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Evans JR, Lawrenson JG. Antioxidant vitamin and mineral supplements for slowing the progression of age-related macular degeneration. Cochrane Database Syst Rev 2023; 9:CD000254. [PMID: 37702300 PMCID: PMC10498493 DOI: 10.1002/14651858.cd000254.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND Age-related macular degeneration (AMD) is a degenerative condition of the back of the eye that occurs in people over the age of 50 years. Antioxidants may prevent cellular damage in the retina by reacting with free radicals that are produced in the process of light absorption. Higher dietary levels of antioxidant vitamins and minerals may reduce the risk of progression of AMD. This is the third update of the review. OBJECTIVES To assess the effects of antioxidant vitamin and mineral supplements on the progression of AMD in people with AMD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, one other database, and three trials registers, most recently on 29 November 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared antioxidant vitamin or mineral supplementation to placebo or no intervention, in people with AMD. DATA COLLECTION AND ANALYSIS We used standard methods expected by Cochrane. MAIN RESULTS We included 26 studies conducted in the USA, Europe, China, and Australia. These studies enroled 11,952 people aged 65 to 75 years and included slightly more women (on average 56% women). We judged the studies that contributed data to the review to be at low or unclear risk of bias. Thirteen studies compared multivitamins with control in people with early and intermediate AMD. Most evidence came from the Age-Related Eye Disease Study (AREDS) in the USA. People taking antioxidant vitamins were less likely to progress to late AMD (odds ratio (OR) 0.72, 95% confidence interval (CI) 0.58 to 0.90; 3 studies, 2445 participants; moderate-certainty evidence). In people with early AMD, who are at low risk of progression, this means there would be approximately four fewer cases of progression to late AMD for every 1000 people taking vitamins (one fewer to six fewer cases). In people with intermediate AMD at higher risk of progression, this corresponds to approximately 78 fewer cases of progression for every 1000 people taking vitamins (26 fewer to 126 fewer). AREDS also provided evidence of a lower risk of progression for both neovascular AMD (OR 0.62, 95% CI 0.47 to 0.82; moderate-certainty evidence) and geographic atrophy (OR 0.75, 95% CI 0.51 to 1.10; moderate-certainty evidence), and a lower risk of losing 3 or more lines of visual acuity (OR 0.77, 95% CI 0.62 to 0.96; moderate-certainty evidence). Low-certainty evidence from one study of 110 people suggested higher quality of life scores (measured with the Visual Function Questionnaire) in treated compared with non-treated people after 24 months (mean difference (MD) 12.30, 95% CI 4.24 to 20.36). In exploratory subgroup analyses in the follow-on study to AREDS (AREDS2), replacing beta-carotene with lutein/zeaxanthin gave hazard ratios (HR) of 0.82 (95% CI 0.69 to 0.96), 0.78 (95% CI 0.64 to 0.94), 0.94 (95% CI 0.70 to 1.26), and 0.88 (95% CI 0.75 to 1.03) for progression to late AMD, neovascular AMD, geographic atrophy, and vision loss, respectively. Six studies compared lutein (with or without zeaxanthin) with placebo and one study compared a multivitamin including lutein/zeaxanthin with multivitamin alone. The duration of supplementation and follow-up ranged from six months to five years. Most evidence came from the AREDS2 study in the USA; almost all participants in AREDS2 also took the original AREDS supplementation formula. People taking lutein/zeaxanthin may have similar or slightly reduced risk of progression to late AMD (RR 0.94, 95% CI 0.87 to 1.01), neovascular AMD (RR 0.92, 95% CI 0.84 to 1.02), and geographic atrophy (RR 0.92, 95% CI 0.80 to 1.05) compared with control (1 study, 4176 participants, 6891 eyes; low-certainty evidence). A similar risk of progression to visual loss of 15 or more letters was seen in the lutein/zeaxanthin and control groups (RR 0.98, 95% CI 0.91 to 1.05; 6656 eyes; low-certainty evidence). Quality of life (Visual Function Questionnaire) was similar between groups (MD 1.21, 95% CI -2.59 to 5.01; 2 studies, 308 participants; moderate-certainty evidence). One study in Australia randomised 1204 people to vitamin E or placebo with four years of follow-up; 19% of participants had AMD. The number of late AMD events was low (N = 7) and the estimate of effect was uncertain (RR 1.36, 95% CI 0.31 to 6.05; very low-certainty evidence). There was no evidence of any effect of treatment on visual loss (RR 1.04, 95% CI 0.74 to 1.47; low-certainty evidence). There were no data on neovascular AMD, geographic atrophy, or quality of life. Five studies compared zinc with placebo. Evidence largely drawn from the largest study (AREDS) found a lower progression to late AMD over six years (OR 0.83, 95% CI 0.70 to 0.98; 3 studies, 3790 participants; moderate-certainty evidence), neovascular AMD (OR 0.76, 95% CI 0.62 to 0.93; moderate-certainty evidence), geographic atrophy (OR 0.84, 95% CI 0.64 to 1.10; moderate-certainty evidence), or visual loss (OR 0.87, 95% CI 0.75 to 1.00; 2 studies, 3791 participants; moderate-certainty evidence). There were no data on quality of life. Gastrointestinal symptoms were the main reported adverse effect. In AREDS, zinc was associated with a higher risk of genitourinary problems in men, but no difference was seen between high- and low-dose zinc groups in AREDS2. Most studies were too small to detect rare adverse effects. Data from larger studies (AREDS/AREDS2) suggested there may be little or no effect on mortality with multivitamin (HR 0.87, 95% CI 0.60 to 1.25; low-certainty evidence) or lutein/zeaxanthin supplementation (HR 1.06, 95% CI 0.87 to 1.31; very low-certainty evidence), but confirmed the increased risk of lung cancer with beta-carotene, mostly in former smokers. AUTHORS' CONCLUSIONS Moderate-certainty evidence suggests that antioxidant vitamin and mineral supplementation (AREDS: vitamin C, E, beta-carotene, and zinc) probably slows down progression to late AMD. People with intermediate AMD have a higher chance of benefiting from antioxidant supplements because their risk of progression is higher than people with early AMD. Although low-certainty evidence suggested little effect with lutein/zeaxanthin alone compared with placebo, exploratory subgroup analyses from one large American study support the view that lutein/zeaxanthin may be a suitable replacement for the beta-carotene used in the original AREDS formula.
