stimulate cell survival mechanisms, respectively.

CONCLUSION

This formulation has exhibited an active role in the prevention or restoration of glaucoma damage for the first time.

Medicinal plants and natural products as neuroprotective agents in age-related macular degeneration

The retina may suffer neurodegenerative damages, as other tissues of the central nervous system do, and serious eye diseases may develop. One of them is age-related macular degeneration, which causes progressive loss of vision due to retina degeneration. Treatment of age-related macular degeneration focuses on antioxidant agents and anti-vascular endothelial growth factor compounds, among others, that prevent/diminish oxidative stress and reduce neovascularisation respectively. The phytochemicals, medicinal plants and/or plant-diet supplements might be a useful adjunct in prevention or treatment of age-related macular degeneration owing to their antioxidant and anti-vascular endothelial growth factor properties. This review article presents the most investigated plants and natural products in relation to age-related macular degeneration, such as saffron, ginkgo, bilberry and blueberry, curcuma or turmeric, carotenoids, polyphenols, and vitamins C and E. This study provides up-to-date information on the effects, treatments, safety and efficiency of these phytotherapy products.

An Open-Label Pilot Study on Macumax Supplementation for Dry-Type Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is one of the most widespread degenerative disorders in elderly people. A 90-day, open-label clinical study was conducted in 40 patients, aged 50 years or older, with early-stage dry-type AMD to evaluate the safety and efficacy of Macumax^®, a novel mixture of a phyto-mineral nutritional supplement containing ZeaLutein^® (consisting of lutein, zeaxanthin, and piperine), extracts of bilberry, saffron, and zinc monomethionine. Subjects received one capsule of the supplement twice daily for 90 days. The treatment measures included physical examination, vital signs, and assessment of subjective and objective symptoms at baseline and after treatment. For efficacy assessment, baseline values were compared with the values after treatment at 30-day intervals, on days 30, 60, and 90. The safety of the treatment was assessed during all the visits. Overall, the patients showed improvement in the subjective symptoms, such as vision scores after treatment compared with baseline. The changes in diminished and distorted vision scores were found to be significant from day 60 (P < .05). In the case of objective symptoms, only 40% of the subjects (P < .05) had abnormal Amsler's grid aberration scores on day 90 compared with 77.5% of subjects at the beginning of the study. No adverse events were observed during the study. This pilot study provides evidence that Macumax^® supplementation is safe and maintained eye health without further progression of the disease in patients with early-stage dry-type AMD. Clinical Trial Registration number: CTRI/2016/02/006676

Topical Ascorbic Acid Ameliorates Oxidative Stress-Induced Corneal Endothelial Damage via Suppression of Apoptosis and Autophagic Flux Blockage

Compromised pumping function of the corneal endothelium, due to loss of endothelial cells, results in corneal edema and subsequent visual problems. Clinically and experimentally, oxidative stress may cause corneal endothelial decompensation after phacoemulsification. Additionally, in vitro and animal studies have demonstrated the protective effects of intraoperative infusion of ascorbic acid (AA). Here, we established a paraquat-induced cell damage model, in which paraquat induced reactive oxygen species (ROS) production and apoptosis in the B4G12 and ARPE-19 cell lines. We demonstrate that oxidative stress triggered autophagic flux blockage in corneal endothelial cells and that addition of AA ameliorated such oxidative damage. We also demonstrate the downregulation of Akt phosphorylation in response to oxidative stress. Pretreatment with ascorbic acid reduced the downregulation of Akt phosphorylation, while inhibition of the PI3K/Akt pathway attenuated the protective effects of AA. Further, we establish an in vivo rabbit model of corneal endothelial damage, in which an intracameral infusion of paraquat caused corneal opacity. Administration of AA via topical application increased its concentration in the corneal stroma and reduced oxidative stress in the corneal endothelium, thereby promoting corneal clarity. Our findings indicate a perioperative strategy of topical AA administration to prevent oxidative stress-induced damage, particularly for those with vulnerable corneal endothelia.

Perioperative topical ascorbic acid for the prevention of phacoemulsification-related corneal endothelial damage: Two case reports and review of literature

BACKGROUND

The current case report describes successful phacoemulsification with the aid of perioperative topical ascorbic acid (AA) in two patients with corneal endothelial disorders to prevent postoperative corneal endothelial decompensation.

CASE SUMMARY

Two eyes of two patients underwent phacoemulsification with pre-existing corneal endothelial disorders including Fuchs corneal endothelial dystrophy (Patient 1) and endotheliitis (Patient 2). Topical AA was applied to both patients at least one month before and after with a frequency of four times per day. After the surgery, both eyes improved best-corrected visual acuity (BCVA) and there was limited human corneal endothelial cell loss without signs of corneal endothelial decompensation, such as deteriorated BCVA or persistent corneal edema during the follow-up of at least two years.

