Macular pigment optical density can be supplemented in patients with primary open-angle glaucoma, according to research published in Ophthalmology Glaucoma. As such, macular carotenoid supplementation could be used as an adjunct therapy to optimize visual function and preserve macular health in patients with glaucoma.

Macular pigment (MP) — composed of the carotenoids lutein, zeaxanthin, and meso-zeaxanthin—is highly concentrated at the fovea. Previous research has concluded that macular pigment optical density (MPOD) is lower in glaucomatous eyes.

Researchers conducted a double-masked, randomized and placebo-controlled clinical trial—the European Nutrition In Glaucoma Management (ENIGMA) study (ClinicalTrials.gov Identifier: NCT04460365) — to evaluate the macular pigment response to carotenoid supplementation in glaucomatous eyes. Investigators enrolled 62 patients (38 men, 24 women) with open-angle glaucoma. A total of 42 patients were randomized to receive the active supplement, while 20 patients received a placebo. The supplement included 10 mg lutein, 2 mg zeaxanthin, and 10mg meso-zeaxanthin.


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Investigators noted a statistically significant increase in MPOD volume during the study period (P <.01). Post-hoc t-tests revealed a significant difference in MPOD volume at each study visit for the treatment group (P <.01 for all), but no change in the placebo group (P >.05 for all). A statistically significant increase in mesopic contrast sensitivity under glare conditions was noted at 18 months in the treatment group, but not in the placebo group. 

This trial had several limitations, including its small sample size and limited 18-month duration.

“A supplement formulation containing 10 mg [lutein], 2 mg [zeaxanthin], and 10 mg [meso-zeaxanthin] can generate a sizeable and continuous increase in overall MPOD throughout an 18-month treatment window independent of baseline MPOD levels,” the researchers explain. “Although structural integrity and functional performance remained relatively unchanged, the improvement in glare affected mesopic [contrast sensitivity] is noteworthy, particularly in the context of the glare-related symptoms known to affect people with glaucoma.” 

Disclosure: This research was supported by Alliance Pharmaceuticals Ltd. Please see the original reference for a full list of disclosures.

Reference

Loughman J, Loskutova E, Butler JS, et al. Macular pigment response to lutein, zeaxanthin and meso-zeaxanthin supplementation in open angle glaucoma: a randomized controlled trial. Ophthalmol Sci. Published online July 11, 2021. doi:10.1016/j.xops.2021.100039