Investigators conducted a randomized, double-blind, placebo-controlled, two-center investigation to examine the effect of daily supplementation with lutein capsules on macular pigment optical density (MPOD) and visual acuity (VA) in patients with early age-related macular degeneration (AMD).

The trial took place at centers in Manchester, the United Kingdom and Maastricht, as well as the Netherlands, and lasted 12 months. The investigators randomly assigned 72 patients (mean age 70.5 ± 8.7) to either lutein capsules (10 mg Ester, n=36) or placebo (n=36) groups. Patients took lutein capsules or placebo daily. MPOD using a flicker-based technique (MPS9000) and best-corrected VA (LogMAR) were measured by investigators at the beginning and at four-month intervals over the duration of the supplementation period. Blood serum samples were collected to monitor compliance.

At the end of the trial, the study investigators observed an overall increase in the mean MPOD level for the lutein group from 0.38 ± 0.19 to 0.53 ± 0.22 optical density (OD) units. According to a mixed design ANOVA, this was statistically significant (p<0.001). No change in MPOD was found for the placebo group and there was no significant change in VA in the lutein group (n=36). The investigators noted that the placebo group (n=36) showed a statistically significant deterioration from 0.05 ± 0.13 to 0.09 ± 0.13 (p<0.05). When comparing the change in VA over the supplementation period, they found a significant difference between the two groups (p<0.05). To avoid ceiling effects, they reanalyzed two subgroups of patients with VA worse than 0.06 at baseline. In the lutein subgroup (n=19), they observed a mean improvement in VA from 0.23 ± 0.12 at baseline to 0.16 ± 0.10 at visit four (p<0.05). They also reported a small deterioration in the placebo subgroup (n=14) from 0.18 ± 0.13 to 0.19 ± 0.12 (p=0.70). They also compared the improvement in VA in the lutein subgroup to the deterioration in VA in the placebo group and this effect reached statistical significance (p<0.05).

Lutein supplementation increases MPOD levels in early stage AMD patients. According to the VA measurements, the progress of the disease might be slowed in some patients with augmented levels of MP.

To assess the relationship between baseline central corneal thickness (CCT) and/or ongoing CCT change over time with subsequent visual field progression, 163 eyes of 163 patients with medically treated glaucoma were followed up for 6.8 ± 1.8 years.

Exclusion criteria was laser or intraocular surgery. Baseline and follow up CCT, confocal scanning laser tomography and visual fields were performed. CCT and CCT change related to visual field progression using Glaucoma Progress Analysis were also assessed and multivariate logistic regression analysis for predictive factors of glaucoma progression was used to analyze data.

Thinner baseline CCT was associated with more advanced damage at presentation, mean deviation (MD) (r=0.17, p=0.02) and neuroretinal rim area (NRR) (r=0.20, p=0.02). It was noted that progressing eyes had significantly thinner (p=0.01) baseline CCT compared to non-progressing eyes and that the slope of visual field change was significantly greater (p=0.05) for thinner (<540 µm) as compared to thicker eyes. A small but significant CCT reduction (12.78 ± 13.35 µm, p<0.0001) was noted in all eyes; however, there was no significant difference (p=0.95) in the amount of change between progressing and non-progressing eyes. CCT change did not correlate with MD or NRR change. Moreover, a thinner CCT (Odds ratio=1.80, p=0.02), but not CCT change (Odds ratio=1.07, p=0.69), was a significant risk factor for glaucoma progression.

In conclusion, CCT correlates significantly with the amount of glaucomatous damage at presentation. Thinner corneas may be associated with increased risk of visual field progression. CCT reduced slightly over time in eyes with glaucoma; but the magnitude of this change was not related to visual field progression.

In the following cross-sectional study, researchers included 25 adult patients (37 eyes) diagnosed with diabetic macular edema (DME) and managed at the Wilmer Eye Institute, Johns Hopkins University, to evaluate the relationship between retinal sensitivity and the photoreceptor inner segment/outer segment (IS/OS) layer status in patients with DME.

They obtained simultaneous fundus microperimetry (MP) and optical coherence tomography (OCT) of patients with DME using a combined MP/OCT system. The device recorded retinal sensitivity and retinal thickness on a three-dimensional tomography map, and the researchers performed a point-by-point analysis of the IS/OS layer integrity at every MP point. They also reviewed OCT scans to determine the type of DME, cystoid macular edema (CME) or diffuse macular edema (absence of any cysts). In addition, they analyzed fixation stability and location. Retinal point sensitivity measured by MP was the main outcome measure.

The study researchers enrolled 25 patients (37 eyes: 29 male and eight female; mean age, 64.16 years) with DME. They observed that fixation was centric in 30 eyes (81%), paracentric in three eyes (8%), and eccentric in four eyes (11%). They noted that 27 eyes had CME and 10 eyes had diffuse macular edema. Mean central subfield thickness was 325 µm. The researchers analyzed a total of 1,036 individual MP points. They reported that mean point sensitivity was 10.51 dB. A total of 793 points (76.5%) had IS/OS layer present, and 243 points (23.5%) had IS/OS layer disrupted. A mixed linear model, constructed to adjust for potential confounders and account for dependence between retinal points, revealed that the absence of the IS/OS junction was significantly associated with a 3.28-dB decrease in retinal point sensitivity (p<0.001).

This novel index study demonstrates that disruption of the IS/OS junction is correlated with a significant decrease in point sensitivity in eyes with DME. Further studies are indicated to confirm and validate this relationship.