CONCLUSION

Perioperative administration of topical AA may be an alternative therapy to the triple procedure in patients expecting to undergo cataract surgery.

Glaucoma: Current and Developing Concepts for Inflammation, Pathogenesis and Treatment

Glaucoma is a prevalent neurodegenerative disorder of the eye. However, the mechanism leading to the disease is still unclear. Increased intraocular pressure (IOP) and subsequent retinal ganglion cell (RGC) death leading to the loss of visual field characterizes the pathology of primary open angle glaucoma, which is the most common form. Possible factors leading to glaucoma include glutamate-induced neurotoxicity, nitric oxide (NO) based damage, disruption of neurotrophic factor transport and immune-induced neurodestruction. Current treatment options primarily aim at decreasing IOP by utilizing pharmacological agents, laser therapy and surgery. Developing treatments target neuroprotection with vaccines, the inhibition of NO synthesis and apoptosis. Gaining a better understanding of the pathogenesis can aid in the development of new treatment options and, perhaps, even a cure for glaucoma.

Oxidant/antioxidant balance in the aqueous humor of patients with glaucoma

AIM

To evaluate total antioxidant status (TAS), total oxidant status (TOS), and the oxidative stress index (OSI) of the aqueous humor (AH) in patients with glaucoma.

METHODS

The prospective study was composed of a study group (n=31) and a control group (n=31). Fifteen patients in the study group were diagnosed with primary open angle glaucoma (POAG), and 16 patients were diagnosed with pseudoexfoliation glaucoma (PEG). The control group was composed of non-glaucomatous patients with cataracts. AH samples were collected and analyzed for TAS, TOS, and OSI levels.

RESULTS

Mean AH TAS level was significantly higher in patients with glaucoma than that in the control group (P<0.01). Mean TOS and OSI levels tended to increase in patients with glaucoma. No significant differences in TAS, TOS, or OSI levels were observed between patients with POAG and PEG.

CONCLUSION

High levels of TAS were observed in patients with glaucoma, which was likely a response to the increased oxidative stress observed in these patients.

The Effect of Lamium album Extract on Cultivated Human Corneal Epithelial Cells (10.014 pRSV-T)

Purpose:

To evaluate the effect of Lamium album extract on human corneal epithelial cells (10.014 pRSV-T cell line) cultured in vitro.

Methods:

Normal human corneal epithelial cells were incubated with ethanol, ethyl acetate and heptane extracts from Lamium album. Their effect on cells was evaluated by neutral red (NR) uptake and MTT assays for cytotoxicity, ELISA for immunomodulation, Griess method for nitric oxide levels, DPPH assay for free radicals scavenging activity. A blank control consisted only of culture medium.

Results:

In NR and MTT assays, Lamium album extracts did not affect cell viability (80% at 125 μg/ml concentration). Ethanol was the least toxic extract (cell viability over 88%) and expressed the most potent reactive oxygen species (ROS) scavenging action. It was 19.88 ± 0.87% higher than controls representing a reduction corresponding to 7.136 μg/ml of trolox. Heptane extract revealed no ROS scavenging activity. All extracts decreased NO production by cells. The most active extract was ethanol (8 μg/ml) which reduced NO level to 0.242 μM (75% decrease compared to control). Extracts influenced pro-inflammatory (IL-1, IL-6, TNF-α) and anti-inflammatory (IL-10) cytokines levels reducing all of them in general. The strongest reduction in tested cytokines level was observed by the heptane extract. On the other hand, the ethanol extract induced mainly TNF-α level in a concentration dependent manner.

Conclusion:

Selected Lamium album extracts influence human corneal epithelial cells. Generally, while not toxic, they modulate pro-inflammatory and anti-inflammatory cytokines levels, and decrease NO release by cells; moreover, ethanol and ethyl acetate extracts reduce ROS levels.

Eye nutrition in context: mechanisms, implementation, and future directions

Carotenoid-based visual cues and roles of carotenoids in human vision are reviewed, with an emphasis on protection by zeaxanthin and lutein against vision loss, and dietary sources of zeaxanthin and lutein are summarized. In addition, attention is given to synergistic interactions of zeaxanthin and lutein with other dietary factors affecting human vision (such as antioxidant vitamins, phenolics, and poly-unsaturated fatty acids) and the emerging mechanisms of these interactions. Emphasis is given to lipid oxidation products serving as messengers with functions in gene regulation. Lastly, the photo-physics of light collection and photoprotection in photosynthesis and vision are compared and their common principles identified as possible targets of future research.

