In vivo resonant Raman measurement of macular carotenoid pigments in the young and the aging human retina

Effect of ageing and cataract formation on the Raman spectroscopic profile of human lens: An observational study

PURPOSE

To observe the spectroscopic profile of human lens in different age groups and varying grades of cataract and to use the data to arrive at differentiating molecular biology.

DESIGN

An observational cross-sectional study.

METHODS

The study enrolled 30 patients (30 eyes) with a mean age of 59.6 years diagnosed with immature senile cataracts. The patients underwent small incision cataract surgery, and the harvested lens nuclei were examined under a Raman spectroscope for studying their molecular composition. The relative intensities of the peaks in the Raman spectra were evaluated and compared among different age groups and grades of cataract. A correlation of tyrosine doublet ratio with grade of cataract and age of the subject was calculated.

RESULT

Several Raman spectral peaks were observed in the range of 600 cm-1 to 1800 cm-1 with correspondence to tyrosine, phenylalanine, tryptophan, and amides I and III. A strong negative correlation between the grade of cataract and the ratio of tyrosine doublet was seen (r = -0.805). Also, a negative correlation between age and tyrosine ratio was seen (r = -0.62). The wavenumber/spectral peak of tryptophan was observed only in one sample, and amides I and III were identified, but the intensity of the peak for amide II was very small or absent.

CONCLUSION

It was observed that the buried conformation of tyrosine was predominant in cases with a higher age or grade of cataract. The buried conformation of tryptophan became less in the higher grades of cataract.

Harnessing the power of Raman spectroscopic imaging for ophthalmology

Eye diseases can cause great inconvenience to people's daily life; therefore, it is necessary to study the causes of ocular diseases and related physiological processes. Raman spectroscopic imaging (RSI) is a non-destructive, non-contact detection technique with the advantages of label-free, non-invasive and highly specific. Compared with other mature imaging technologies, RSI can provide real-time molecular information and high-resolution imaging at relatively low cost, making it very suitable for quantitative detection of biological molecules. RSI can reflect the overall situation of the sample, revealing the content distribution of the same substance in different areas of the sample. This review focuses on the recent advances in ophthalmology, with particular emphasis on the powerful use of RSI techniques, as well as its combination with other imaging techniques. Finally, we prospect the wider application and future potential of RSI approaches in ophthalmology.

Multimodal Raman spectroscopy and optical coherence tomography for biomedical analysis

Optical techniques hold great potential to detect and monitor disease states as they are a fast, non-invasive toolkit. Raman spectroscopy (RS) in particular is a powerful label-free method capable of quantifying the biomolecular content of tissues. Still, spontaneous Raman scattering lacks information about tissue morphology due to its inability to rapidly assess a large field of view. Optical Coherence Tomography (OCT) is an interferometric optical method capable of fast, depth-resolved imaging of tissue morphology, but lacks detailed molecular contrast. In many cases, pairing label-free techniques into multimodal systems allows for a more diverse field of applications. Integrating RS and OCT into a single instrument allows for both structural imaging and biochemical interrogation of tissues and therefore offers a more comprehensive means for clinical diagnosis. This review summarizes the efforts made to date toward combining spontaneous RS-OCT instrumentation for biomedical analysis, including insights into primary design considerations and data interpretation.

Review: Emerging Eye-Based Diagnostic Technologies for Traumatic Brain Injury

The study of ocular manifestations of neurodegenerative disorders, Oculomics, is a growing field of investigation for early diagnostics, enabling structural and chemical biomarkers to be monitored overtime to predict prognosis. Traumatic brain injury (TBI) triggers a cascade of events harmful to the brain, which can lead to neurodegeneration. TBI, termed the "silent epidemic" is becoming a leading cause of death and disability worldwide. There is currently no effective diagnostic tool for TBI, and yet, early-intervention is known to considerably shorten hospital stays, improve outcomes, fasten neurological recovery and lower mortality rates, highlighting the unmet need for techniques capable of rapid and accurate point-of-care diagnostics, implemented in the earliest stages. This review focuses on the latest advances in the main neuropathophysiological responses and the achievements and shortfalls of TBI diagnostic methods. Validated and emerging TBI-indicative biomarkers are outlined and linked to ocular neuro-disorders. Methods detecting structural and chemical ocular responses to TBI are categorised along with prospective chemical and physical sensing techniques. Particular attention is drawn to the potential of Raman spectroscopy as a non-invasive sensing of neurological molecular signatures in the ocular projections of the brain, laying the platform for the first tangible path towards alternative point-of-care diagnostic technologies for TBI.

Analysis of macular carotenoids in the developing macaque retina: The timeline of macular pigment development

In the mature retina, the components of the macular pigment, lutein (L), R,R-zeaxanthin (RRZ), R,S-zeaxanthin (RSZ, meso-zeaxanthin) are most concentrated in the central macula. L and RRZ are of dietary origin but RSZ is produced in situ from L. The relative proportions of L and Z isomers vary across the retina with eccentricity in the adult retina. Early reports have shown that during development, the proportions of L and Z isomers undergo changes as the total pigment levels increase. The methods described here demonstrate the unique utility of chiral phase HPLC to measure the amounts of L, RRZ, and RSZ, discriminating between the two zeaxanthin stereoisomers. In three concentric retinal sections of macaque retinas chiral phase HPLC has been employed to document the developmental changes in the distribution of each L, RSZ, and RRZ during the period just prior to full term gestation through 19 months after birth. The net rate of accumulation of carotenoids within the central retina during the first 20 months is quasi-linear and fit by a linear regression. During development, the rate of transport of L (0.12 (±0.033)ngmm^-2mo^-1 (SE)) into the central 2mm of the retina is double that of RRZ (0.062 (±0.02)ngmm^-2mo^-1 (SE)). The rate of accumulation of RSZ (0.06 (±0.01)ngmm^-2mo^-1 (SE)) is comparable to that of RRZ. In the peripheral retina, the rates of accumulation of L and RRZ are not correlated with increasing age, whereas accumulation of RSZ does correlate with age. The changing proportions of L to Z isomers in the central retina during development are explained by the rates for carotenoid accumulation within the central retina. At birth, the macular pigment in the central retina is dominated by L and RRZ, 0.35±0.11 and 0.21±0.054ngmm^-2. In the central retina, RSZ was rarely detected in the youngest tissues analyzed. It can be estimated to represent 6% of the total macular pigment (0.033±0.11ngmm^-2) at birth based on extrapolation from measurements in the peripheral retina and the ratio of L/(RRZ+RSZ) is ≈1.5. At maturity, the concentrations for L, RRZ, and RSZ in the central macaque retina are estimated to be 1.7, 1.8 and 1.08ngmm^-2, with L/(RRZ+RSZ) being 0.6.

Challenges in Age-Related Macular Degeneration: From Risk Factors to Novel Diagnostics and Prevention Strategies

Age-related macular degeneration (AMD) is a chronic multifactorial eye disease representing the primary cause of vision loss in people aged 60 years and older. The etiopathogenesis of the disease remains uncertain, with several risk factors contributing to its onset and progression, such as genotype, aging, hypertension, smoking, overweight, and low dietary intake of carotenoids. Since the aging populations of the industrialized world are increasing rapidly, the impact of AMD in the socio-economical life-developed countries is expected to increase dramatically in the next years. In this context, the benefits of prevention and early disease detection for prompt and effective treatment can be enormous to reduce the social and economic burden of AMD. Nutritional and lifestyle changes, including dietary intake of xanthophyll pigments, such as lutein and zeaxanthin, no smoking, and regular exercise, are known to protect from risk of AMD progression from early to advanced disease stages. In this review, we present the clinical outcomes of a pilot study on trans-scleral iontophoresis delivery of lutein in patients with AMD. Topical delivery of lutein directly to the macula may provide a more efficient method for enriching the macular pigment and for achieving greater patient compliance to therapy than oral administration and thus enhancing prevention strategies. Modern diagnostic methodologies shall address the major problem of accurately detecting the risk of transition from intermediate AMD to advanced AMD stages. Adaptive optics retinal imaging and resonance Raman spectroscopy are two highly promising technologies for the objective assessment of patients with AMD. In this review, we present some of their clinical applications for collecting quantitative measurements of retinal cellular changes and macular content of xanthophyll pigments, respectively. In conclusion, there is great expectation that technological advancements in AMD management will deliver improved screening, therapeutic prevention, and diagnostic systems in the coming decade through a pro-active strategy of “treatment for prevention” that will aim to reduce the global burden of vision loss caused by AMD in the elderly.

