Sustained supplementation and monitored response with differing carotenoid formulations in early age-related macular degeneration

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.

Figure 1

Macular pigment response at different retinal eccentricities over the course of the MOST AMD study. Boxplots representing macular pigment optical density at four time points (baseline, 12 months, 24 months, and 36 months) for each intervention group: Group 1—20 mg L and 0.86 mg Z; Group 2—10 mg MZ, 10 mg L, and 2 mg Z; Group 3—17 mg MZ, 3 mg L, and 2 mg Z Macular pigment was measured at 0.25° (a), 0.5° (b), 1.0° (c), and 1.75° (d) eccentricity using cHFP. 0-G1, Baseline Group 1; 12-G1, 12 months Group 1; 24-G1, 24 months Group 1; 36-G1, 36 months Group 1; 0-G2, Baseline Group 2; 12-G2, 12 months Group 2; 24-G2, 24 months Group 2; 36-G2, 36 months Group 2; 0-G3, Baseline Group 3; 12-G3, 12 months Group 3; 24-G3, 24 months Group 3; 36-G3, 36 months Group 3. MPOD, macular pigment optical density.

Figure 2

Serum response of L, MZ, and Z over the course of the MOST AMD study. Boxplots representing serum concentrations of L (a), MZ (b), and zeaxanthin (c) at four time points (baseline, 12 months, 24 months, and 36 months) for each intervention group: Group 1—20 mg L and 0.86 mg Z; Group 2—10 mg MZ, 10 mg L, and 2 mg Z; Group 3—17 mg MZ, 3 mg L, and 2 mg Z. Serum macular carotenoids were analysed by HPLC and expressed as μmol/L; 0-G1, Baseline Group 1; 12-G1, 12 months Group 1; 24-G1, 24 months Group 1; 36-G1, 36 months Group 1; 0-G2, Baseline Group 2; 12-G2, 12 months Group 2; 24-G2, 24 months Group 2; 36-G2, 36 months Group 2; 0-G3, Baseline Group 3; 12-G3, 12 months Group 3; 24-G3, 24 months Group 3; 36-G3, 36 months Group 3.