Dietary supplementation: effects on visual performance and occurrence of AMD and cataracts

OBJECTIVE

To evaluate results of studies that have provided information regarding the effects of dietary supplementation on visual performance, development and progression of age-related macular degeneration (AMD), and risk for cataracts.

RESEARCH DESIGN AND METHODS

Studies with information about the effects of dietary supplementation were identified via PubMed searches that combined (in separate searches) the terms 'supplement' OR 'supplementation' OR 'diet' AND 'cataract' or 'macular degeneration' or 'visual' OR 'vision'. Additional references concerned with biologic effects of specific agents, measurement of visual function, and the etiology and epidemiology of cataracts and AMD were identified on the basis of PubMed conventional literature searches.

RESULTS

Studies of the effects of dietary supplementation, primarily with preparations including lutein and zeaxanthin, have demonstrated improvements in contrast sensitivity and visual performance under glare conditions that, in some studies, have been correlated with effects of treatment on macular pigment optical density. Results from both observational and prospective interventional studies generally support the conclusion that dietary supplements including these xanthophylls significantly decrease the occurrence of AMD and the development of nuclear lens opacities. However, there is variability in results regarding effects of dietary supplementation that may be related to limitations of long-term observational or interventional studies and which cannot be easily controlled or which may also be related in some studies to other important, yet unrecorded, diet- and lifestyle-related factors that are capable of influencing the risks for AMD and/or cataracts.

CONCLUSIONS

The multiple benefits of dietary supplementation support the development and use of these preparations to promote optimal visual function and decrease risk for AMD and cataracts. Increasing understanding of the optimal approach to supplementation will depend upon results from interventional studies that also carefully evaluate and analyze well-established factors for these two conditions.

Comparative study of plasma ascorbic acid levels in senile cataract patients and in normal individuals

OBJECTIVE

Dietary antioxidant vitamins, in particular vitamin C, could play a role in preventing the onset or progression of age-related visual impairment. The aim of this study was to determine the plasma ascorbic acid levels in normal individuals and in senile cataract patients.

METHOD

The test group included 50 cataract patients, while the control group members were selected among medical staff and patients' companions after age matching with the test group. Questionnaire forms contained age, sex, and location of residency (urban or rural) inquiries. Five milliliters of drawn blood was centrifuged, and plasma ascorbic acid level was measured by spectrophotometer. Statistical analysis of plasma ascorbic acid concentrations were done by paired test.

RESULTS

The mean plasma ascorbic acid level in the test group was 0.96 +/- 0.08 mg/dl and 1.12 +/- 0.15 mg/dl in the control group. Ascorbic acid level in the test group was significantly lower than the control group and p value = 0.00001. Aging had a reverse relation with plasma ascorbic acid level in males, while it showed no significant alterations in females. Rural compared with urban and females compared to males showed higher levels of plasma ascorbic acid.

CONCLUSION

This study revealed that plasma ascorbic acid level in cataract patients was lower than normal individuals. Antioxidant vitamins, in particular vitamin C, found in Mediterranean fruits and vegetables, can help with the prevention of cataracts, which is a major health service burden in many countries.

Biological diversity, dietary diversity, and eye health in developing country populations: establishing the evidence-base

Human and ecosystem health converge around biological diversity issues. Cultivated and wild plants as food and medicine make essential contributions to human health, which in turn provides rationales for conservation. While wild and cultivated plant diversity reasonably facilitates dietary diversity and positive health outcomes, the challenges of demonstrating this relationship limit its impact in concept, policy, and practice. We present a rationale for testing the dietary contribution of biological diversity to improved eye health as a case study based on existing phytochemical, pharmacological, and clinical knowledge. We consider the empirical evidence needed to substantiate, interpret, and apply this relationship at a population and ecosystem level within a unified research framework. Epidemiological data strongly support the prevention of childhood vitamin A deficiency blindness, cataract, and age-related macular degeneration by fruit and vegetable consumption. Phytonutrients, including the carotenoids lutein and zeaxanthin, protect the eye from oxidative stress and harmful light exposure. Laboratory, community, and population level research should prioritize food composition of dietary plants from both agriculture and the wild. Intervention studies, focus groups, and transmission of knowledge of local species and varieties within communities will further interpretation of epidemiological data. Population-based studies combining clinical data and measures of access and consumption of biological diversity are key to demonstrating the important relationships among biodiversity, dietary diversity, and health outcomes.