Raman Spectroscopy and Its Modifications Applied to Biological and Medical Research

Nowadays, there is an interest in biomedical and nanobiotechnological studies, such as studies on carotenoids as antioxidants and studies on molecular markers for cardiovascular, endocrine, and oncological diseases. Moreover, interest in industrial production of microalgal biomass for biofuels and bioproducts has stimulated studies on microalgal physiology and mechanisms of synthesis and accumulation of valuable biomolecules in algal cells. Biomolecules such as neutral lipids and carotenoids are being actively explored by the biotechnology community. Raman spectroscopy (RS) has become an important tool for researchers to understand biological processes at the cellular level in medicine and biotechnology. This review provides a brief analysis of existing studies on the application of RS for investigation of biological, medical, analytical, photosynthetic, and algal research, particularly to understand how the technique can be used for lipids, carotenoids, and cellular research. First, the review article shows the main applications of the modified Raman spectroscopy in medicine and biotechnology. Research works in the field of medicine and biotechnology are analysed in terms of showing the common connections of some studies as caretenoids and lipids. Second, this article summarises some of the recent advances in Raman microspectroscopy applications in areas related to microalgal detection. Strategies based on Raman spectroscopy provide potential for biochemical-composition analysis and imaging of living microalgal cells, in situ and in vivo. Finally, current approaches used in the papers presented show the advantages, perspectives, and other essential specifics of the method applied to plants and other species/objects.

A Systematic Review of Carotenoids in the Management of Age-Related Macular Degeneration

Age-related macular degeneration (AMD) remains a leading cause of modifiable vision loss in older adults. Chronic oxidative injury and compromised antioxidant defenses represent essential drivers in the development of retinal neurodegeneration. Overwhelming free radical species formation results in mitochondrial dysfunction, as well as cellular and metabolic imbalance, which becomes exacerbated with increasing age. Thus, the depletion of systemic antioxidant capacity further proliferates oxidative stress in AMD-affected eyes, resulting in loss of photoreceptors, neuroinflammation, and ultimately atrophy within the retinal tissue. The aim of this systematic review is to examine the neuroprotective potential of the xanthophyll carotenoids lutein, zeaxanthin, and meso-zeaxanthin on retinal neurodegeneration for the purpose of adjunctive nutraceutical strategy in the management of AMD. A comprehensive literature review was performed to retrieve 55 eligible publications, using four database searches from PubMed, Embase, Cochrane Library, and the Web of Science. Epidemiology studies indicated an enhanced risk reduction against late AMD with greater dietary consumption of carotenoids, meanwhile greater concentrations in macular pigment demonstrated significant improvements in visual function among AMD patients. Collectively, evidence strongly suggests that carotenoid vitamin therapies offer remarkable synergic protection in the neurosensory retina, with the potential to serve as adjunctive nutraceutical therapy in the management of established AMD, albeit these benefits may vary among different stages of disease.

Dopamine Imaging in Living Cells and Retina by Surface-Enhanced Raman Scattering Based on Functionalized Gold Nanoparticles

Retinal dopamine is believed to be involved in the development of myopia, which is projected to affect almost half of the world population's visual health by 2050. Direct visualization of dopamine in the retina with high spatial precision is essential for understanding the biochemical mechanism during the development of myopia. However, there are very few approaches for the direct detection of dopamine in the visual system, particularly in the retina. Here, we report surface-enhanced Raman scattering (SERS)-based dopamine imaging in cells and retinal tissues with high spatial precision. The surface of gold nanoparticles is modified with N-butylboronic acid-2-mercaptoethylamine and 3,3'-dithiodipropionic acid di(N-hydroxysuccinimide ester), which shows excellent specific reaction with dopamine. The existence of dopamine triggers the aggregation of gold nanoparticles that subsequently form plasmonic hot spots to dramatically increase the Raman signal of dopamine. The as-synthesized SERS nanoprobes have been evaluated and applied for dopamine imaging in living cells and retinal tissues in form-deprivation (FD) myopia guinea pigs, followed by further investigation on localized dopamine levels in the FD-treated mice. The results suggest a declined dopamine level in mice retina after 2-week FD treatment, which is associated with the development of myopia. Our approach will greatly contribute to better understanding the localized dopamine level associated with myopia and its possible treatments. Furthermore, the imaging platform can be utilized to sensing other important small molecules within the biological samples.

A Systematic Review of Carotenoids in the Management of Diabetic Retinopathy

Diabetic retinopathy, which was primarily regarded as a microvascular disease, is the leading cause of irreversible blindness worldwide. With obesity at epidemic proportions, diabetes-related ocular problems are exponentially increasing in the developed world. Oxidative stress due to hyperglycemic states and its associated inflammation is one of the pathological mechanisms which leads to depletion of endogenous antioxidants in retina in a diabetic patient. This contributes to a cascade of events that finally leads to retinal neurodegeneration and irreversible vision loss. The xanthophylls lutein and zeaxanthin are known to promote retinal health, improve visual function in retinal diseases such as age-related macular degeneration that has oxidative damage central in its etiopathogenesis. Thus, it can be hypothesized that dietary supplements with xanthophylls that are potent antioxidants may regenerate the compromised antioxidant capacity as a consequence of the diabetic state, therefore ultimately promoting retinal health and visual improvement. We performed a comprehensive literature review of the National Library of Medicine and Web of Science databases, resulting in 341 publications meeting search criteria, of which, 18 were found eligible for inclusion in this review. Lutein and zeaxanthin demonstrated significant protection against capillary cell degeneration and hyperglycemia-induced changes in retinal vasculature. Observational studies indicate that depletion of xanthophyll carotenoids in the macula may represent a novel feature of DR, specifically in patients with type 2 or poorly managed type 1 diabetes. Meanwhile, early interventional trials with dietary carotenoid supplementation show promise in improving their levels in serum and macular pigments concomitant with benefits in visual performance. These findings provide a strong molecular basis and a line of evidence that suggests carotenoid vitamin therapy may offer enhanced neuroprotective effects with therapeutic potential to function as an adjunct nutraceutical strategy for management of diabetic retinopathy.

Correction for the Influence of Cataract on Macular Pigment Measurement by Autofluorescence Technique Using Deep Learning

Purpose

Measurements of macular pigment optical density (MPOD) by the autofluorescence technique yield underestimations of actual values in eyes with cataract. We applied deep learning (DL) to correct this error.

Subjects and Methods

MPOD was measured by SPECTRALIS (Heidelberg Engineering, Heidelberg, Germany) in 197 eyes before and after cataract surgery. The nominal MPOD values (= preoperative value) were corrected by three methods: the regression equation (RE) method, subjective classification (SC) method (described in our previous study), and DL method. The errors between the corrected and true values (= postoperative value) were calculated for local MPODs at 0.25°, 0.5°, 1°, and 2° eccentricities and macular pigment optical volume (MPOV) within 9° eccentricity.

Results

The mean error for MPODs at four eccentricities was 32% without any correction, 15% with correction by RE, 16% with correction by SC, and 14% with correction by DL. The mean error for MPOV was 21% without correction and 14%, 10%, and 10%, respectively, with correction by the same methods. The errors with any correction were significantly lower than those without correction (P < 0.001, linear mixed model with Tukey's test). The errors with DL correction were significantly lower than those with RE correction in MPOD at 1° eccentricity and MPOV (P < 0.001) and were equivalent to those with SC correction.

Conclusions

The objective method using DL was useful to correct MPOD values measured in aged people.

Translational Relevance

MPOD can be obtained with small errors in eyes with cataract using DL.

