The effect of nutritional supplementation on the multifocal electroretinogram in healthy eyes
Previous studies have demonstrated an increase in macular pigment optical density (MPOD) with lutein (L)-based supplementation in healthy eyes. However, not all studies have assessed whether this increase in MPOD is associated with changes to other measures of retinal function such as the multifocal ERG (mfERG). Some studies also fail to report dietary levels of L and zeaxanthin (Z). Because of the associations between increased levels of L and Z, and reduced risk of AMD, this study was designed to assess the effects of L-based supplementation on mfERG amplitudes and latencies in healthy eyes.
Multifocal ERG amplitudes, visual acuity, contrast sensitivity, MPOD and dietary levels of L and Z were assessed in this longitudinal, randomized clinical trial. Fifty-two healthy eyes from 52 participants were randomly allocated to receive a L-based supplement (treated group), or no supplement (non-treated group).
There were 25 subjects aged 18–77 (mean age ± SD; 48 ± 17) in the treated group and 27 subjects aged 21–69 (mean age ± SD; 43 ± 16) in the non-treated group. All participants attended for three visits: visit one at baseline, visit two at 20 weeks and visit three at 40 weeks. A statistically significant increase in MPOD (F = 17.0, p ≤ 0.001) and shortening of mfERG ring 2 P1 latency (F = 3.69, p = 0.04) was seen in the treated group.
Although the results were not clinically significant, the reported trend for improvement in MPOD and mfERG outcomes warrants further investigation.
KeywordsLutein Macular pigment optical density Multifocal electroretinogram Randomized trial
Bausch and Lomb provided financial support in the form of Ph.D. funding. The sponsor had no role in the design or conduct of this research.
Compliance with ethical standards
Statement of human rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Statement on the welfare of animals
This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
Conflict of interest
All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
- 3.Kaufman PL, Adler FH, Levin LA, Alm A (2011) Adler’s physiology of the eye. Elsevier Health SciencesGoogle Scholar
- 14.Trieschmann M, Beatty S, Nolan JM, Hense HW, Heimes B, Austermann U, Fobker M, Pauleikhoff D (2007) Changes in macular pigment optical density and serum concentrations of its constituent carotenoids following supplemental lutein and zeaxanthin: the LUNA study. Exp Eye Res 84(4):718–728. doi: 10.1016/j.exer.2006.12.010 CrossRefPubMedGoogle Scholar
- 15.Schalch W, Cohn W, Barker FM, Kopcke W, Mellerio J, Bird AC, Robson AG, Fitzke FF, van Kuijk FJ (2007) Xanthophyll accumulation in the human retina during supplementation with lutein or zeaxanthin—the LUXEA (LUtein Xanthophyll Eye Accumulation) study. Arch Biochem Biophys 458(2):128–135. doi: 10.1016/j.abb.2006.09.032 CrossRefPubMedGoogle Scholar
- 16.Rodriguez-Carmona M, Kvansakul J, Harlow JA, Kopcke W, Schalch W, Barbur JL (2006) The effects of supplementation with lutein and/or zeaxanthin on human macular pigment density and colour vision. Ophthalmic Physiol Opt 26(2):137–147. doi: 10.1111/j.1475-1313.2006.00386.x CrossRefPubMedGoogle Scholar
- 21.Richer S, Stiles W, Statkute L, Pulido J, Frankowski J, Rudy D, Pei K, Tsipursky M, Nyland J (2004) Double-masked, placebo-controlled, randomized trial of lutein and antioxidant supplementation in the intervention of atrophic age-related macular degeneration: the Veterans LAST study (Lutein Antioxidant Supplementation Trial). Optometry 75(4):216–230CrossRefPubMedGoogle Scholar
- 24.Chew EY, Clemons TE, SanGiovanni JP, Danis R, Ferris FL, Elman M, Antoszyk A, Ruby A, Orth D, Bressler S, Fish G, Hubbard B, Klein M, Chandra S, Blodi B, Domalpally A, Friberg T, Wong W, Rosenfeld P, Agron E, Toth C, Bernstein P, Sperduto R (2013) Lutein plus zeaxanthin and omega-3 fatty acids for age-related macular degeneration The Age-Related Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA 309:2005–2015CrossRefGoogle Scholar
- 30.World Medical Association (2000) Declaration of Helsinki, ethical principles for medical research involving human subjects. 52nd WMA General Assembly, Edinburgh, ScotlandGoogle Scholar
- 31.Schulz K, Altman D, Moher D, Group tC (2010) CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. Biomed Central Med 8(1):18Google Scholar
- 33.FSA (2003) Expert group on vitamins and minerals—safe upper levels for vitamins and minerals. Food standards agencyGoogle Scholar
- 35.Elliott DB, Sheridan M (1988) The use of accurate visual acuity measurements in clinical anti-cataract formulation trials. Ophthalmic Physiol Opt J Br Coll Ophthalmic Opt 8(4):397–401Google Scholar
- 36.Arditi A, Cagenello R (1993) On the statistical reliability of letter-chart visual acuity measurements. Investig Ophthalmol Vis Sci 34(1):120–129Google Scholar
- 37.Bailey IL, Bullimore MA, Raasch TW, Taylor HR (1991) Clinical grading and the effects of scaling. Investig Ophthalmol Vis Sci 32(2):422–432Google Scholar
- 38.Lovie-Kitchin JE (1988) Validity and reliability of visual acuity measurements. Ophthalmic Physiol Opt J Br Coll Ophthalmic Opt 8(4):363–370Google Scholar
- 39.Reeves BC, Wood JM, Hill AR (1991) Vistech VCTS 6500 charts—within- and between-session reliability. Optom Vis Sci Off Publ Am Acad Optom 68(9):728–737Google Scholar
- 40.Elliott DB, Sanderson K, Conkey A (1990) The reliability of the Pelli-Robson contrast sensitivity chart. Ophthalmic Physiol Opt J Br Coll Ophthalmic Opt 10(1):21–24Google Scholar
- 41.Bartlett H, Stainer L, Singh S, Eperjesi F, Howells O (2010) Clinical evaluation of the MPS 9000 macular pigment screener. Br J Ophthalmol 94(6):753–756. doi: 10.1136/bjo.2009.175901
- 42.Dolan F, Sandinha T, Purdy A, Parks S, Keating D (2006) Vitamin A deficiency modifies the mfERG: a case study of rod influence on the mfERG. Doc Ophthalmol 112(1):31–34. doi: 10.1007/s10633-006-0002-1
- 46.Hood DC, Bach M, Brigell M, Keating D, Kondo M, Lyons JS, Marmor MF, McCulloch DL, Palmowski-Wolfe AM (2012) ISCEV Standard for clinical multifocal electroretinography (2011 edition). Doc Ophthalmol 124:1–13Google Scholar
- 47.van der Veen RL, Berendschot TT, Hendrikse F, Carden D, Makridaki M, Murray IJ (2009) A new desktop instrument for measuring macular pigment optical density based on a novel technique for setting flicker thresholds. Ophthalmic Physiol Opt 29(2):127–137. doi: 10.1111/j.1475-1313.2008.00618.x CrossRefPubMedGoogle Scholar
- 48.Gravetter F, Wallnau L (2000) Statistics for the behavioural sciences, 5th edn. Wadsworth, BelmontGoogle Scholar