Vitamin and mineral deficiencies in the developed world and their effect on the eye and vision

Vitamin and mineral deficiencies are common in developing countries, but also occur in developed countries. We review micronutrient deficiencies for the major vitamins A, cobalamin (B(12)), biotin (vitamin H), vitamins C and E, as well as the minerals iron, and zinc, in the developed world, in terms of their relationship to systemic health and any resulting ocular disease and/or visual dysfunction. A knowledge of these effects is important as individuals with consequent poor ocular health and reduced visual function may present for ophthalmic care.

Management of a South African family with retinitis pigmentosa-should potential therapy influence translational research protocols?

Mutation analysis of retinal candidate genes is performed as part of an ongoing research to identify the causative genetic defect in South African families with retinal degenerative disorders (RDDs). A translational research protocol has been established whereby probands are counseled and given their molecular genetic results to take back to other family members, who can then request individual diagnostic testing. A Thr17Met mutation of the rhodopsin gene was identified in a Caucasian South African family with autosomal dominant retinitis pigmentosa. Patients with this mutation appear to benefit from treatment using oral vitamin A supplementation. This family has been informed that a molecular diagnosis is available; however, one individual has refused testing and none of the younger generation has shown interest in receiving molecular results or genetic counseling. Adapting the established protocol for the translation of RDD research results and contacting mutation positive individuals may be justifiable in light of the potential benefit of therapy.

Protection against beta-amyloid induced abnormal synaptic function and cell death by Ginkgolide J

A new Ginkgo biloba extract P8A (TTL), 70% enriched with terpene trilactones, prevents A beta(1-42) induced inhibition of long-term potentiation in the CA1 region of mouse hippocampal slices. This neuroprotective effect is attributed in large part to ginkgolide J that completely replicates the effect of the extract. Ginkgolide J is also capable of inhibiting cell death of rodent hippocampal neurons caused by A beta(1-42). This beneficial and multi-faceted mode of action of the ginkgolide makes it a new and promising lead in designing therapies against Alzheimer's disease.

Preliminary identification of Beta-carotene in the vitreous asteroid bodies by micro-Raman spectroscopy and HPLC analysis

beta-carotene was first identified from the vitreous asteroid bodies (ABs) excised from one patient with asteroid hyalosis (AH) by confocal Raman microspectroscopy and was also verified by high performance liquid chromatography (HPLC). Two patients had been diagnosed with AH and intervened by surgical vitrectomy due to blurred vision. The morphology and components of both AB specimens were observed by optical microscopy and determined by using confocal Raman microspectroscopy and HPLC analysis, respectively. Surprisingly, two unique peaks at 1528 and 1157 cm(-1) were found in the Raman spectrum for the AB specimen of patient 1 alone, which were in close agreement with that of the Raman peaks at 1525 and 1158 cm(-1) for beta-carotene and/or lutein. However, HPLC analytical data clearly indicated that the retention time for the extracted sample from the AB specimen of patient 1 was observed at 13.685 min and just identical to that of beta-carotene (13.759 min) rather than lutein (2.978 min). In addition, the lack of any peak in the HPLC profile for the AB specimen of patient 2 also confirmed the absence of Raman peaks at 1525 and 1158 cm(-1). Thus this preliminary study strongly suggests that beta-carotene as a unique component of ABs was specifically detected from the AB specimen of one AH patient by using confocal Raman microspectroscopy and HPLC analysis.

Effect of lutein and antioxidant dietary supplementation on contrast sensitivity in age-related macular disease: a randomized controlled trial

OBJECTIVE

The aim of the study is to determine the effect of lutein combined with vitamin and mineral supplementation on contrast sensitivity in people with age-related macular disease (ARMD).

DESIGN

A prospective, 9-month, double-masked randomized controlled trial.

SETTING

Aston University, Birmingham, UK and a UK optometric clinical practice.

SUBJECTS

Age-related maculopathy (ARM) and atrophic age-related macular degeneration (AMD) participants were randomized (using a random number generator) to either placebo (n=10) or active (n=15) groups. Three of the placebo group and two of the active group dropped out.

INTERVENTIONS

The active group supplemented daily with 6 mg lutein combined with vitamins and minerals. The outcome measure was contrast sensitivity (CS) measured using the Pelli-Robson chart, for which the study had 80% power at the 5% significance level to detect a change of 0.3 log units.

RESULTS

The CS score increased by 0.07+/-0.07 and decreased by 0.02+/-0.18 log units for the placebo and active groups, respectively. The difference between these values is not statistically significant (z=-0.903, P=0.376).

CONCLUSION

The results suggest that 6 mg of lutein supplementation in combination with other antioxidants is not beneficial for this group. Further work is required to establish optimum dosage levels.