Multimodal, label-free fluorescence and Raman imaging of amyloid deposits in snap-frozen Alzheimer's disease human brain tissue

Alzheimer's disease (AD) neuropathology is characterized by hyperphosphorylated tau containing neurofibrillary tangles and amyloid-beta (Aβ) plaques. Normally these hallmarks are studied by (immuno-) histological techniques requiring chemical pretreatment and indirect labelling. Label-free imaging enables one to visualize normal tissue and pathology in its native form. Therefore, these techniques could contribute to a better understanding of the disease. Here, we present a comprehensive study of high-resolution fluorescence imaging (before and after staining) and spectroscopic modalities (Raman mapping under pre-resonance conditions and stimulated Raman scattering (SRS)) of amyloid deposits in snap-frozen AD human brain tissue. We performed fluorescence and spectroscopic imaging and subsequent thioflavin-S staining of the same tissue slices to provide direct confirmation of plaque location and correlation of spectroscopic biomarkers with plaque morphology; differences were observed between cored and fibrillar plaques. The SRS results showed a protein peak shift towards the β-sheet structure in cored amyloid deposits. In the Raman maps recorded with 532 nm excitation we identified the presence of carotenoids as a unique marker to differentiate between a cored amyloid plaque area versus a non-plaque area without prior knowledge of their location. The observed presence of carotenoids suggests a distinct neuroinflammatory response to misfolded protein accumulations.

Nonresonant Raman spectroscopy of isolated human retina samples complying with laser safety regulations for in vivo measurements

Retinal diseases, such as age-related macular degeneration, are leading causes of vision impairment, increasing in incidence worldwide due to an aging society. If diagnosed early, most cases could be prevented. In contrast to standard ophthalmic diagnostic tools, Raman spectroscopy can provide a comprehensive overview of the biochemical composition of the retina in a label-free manner. A proof of concept study of the applicability of nonresonant Raman spectroscopy for retinal investigations is presented. Raman imaging provides valuable insights into the molecular composition of an isolated ex vivo human retina sample by probing the entire molecular fingerprint, i.e., the lipid, protein, carotenoid, and nucleic acid content. The results are compared to morphological information obtained by optical coherence tomography of the sample. The challenges of in vivo Raman studies due to laser safety limitations and predefined optical parameters given by the eye itself are explored. An in-house built setup simulating the optical pathway in the human eye was developed and used to demonstrate that even under laser safety regulations and the above-mentioned optical restrictions, Raman spectra of isolated ex vivo human retinas can be recorded. The results strongly support that in vivo studies using nonresonant Raman spectroscopy are feasible and that these studies provide comprehensive molecular information of the human retina.

Assessment of trans-scleral iontophoresis delivery of lutein to the human retina

The efficacy of novel scleral iontophoresis device for in situ delivery of lutein to the human retina was assessed by Resonance Raman spectroscopy (RRS) technique. Eight human donor eye globes were used for experiments, 6 of which underwent trans-scleral iontophoresis delivery of lutein and the other 2 were used as controls. The scleral iontophoresis applicator was filled with liposome-enriched 0.1% lutein solution and the generator's current was set at 2.5 mA and delivered for 4 min. A custom RRS setup was used for detecting lutein in the inner sclera, choroid, retinal periphery and macula of treated samples and controls. Forty minutes after iontophoresis, the inner sclera, choroid and retinal periphery were greatly enriched with lutein (P < .05); no lutein was found in the same ocular regions of non-treated samples. In the same period, the average concentration of lutein in the macula (4.8 ± 1.7 ng/mm² ) of treated samples was 1.3 times greater than controls (3.7 ± 1.0 ng/mm² ; P = .4). Scleral iontophoresis was shown to be effective in delivering lutein to the human retina. Future studies will aim at assessing if this therapeutic strategy is valuable to enrich the macular pigment in human subjects.

Clinical imaging of macular pigment optical density and spatial distribution

Clinical research continues to provide an increasing number of studies that reveal an association between macular pigment optical density (MPOD) and both visual function and ocular health. As a result, there is a growing need for repeatable, accurate measures of MPOD that can describe peak optical density as well as spatial distribution. Measurement of MPOD in a research setting has an established history encompassing a number of both objective and subjective techniques. Transition of these techniques to a clinical setting has produced an array of commercial devices using three primary methods: heterochromatic flicker photometry, fundus autofluorescence and fundus reflectometry. The inherent differences among the techniques create difficulty in making direct comparisons between MPOD measurement devices. Understanding the limitations of each technique is critical in the clinical interpretation of MPOD results. Here, both the objective and subjective methods of MPOD measurement are reviewed with emphasis on the commercially available devices used in clinical settings.

Autofluorescence imaging of macular pigment: influence and correction of ocular media opacities

The healthy adult human retina contains in its macular region a high concentration of blue-light absorbing carotenoid compounds, known as macular pigment (MP). Consisting of the carotenoids lutein, zeaxanthin, and meso-zeaxanthin, the MP is thought to shield the vulnerable tissue layers in the retina from lightinduced damage through its function as an optical attenuator and to protect the tissue cells within its immediate vicinity through its function as a potent antioxidant. Autofluorescence imaging (AFI) is emerging as a viable optical method for MP screening of large subject populations, for tracking of MP changes over time, and for monitoring MP uptake in response to dietary supplementation. To investigate the influence of ocular media opacities on AFI-based MP measurements, in particular, the influence of lens cataracts, we conducted a clinical trial with a large subject population (93 subjects) measured before and after cataract surgery. General AFI image contrast, retinal blood vessel contrast, and presurgery lens opacity scores [Lens Opacities Classification System III (LOCS III)] were investigated as potential predictors for image degradation. These clinical results show that lens cataracts can severely degrade the achievable pixel contrasts in the AFI images, which results in nominal MP optical density levels that are artifactually reduced. While LOCS III scores and blood vessel contrast are found to be only a weak predictor for this effect, a strong correlation exists between the reduction factor and the image contrast, which can be quantified via pixel intensity histogram parameters. Choosing the base width of the histogram, the presence or absence of ocular media opacities can be determined and, if needed, the nominal MP levels can be corrected with factors depending on the strength of the opacity.

Zeaxanthin induces Nrf2-mediated phase II enzymes in protection of cell death

Zeaxanthin (Zea) is a major carotenoid pigment contained in human retina, and its daily supplementation associated with lower risk of age-related macular degeneration. Despite known property of Zea as an antioxidant, its underlying molecular mechanisms of action remain poorly understood. In this study, we aim to study the regulation mechanism of Zea on phase II detoxification enzymes. In normal human retinal pigment epithelium cells, Zea promoted the nuclear translocation of NF-E2-related factor 2 (Nrf2) and induced mRNA and protein expression of phase II enzymes, the induction was suppressed by specific knockdown of Nrf2. Zea also effectively protected against tert-butyl hydroperoxide-induced mitochondrial dysfunction and apoptosis. Glutathione (GSH) as the most important antioxidant was also induced by Zea through Nrf2 activation in a time- and dose-dependent manner, whereas the protective effects of Zea were decimated by inhibition of GSH synthesis. Finally, Zea activated the PI3K/Akt and MAPK/ERK pathway, whereas only PI3K/Akt activation correlated with phase II enzymes induction and Zea protection. In further in vivo analyses, Zea showed effects of inducing phase II enzymes and increased GSH content, which contributed to the reduced lipid and protein peroxidation in the retina as well as the liver, heart, and serum of the Sprague–Dawley rats. For the first time, Zea is presented as a phase II enzymes inducer instead of being an antioxidant. By activating Nrf2-mediated phase II enzymes, Zea could enhance anti-oxidative capacity and prevent cell death both in vivo and in vitro.

Macular pigment optical density measurements by one-wavelength reflection photometry--influence of cataract surgery on the measurement results

PURPOSE

The main objective of the present study was the investigation of possible influence of lens opacification on macular pigment optical density (MPOD) measurements.

METHODS

Eighty-six eyes of 64 patients (mean age 73.4 ± 8.3 years) were included in the study. MPOD was prospectively measured using the one-wavelength reflection method (Visucam500, Carl Zeiss Meditec AG) before and after cataract extraction, with implantation of a blue-light filtering intraocular lens (AlconSN60WF). The median of the maximum optical density (MaxOD) and the median of the mean optical density (MeanOD) measurements of macular pigment across the subject group were evaluated.

