Journal Article

Retinal Spectral Domain Optical Coherence Tomography in Early Atrophic Age-Related Macular Degeneration (AMD) and a New Metric for Objective Evaluation of the Efficacy of Ocular Nutrition

Richer, Stuart, Levin, Marc, Sinai, Michael, Thomas, Carla, Wrobel, James, Cho, Jane, Stiles, William

2012

Overview

Purpose: A challenge in ocular preventive medicine is identification of patients with early pathological retinal damage that might benefit from nutritional intervention. The purpose of this study is to evaluate retinal thinning (RT) in early atrophic age-related macular degeneration (AMD) against visual function data from the Zeaxanthin and Visual Function (ZVF) randomized double masked placebo controlled clinical trial (FDA IND #78973). Methods: Retrospective, observational case series of medical center veterans with minimal visible AMD retinopathy (AREDS Report #18 simplified grading 1.4/4.0 bilateral retinopathy). Foveal and extra-foveal four quadrant SDOCT RT measurements were evaluated in n = 54 clinical and ZVF AMD patients. RT by age was determined and compared to the OptoVue SD OCT normative database. RT by quadrant in a subset of n = 29 ZVF patients was correlated with contrast sensitivity and parafoveal blue cone increment thresholds. Results: Foveal RT in AMD patients and non-AMD patients was preserved with age. Extrafoveal regions, however, showed significant slope differences between AMD patients and non-AMD patients, with the superior and nasal quadrants most vulnerable to retinal thinning (sup quad: −5.5 μm/decade thinning vs. Non-AMD: −1.1 μm/decade, P < 0.02; nasal quad: −5.0 μm/decade thinning vs. Non-AMD: −1.0 μm/decade, P < 0.04). Two measures of extrafoveal visual deterioration were correlated: A significant inverse correlation between % RT and contrast sensitivity (r = −0.33, P = 0.01, 2 Tailed Paired T) and an elevated extrafoveal increment blue cone threshold (r = +0.34, P = 0.01, 2 Tailed T). Additional SD OCT RT data for the non-AMD oldest age group (ages 82–91) is needed to fully substantiate the model. Conclusion: A simple new SD OCT clinical metric called “% extra-foveal RT” correlates well with functional visual loss in early AMD patients having minimal visible retinopathy. This metric can be used to follow the effect of repleting ocular nutrients, such as zinc, antioxidants, carotenoids, n-3 essential fats, resveratrol and vitamin D.

• Publisher: MDPI AG,MDPI
• Subject: Age / Age Factors / Aged / Aged, 80 and over / antioxidants / Antioxidants - therapeutic use / clinical trials / Contrast Sensitivity - physiology / Dietary Supplements / Disease prevention / Disease Progression / Fovea Centralis / Humans / lipids / Macular degeneration / Macular Degeneration - complications / Macular Degeneration - drug therapy / Macular Degeneration - pathology / Macular Degeneration - physiopathology / Male / medical facilities / medicine / Middle Aged / nose / Nutrients / Nutrition / nutritional intervention / patients / placebos / Preventive medicine / resveratrol / Retina / Retina - pathology / Retina - physiopathology / Retinal Cone Photoreceptor Cells / Retinal Diseases / Retrospective Studies / Sensory Thresholds - physiology / Tomography / Tomography, Optical Coherence - methods / veterans / Vision Disorders - drug therapy / Vision Disorders - etiology / Vision Disorders - pathology / Vision Disorders - physiopathology / vitamin D / Xanthophylls - therapeutic use / zeaxanthin / Zeaxanthins / zinc