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Affiliation(s)
- Jennifer R Evans
- Centre for Public Health, International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Belfast, UK
| | - John G Lawrenson
- Centre for Applied Vision Research, School of Health Sciences, City University of London, London, UK
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Yoshida T, Takagi Y, Igarashi-Yokoi T, Ohno-Matsui K. Efficacy of lutein supplements on macular pigment optical density in highly myopic individuals: A randomized controlled trial. Medicine (Baltimore) 2023; 102:e33280. [PMID: 36961139 PMCID: PMC10036027 DOI: 10.1097/md.0000000000033280] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/23/2023] [Indexed: 03/25/2023] Open
Abstract
INTRODUCTION Lutein supplementation is beneficial in preventing maculae from developing serious ocular diseases. This study aimed to evaluate the efficacy and safety of lutein administration in patients with high myopia (HM). METHODS In a single-center randomized double-blinded placebo-controlled trial conducted over 24 months, 22 eyes were enrolled in lutein and control groups. Among them, 15 eyes in the lutein group and 13 eyes in the control group completed the study. All patients with HM (axial length > 26.00) were administered lutein (20 mg) or placebo once daily for 6 months. The macular pigment optical density (MPOD), rate of change in MPOD, visual acuity, contrast sensitivity, and electroretinogram after administration were examined at baseline, 3 months, and 6 months. RESULTS The baseline MPOD in the control and lutein groups was 0.71 ± 0.21 and 0.70 ± 0.22, respectively. The MPOD in the control and lutein groups at 3 months was 0.70 ± 0.21 and 0.70 ± 0.25, respectively, and at 6 months was 0.66 ± 0.20 and 0.72 ± 0.27, respectively, which was not significantly different from those at baseline or between the groups. The MPOD significantly increased from baseline in the lutein group with less than 28.25 mm of axial length at 6 months (from 0.71 ± 0.20 to 0.78 ± 0.22, P = .02, t test). visual acuity, contrast sensitivity, and electroretinogram values were similar between the groups. CONCLUSION Lutein supplementation showed significant benefits in MPOD augmentation in patients with HM.
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Affiliation(s)
- Takeshi Yoshida
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Advanced Ophthalmic Imaging, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasutaka Takagi
- Japan Medical Affairs, Japan business, Santen Pharmaceutical Co. Ltd., Osaka, Japan
| | - Tae Igarashi-Yokoi
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
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Assessing the Highest Level of Evidence from Randomized Controlled Trials in Omega-3 Research. Nutrients 2023; 15:nu15041001. [PMID: 36839358 PMCID: PMC9959429 DOI: 10.3390/nu15041001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
Over the years, there has been heightened interest in the health benefits of n-3 polyunsaturated fatty acids (PUFA) in reducing chronic diseases such as, cardiovascular disease (CVD), cancer, type 2 diabetes, and acute macular degeneration (AMD). Due to inconsistent findings in the evidence, a review to critically examine the plethora of evidence from randomized controlled trials (RCTs) in n-3 PUFA research was undertaken. The aim of this review is to study the highest level of evidence and to identify gaps in n-3 PUFA research. RCTs were originally designed for pharmaceutical research and later adopted for nutrition and food-related research. RCTs with active diseases assume that n-3 PUFA will have "drug" like effects, and this high expectation may have led to the inconsistent evidence in the literature. The inconsistency in the literature may be related to varying doses of n-3 PUFA, sources of n-3 PUFA (food vs. supplement; plant vs. marine), type of n-3 PUFA (mixture vs. purified), trial duration, population characteristics, sample size, and genetic variation. For future research, there is a need to distinguish between primary and secondary prevention, and to focus RCTs on primary prevention of chronic diseases by n-3 PUFA which is lacking in the literature.
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Ankamah E, Green-Gomez M, Roche W, Ng E, Welge-Lüßen U, Kaercher T, Nolan JM. Dietary Intervention With a Targeted Micronutrient Formulation Reduces the Visual Discomfort Associated With Vitreous Degeneration. Transl Vis Sci Technol 2021; 10:19. [PMID: 34647961 PMCID: PMC8525826 DOI: 10.1167/tvst.10.12.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the impact of supplementation with a targeted micronutrient formulation on the visual discomfort associated with vitreous degeneration. Methods In this clinical trial, 61 patients with symptomatic vitreous floaters were randomized to consume daily, the active supplement consisting of 125 mg L-lysine, 40 mg vitamin C, 26.3 mg Vitis vinifera extract, 5 mg zinc, and 100 mg Citrus aurantium or placebo for 6 months. Change in visual discomfort from floaters, assessed with the Floater Disturbance Questionnaire, was the primary outcome measure. Secondary outcome measures included best-corrected visual acuity, letter contrast sensitivity, photopic functional contrast sensitivity with positive and negative contrast polarity, and quantitative vitreous opacity areas. Results After supplementation, the active group reported a significant decrease in their visual discomfort from floaters (P < 0.001), whereas the placebo group had no significant change in their visual discomfort (P = 0.416). At 6 months, there was a significant decrease in vitreous opacity areas in the active group (P < 0.001) and an insignificant increase in vitreous opacity areas in the placebo group (P = 0.081). Also, there was a significant improvement in photopic functional contrast sensitivity with positive contrast polarity in the active group after supplementation (P = 0.047). Conclusions The findings of this study indicate improvements in vision-related quality of life and visual function of patients suffering from vitreous floaters after supplementation with a formulation of antioxidative and antiglycation micronutrients. Notably, these improvements were confirmed by the decrease in vitreous opacity areas in the active group. Translational Relevance This targeted dietary intervention should be considered to support patients with symptomatic vitreous degeneration.
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Affiliation(s)
- Emmanuel Ankamah
- Nutrition Research Centre Ireland, School of Health Science, Carriganore House, Waterford Institute of Technology, West Campus, Waterford, Ireland
| | - Marina Green-Gomez
- Nutrition Research Centre Ireland, School of Health Science, Carriganore House, Waterford Institute of Technology, West Campus, Waterford, Ireland
| | - Warren Roche
- Nutrition Research Centre Ireland, School of Health Science, Carriganore House, Waterford Institute of Technology, West Campus, Waterford, Ireland
| | - Eugene Ng
- Nutrition Research Centre Ireland, School of Health Science, Carriganore House, Waterford Institute of Technology, West Campus, Waterford, Ireland.,Institute of Eye Surgery, UPMC Whitfield, Buttlerstown, County Waterford, Ireland
| | | | | | - John M Nolan
- Nutrition Research Centre Ireland, School of Health Science, Carriganore House, Waterford Institute of Technology, West Campus, Waterford, Ireland
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Lem DW, Davey PG, Gierhart DL, Rosen RB. A Systematic Review of Carotenoids in the Management of Age-Related Macular Degeneration. Antioxidants (Basel) 2021; 10:1255. [PMID: 34439503 PMCID: PMC8389280 DOI: 10.3390/antiox10081255] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 01/14/2023] Open
Abstract
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.