RESULTS

Statistically significant differences were noticed between pre-operative and post-operative measurements, the absolute values were generally lower after cataract extraction. The following median (lower/upper quartile) differences across the group were determined: MaxOD -33.8 % (-46.2 to -19.1 %), MeanOD -44.0 % (-54.6 to -26.6 %). Larger changes were observed in elderly patients [<70 years of age (n = 25 eyes): MaxOD -13.4 % (-20.5 to 3.6 %), MeanOD -23.6 % (-30.5 to -15.3 %) versus patients ≥70 years (n = 61 eyes) MaxOD -40.5 % (-53.2 to -30.1 %), MeanOD -47.2 % (-57.8 to -40.1 %)] and in patients with progressed stage of cataract. MaxOD for lens opacification grade 1 (n = 9 eyes): -27.4 % (-42.1 to -19.6 %), grade 2 (n = 26 eyes): -35.0 % (-44.2 to -25.3 %), grade 3 (n = 21 eyes): -34.4 % (-45.4 to -11.4 %), grade 4 (n = 25 eyes): -32.6 % (-53.2 to -6.4 %), and grade 5 (n = 5 eyes): -53.5 % (-61.7 to -38.7 %) and MeanOD for cataract stage 1 (n = 9 eyes): -42.6 % (-46.0 to -26.0 %), stage 2 (n = 26 eyes): -44.1 % (-51.8 to -26.2 %), stage 3 (n = 21 eyes): -45.7 % (-54.7 to -24.7 %), stage 4 (n = 25 eyes): -39.5 % (-59.4 to -26.1 %), and stage 5 (n = 5 eyes): -57.0 % (-66.1 to -51.4 %).

CONCLUSIONS

As established by comparison of pre- to post-operative measurements, cataract presented a strong effect on MPOD measured by one-wavelength reflection method. Particular care should therefore be taken when evaluating MPOD using this method in elderly patients with progressed stage of cataract. Future optimization of correcting parameters of scattered light and consideration of cataract influence may allow more precise evaluation of MPOD.

Effect of age and other factors on macular pigment optical density measured with resonance Raman spectroscopy

BACKGROUND

Macular pigment is a defense system against phototoxic damage of the retina by visible light. It is still under debate whether or not macular pigment optical density (MPOD) levels decline with age, because the age effect varied depending on the technique used to measure MPOD levels. Resonance Raman spectroscopy (RRS) is an objective method to measure MPOD, and studies using RRS showed a drastic age-related decline of MPOD levels; however, since RRS measurements are influenced by cataracts, it has been argued that the age-related decline of RRS measurements is an artifact from lens changes in aged subjects. In the present study, MPOD levels were measured with RRS in pseudophakic eyes, and the effects of age and other factors on MPOD levels were investigated.

METHODS

The subjects included 144 patients with no fundus disorders who received cataract surgery with untinted intraocular lens implantation. MPOD levels were measured in 144 eyes using integral RRS 1 day post surgery. Factors potentially associated with MPOD levels such as age, gender, smoking habits, body mass index, diabetes, glaucoma, axial length, pupil diameter, spherical equivalent refractive error, and foveal thickness were examined by multiple regression analysis.

RESULTS

The macular pigment RRS levels ranged from 776 to 11,815 Raman counts, with an average level of 4,375 ± 1,917 (standard deviation [SD]) Raman counts. Multiple regression analysis revealed that age and axial length were significantly correlated with low MPOD values (regression coefficient of -59 for age and -404 for axial length, respectively). No significant correlations were observed for other factors.

CONCLUSIONS

After removing the potentially confounding effect of age-related lens yellowing on the RRS measurements, age remained a significant patient parameter for lowered MPOD levels. MPOD levels were found to decline by more than 10 % each decade. Axial length was also a negative predictor of MPOD levels. Since the present study included only patients aged 50 years and older, the effects of age and other factors on MPOD levels for younger subjects remain unknown.

Reflection-based imaging of macular pigment distributions in infants and children

We have developed a reflection-based capability of the RetCam(®) platform, an FDA-cleared pediatric retinal-imaging instrument, for the purpose of measuring macular pigment levels as well as their spatial distributions in infants and children. Our modifications include narrow-band blue-wavelength excitation of the macular pigment absorption in combination with spectrally selective blue-wavelength readout of the reflection signals received by the instrument's CCD detector array. Furthermore, an algorithm is developed that allows the computation of optical density maps for the macular pigment relative to peripheral retinal areas. This made it possible for the first time to directly measure macular pigment levels and their spatial features in the developing human retina. In contrast to adults, infants with measurable pigment levels had almost exclusively a narrow, circularly symmetric, pigment distribution. The described methodology holds promise for future investigations into the role of macular pigment in the developing human retina and the effect of dietary interventions in diseases resulting from a lack of normal carotenoid levels.

Resonance Raman based skin carotenoid measurements in newborns and infants

We describe Resonance Raman based skin carotenoid measurements in newborns and infants. Skin- and serum carotenoid levels correlate with high statistical significance in healthy newborns and infants, and with reduced accuracy also in prematurely born infants, who in general feature very low carotenoid levels and thin transparent skin giving rise to large background absorption effects. Skin carotenoid levels can be easily compared among subjects and/or tracked in longitudinal studies with the highly molecule-specific Raman method. It therefore holds promise as a rapid, non-invasive, carotenoid antioxidant assessment method for newborns and infants in the field of pediatrics.

Imaging system to assess objectively the optical density of the macular pigment in vivo

This paper presents an optical system called MacPI, which implements a two-color reflectance technique in combination with various hardware and software tools to assess objectively the macular pigment (MP) optical density in vivo. The system consists of a bespoke optical design, a control architecture, driver electronics, a collection of image-processing techniques, and a graphical user interface. The deficiencies of the technique employed and the solutions implemented in the MacPI system to confront those inherent frailties are presented. An overview of the effective interpretation of the acquired data and the techniques employed by MacPI in the acquisition of that data is discussed. The result of a comparison trial with an alternative device is also presented. We suggest that appropriate design of the hardware and an efficient interpretation of the acquired data should produce a system capable of consistent, accurate, and rapid measurements, while retaining the distinction of ease of use, portability, comfort for the subject, and a design that is economic to produce. Its versatility should allow both for a clinical screening application and for further investigation and establishment of the physiological role of the MP in a laboratory-based environment.

Phototoxic action spectrum on a retinal pigment epithelium model of age-related macular degeneration exposed to sunlight normalized conditions

Among the identified risk factors of age-related macular degeneration, sunlight is known to induce cumulative damage to the retina. A photosensitive derivative of the visual pigment, N-retinylidene-N-retinylethanolamine (A2E), may be involved in this phototoxicity. The high energy visible light between 380 nm and 500 nm (blue light) is incriminated. Our aim was to define the most toxic wavelengths in the blue-green range on an in vitro model of the disease. Primary cultures of porcine retinal pigment epithelium cells were incubated for 6 hours with different A2E concentrations and exposed for 18 hours to 10 nm illumination bands centered from 380 to 520 nm in 10 nm increments. Light irradiances were normalized with respect to the natural sunlight reaching the retina. Six hours after light exposure, cell viability, necrosis and apoptosis were assessed using the Apotox-Glo Triplex™ assay. Retinal pigment epithelium cells incubated with A2E displayed fluorescent bodies within the cytoplasm. Their absorption and emission spectra were similar to those of A2E. Exposure to 10 nm illumination bands induced a loss in cell viability with a dose dependence upon A2E concentrations. Irrespective of A2E concentration, the loss of cell viability was maximal for wavelengths from 415 to 455 nm. Cell viability decrease was correlated to an increase in cell apoptosis indicated by caspase-3/7 activities in the same spectral range. No light-elicited necrosis was measured as compared to control cells maintained in darkness. Our results defined the precise spectrum of light retinal toxicity in physiological irradiance conditions on an in vitro model of age-related macular degeneration. Surprisingly, a narrow bandwidth in blue light generated the greatest phototoxic risk to retinal pigment epithelium cells. This phototoxic spectrum may be advantageously valued in designing selective photoprotection ophthalmic filters, without disrupting essential visual and non-visual functions of the eye.

Blue-light reflectance imaging of macular pigment in infants and children

PURPOSE

While the role of the macular pigment carotenoids in the prevention of age-related macular degeneration has been extensively studied in adults, comparatively little is known about the physiology and function of lutein and zeaxanthin in the developing eye. We therefore developed a protocol using a digital video fundus camera (RetCam) to measure macular pigment optical density (MPOD) and distributions in premature infants and in children.

