First Author: R.Crosby-Nwaobi UK
Co Author(s): K. Bibi V. Rocco M. Clemo P. Hykin S. Sivaprasad 0 0 0 0 0 0 0 0 0
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Response of visual functions in patients with retinal diseases after multiple xanthophyll supplementation.
Patients with any retinal disease were recruited from the Medical Retina clinics in London. All examinations were conducted in the NIHR Clinical Research Facility at Moorfields Eye Hospital.
51 patients with retinal diseases were recruited to have xanthophyll supplementation with Lutein 10mg , Zexanthin 2mg and Mesozeaxanthin 10mg (Macushield capsules, Macuvision Europe, Ltd) once daily for 6 months. Each participant underwent tests of refracted best corrected visual acuity (BCVA; ETDRS letters), Pelli-Robson contrast sensitivity (CS) and functional acuity contrast test (FACT; photopic and mesopic), glare disability (FACT), macular pigment densitometry (MPOD using Hetereochromatic Flicker Photometry), ocular coherence tomography (OCT), dual wavelength autofluorescence (DWAF, macular pigment volume), 2 field fundus photographs, vision-related quality of life (NEI-VFQ25), drug compliance, dietary intake (Xanthophyll screener), ophthalmic and physical examination at baseline, month 3 and month 6. MPOD was measured at a retinal eccentricity of 0.5° relative to 7° radius from the fovea. DWAF – MP volume was measured at two different retinal eccentricities: 0.5° relative to 7° radius from the fovea (0.5wrt7) and 10.5° relative to 10.5° radius from the fovea (10.5wrt10.5). Univariate analysis to determine the mean change in BCVA, CS, FACT, MPOD and DWAF; correlation of drug compliance with change in visual function were conducted using SPSS v22. Significance set at p≤0.01 due to multiple testing.
45 (88.2%) participants completed the study. Median drug compliance was 100% (IQR 6.7) at both 3 and 6 months. MPOD, BCVA and CS were not significant at month 3 and month 6. Mesopic FACT demonstrated an improvement at month 3 for 6.0cpd and 12.0cpd (p≤0.01) and at month 6, for all ranges of mesopic FACT (p≤0.001). Photopic FACT improved at frequencies 12.0cpd and 18.0cpd at month 6 only. Mesopic FACT with glare improved for all the spatial frequencies at month 3 and month 6 apart from 18cpd (p≤0.009). Only spatial frequency 3.0cpd improved at month 3 for photopic FACT with glare. Drug compliance demonstrated a moderate correlation with photopic FACT at 6.0cpd. A moderate correlation was found between OCT central macular thickness and mesopic FACT spatial frequencies 1.5cpd and 3.0cpd at month 6 (p=0.001). DWAF 0.5wrt7 showed an increase in macular pigment volume at month 3 (p=0.019) and month 6 (p=0.026). DWAF 10.5wrt10.5 also showed a significant increase in macular pigment volume at month 3 (p=0.001) and month 6 (p<0.001). Dietary intake of xanthophyll was stable throughout the trial (p=0.180). NEI-VFQ25 improved at month 3 and month 6 (p= 0.005 and p=0.001, respectively).
Glare sensitivity has improved in patients with varying retinal diseases after multiple xanthophyll supplementation. At month 6, an improvement in mesopic contrast sensitivity was found for all spatial frequencies. Macular pigment volume significantly increased after supplementation at month 3 and month 6. Significant improvement in patient reported quality of life was also found. Therefore, supplementation may be recommended in persons suffering glare disability but larger delineated studies are required to determine its effect in each retinal condition.