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Affiliation(s)
- Drake W. Lem
- College of Optometry, Western University of Health Sciences, Pomona, CA 91766, USA;
| | | | | | - Richard B. Rosen
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
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Lem DW, Gierhart DL, Davey PG. A Systematic Review of Carotenoids in the Management of Diabetic Retinopathy. Nutrients 2021; 13:2441. [PMID: 34371951 PMCID: PMC8308772 DOI: 10.3390/nu13072441] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Drake W. Lem
- College of Optometry, Western University of Health Sciences, 309 E Second St, Pomona, CA 91766, USA;
| | | | - Pinakin Gunvant Davey
- College of Optometry, Western University of Health Sciences, 309 E Second St, Pomona, CA 91766, USA;
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7
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Green-Gomez M, Moran R, Stringham J, Hernández-Alcaraz C, Mendoza-Herrera K, Fromow-Guerra JJ, Prado-Cabrero A, Nolan J. Environmental and Nutritional Determinants of Macular Pigment in a Mexican Population. Invest Ophthalmol Vis Sci 2021; 62:18. [PMID: 34241622 PMCID: PMC8288050 DOI: 10.1167/iovs.62.9.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/21/2021] [Indexed: 01/23/2023] Open
Abstract
Purpose The carotenoids lutein (L), zeaxanthin (Z), and meso-zeaxanthin deposit at the macula as macular pigment (MP) and provide visual benefits and protection against macular diseases. The present study investigated MP, its nutritional and environmental determinants, and its constituent carotenoids in serum from a Mexican sample, in healthy participants and with metabolic diseases. Additionally, we compared these variables with an Irish sample. Methods MP was measured in 215 subjects from a rural community in Mexico with dual-wavelength autofluorescence imaging reported as MP optical volume (MPOV). Dietary intake and serum concentrations of L and Z were evaluated. Results The mean MPOV was 8429 (95% confidence interval, 8060-8797); range. 1171-15,976. The mean L and Z serum concentrations were 0.25 ± 0.15 µmol/L and 0.09 ± 0.04 µmol/L, respectively. The MPOV was positively correlated with L and Z serum concentrations (r = 0.347; P < 0.001 and r = 0.311; P < 0.001, respectively), but not with L + Z dietary estimates. Subjects with daily sunlight exposure of more than 50% were found to have significantly higher MPOV than those with less than 50% (P = 0.005). MPOV and serum concentrations of L and Z were significantly higher in the Mexican sample compared with the Irish sample, but this difference was not reflected in dietary analysis. Conclusions These new data from a Mexican sample provide evidence of the multifactorial interactions and environmental determinants of MP such as sunlight exposure and dietary patterns. These findings will be essential for future studies in Mexico for eye health, visual function, and ocular pathology.
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Affiliation(s)
- Marina Green-Gomez
- Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - Rachel Moran
- Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - James Stringham
- Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - Cesar Hernández-Alcaraz
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Kenny Mendoza-Herrera
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - J Jans Fromow-Guerra
- Retina Division, Asociación Para Evitar la Ceguera en México I.A.P., México City, México
| | - Alfonso Prado-Cabrero
- Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - John Nolan
- Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
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8
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Daga FB, Ogata NG, Medeiros FA, Moran R, Morris J, Zangwill LM, Weinreb RN, Nolan JM. Macular Pigment and Visual Function in Patients With Glaucoma: The San Diego Macular Pigment Study. Invest Ophthalmol Vis Sci 2019; 59:4471-4476. [PMID: 30193322 PMCID: PMC6133244 DOI: 10.1167/iovs.18-24170] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose Although recent studies have shown that macular pigment (MP) is significantly lower in glaucoma patients, this relationship merits further investigation. Methods This cross-sectional study included 85 glaucoma patients and 22 controls. All subjects had standard automated perimetry (SAP) and retinal nerve fiber layer (RNFL) thickness measurements. Intake of lutein (L) and zeaxanthin (Z) was estimated using a novel dietary screener. The Heidelberg Spectralis dual-wavelength autofluorescence (AF) technology was employed to study the relationship between MP and glaucoma. The association between MP volume and glaucoma was investigated using linear regression models accounting for potential confounding factors. Results Glaucoma patients had significantly worse SAP mean deviation (MD) and lower RNFL thickness in the study eye compared to control subjects (P < 0.001 for both). MP (volume) was comparable between groups (P = 0.436). In the univariable model, diagnosis of glaucoma was not associated with MP volume (R2 = 1.22%; P = 0.257). Dietary intake of L and Z was positively and significantly related to MP in the univariable (P = 0.022) and multivariable (P = 0.020) models. Conclusions These results challenge previous studies that reported that glaucoma is associated with low MP. Dietary habits were found to be the main predictor of MP in this sample. Further research is merited to better understand the relationship between glaucoma, MP, and visual performance in these patients.
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Affiliation(s)
- Fábio B Daga
- Hamilton Glaucoma Center and Shiley Eye Institute and Department of Ophthalmology, University of California San Diego, La Jolla, California, United States.,Department of Ophthalmology, Duke Eye Center, Duke University, Durham, North Carolina, United States
| | - Nara G Ogata
- Hamilton Glaucoma Center and Shiley Eye Institute and Department of Ophthalmology, University of California San Diego, La Jolla, California, United States.,Department of Ophthalmology, Duke Eye Center, Duke University, Durham, North Carolina, United States
| | - Felipe A Medeiros
- Hamilton Glaucoma Center and Shiley Eye Institute and Department of Ophthalmology, University of California San Diego, La Jolla, California, United States.,Department of Ophthalmology, Duke Eye Center, Duke University, Durham, North Carolina, United States
| | - Rachel Moran
- Nutrition Research Centre Ireland, School of Health Sciences, Carriganore House, Waterford Institute of Technology, West Campus, Carriganore, Waterford, Ireland
| | - Jeffrey Morris
- Morris Eye Group, Encinitas, Vista, California, United States
| | - Linda M Zangwill
- Hamilton Glaucoma Center and Shiley Eye Institute and Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Robert N Weinreb
- Hamilton Glaucoma Center and Shiley Eye Institute and Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - John M Nolan
- Hamilton Glaucoma Center and Shiley Eye Institute and Department of Ophthalmology, University of California San Diego, La Jolla, California, United States.,Nutrition Research Centre Ireland, School of Health Sciences, Carriganore House, Waterford Institute of Technology, West Campus, Carriganore, Waterford, Ireland
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Power R, Coen RF, Beatty S, Mulcahy R, Moran R, Stack J, Howard AN, Nolan JM. Supplemental Retinal Carotenoids Enhance Memory in Healthy Individuals with Low Levels of Macular Pigment in A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. J Alzheimers Dis 2018; 61:947-961. [PMID: 29332050 DOI: 10.3233/jad-170713] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Rebecca Power
- Nutrition Research Centre Ireland, School of Health Science, Carriganore House, Waterford Institute of Technology, West Campus, Waterford, Ireland
| | - Robert F. Coen
- Mercer’s Institute for Research on Ageing, St. James’s Hospital, Dublin, Ireland
| | - Stephen Beatty
- Nutrition Research Centre Ireland, School of Health Science, Carriganore House, Waterford Institute of Technology, West Campus, Waterford, Ireland
| | - Riona Mulcahy
- Age-related Care Unit, University Hospital Waterford, Waterford, Ireland
| | - Rachel Moran
- Nutrition Research Centre Ireland, School of Health Science, Carriganore House, Waterford Institute of Technology, West Campus, Waterford, Ireland
| | - Jim Stack
- Nutrition Research Centre Ireland, School of Health Science, Carriganore House, Waterford Institute of Technology, West Campus, Waterford, Ireland
| | | | - John M. Nolan
- Nutrition Research Centre Ireland, School of Health Science, Carriganore House, Waterford Institute of Technology, West Campus, Waterford, Ireland