METHODS

We used blue light reflectance to image the macular pigment in premature babies at the time of retinopathy of prematurity (ROP) screening and in children aged under 7 years who were undergoing examinations under anesthesia for other reasons. We correlated the MPOD with skin carotenoid levels measured by resonance Raman spectroscopy, serum carotenoids measured by HPLC, and dietary carotenoid intake.

RESULTS

We enrolled 51 infants and children ranging from preterm to age 7 years. MPOD correlated significantly with age (r = 0.36; P = 0.0142), with serum lutein + zeaxanthin (r = 0.44; P = 0.0049) and with skin carotenoid levels (r = 0.42; P = 0.0106), but not with dietary lutein + zeaxanthin intake (r = 0.13; P = 0.50). All premature infants had undetectable macular pigment, and most had unusually low serum and skin carotenoid concentrations.

CONCLUSIONS

Our most remarkable finding is the undetectable MPOD in premature infants. This may be due in part to foveal immaturity, but the very low levels of serum and skin carotenoids suggest that these infants are carotenoid insufficient as a consequence of low dietary intake and/or severe oxidative stress. The potential value of carotenoid supplementation in the prevention of ROP and other disorders of prematurity should be a fruitful direction for further investigation.

Panoramic autofluorescence: highlighting retinal pathology

PURPOSE

Recent technological advances in fundus autofluorescence (FAF) are providing new opportunities for insight into retinal physiology and pathophysiology. FAF provides distinctly different imaging information than standard photography or color separation. A review of the basis for this imaging technology is included to help the clinician understand how to interpret FAF images. Cases are presented to illustrate image interpretation.

METHODS

Optos, which manufactures equipment for simultaneous panoramic imaging, has recently outfitted several units with AF capabilities. Six cases are presented in which panoramic autofluorescent (PAF) images highlight retinal pathology, using Optos' Ultra-Widefield technology. Supportive imaging technologies, such as Optomap® images and spectral domain optical coherence tomography (SD-OCT), are used to assist in the clinical interpretation of retinal pathology detected on PAF.

RESULTS

Hypofluorescent regions on FAF are identified to occur along with a disruption in the photoreceptors and/or retinal pigment epithelium, as borne out on SD-OCT. Hyperfluorescent regions on FAF occur at the advancing zones of retinal degeneration, indicating impending damage. PAF enables such inferences to be made in retinal areas which lie beyond the reach of SD-OCT imaging. PAF also enhances clinical pattern recognition over a large area and in comparison with the fellow eye. Symmetric retinal degenerations often occur with genetic conditions, such as retinitis pigmentosa, and may impel the clinician to recommend genetic testing.

CONCLUSIONS

Autofluorescent ophthalmoscopy is a non-invasive procedure that can detect changes in metabolic activity at the retinal pigment epithelium before clinical ophthalmoscopy. Already, AF is being used as an adjunct technology to fluorescein angiography in cases of age-related macular degeneration. Both hyper- and hypoautofluorescent changes are indicative of pathology. Peripheral retinal abnormalities may precede central retinal impacts, potentially providing early signs for intervention before impacting visual acuity. The panoramic image enhances clinical pattern recognition over a large area and in comparison between eyes. Optos' Ultra-Widefield technology is capable of capturing high-resolution images of the peripheral retina without requiring dilation.

Dermal carotenoid measurements via pressure mediated reflection spectroscopy

We describe a reflection-based method for the quantitative detection of carotenoid antioxidants in living human skin. The skin tissue site of interest is illuminated with broad-band white light spanning the spectral range from 350-850 nm and the spectral composition of the diffusively reflected light is analyzed in real time. Topical pressure is applied to temporarily squeeze blood out of the illuminated tissue volume. In this way the influence of oxy-hemoglobin on the reflection spectra is effectively reduced. After a short optical clearing time the carotenoid absorption becomes easily discernable in a 460-500 nm spectral window and its optical density can be calculated with high accuracy. Our empirical methodology provides a non-invasive rapid determination of skin carotenoid levels, can be used to monitor skin carotenoid concentration changes over time in response to carotenoid containing natural or supplemental diets, and is easily adaptable for applications in clinical and field settings.

Macular pigment density changes in Japanese individuals supplemented with lutein or zeaxanthin: quantification via resonance Raman spectrophotometry and autofluorescence imaging

PURPOSE

Our purpose was to determine whether either lutein or zeaxanthin supplementation affects macular pigment concentration/optical density (MPOD) in healthy Japanese individuals.

METHODS

Twenty-two healthy volunteers were randomized to either 10 mg of orally administered lutein or zeaxanthin daily for up to 3 months. MPOD levels were measured by resonance Raman spectrophotometry (RRS) and one-wavelength autofluorescence imaging (AFI) at baseline and 1, 2, and 3 months after the start of supplementation.

RESULTS

MPOD levels measured with each method were correlated significantly at all time points. MPOD(RRS) and MPOD(AFI) levels increased >20 % from baseline at 2 and 3 months after lutein supplementation. By multiple regression analyses, the refractive error was correlated positively with MPOD(RRS) levels at baseline, whereas age and sex were not significant. In the lutein group, MPOD(RRS) levels significantly increased from baseline at all time points in individuals without high myopia exceeding -4 diopters, whereas the increase was not observed in individuals with high myopia. In the zeaxanthin group, MPOD(RRS) levels remained unchanged in those with and without high myopia.

CONCLUSIONS

MPOD(RRS) and MPOD(AFI) levels correlated significantly with each other. In normal healthy Japanese individuals without high myopia, lutein supplementation increased MPOD levels within the fovea more effectively than did zeaxanthin.

Macular pigment changes in pseudophakic eyes quantified with resonance Raman spectroscopy

PURPOSE

We examined changes in macular pigment optical density (MPOD) levels after cataract surgery and compared the MPOD between eyes with clear intraocular lenses (IOLs) and yellow-tinted IOLs.

DESIGN

Prospective, comparative case series.

PARTICIPANTS

The MPOD levels were measured in 480 eyes of 337 patients after cataract surgery. Among them, the data from 259 eyes (clear IOL group, 121 eyes; yellow-tinted IOL group, 138 eyes) of 259 Japanese patients were selected for statistical analyses on the basis of the inclusion criteria: a postoperative visual acuity (VA) of ≥0.8 and no fundus diseases. Only 1 eye of each patient was enrolled. Patients provided informed consent to participate in this study on the basis of the approval of the institutional review board before surgery.

METHODS

The patients selected the type of IOL to be implanted. The MPOD levels were measured using resonance Raman spectroscopy on day 1 (baseline value); months 1, 3, and 6; and years 1 and 2 postoperatively.

MAIN OUTCOME MEASURES

The difference in MPOD levels between the IOL groups was analyzed by unpaired t tests. The following parameters were analyzed by multiple regression analysis: age, gender, body mass index (BMI), smoking history, glaucoma, diabetes, preoperative VA, preoperative refractive error, and IOL power and type.

RESULTS

We found no significant differences in the baseline characteristics between the 2 groups. Until 6 months postoperatively, the MPOD levels did not differ significantly between the groups. However, from 1 year onward, the levels were significantly higher in the yellow-tinted IOL group compared with the clear IOL group. By multiple regression analysis, 1 day postoperatively, older age and diabetes were correlated with lower MPOD levels; 1 year postoperatively and thereafter, however, lower MPOD levels were correlated with clear IOLs.

CONCLUSIONS

Cataract surgery with clear IOLs induced a greater decrease in macular pigment levels compared with yellow-tinted IOLs during a longer follow-up period. These findings agreed with observations that excessive light exposure is associated inversely with MPOD, because clear IOLs transmit higher intensities of blue light than yellow-tinted IOLs.

Measuring macular pigment optical density in vivo: a review of techniques

BACKGROUND

Macular pigment has been the focus of much attention in recent years, as a potential modifiable risk factor for age-related macular degeneration. This interest has been heightened by the ability to measure macular pigment optical density (MPOD) in vivo.

