Low Macular Pigment Optical Density Is Associated with Manifest Primary Open-Angle Glaucoma in Older Women <sup>☆</sup>

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Abstract

Background

Lower density of carotenoids lutein and zeaxanthin (L/Z) in the macula (i.e., macular pigment) has been linked to greater risk for age-related eye disease.

Objectives

We evaluated 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).

Methods

MPOD was measured with customized heterochromatic flicker photometry in women who attended CAREDS2 (2016–2019) and CAREDS1 (2001–2004) study visits. Manifest POAG at CAREDS2 was assessed using visual fields, disc photos, optical coherence tomography, and medical records. 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.

Results

Among 426 CAREDS2 participants (mean age: 80 y; range: 69–98 y), 26 eyes with manifest POAG from 26 participants were identified. Glaucomatous eyes had 25% lower MPOD compared to nonglaucomatous eyes [mean (SE): 0.40 (0.05) compared with 0.53 (0.01)] optical density units (ODU), respectively ( P = 0.01). Compared with MPOD quartile 1, odds for POAG were lower for women in quartiles 2–4 ( P-trend = 0.01). After excluding eyes with age-related macular degeneration, associations were similar but not statistically significant ( P-trend = 0.16). Results were similar for MPOD measured at CAREDS1.

Conclusions

Our results add to growing evidence that low MPOD may be a novel glaucoma risk factor and support further studies to assess the utility of dietary interventions for glaucoma prevention.

Related collections

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To provide the results of the Early Manifest Glaucoma Trial, which compared the effect of immediately lowering the intraocular pressure (IOP), vs no treatment or later treatment, on the progression of newly detected open-angle glaucoma. Randomized clinical trial. Two hundred fifty-five patients aged 50 to 80 years (median, 68 years) with early glaucoma, visual field defects (median mean deviation, -4 dB), and a median IOP of 20 mm Hg, mainly identified through a population screening. Patients with an IOP greater than 30 mm Hg or advanced visual field loss were ineligible. Patients were randomized to either laser trabeculoplasty plus topical betaxolol hydrochloride (n = 129) or no initial treatment (n = 126). Study visits included Humphrey Full Threshold 30-2 visual field tests and tonometry every 3 months, and optic disc photography every 6 months. Decisions regarding treatment were made jointly with the patient when progression occurred and thereafter. Glaucoma progression was defined by specific visual field and optic disc outcomes. Criteria for perimetric progression were computer based and defined as the same 3 or more test point locations showing significant deterioration from baseline in glaucoma change probability maps from 3 consecutive tests. Optic disc progression was determined by masked graders using flicker chronoscopy plus side-by-side photogradings. After a median follow-up period of 6 years (range, 51-102 months), retention was excellent, with only 6 patients lost to follow-up for reasons other than death. On average, treatment reduced the IOP by 5.1 mm Hg or 25%, a reduction maintained throughout follow-up. Progression was less frequent in the treatment group (58/129; 45%) than in controls (78/126; 62%) (P =.007) and occurred significantly later in treated patients. Treatment effects were also evident when stratifying patients by median IOP, mean deviation, and age as well as exfoliation status. Although patients reported few systemic or ocular conditions, increases in clinical nuclear lens opacity gradings were associated with treatment (P =.002). The Early Manifest Glaucoma Trial is the first adequately powered randomized trial with an untreated control arm to evaluate the effects of IOP reduction in patients with open-angle glaucoma who have elevated and normal IOP. Its intent-to-treat analysis showed considerable beneficial effects of treatment that significantly delayed progression. Whereas progression varied across patient categories, treatment effects were present in both older and younger patients, high- and normal-tension glaucoma, and eyes with less and greater visual field loss.

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Author and article information

Contributors

Yao Liu

Journal

Journal ID (nlm-ta): Curr Dev Nutr

Journal ID (iso-abbrev): Curr Dev Nutr

Title: Current Developments in Nutrition

Publisher: American Society for Nutrition

ISSN (Electronic): 2475-2991

Publication date PMC-release: 25 May 2024

Publication date Collection: June 2024

Publication date (Electronic): 25 May 2024

Volume: 8

Issue: 6

Electronic Location Identifier: 103789

Affiliations

[1 ]Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, United States

[2 ]Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, United States

[3 ]Eye Institute, Medical College of Wisconsin, Milwaukee, WI, United States

[4 ]Department of Ophthalmology and Visual Sciences, University of Illinois-Chicago, Chicago, IL, United States

[5 ]Department of Epidemiology, University of Iowa, Iowa City, IA, United States

[6 ]Department of Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, United States

Author notes

[* ]Corresponding author. yao.liu2@ 123456wisc.edu

Article

Publisher Item ID: S2475-2991(24)01723-2 Publisher ID: 103789

DOI: 10.1016/j.cdnut.2024.103789

PMC ID: 11225677

SO-VID: c12ce4aa-7ceb-400e-b967-8f1af51c712f

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

History

Date received : 10 March 2024

Date revision received : 14 May 2024

Date accepted : 22 May 2024