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Evans JR, Lawrenson JG. Antioxidant vitamin and mineral supplements for slowing the progression of age-related macular degeneration. Cochrane Database Syst Rev 2017; 7:CD000254. [PMID: 28756618 PMCID: PMC6483465 DOI: 10.1002/14651858.cd000254.pub4] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND It has been proposed that antioxidants may prevent cellular damage in the retina by reacting with free radicals that are produced in the process of light absorption. Higher dietary levels of antioxidant vitamins and minerals may reduce the risk of progression of age-related macular degeneration (AMD). OBJECTIVES The objective of this review was to assess the effects of antioxidant vitamin or mineral supplementation on the progression of AMD in people with AMD. SEARCH METHODS We searched CENTRAL (2017, Issue 2), MEDLINE Ovid (1946 to March 2017), Embase Ovid (1947 to March 2017), AMED (1985 to March 2017), OpenGrey (System for Information on Grey Literature in Europe, the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 29 March 2017. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared antioxidant vitamin or mineral supplementation (alone or in combination) to placebo or no intervention, in people with AMD. DATA COLLECTION AND ANALYSIS Both review authors independently assessed risk of bias in the included studies and extracted data. One author entered data into RevMan 5; the other author checked the data entry. We graded the certainty of the evidence using GRADE. MAIN RESULTS We included 19 studies conducted in USA, Europe, China, and Australia. We judged the trials that contributed data to the review to be at low or unclear risk of bias.Nine studies compared multivitamins with placebo (7 studies) or no treatment (2 studies) in people with early and moderate AMD. The duration of supplementation and follow-up ranged from nine months to six years; one trial followed up beyond two years. Most evidence came from the Age-Related Eye Disease Study (AREDS) in the USA. People taking antioxidant vitamins were less likely to progress to late AMD (odds ratio (OR) 0.72, 95% confidence interval (CI) 0.58 to 0.90; 2445 participants; 3 RCTs; moderate-certainty evidence). In people with very early signs of AMD, who are at low risk of progression, this would mean that there would be approximately 4 fewer cases of progression to late AMD for every 1000 people taking vitamins (1 fewer to 6 fewer cases). In people at high risk of progression (i.e. people with moderate AMD) this would correspond to approximately 8 fewer cases of progression for every 100 people taking vitamins (3 fewer to 13 fewer). In one study of 1206 people, there was a lower risk of progression for both neovascular AMD (OR 0.62, 95% CI 0.47 to 0.82; moderate-certainty evidence) and geographic atrophy (OR 0.75, 95% CI 0.51 to 1.10; moderate-certainty evidence) and a lower risk of losing 3 or more lines of visual acuity (OR 0.77, 95% CI 0.62 to 0.96; 1791 participants; moderate-certainty evidence). Low-certainty evidence from one study of 110 people suggested higher quality of life scores (National Eye Institute Visual Function Questionnaire) in treated compared with the non-treated people after 24 months (mean difference (MD) 12.30, 95% CI 4.24 to 20.36). Six studies compared lutein (with or without zeaxanthin) with placebo. The duration of supplementation and follow-up ranged from six months to five years. Most evidence came from the AREDS2 study in the USA. People taking lutein or zeaxanthin may have similar or slightly reduced risk of progression to late AMD (RR 0.94, 95% CI 0.87 to 1.01; 6891 eyes; low-certainty evidence), neovascular AMD (RR 0.92, 95% CI 0.84 to 1.02; 6891 eyes; low-certainty evidence), and geographic atrophy (RR 0.92, 95% CI 0.80 to 1.05; 6891 eyes; low-certainty evidence). A similar risk of progression to visual loss of 15 or more letters was seen in the lutein and control groups (RR 0.98, 95% CI 0.91 to 1.05; 6656 eyes; low-certainty evidence). Quality of life (measured with Visual Function Questionnaire) was similar between groups in one study of 108 participants (MD 1.48, 95% -5.53 to 8.49, moderate-certainty evidence). One study, conducted in Australia, compared vitamin E with placebo. This study randomised 1204 people to vitamin E or placebo, and followed up for four years. Participants were enrolled from the general population; 19% had AMD. The number of late AMD events was low (N = 7) and the estimate of effect was uncertain (RR 1.36, 95% CI 0.31 to 6.05, very low-certainty evidence). There were no data on neovascular AMD or geographic atrophy.There was no evidence of any effect of treatment on visual loss (RR 1.04, 95% CI 0.74 to 1.47, low-certainty evidence). There were no data on quality of life. Five studies compared zinc with placebo. The duration of supplementation and follow-up ranged from six months to seven years. People taking zinc supplements may be less likely to progress to late AMD (OR 0.83, 95% CI 0.70 to 0.98; 3790 participants; 3 RCTs; low-certainty evidence), neovascular AMD (OR 0.76, 95% CI 0.62 to 0.93; 2442 participants; 1 RCT; moderate-certainty evidence), geographic atrophy (OR 0.84, 95% CI 0.64 to 1.10; 2442 participants; 1 RCT; moderate-certainty evidence), or visual loss (OR 0.87, 95% CI 0.75 to 1.00; 3791 participants; 2 RCTs; moderate-certainty evidence). There were no data reported on quality of life.Very low-certainty evidence was available on adverse effects because the included studies were underpowered and adverse effects inconsistently reported. AUTHORS' CONCLUSIONS People with AMD may experience some delay in progression of the disease with multivitamin antioxidant vitamin and mineral supplementation. This finding was largely drawn from one large trial, conducted in a relatively well-nourished American population. We do not know the generalisability of these findings to other populations. Although generally regarded as safe, vitamin supplements may have harmful effects. A systematic review of the evidence on harms of vitamin supplements is needed. Supplements containing lutein and zeaxanthin are heavily marketed for people with age-related macular degeneration but our review shows they may have little or no effect on the progression of AMD.
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Affiliation(s)
- Jennifer R Evans
- London School of Hygiene & Tropical MedicineCochrane Eyes and Vision, ICEHKeppel StreetLondonUKWC1E 7HT
| | - John G Lawrenson
- City University of LondonCentre for Applied Vision Research, School of Health SciencesNorthampton SquareLondonUKEC1V 0HB
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11
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Serum and macular response to carotenoid-enriched egg supplementation in human subjects: the Egg Xanthophyll Intervention clinical Trial (EXIT). Br J Nutr 2017; 117:108-123. [PMID: 28122649 PMCID: PMC5297582 DOI: 10.1017/s0007114516003895] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The macular carotenoids lutein (L), zeaxanthin (Z) and meso-zeaxanthin
(MZ) accumulate at the macula, where they are collectively referred to as macular pigment
(MP). Augmentation of this pigment, typically achieved through diet and supplementation,
enhances visual function and protects against progression of age-related macular
degeneration. However, it is known that eggs are a rich dietary source of L and Z, in a
highly bioavailable matrix. In this single-blind placebo-controlled study, L- and
MZ-enriched eggs and control non-enriched eggs were fed to human subjects (mean age 41 and
35 years, respectively) over an 8-week period, and outcome measures included MP, visual
function and serum concentrations of carotenoids and cholesterol. Serum carotenoid
concentrations increased significantly in control and enriched egg groups, but to a
significantly greater extent in the enriched egg group (P<0·001
for L, Z and MZ). There was no significant increase in MP in either study group post
intervention, and we saw no significant improvement in visual performance in either group.
Total cholesterol increased significantly in each group, but it did not exceed the upper
limit of the normative range (6·5 mmol/l). Therefore, carotenoid-enriched eggs may
represent an effective dietary source of L, Z and MZ, reflected in significantly raised
serum concentrations of these carotenoids, and consequentially improved bioavailability
for capture by target tissues. However, benefits in terms of MP augmentation and /or
improved visual performance were not realised over the 8-week study period, and a study of
greater duration will be required to address these questions.