METHOD

A systematic literature search was undertaken to identify all available papers that have used in vivo MPOD techniques. The papers were reviewed, and all relevant information was incorporated into this article.

RESULTS

Measurement of MPOD is achievable with a wide range of techniques, which are typically categorized into one of two groups: psychophysical (requiring a response from the subject) or objective (requiring minimal input from the subject). The psychophysical methods include heterochromatic flicker photometry and minimum motion photometry. The objective methods include fundus reflectometry, fundus autofluorescence, resonance Raman spectroscopy and visual evoked potentials. Even within the individual techniques, there is often much variation in how data is obtained and processed.

CONCLUSION

This review comprehensively details the procedure, instrumentation, assumptions, validity and reliability of each MPOD measurement technique currently available, along with their respective advantages and disadvantages. This leads us to conclude that development of a commercial instrument, based on fundus reflectometry or fundus autofluorescence, would be beneficial to macular pigment research and would support MPOD screening in a clinical setting.

Noninvasive assessment of dermal carotenoids as a biomarker of fruit and vegetable intake

BACKGROUND

Resonance Raman spectroscopy (RRS) has been suggested as a feasible method for noninvasive carotenoid measurement of human skin. However, before RRS measures of dermal carotenoids can be used as a biomarker, data on intra- and intersubject variability and validity are needed.

OBJECTIVE

The purpose of this study was to evaluate the reproducibility and validity of RRS measures of dermal total carotenoids and lycopene in humans.

DESIGN

In study 1, 74 men and women with diverse skin pigmentation were recruited. RRS measures of the palm, inner arm, and outer arm were obtained at baseline, 1 wk, 2 wk, 1 mo, 3 mo, and 6 mo (to maximize seasonal variation). The RRS device used visible light at 488 nm to estimate total carotenoids and at 514 nm to estimate lycopene. Reproducibility was assessed by intraclass correlation coefficients (ICCs). In study 2, we recruited 28 subjects and assessed dietary carotenoid intake, obtained blood for HPLC analyses, performed RRS measures of dermal carotenoid status, and performed dermal biopsies (3-mm punch biopsy) with dermal carotenoids assessed by HPLC.

RESULTS

ICCs for total carotenoids across time were 0.97 (palm), 0.95 (inner arm), and 0.93 (outer arm). Total dermal carotenoids assessed by RRS were significantly correlated with total dermal carotenoids assessed by HPLC of dermal biopsies (r = 0.66, P = 0.0001). Similarly, lycopene assessed by RRS was significantly correlated with lycopene assessed by HPLC of dermal biopsies (r = 0.74, P < 0.0001).

CONCLUSION

RRS is a feasible and valid method for noninvasively assessing dermal carotenoids as a biomarker for studies of nutrition and health.

Clinical validation of a noninvasive, Raman spectroscopic method to assess carotenoid nutritional status in humans

BACKGROUND

Carotenoids are an important group of phytonutrients that are abundant in fruits and vegetables. Epidemiological and clinical intervention studies have implied the presence of protective qualities of these nutrients against the development of a variety of chronic diseases. Previously, human carotenoid status has been assessed in serum and tissue using high-performance liquid chromatography (HPLC) methodology. Recently, a Raman spectroscopy (RS)-based photonic method has been developed to accurately and noninvasively measure the carotenoid concentration in human skin.

OBJECTIVES

(1) To validate skin RS methodology against standard serum carotenoid measurements by HPLC and (2) to establish and compare the reliability of the 2 methods.

DESIGN

This study included 372 healthy adults who provided 3 blood samples and 3 RS skin carotenoid measurements within an 8-day period; each day-matched blood sample and RS determination was spaced by >or=48 hours.

RESULTS

Consistent positive correlations were observed for each of 3 separate same-day correlation plots of total serum versus RS skin carotenoids. Overall estimate of the line of best fit from analysis of covariance, using all 3 samples (n = 1116), yielded a Pearson correlation of R = 0.81 (r(2) = 0.66; p < 0.001). Based on analysis of variance, RS skin carotenoid methodology exhibited 0.9% less variance over the 3 tests than serum carotenoids by the HPLC method (p < 0.03).

CONCLUSIONS

RS accurately measures total carotenoids in human skin with less intra-individual variability than measurement of serum carotenoids by HPLC analysis. RS technology is a valid and reliable noninvasive method to rapidly assess carotenoid nutritional status in humans.

Repeated measures of macular pigment optical density to test reproducibility of heterochromatic flicker photometry

PURPOSE

To report the reproducibility of macular pigment optical density (MPOD) values assessed with heterochromatic flicker photometry (HFP) in healthy individuals.

METHODS

Twenty-four volunteers from our department underwent MPOD testing of both eyes by flicker photometry on three separate occasions. To test reproducibility of MPOD, the coefficient of variance was calculated separately for right and left eyes. In addition, we investigated MPOD averages of right and left eyes and interocular correlations (Pearson's r) at every visit.

RESULTS

The mean MPODs at the first visit were 0.61 +/- 0.24 and 0.72 +/- 0.27 in right and left eyes, respectively. Mean values of 0.58 +/- 0.29 and 0.60 +/- 0.21 (second visit) and 0.62 +/- 0.27 and 0.63 +/- 0.24 (third visit) were assessed for right and left eyes, respectively. Differences of the mean values between eyes were not significant. Correlations were weak at visits one and two (r = 0.49, p < 0.014 and r = 0.43, p < 0.038, respectively) and moderate at visit three (r = 0.58, p < 0.003). The coefficients of variance were 36.1% and 23% for right and left eyes, respectively.

CONCLUSION

Our mean MPODs are higher and the interocular correlations weaker compared to the literature. The coefficient of variance in both eyes is high and does not imply good reproducibility of obtained MPOD values.

The value of measurement of macular carotenoid pigment optical densities and distributions in age-related macular degeneration and other retinal disorders

There is increasing recognition that the optical and antioxidant properties of the xanthophyll carotenoids lutein and zeaxanthin play an important role in maintaining the health and function of the human macula. In this review article, we assess the value of non-invasive quantification of macular pigment levels and distributions to identify individuals potentially at risk for visual disability or catastrophic vision loss from age-related macular degeneration, and we consider the strengths and weaknesses of the diverse measurement methods currently available.

[The macular pigment: short- and intermediate-term changes of macular pigment optical density following supplementation with lutein and zeaxanthin and co-antioxidants. The LUNA Study]

BACKGROUND

How long do the elevated concentrations of macular pigment persist after stopping supplementation with lutein and zeaxanthin?

METHODS

One hundred eight (108) probands with and without age-related macular degeneration (68 female, 40 male, age 51-87 years) received a supplement containing 12 mg lutein and 1 mg zeaxanthin once per day (Ocuvite lutein) for 6 months. Analysis of macular pigment optical density (MPOD) was performed during the period of supplementation and again 3, 6, and 9 months following discontinuation of the supplement. A control group of 28 subjects received no dietary supplement.

RESULTS

At baseline, the mean MPOD at 0.5 degrees was 0.50 in the supplemented group. Following supplementation, values rose, and 3 months after discontinuation of supplementation the highest levels of MPOD0.5 degrees (0.59 ODU) were detected (increase of +0.1 ODU, (p<0.001). Six months after supplement discontinuation, a slight decrease of mean MPOD0.5 degrees appeared (to 0.54 ODU), followed again by a slight increase 3 months later (to 0.57 ODU). An increment of MPOD0.5 degrees in the control group was not significant (0.03 ODU, p=0.15).

DISCUSSION

Supplementation of lutein and zeaxanthin leads to an increase of MPOD0.5 degrees . This effect outlasts the duration of intake, and 9 months after supplementation was stopped, the mean MPOD0.5 degrees was still elevated compared with baseline levels. A longer follow-up subsequent to stopping supplementation might clarify whether the values decrease over time or whether a plateau of elevated MPOD levels is reached. High doses of lutein and zeaxanthin seem to be necessary to increase macular pigment density in the retina; afterwards, the amount of carotenoids needed to maintain high concentrations seems to be covered by daily food.

