Primary Open Angle Glaucoma due to Low Macular Pigment

Primary open-angle glaucoma due to low macular pigment optical density.

<h2 id="background">Background</h2><ul><li>Primary open-angle glaucoma (POAG), is a neurodegenerative condition characterized by loss of retinal ganglion cells and visual field, impacts more than 44 million individuals globally.</li><li>It has a higher prevalence among women, Black, and Hispanic communities.</li><li>At present, the only modifiable risk factor for primary open-angle glaucoma (POAG) is intraocular pressure (IOP).</li><li>Nevertheless, certain patients experience severe vision impairment even after successfully lowering their IOP through medication and/or surgery.</li><li>Therefore, it is crucial to discover new modifiable risk factors for glaucoma.</li></ul><h2 id="objectives">Objectives</h2><ul><li>To evaluate whether macular pigment optical density (MPOD) was associated with manifest primary open-angle glaucoma (POAG) among older women in the Carotenoids in Age-Related Eye Disease Study 2 (CAREDS2).</li></ul><h2 id="methods">Methods</h2><ul><li>The Carotenoids in Age-Related Eye Disease Study (CAREDS) is a 15-years prospective study conducted in 2001-2004 (CAREDS1) and 2016-2019 (CAREDS2) to evaluate the relationships between MPOD with age-related macular degeneration (AMD) and cataract among women from 3 clinical sites in the Women’s Health Initiative (WHI) a observational study.</li><li>MPOD was measured with customized heterochromatic flicker photometry in women who attended CAREDS2 and CAREDS1 study visits.</li><li>Manifest POAG at CAREDS2 was assessed using visual fields, disc photos, optical coherence tomography, and medical records.</li><li>Age-adjusted linear and logistic regression models were used to investigate the cross-sectional association between POAG and MPOD at CAREDS2, and MPOD measured 15 years earlier at CAREDS1.</li></ul><h2 id="results">Results</h2><ul><li>Out of 426 CAREDS2 participants (mean age: 80 y; range: 69-98 y), 26 eyes with manifest POAG from 26 participants were identified.</li></ul><h4>1. MPOD and manifest POAG at CAREDS2</h4><ul><li>Eyes with manifest POAG at CAREDS2 had 25% lower MPOD at CAREDS2 than non glaucomatous eyes. This result remained consistent even after removing participants who were using lutein and zeaxanthin (L/Z) supplements.</li><li>In sensitivity analyses, the association between lower MPOD at CAREDS2 and manifest POAG at CAREDS2 remained significant after excluding eyes from participants using L/Z supplements.</li><li>In this subgroup, eyes with manifest POAG at CAREDS2 had 34% lower MPOD at CAREDS2 than non glaucomatous eyes.</li></ul><h4>2. MPOD at CAREDS1 and manifest POAG at CAREDS2</h4><ul><li>Eyes with manifest POAG compared with non glaucomatous eyes at CAREDS2 had 21% lower MPOD at CAREDS1 with consistent results observed for the right and left eyes (P &lt; 0.05).</li><li>After excluding eyes with age-related macular degeneration, the associations were similar but not<br>statistically significant (P-trend = 0.16).</li><li>The results for MPOD measured at CAREDS1 were also similar.</li><li>Findings were consistent for associations observed between manifest POAG in CAREDS2 and lower MPOD measured 15 years earlier at CAREDS1 for all eyes, as well as by eye laterality.</li></ul><h2 id="key-takeaways">Key Takeaways</h2><ul><li>This study contribute to the evidence of a protective association between macular pigment and manifest POAG in a sample of older women in CAREDS2.</li><li>Emerging evidence suggests that low macular pigment optical density (MPOD), modifiable through dietary intake of carotenoids lutein and zeaxanthin (L/Z), may lower risk for glaucoma.</li><li>L/Z may help to maintain normal blood perfusion to the optic nerve head, an emerging glaucoma risk factor.</li><li>These carotenoids preferentially accumulate in the retina, including the retinal ganglion cell complex.</li><li>Carotenoids are powerful antioxidants, which may prevent the oxidative stress implicated in glaucoma pathogenesis.</li></ul>

Opthal Update 2024 Issue 4

<ul><li><a href="#background">Background</a></li><li><a href="#objectives">Objectives</a></li><li><a href="#methods">Methods</a></li><li><a href="#results">Results</a></li><li><a href="#key-takeaways">Key Takeaways</a></li></ul>

Primary open-angle glaucoma due to low macular pigment optical density.

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