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12
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Li X, Kelly D, Nolan JM, Dennison JL, Beatty S. The evidence informing the surgeon's selection of intraocular lens on the basis of light transmittance properties. Eye (Lond) 2016; 31:258-272. [PMID: 27935597 PMCID: PMC5306461 DOI: 10.1038/eye.2016.266] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/27/2016] [Indexed: 01/01/2023] Open
Abstract
In recent years, manufacturers and distributors have promoted commercially available intraocular lenses (IOLs) with transmittance properties that filter visible short-wavelength (blue) light on the basis of a putative photoprotective effect. Systematic literature review. Out of 21 studies reporting on outcomes following implantation of blue-light-filtering IOLs (involving 8914 patients and 12 919 study eyes undergoing cataract surgery), the primary outcome was vision, sleep pattern, and photoprotection in 9 (42.9%), 9 (42.9%), and 3 (14.2%) respectively, and, of these, only 7 (33.3%) can be classed as high as level 2b (individual cohort study/low-quality randomized controlled trials), all other studies being classed as level 3b or lower. Of the level 2b studies, only one (14.3%) found in favor of blue-light-filtering IOLs vs ultraviolet (UV)-only filtering IOLs on the basis of an association between better post-operative contrast sensitivity (CS) at select frequencies with the former; however, that study did not measure or report CS preoperatively in either group, and the finding may simply reflect better preoperative CS in the eyes scheduled to be implanted with the blue-light-filtering IOL; moreover, that study failed to measure macular pigment, a natural preceptoral filter of blue-light, augmentation of which is now known to improve CS. In terms of photoprotection, there is no level 2b (or higher) evidence in support of blue filtering IOLs vs UV-only filtering IOLs. On the basis of currently available evidence, one cannot advocate for the use of blue-light-filtering IOLs over UV-only filtering IOLs.
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Affiliation(s)
- X Li
- Pharmaceutical & Molecular Biotechnology Research Centre, Department of Chemical & Life Sciences, Waterford Institute of Technology, Waterford, Ireland
| | - D Kelly
- Nutrition Research Centre Ireland, Macular Pigment Research Group, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - J M Nolan
- Nutrition Research Centre Ireland, Macular Pigment Research Group, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - J L Dennison
- Nutrition Research Centre Ireland, Macular Pigment Research Group, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - S Beatty
- Nutrition Research Centre Ireland, Macular Pigment Research Group, School of Health Science, Waterford Institute of Technology, Waterford, Ireland.,Institute of Vision Research, Whitfield Clinic, Waterford, Ireland
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13
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Zhu W, Wu Y, Meng YF, Xing Q, Tao JJ, Lu J. Fish Consumption and Age-Related Macular Degeneration Incidence: A Meta-Analysis and Systematic Review of Prospective Cohort Studies. Nutrients 2016; 8:nu8110743. [PMID: 27879656 PMCID: PMC5133126 DOI: 10.3390/nu8110743] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/02/2016] [Accepted: 11/11/2016] [Indexed: 12/31/2022] Open
Abstract
The association between fish consumption and risk of age-related macular degeneration (AMD) is still unclear. The aim of the current meta-analysis and systematic review was to quantitatively evaluate findings from observational studies on fish consumption and the risk of AMD. Relevant studies were identified by searching electronic databases (Medline and EMBASE) and reviewing the reference lists of relevant articles up to August, 2016. Prospective cohort studies that reported relative risks (RRs) and 95% confidence intervals (CIs) for the link between fish consumption and risk of AMD were included. A total of 4202 cases with 128,988 individuals from eight cohort studies were identified in the current meta-analysis. The meta-analyzed RR was 0.76 (95% CI, 0.65-0.90) when any AMD was considered. Subgroup analyses by AMD stages showed that fish consumption would reduce the risk of both early (RR, 0.83; 95% CI, 0.72-0.96) and late (RR; 0.76; 95% CI, 0.60-0.97) AMD. When stratified by the follow-up duration, fish consumption was a protective factor of AMD in both over 10 years (n = 5; RR, 0.81; 95% CI, 0.67-0.97) and less than 10 years (n = 3; RR, 0.70; 95% CI, 0.51 to 0.97) follow-up duration. Stratified analyses by fish type demonstrated that dark meat fish (RR, 0.68, 95% CI, 0.46-0.99), especially tuna fish (RR, 0.58; 95% CI, 95% CI, 0.47-0.71) intake was associated with reduced AMD risk. Evidence of a linear association between dose of fish consumption and risk of AMD was demonstrated. The results of this meta-analysis demonstrated that fish consumption can reduce AMD risk. Advanced, well-designed, randomized clinical trials are required in order to validate the conclusions in this study.
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Affiliation(s)
- Wei Zhu
- Department of Ophthalmology, Changshu No. 2 People's Hospital, Changshu 215500, China.
| | - Yan Wu
- Department of Ophthalmology, First Hospital Affiliated to Soochow University, Suzhou 215000, China.
| | - Yi-Fang Meng
- Department of Ophthalmology, Changshu No. 2 People's Hospital, Changshu 215500, China.
| | - Qian Xing
- Department of Ophthalmology, Changshu No. 2 People's Hospital, Changshu 215500, China.
| | - Jian-Jun Tao
- Department of Ophthalmology, Changshu No. 2 People's Hospital, Changshu 215500, China.
| | - Jiong Lu
- Department of Ophthalmology, Changshu No. 2 People's Hospital, Changshu 215500, China.
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14
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Davey PG, Alvarez SD, Lee JY. Macular pigment optical density: repeatability, intereye correlation, and effect of ocular dominance. Clin Ophthalmol 2016; 10:1671-8. [PMID: 27621586 PMCID: PMC5010153 DOI: 10.2147/opth.s111708] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate short-term repeatability, intereye correlation, and effect of ocular dominance on macular pigment optical density (MPOD) measurements obtained using the QuantifEye Heterochromatic Flicker Photometer. Patients and methods A total of 72 study participants were enrolled in this prospective, cross-sectional study. Participants underwent a comprehensive ocular evaluation, including visual acuity, evaluation of ocular dominance, slit lamp examination, intraocular pressure measurement, and optic nerve head and macula analysis using optical coherence tomography and fundus photography. All study participants after initial training underwent MPOD measurement twice in both eyes in a randomized sequence. The repeatability was tested using Altman and Bland plots for first measurements with the second measurements for right eye and left eye and additionally by grouping eyes as a function of ocular dominance. The Pearson correlation coefficient was performed to assess the intereye correlation of MPOD values. Results The mean age of study participants was 35.5 years (range 22–68 years). The mean MPOD measurements for OD (right eye) and OS (left eye) were 0.47 and 0.48, respectively, which followed a normal distribution (Shapiro–Wilk test, P=0.6 and 0.2). The 95% limits of agreement of Altman and Bland plots for the first and second measurements were −0.12 to +0.11 and −0.13 to +0.12 for OD and OS, respectively. The correlation coefficient of mean MPOD measurements of OD and OS was r statistic =0.94 (Pearson correlation coefficient P<0.0001; r2 0.89). The 95% limits of agreement of Altman and Bland plots when evaluated by laterality of eye or by ocular dominance were narrow, with limits of agreement ranging from −0.13 to +0.12. Conclusion The MPOD measurements obtained using the QuantifEye show good short-term repeatability. There is excellent intereye correlation, indicating that the MPOD values of one eye data can predict the fellow eye value with 89% accuracy. The ocular dominance had no bearing on the outcome of this psychophysical test in ocular healthy eyes.