Macular pigment: new clinical methods of detection and the role of carotenoids in age-related macular degeneration

Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in people over the age of 65. The Age-Related Eye Disease Study (AREDS) suggests antioxidants may delay the advance of age-related macular degeneration. The macular pigments zeaxanthin and lutein may serve as antioxidants as well as blue filter to protect the retina. In this review, the general characteristics of macular pigment are described. The nutritional value of zeaxanthin/lutein and methods to assess macular pigment are discussed. Several emerging instruments to assess macular pigment, including heterochromatic flickering photometer, motion detection photometer, fundus reflectance spectroscope, Raman spectrometer, and autofluorescence spectrometry, are introduced and reviewed. Optometrists should be aware that they may play a role to assess and monitor the risk of AMD. There is an opportunity to incorporate measurement of macular pigment in optometric practice.

Resonance Raman measurements of carotenoids using light-emitting diodes

We report on the development of a compact commercial instrument for measuring carotenoids in skin tissue. The instrument uses two light-emitting diodes (LEDs) for dual-wavelength excitation and four photomultiplier tubes for multichannel detection. Bandpass filters are used to select the excitation detection wavelengths. The f1.3 optical system has high optical throughput and single photon sensitivity, both of which are crucial in LED-based Raman measurements. We employ a signal processing technique that compensates for detector drift and error. The sensitivity and reproducibility of the LED Raman instrument compares favorably to laser-based Raman spectrometers. This compact, portable instrument is used for noninvasive measurement of carotenoid molecules in human skin with a repeatability better than 10%.

Measurement of hemoglobin oxygen saturation using Raman microspectroscopy and 532-nm excitation

The resonant Raman enhancement of hemoglobin (Hb) in the Q band region allows simultaneous identification of oxy- and deoxy-Hb. The heme vibrational bands are well known at 532 nm, but the technique has never been used to determine microvascular Hb oxygen saturation (So2) in vivo. We implemented a system for in vivo noninvasive measurements of So2. A laser light was focused onto areas of 15–30 μm in diameter. Using a microscope coupled to a spectrometer and a cooled detector, Raman spectra were obtained in backscattering geometry. Calibration was performed in vitro using blood at several Hb concentrations, equilibrated at various oxygen tensions. So2 was estimated by measuring the intensity of Raman signals (peaks) in the 1,355- to 1,380-cm−1 range (oxidation state marker band ν4), as well as from the ν19 and ν10 bands (1,500- to 1,650-cm−1 range). In vivo observations were made in microvessels of anesthetized rats. Glass capillary pathlength and Hb concentration did not affect So2 estimations from Raman spectra. The Hb Raman peaks observed in blood were consistent with earlier Raman studies using Hb solutions and isolated cells. The correlation between Raman-based So2 estimations and So2 measured by CO-oximetry was highly significant for ν4, ν10, and ν19 bands. The method allowed So2 determinations in all microvessel types, while diameter and erythrocyte velocity could be measured in the same vessels. Raman microspectroscopy has advantages over other techniques by providing noninvasive and reliable in vivo So2 determinations in thin tissues, as well as in solid organs and tissues in which transillumination is not possible.

Macular pigment optical density measurement in autofluorescence imaging: comparison of one- and two-wavelength methods

BACKGROUND

Measurement of macular pigment (MP) can be performed by analysis of autofluorescence (AF) images. These can be obtained by standard 488-nm argon-imaging alone (one wavelength, 1-Lambda) or with additional digital subtraction of a second image at 514 nm (two wavelengths, 2-Lambda). The analyses are easy to perform, and we present a comparison of both methods and investigate their reliability and repeatability.

METHODS

Inter-individual variability of MP optical density (MPOD) measurements was assessed in single eyes of 120 subjects with a modified Heidelberg retina angiograph (HRA). MPOD values obtained with one (488 nm) Lambda (MPOD(1Lambda)) were compared with those obtained with two (488 nm and 514 nm) Lambda (MPOD(2Lambda)). To test the repeatability of the two methods, 20 subjects were subjected to five repeated measurements.

RESULTS

Among 120 individuals, mean MPOD(1Lambda) at 0.5 degrees eccentricity was 0.59 (range 0.06-1.32), mean MPOD(2Lambda) was 0.5 (range 0.01-1.21). Apart from this systematic difference, 1-Lambda and 2-Lambda measurements at 0.5 degrees agreed well across the range of MPOD values (beta=0.964, around the fovea, a systematic difference (0.11) was accompanied by declining agreement at higher MPOD values (beta=0.669, 95% CI 0.519-0.844; R=0.48). Among 20 subjects with five repeated measurements, the reliability ratio was 0.97 for 1-Lambda and 0.94 for 2-Lambda at 0.5 degrees and 0.93 and 0.94, respectively, at a distance of 2 degrees.

CONCLUSIONS

Both methods showed a high repeatability with little influence of measurement error. They agree well at the fovea centre in terms of ranking individuals according to their MPOD, but provide increasingly deviating results at a distance of 2 degrees around the fovea, probably because the 1-Lambda method, in contrast to the 2-Lambda method, cannot compensate for disruptive influences and for heterogeneous distributions of the lipofuscin fluorophores. The 1-Lambda method can be performed by standard HRA and could therefore be used for screening in multicentre studies, but only approaches the actual amounts of MP. The 2-Lambda method remains the more precise method for MPOD measurement in autofluorescence imaging.

Identification and metabolic transformations of carotenoids in ocular tissues of the Japanese quail Coturnix japonica

As in humans and monkeys, lutein [(3R,3'R,6'R)-beta,epsilon-carotene-3,3'-diol] and zeaxanthin [a mixture of (3R,3'R)-beta,beta-carotene-3,3'diol and (3R,3'S-meso)-beta,beta-carotene-3,3'-diol] are found in substantial amounts in the retina of the Japanese quail Coturnix japonica. This makes the quail retina an excellent nonprimate small animal model for studying the metabolic transformations of these important macular carotenoids that are thought to play an integral role in protection against light-induced oxidative damage such as that found in age-related macular degeneration (AMD). In this study, we first identified the array of carotenoids present in the quail retina using C30 HPLC coupled with in-line mass spectral and photodiode array detectors. In addition to dietary lutein (2.1%) and zeaxanthin (11.8%), we identified adonirubin (5.4%), 3'-oxolutein (3.8%), meso-zeaxanthin (3.0%), astaxanthin (28.2%), galloxanthin (12.2%), epsilon,epsilon-carotene (18.5%), and beta-apo-2'-carotenol (9.5%) as major ocular carotenoids. We next used deuterium-labeled lutein and zeaxanthin as dietary supplements to study the pharmacokinetics and metabolic transformations of these two ocular pigments in serum and ocular tissues. We then detected and quantitated labeled carotenoids in ocular tissue using both HPLC-coupled mass spectrometry and noninvasive resonance Raman spectroscopy. Results indicated that dietary zeaxanthin is the precursor of 3'-oxolutein, beta-apo-2'-carotenol, adonirubin, astaxanthin, galloxanthin, and epsilon,epsilon-carotene, whereas dietary lutein is the precursor for meso-zeaxanthin. Studies also revealed that the pharmacokinetic patterns of uptake, carotenoid absorption, and transport from serum into ocular tissues were similar to results observed in most human clinical studies.

Optical density of the aging human ocular media in the visible and the UV

We analyzed the literature on the absorption in the young and aging human eye media. Five templates were derived to provide an adequate description of the spectra from 300 to 700 nm for the lens, cornea, aqueous, and vitreous. Two templates were found in all media. They stand for Rayleigh scatter and the absorbance of tryptophan. Three additional templates for the lens represent absorbance in kynurenine derivatives, such as 3-hydroxykynurenine glucoside (3HKG), and absorbance in two substances found at older age. Except for Rayleigh scatter, all templates have a Gaussian shape. Aging-trend functions were derived that show a linear slope on an age-squared scale. The result can be used to correct for media losses in visual perception tasks, in fundus reflectometry, and in studies on light damage.

Investigation of the effect of simulated lens yellowing, transparency loss and refractive error on in vivo resonance Raman spectroscopy

PURPOSE

To separately investigate the impact of simulated age-related lens yellowing, transparency loss and refractive error on measurements of macular pigment (MP) using resonance Raman spectroscopy.

