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Renewed attention is being directed to luteal pigment loss in the perplexing neurodegenerative disease, idiopathic macular telangiectasia type 2 (IMT2 or MacTel). In the first controlled study of off-label Age-Related Eye Disease Study 2 (AREDS2) oral supplement, patients with MacTel maintained more stability in visual acuity and anatomic structures after 24 months, losing less ground than the natural history group, according to data published in Clinical Ophthalmology. The formulation contains antioxidants and carotenoids; vitamins C and E, zinc, copper, lutein, and zeaxanthin.
The retrospective review examines records of 82 eyes of 43 patients with nonproliferative MacTel who were treated at Cincinnati Eye Institute in Cincinnati, Ohio, from January 2013 to January 2018. Two study arms were developed; a noncomparative cohort for which the impact of supplementation was tracked for 2 years — and an arm that compared supplement-treated eyes with untreated control eyes. Previous smaller studies with carotenoids demonstrated mixed results: either showing acuity stabilization, no acuity benefits, or better pigment density where macular pigment was already present.
Of 82 eyes in the noncomparative cohort, best corrected visual acuity (BCVA) remained similar from 12 months to 24 months (P =.86). In the comparative study arm with 27 supplement-treated and 42 natural history eyes, those not taking supplements showed reduced acuity at 12 and 24 months, significantly greater than AREDS2 eyes (P <.001). In subsets of baseline BCVA better- and worse-seeing eyes, untreated eyes had significantly reduced vision at 24 months (better eyes P =.01, worse eyes P =.01).
Spectral-domain optical coherence tomography revealed that treated eyes exhibited less mean ellipsoid zone (EZ) loss than eyes not taking the supplement (P =.02). When grouped by better- and worse-seeing eyes, untreated eyes lost more EZ length in worse-seeing eyes after 24 months (P =.04). Conversely, better-seeing eyes in both groups experienced similar rates of EZ loss (P =.35). Mean central macular thickness remained relatively stable in both study arms, including supplement and control groups.
Intraretinal cavities are distinctive in MacTel. In 24 months, cavitary diameter significantly increased in untreated eyes compared with treated eyes (P =.01). When grouped by baseline better- and worse-seeing eyes, mean cavitary diameter was larger in worse-seeing eyes of control participants than in those receiving supplements (P =.001), “while no significant difference (in cavitary diameter or EZ loss) was appreciated in eyes with better baseline BCVA.” Further, study authors speculate that while EZ loss has been associated with better acuity, stability in cavitary size may also be crucial.
Limitations of the study include imaging based on customary clinic practices — potentially nonuniform — and the graders were unmasked. Also, EZ loss was measured by length rather than en face area, due to standard use of optical coherence tomography (OCT) in practice at the time.
Prior studies have demonstrated a connection between oxidative stress and damage to Müller cells. The antioxidants; vitamins C and E, and zinc also may have played a supportive stabilizing role in this study, according to the authors. Overall, because the supplement is low risk, and may yield considerable benefits, the current results are encouraging both for future prospective trials and in clinical relevance.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Reference
Berger TA, Manry MW, Lindsell LB, et al. Outcome of off-label areds 2 supplementation for the treatment of macular degeneration in non-proliferative idiopathic type 2 macular telangiectasia. Clin Ophthalmol. 2021;15(3):1133-1143. doi:10.2147/OPTH.S294789