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Affiliation(s)
| | - Silverio D Alvarez
- College of Optometry, Western University of Health Sciences, Pomona, CA, USA
| | - Jessica Y Lee
- College of Optometry, Western University of Health Sciences, Pomona, CA, USA
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15
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Ma L, Liu R, Du JH, Liu T, Wu SS, Liu XH. Lutein, Zeaxanthin and Meso-zeaxanthin Supplementation Associated with Macular Pigment Optical Density. Nutrients 2016; 8:nu8070426. [PMID: 27420092 PMCID: PMC4963902 DOI: 10.3390/nu8070426] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 07/02/2016] [Accepted: 07/06/2016] [Indexed: 01/16/2023] Open
Abstract
The purpose of this study was to evaluate the effects of lutein, zeaxanthin and meso-zeaxanthin on macular pigment optical density (MPOD) in randomized controlled trials (RCTs) among patients with age-related macular degeneration (AMD) and healthy subjects. Medline, Embase, Web of Science and Cochrane Library databases was searched through May 2016. Meta-analysis was conducted to obtain adjusted weighted mean differences (WMD) for intervention-versus-placebo group about the change of MPOD between baseline and terminal point. Pearson correlation analysis was used to determine the relationship between the changes in MPOD and blood xanthophyll carotenoids or baseline MPOD levels. Twenty RCTs involving 938 AMD patients and 826 healthy subjects were identified. Xanthophyll carotenoids supplementation was associated with significant increase in MPOD in AMD patients (WMD, 0.07; 95% CI, 0.03 to 0.11) and healthy subjects (WMD, 0.09; 95% CI, 0.05 to 0.14). Stratified analysis showed a greater increase in MPOD among trials supplemented and combined with meso-zeaxanthin. Additionally, the changes in MPOD were related with baseline MPOD levels (rAMD = −0.43, p = 0.06; rhealthy subjects = −0.71, p < 0.001) and blood xanthophyll carotenoids concentration (rAMD = 0.40, p = 0.07; rhealthy subjects = 0.33, p = 0.05). This meta-analysis revealed that lutein, zeaxanthin and meso-zeaxanthin supplementation improved MPOD both in AMD patients and healthy subjects with a dose-response relationship.
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Affiliation(s)
- Le Ma
- The First Affiliated Hospital, Xi'an Jiaotong University College of Medicine, 277 Yanta West Road, Xi'an 710061, Shaanxi, China.
- School of Public Health, Xi'an Jiaotong University Health Science Center, 76 Yanta West Road, Xi'an 710061, Shaanxi, China.
| | - Rong Liu
- School of Public Health, Xi'an Jiaotong University Health Science Center, 76 Yanta West Road, Xi'an 710061, Shaanxi, China.
- The 3201 Hospital, Xi'an Jiao tong University College of Medicine, 783 Tianhan Road, Hanzhong 723000, Shaanxi, China.
| | - Jun Hui Du
- The Ninth Hospital of Xi'an, Xi'an Jiaotong University College of Medicine, 151 East of South Second Ring Road, Xi'an 710054, Shaanxi, China.
| | - Tao Liu
- The 3201 Hospital, Xi'an Jiao tong University College of Medicine, 783 Tianhan Road, Hanzhong 723000, Shaanxi, China.
| | - Shan Shan Wu
- National Clinical Research Center of Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Road, Beijing 100050, China.
| | - Xiao Hong Liu
- The First Affiliated Hospital, Xi'an Jiaotong University College of Medicine, 277 Yanta West Road, Xi'an 710061, Shaanxi, China.
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16
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Kelly D, Coen RF, Akuffo KO, Beatty S, Dennison J, Moran R, Stack J, Howard AN, Mulcahy R, Nolan JM. Cognitive Function and Its Relationship with Macular Pigment Optical Density and Serum Concentrations of its Constituent Carotenoids. J Alzheimers Dis 2016; 48:261-77. [PMID: 26401946 PMCID: PMC4923753 DOI: 10.3233/jad-150199] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Macular pigment (MP) levels correlate with brain concentrations of lutein (L) and zeaxanthin (Z), and have also been shown to correlate with cognitive performance in the young and elderly. Objective: To investigate the relationship between MP, serum concentrations of L and Z, and cognitive function in subjects free of retinal disease with low MP (Group 1, n = 105) and in subjects with AMD (Group 2, n = 121). Methods: MP was measured using customized heterochromatic flicker photometry and dual-wavelength autofluorescence; cognitive function was assessed using a battery of validated cognition tests; serum L and Z concentrations were determined by HPLC. Results: Significant correlations were evident between MP and various measures of cognitive function in both groups (r = –0.273 to 0.261, p≤0.05, for all). Both serum L and Z concentrations correlated significantly (r = 0.187, p≤0.05 and r = 0.197, p≤0.05, respectively) with semantic (animal) fluency cognitive scores in Group 2 (the AMD study group), while serum L concentrations also correlated significantly with Verbal Recognition Memory learning slope scores in the AMD study group (r = 0.200, p = 0.031). Most of the correlations with MP, but not serum L or Z, remained significant after controlling for age, gender, diet, and education level. Conclusion: MP offers potential as a non-invasive clinical biomarker of cognitive health, and appears more successful in this role than serum concentrations of L or Z.
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Affiliation(s)
- David Kelly
- Macular Pigment Research Group, Department of Chemical and Life Sciences, Waterford Institute of Technology, Waterford, Ireland
| | - Robert F Coen
- Memory Clinic, Mercers Institute for Research on Ageing, St. James's Hospital, Dublin, Ireland
| | - Kwadwo Owusu Akuffo
- Macular Pigment Research Group, Department of Chemical and Life Sciences, Waterford Institute of Technology, Waterford, Ireland
| | - Stephen Beatty
- Macular Pigment Research Group, Department of Chemical and Life Sciences, Waterford Institute of Technology, Waterford, Ireland.,Institute of Vision Research, Whitfield Clinic, Waterford, Ireland
| | - Jessica Dennison
- Macular Pigment Research Group, Department of Chemical and Life Sciences, Waterford Institute of Technology, Waterford, Ireland
| | - Rachel Moran
- Macular Pigment Research Group, Department of Chemical and Life Sciences, Waterford Institute of Technology, Waterford, Ireland
| | - Jim Stack
- Macular Pigment Research Group, Department of Chemical and Life Sciences, Waterford Institute of Technology, Waterford, Ireland
| | | | - Riona Mulcahy
- University Hospital Waterford, Age-Related Care Unit, Waterford, Ireland
| | - John M Nolan
- Macular Pigment Research Group, Department of Chemical and Life Sciences, Waterford Institute of Technology, Waterford, Ireland
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17
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Akuffo KO, Nolan JM, Peto T, Stack J, Leung I, Corcoran L, Beatty S. Relationship between macular pigment and visual function in subjects with early age-related macular degeneration. Br J Ophthalmol 2016; 101:190-197. [PMID: 27091854 PMCID: PMC5293853 DOI: 10.1136/bjophthalmol-2016-308418] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/11/2016] [Accepted: 03/15/2016] [Indexed: 12/03/2022]
Abstract
Purpose To investigate the relationship between macular pigment (MP) and visual function in subjects with early age-related macular degeneration (AMD). Methods 121 subjects with early AMD enrolled as part of the Central Retinal Enrichment Supplementation Trial (CREST; ISRCTN13894787) were assessed using a range of psychophysical measures of visual function, including best corrected visual acuity (BCVA), letter contrast sensitivity (CS), mesopic and photopic CS, mesopic and photopic glare disability (GD), photostress recovery time (PRT), reading performance and subjective visual function, using the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25). MP was measured using customised heterochromatic flicker photometry. Results Letter CS, mesopic and photopic CS, photopic GD and mean reading speed were each significantly (p<0.05) associated with MP across a range of retinal eccentricities, and these statistically significant relationships persisted after controlling for age, sex and cataract grade. BCVA, NEI VFQ-25 score, PRT and mesopic GD were unrelated to MP after controlling for age, sex and cataract grade (p>0.05, for all). Conclusions MP relates positively to many measures of visual function in unsupplemented subjects with early AMD. The CREST trial will investigate whether enrichment of MP influences visual function among those afflicted with this condition. Trial registration number ISRCTN13894787.