METHODS

Two healthy young subjects with clear media underwent Raman spectroscopy under the following conditions: age-related lens yellowing was simulated using seven broad-band yellow filters with transmittance at 488 nm ranging from 0.54 to 0.90; cataract was simulated using five white filters of increasing opacity (scatter filters), the transmittance of which ranged from 0.42 to 0.86, each of which reduced peak contrast sensitivity by approximately 0.1 log units over the previous filter. Refractive error up to +6.25 D was achieved using soft contact lenses.

RESULTS

The Raman signal declined steadily to an average value of 43% of the starting value with the densest yellow filter in place. The white scatter filters produced a progressive linear reduction in signal resulting in almost complete signal loss with the densest filter. Refractive error resulted in an initial slight improvement in Raman count up to a value of +2.00 D followed by a decline thereafter.

CONCLUSIONS

These results imply that lens yellowing and increasing scatter has an influence on the Raman signal and suggest that studies using this technology to estimate MP levels in older populations should carefully account for the status of the lens.

Interocular agreement in melanin and macular pigment optical density

Macular pigment (MP) and melanin possibly protect the macular area by absorbing blue light and acting as antioxidants. Because little is known about the interocular correlation of melanin, we determined its optical density (MOD) in both eyes of healthy subjects using fundus reflectometry. The measuring method also provided optical densities of MP (MPOD). In addition to evaluating its interocular correspondence we checked its dependency on central retinal thickness as measured with optical coherence tomography (OCT). Spectral fundus reflectance was measured in 69 eyes of 37 healthy participants. Both eyes of 32 subjects (15 males and 17 females, aged 57.9+/-14.6 years) were used to evaluate interocular correspondences. MPOD data from 35 right eyes of 18 males and 17 females, aged 55.7+/-15.7 years, was used to evaluate the relation between central retinal thickness and MPOD. MOD was 0.99+/-0.30 (range: 0.57-2.07) for the left eyes and 1.02+/-0.28 (range: 0.62-2.07) for the right eyes. The intraclass correlation coefficient (ICC) was 0.89 (P<0.001). MPOD was 0.49+/-0.19 for the left eyes (range: 0.12-0.81) and 0.47+/-0.17 (range: 0.14-0.73) for the right eyes. The ICC was 0.91 (P<0.001). Macular retinal thickness (MRT), representing the average macular thickness in the central 1000 microm zone, was 210+/-28 microm. Foveal retinal thickness (FRT), representing the retinal thickness at the crossing of the 6 radial scan lines on OCT, was 175+/-34 microm. Pearson's correlation coefficient showed no significant linear association between MRT and MPOD (r=-0.04, P=0.82), and between FRT and MPOD (r=0.05, P=0.78). The optical density of melanin showed a high interocular correspondence in healthy white participants. Similar results were found for MPOD. Relative interocular differences of more than 32% in MOD, or more than 34% in MPOD, may point to pathology. No relation between central retinal thickness and MPOD was found.

Changes in macular pigment optical density and serum concentrations of its constituent carotenoids following supplemental lutein and zeaxanthin: The LUNA study

Macular pigment (MP), consisting of lutein (L) and zeaxanthin (Z), is believed to protect the retina from photo-oxidative damage. The current study investigates, in terms of MP optical density (MPOD) and serum concentrations of its constituent carotenoids, response to supplemental L and Z, and co-antioxidants. An intervention (I) group, consisting of 108 subjects (mean [+/-SD] age: 71.5 [+/-7.1] years), of which 92.6% exhibited features of age-related macular degeneration (AMD), received a daily supplement consisting of 12 mg L and 1 mg Z, both provided as ester 120 mg vitamin C, 17.6 mg vitamin E, 10 mg zinc, 40 microg selenium (Ocuvite Luteintrade mark) for a period of 6 months. MPOD was measured, by 2-wavelength autofluorescence (AF), on five occasions during the period of supplementation, and once again 3 months following discontinuation of the supplement. A control (C) group of 28 subjects (mean [+/-SD] age: 71.0 [+/-8.1] years), who received no dietary supplementation or modification, was examined at baseline and once again after a mean of 29.4 (+/-9.3) weeks. At baseline, mean (+/-SD) MPOD (at 0.5 degrees) was 0.504 (+/-0.197) and 0.525 (+/-0.189) in the I and C groups, respectively. There was a statistically significant increase in MPOD (at 0.5 degrees) for the I group (0.1 [+/-0.009]; p<0.0008), whereas no significant increase was seen in the C group (0.03 [+/-0.02]; p>0.05), over the period of supplementation. In order to classify supplemented subjects into quartiles, in terms of MPOD response, we calculated the difference between MPOD (at 0.5 degrees) at visit 6 and at baseline (visit 1). Quartile 1 (the "non-responder" quartile) displayed no increase in MPOD (at 0.5 degrees), in spite of rises seen in serum concentrations of L and Z. The three "responder" quartiles reached similar final plateaus of MPOD (at 0.5 degrees), reflected in final mean (+/-SEM) values of 0.59 (+/-0.04) optical density unit (ODU), 0.64 (+/-0.03) ODU and 0.64 (+/-0.03) ODU for quartiles 2, 3 and 4, respectively. Subjects with low baseline MPOD were more likely to exhibit a dramatic rise in MPOD, or to exhibit no rise in MPOD, in response to supplements than subjects with medium to high baseline MPOD values. Supplementation with 12 mg L and 1 mg Z, combined with co-antioxidants, resulted in an increase of MPOD at 0.5 degrees eccentricity in a majority of subjects, including those afflicted with AMD. However, there remains a substantial proportion of subjects for whom, in spite of rises in serum concentrations of L and Z in these subjects, MPOD augmentation in response to supplemental L, Z and co-antioxidants could not be detected over the study period, thus indicating that intestinal malabsorption of these carotenoids is not responsible for the lack of a macular response to such supplements. Further, our results suggest that saturable mechanisms play a role in the retinal capture and/or stabilisation of the macular carotenoids.

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.

Risk factors for age-related maculopathy are associated with a relative lack of macular pigment

Macular pigment (MP) is composed of the two dietary carotenoids lutein (L) and zeaxanthin (Z), and is believed to protect against age-related maculopathy (ARM). This study was undertaken to investigate MP optical density with respect to risk factors for ARM, in 828 healthy subjects from an Irish population. MP optical density was measured psychophysically using heterochromatic flicker photometry, serum L and Z were quantified by HPLC, and dietary intake of L and Z was assessed using a validated food-frequency questionnaire. Clinical and personal details were also recorded, with particular attention directed towards risk factors for ARM. We report a statistically significant age-related decline in MP optical density (r2=0.082, p<0.01). Current and past smokers had lower average MP optical density than never smokers and this difference was statistically significant (p<0.01). Subjects with a confirmed family history of ARM had significantly lower levels of MP optical density than subjects with no known family history of disease (p<0.01). For each of these established risk factors, their statistically significant negative association with MP persisted after controlling for the other two, and also after controlling for other potentially confounding variables such as sex, cholesterol, dietary and serum L (p<0.01). In the absence of retinal pathology, and in advance of disease onset, the relative lack of MP seen in association with increasing age, tobacco use and family history of ARM supports the hypothesis that the enhanced risk that these variables represent for ARM may be attributable, at least in part, to a parallel deficiency of macular carotenoids.

Visualization of astaxanthin localization in HT29 human colon adenocarcinoma cells by combined confocal resonance Raman and fluorescence microspectroscopy

Astaxanthin, a carotenoid found in plants and seafood, exhibits antiproliferative, antioxidant and anticarcinogenic properties. We show that astaxanthin delivered with tetrahydrofuran is effectively taken up by cultured colon adenocarcinoma cells and is localized mostly in the cytoplasm as detected by confocal resonance Raman and broad-band fluorescence microspectroscopy image analysis. Cells incubated with beta-carotene at the same concentration as astaxanthin (10 microM) showed about a 50-fold lower cellular amount of beta-carotene, as detected by HPLC. No detectable Raman signal of beta-carotene was found in cells, but a weak broad-band fluorescence signal of beta-carotene was observed. beta-Carotene, like astaxanthin, was localized mostly in the cytoplasm. The heterogeneity of astaxanthin and beta-carotene cellular distribution in cells of intestinal origin suggests that the possible defense against reactive molecules by carotenoids in these cells may also be heterogeneous.