Effect of lipid-hydroperoxide-induced oxidative stress on vitamin E, ascorbate and glutathione in the rabbit retina

BACKGROUND

It is possible that oxidative stress causes several retinal diseases. However, the natural biogenic role of antioxidants in the retina is not clear.

PURPOSE

This study investigates the change in concentration of vitamin E (VE), ascorbate and glutathione (GSH) in the retina following vitreous injection of 600 mug 18:2 linoleic acid hydroperoxide (LHP) in male New Zealand rabbits.

METHOD

LHP was injected above the retinal surface. The animals were sacrificed and the eyes enucleated before LHP injection, 1, 3, 6, 12, 24 h and 4 and 7 days after LHP injection. Retinas were removed, VE and ascorbate measured by HPLC, and GSH determined by a fluorometric method.

RESULTS

The concentration of VE in the retina decreased from pretreatment levels of 154.6 +/- 29.7 nmol/g wet weight (n = 7) and was lowest at 6 h (61.1 +/- 18.1 nmol/g wet weight, n = 4, p < 0.05), then increased gradually, returning slowly to pre-LHP levels by 7 days. The concentration of ascorbate in control retinas decreased at 6 h from pretreatment levels of 7.33 +/- 0.93 micromol/g wet weight (n = 7) to 2.74 +/- 0.16 micromol/g wet weight (n = 4, p < 0.05) and returned to pretreatment levels rapidly by 24 h after injection. The concentration of GSH in retinas decreased from baseline levels of 109.53 +/- 8.19 microg/g wet weight (n = 9), was lowest at 12 h (72.40 +/- 11.17 microg/g wet weight, n = 5, p < 0.05) and returned to pretreatment levels by 7 days.

CONCLUSION

The results suggest that intravitreous LHP injection is a contributor to oxidative stress in the rabbit retina by causing a reduction in antioxidant capacity.

Fruit and Vegetable Intake during Pregnancy and Risk for Development of Sporadic Retinoblastoma

OBJECTIVE

Little is known about the causes of sporadic (noninherited) retinoblastoma. Rates seem to be somewhat higher among poorer populations in Mexico. Fruits and vegetables are important sources of carotenoids and folate. We examined whether decreased gestational maternal intake of fruits and vegetables may contribute to development of sporadic retinoblastoma.

METHODS

At the Instituto Nacional de Pediatria in Mexico City, we conducted a hospital-based case-control study to evaluate prenatal maternal diet. We examined dietary intake of fruits and vegetables of mothers of 101 children with retinoblastoma and 172 control children using a dietary recall questionnaire and published food nutrient content tables.

RESULTS

The reported number of mean daily servings of fruits and vegetables was lower among case mothers when compared with control mothers [vegetables: 2.28 in controls, 1.75 in cases (P < 0.01); fruits: 2.13 in controls, 1.59 in cases (P = 0.07)]. Mean daily maternal folate intake from both vegetables and fruits was higher in controls (103 microg) than in cases (48 microg; P < 0.05). Risk for having a child with retinoblastoma was increased for mothers consuming fewer than 2 daily servings of vegetables [odds ratios (OR), 3.4; 95% confidence interval (95% CI), 2.0-6.0] or with a low intake of folate (OR, 3.9; 95% CI, 2.1, 7.3), or lutein/zeaxanthin (OR, 2.6; 95% CI, 1.5-4.6) derived from fruits and vegetables.

CONCLUSIONS

Decreased intake of vegetables and fruits during pregnancy and the consequent decreased intake of nutrients such as folate and lutein/zeaxanthin, necessary for DNA methylation, synthesis, and retinal function, may increase risk for having a child with sporadic retinoblastoma.

Possible contraindications and adverse reactions associated with the use of ocular nutritional supplements

The role of oxidation in the development of age-related eye disease has prompted interest in the use of nutritional supplementation for prevention of onset and progression. Our aim is to highlight possible contraindications and adverse reactions of isolated or high dose ocular nutritional supplements. Web of Science and PubMed database searches were carried out, followed by a manual search of the bibliographies of retrieved articles. Vitamin A should be avoided in women who may become pregnant, in those with liver disease, and in people who drink heavily. Relationships have been found between vitamin A and reduced bone mineral density, and beta-carotene and increased risk of lung cancer in smoking males. Vitamin E and Ginkgo biloba have anticoagulant and anti-platelet effects respectively, and high doses are contraindicated in those being treated for vascular disorders. Those patients with contraindications or who are considered at risk of adverse reactions should be advised to seek specialist dietary advice via their medical practitioner.