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Affiliation(s)
- Kwadwo Owusu Akuffo
- Nutrition Research Centre Ireland, Macular Pigment Research Group, School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland
| | - John M Nolan
- Nutrition Research Centre Ireland, Macular Pigment Research Group, School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland
| | - Tunde Peto
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Jim Stack
- Nutrition Research Centre Ireland, Macular Pigment Research Group, School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland
| | - Irene Leung
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Laura Corcoran
- Nutrition Research Centre Ireland, Macular Pigment Research Group, School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland
| | - Stephen Beatty
- Nutrition Research Centre Ireland, Macular Pigment Research Group, School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland
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18
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Bernstein PS, Li B, Vachali PP, Gorusupudi A, Shyam R, Henriksen BS, Nolan JM. Lutein, zeaxanthin, and meso-zeaxanthin: The basic and clinical science underlying carotenoid-based nutritional interventions against ocular disease. Prog Retin Eye Res 2016; 50:34-66. [PMID: 26541886 PMCID: PMC4698241 DOI: 10.1016/j.preteyeres.2015.10.003] [Citation(s) in RCA: 306] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 10/04/2015] [Accepted: 10/29/2015] [Indexed: 12/31/2022]
Abstract
The human macula uniquely concentrates three carotenoids: lutein, zeaxanthin, and meso-zeaxanthin. Lutein and zeaxanthin must be obtained from dietary sources such as green leafy vegetables and orange and yellow fruits and vegetables, while meso-zeaxanthin is rarely found in diet and is believed to be formed at the macula by metabolic transformations of ingested carotenoids. Epidemiological studies and large-scale clinical trials such as AREDS2 have brought attention to the potential ocular health and functional benefits of these three xanthophyll carotenoids consumed through the diet or supplements, but the basic science and clinical research underlying recommendations for nutritional interventions against age-related macular degeneration and other eye diseases are underappreciated by clinicians and vision researchers alike. In this review article, we first examine the chemistry, biochemistry, biophysics, and physiology of these yellow pigments that are specifically concentrated in the macula lutea through the means of high-affinity binding proteins and specialized transport and metabolic proteins where they play important roles as short-wavelength (blue) light-absorbers and localized, efficient antioxidants in a region at high risk for light-induced oxidative stress. Next, we turn to clinical evidence supporting functional benefits of these carotenoids in normal eyes and for their potential protective actions against ocular disease from infancy to old age.
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Affiliation(s)
- Paul S Bernstein
- Department of Ophthalmology and Visual Sciences, Moran Eye Center, University of Utah School of Medicine, 65 Mario Capecchi Drive, Salt Lake City, UT, 84132, USA.
| | - Binxing Li
- Department of Ophthalmology and Visual Sciences, Moran Eye Center, University of Utah School of Medicine, 65 Mario Capecchi Drive, Salt Lake City, UT, 84132, USA.
| | - Preejith P Vachali
- Department of Ophthalmology and Visual Sciences, Moran Eye Center, University of Utah School of Medicine, 65 Mario Capecchi Drive, Salt Lake City, UT, 84132, USA.
| | - Aruna Gorusupudi
- Department of Ophthalmology and Visual Sciences, Moran Eye Center, University of Utah School of Medicine, 65 Mario Capecchi Drive, Salt Lake City, UT, 84132, USA.
| | - Rajalekshmy Shyam
- Department of Ophthalmology and Visual Sciences, Moran Eye Center, University of Utah School of Medicine, 65 Mario Capecchi Drive, Salt Lake City, UT, 84132, USA.
| | - Bradley S Henriksen
- Department of Ophthalmology and Visual Sciences, Moran Eye Center, University of Utah School of Medicine, 65 Mario Capecchi Drive, Salt Lake City, UT, 84132, USA.
| | - John M Nolan
- Macular Pigment Research Group, Vision Research Centre, School of Health Science, Carriganore House, Waterford Institute of Technology West Campus, Carriganore, Waterford, Ireland.
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19
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Saidi EA, Davey PG, Cameron DJ. The Effect of Zeaxanthin on the Visual Acuity of Zebrafish. PLoS One 2015; 10:e0135211. [PMID: 26267864 PMCID: PMC4534338 DOI: 10.1371/journal.pone.0135211] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 07/19/2015] [Indexed: 11/18/2022] Open
Abstract
Oral supplementation of carotenoids such as zeaxanthin or lutein which naturally occur in human retina have been shown to improve vision and prevent progression of damage to advanced AMD in some studies. The zebrafish eye shares many physiological similarities with the human eye and is increasingly being used as model for vision research. We hypothesized that injection of zeaxanthin into the zebrafish eye would improve the visual acuity of the zebrafish over time. Visual acuity, calculated in cycles per degree, was measured in adult zebrafish to establish a consistent baseline using the optokinetic response. Zeaxanthin dissolved into phosphate buffered saline (PBS) or PBS only was injected into the anterior chamber of the right and left eyes of the Zebrafish. Visual acuities were measured at 1 week and 3, 8 and 12 weeks post-injection to compare to baseline values. Repeated measures ANOVA was used to compare visual acuities between fish injected with PBS and zeaxanthin. A significant improvement in visual acuity, 14% better than before the injection (baseline levels), was observed one week after injection with zeaxanthin (p = 0.04). This improvement peaked at more than 30% for some fish a few weeks after the injection and improvement in vision persisted at 3 weeks after injection (p = 0.006). The enhanced visual function was not significantly better than baseline at 8 weeks (p = 0.19) and returned to baseline levels 12 weeks after the initial injection (p = 0.50). Zeaxanthin can improve visual acuity in zebrafish eyes. Further studies are required to develop a better understanding of the role zeaxanthin and other carotenoids play during normal visual function.
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Affiliation(s)
- Eric A. Saidi
- College of Optometry, Western University of Health Sciences, Pomona, CA, United States of America
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA, United States of America
| | - Pinakin Gunvant Davey
- College of Optometry, Western University of Health Sciences, Pomona, CA, United States of America
| | - D. Joshua Cameron
- College of Optometry, Western University of Health Sciences, Pomona, CA, United States of America
- * E-mail:
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Sustained supplementation and monitored response with differing carotenoid formulations in early age-related macular degeneration. Eye (Lond) 2015; 29:902-12. [PMID: 25976647 PMCID: PMC4506345 DOI: 10.1038/eye.2015.64] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 03/26/2015] [Indexed: 11/21/2022] Open
Abstract
Purpose To compare the impact of sustained supplementation using different macular carotenoid formulations on macular pigment (MP) and visual function in early age-related macular degeneration (AMD). Patients and methods Sixty-seven subjects with early AMD were randomly assigned to: Group 1 (20 mg per day lutein (L), 0.86 mg per day zeaxanthin (Z); Ultra Lutein), Group 2 (10 mg per day meso-zeaxanthin (MZ), 10 mg per day L, 2 mg per day Z; Macushield; Macuhealth), Group 3 (17 mg per day MZ, 3 mg per day L, 2 mg per day Z). MP was measured using customised heterochromatic flicker photometry and visual function was assessed by measuring contrast sensitivity (CS) and best-corrected visual acuity (BCVA). AMD was graded using the Wisconsin Age-Related Maculopathy Grading System (AREDS 11-step severity scale). Results At 3 years, a significant increase in MP from baseline was observed in all groups at each eccentricity (P<0.05), except at 1.75° in Group 1 (P=0.160). Between 24 and 36 months, significant increases in MP at each eccentricity were seen in Group 3 (P<0.05 for all), and at 0.50° in Group 2 (P<0.05), whereas no significant increases were seen in Group 1 (P>0.05 for all). At 36 months, compared with baseline, the following significant improvements (P<0.05) in CS were observed: Group 2—1.2, 6, and 9.6 cycles per degree (c.p.d.); Group 1—15.15 c.p.d.; and Group 3—6, 9.6, and 15.15 c.p.d. No significant changes in BCVA, or progression to advanced AMD, were observed. Conclusion In early AMD, MP can be augmented with a variety of supplements, although the inclusion of MZ may confer benefits in terms of panprofile augmentation and in terms of CS enhancement.
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Supplementation with three different macular carotenoid formulations in patients with early age-related macular degeneration. Retina 2015; 34:1757-66. [PMID: 24887490 DOI: 10.1097/iae.0000000000000174] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the impact of three different macular carotenoid formulations on macular pigment optical density and visual performance in subjects with early age-related macular degeneration. METHODS Fifty-two subjects were supplemented and followed for 12 months, 17 of them were in intervention Group 1 (20 mg/day lutein and 2 mg/day zeaxanthin); 21 in Group 2 (10 mg/day meso-zeaxanthin, 10 mg/day lutein, and 2 mg/day zeaxanthin); and 14 in Group 3 (17 mg/day meso-zeaxanthin, 3 mg/day lutein, and 2 mg/day zeaxanthin). The macular pigment optical density was measured using customized heterochromatic flicker photometry, and visual function was assessed using corrected distance visual acuity and by letter contrast sensitivity. RESULTS A statistically significant increase in the macular pigment optical density was observed at all measured eccentricities in Group 2 (P ≤ 0.005) and in Group 3 (P < 0.05, for all), but only at 1.75° in Group 1 (P = 0.018). Statistically significant (P < 0.05) improvements in letter contrast sensitivity were seen at all spatial frequencies (except 1.2 cycles per degree) in Group 3, and at low spatial frequencies in Groups 1 and 2. CONCLUSION Augmentation of the macular pigment optical density across its spatial profile and enhancements in contrast sensitivity were best achieved after supplementation with a formulation containing high doses of meso-zeaxanthin in combination with lutein and zeaxanthin.
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Gregori NZ, Goldhardt R. Nutritional Supplements for Age-Related Macular Degeneration. CURRENT OPHTHALMOLOGY REPORTS 2015; 3:34-39. [PMID: 32051790 DOI: 10.1007/s40135-014-0059-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The Age-Related Eye Disease Study (AREDS) and The Age-Related Eye Disease Study 2 (AREDS2), are the only large-scale, long-term, randomized controlled trials to demonstrate a role of nutritional supplements in reducing risk of progression to advanced forms of age-related macular degeneration (AMD). This review summarizes the study design, main results, and implications of these trials in the clinical care of nonexudative AMD patients. In addition, it discusses other recent prospective studies focusing on efficacy of nutritional supplementation for prevention or slowing progression of AMD as well as briefly discusses possible effect of genotypes on response to AREDS supplementation.
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Affiliation(s)
- Ninel Z Gregori
- Bascom Palmer Eye Institute, Department of Ophthalmology, Miller School of Medicine, University of Miami, 900 NW 17 St., Miami, FL 33136, USA, Miami Veterans Affairs Medical Center, 1201 NW 16, Miami, FL 33126, USA
| | - Raquel Goldhardt
- Bascom Palmer Eye Institute, Department of Ophthalmology, Miller School of Medicine, University of Miami, 900 NW 17 St. Miami, FL 33136, Miami Veterans Affairs Medical Center, 1201 NW 16, Miami, FL 33126, USA
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Marquioni-Ramella MD, Suburo AM. Photo-damage, photo-protection and age-related macular degeneration. Photochem Photobiol Sci 2015. [DOI: 10.1039/c5pp00188a] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The course of Age-related Macular Degeneration (AMD) is described as the effect of light (400–580 nm) on various molecular targets in photoreceptors and the retinal pigment epithelium (RPE). Photo-damage is followed by inflammation, increasing oxidative stress and, probably, unveiling new photosensitive molecules.
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Affiliation(s)
| | - Angela M. Suburo
- Medicina Celular y Molecular
- Facultad de Ciencias Biomédicas
- Universidad Austral
- Pilar B1629AHJ
- Argentina
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Tolentino MJ, Dennrick A, John E, Tolentino MS. Drugs in Phase II clinical trials for the treatment of age-related macular degeneration. Expert Opin Investig Drugs 2014; 24:183-99. [PMID: 25243494 DOI: 10.1517/13543784.2015.961601] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The clinical development of anti-VEGF therapies for the treatment of exudative age-related macular degeneration (wet AMD) has revolutionized ophthalmology. Indeed, it has provided clinicians and patients with treatments that lessen visual loss from in a disease that once was uniformly blinding. Although blindness is yet to be eradicated from AMD, repeated intraocular anti-VEGF injections are required to preserve a patient's vision. Therefore, further advances in this field are necessary. AREAS COVERED This review provides an overview of the agents that are in mid-stage phase trials for both exudative (wet AMD) and nonexudative macular degeneration (dry AMD). For wet AMD, new agents intend to enhance efficacy, develop alternative delivery such as eye drops, investigate alternate targets and construct sustained release strategies. For advanced dry AMD, the goal is to develop a strategy to slow or stop progressive loss of retinal tissue seen in geographic atrophy, the hallmark of advanced dry AMD. EXPERT OPINION It is important to develop better more sensitive biomarkers, validating different approvable clinical trial endpoints and stratifying patients on their genetic polymorphisms. These developments should help to progress the already rapidly developing field of macular degeneration therapy.
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Affiliation(s)
- Michael John Tolentino
- University of Central Florida, College of Medicine , 6850 Lake Nona Blvd. Orlando, FL 32827 , USA
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