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Lutein und Antioxidantien zur Prävention der AMD

Lutein and antioxidants in the prevention of age-related macular degeneration

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Zusammenfassung

Aufgrund der demographischen Entwicklung ist in Europa und Nordamerika eine Zunahme der altersabhängigen Makuladegeneration (AMD) zu beobachten. Sie ist eine der führenden Ursachen für Blindheit und stellt gleichzeitig ein großes ökonomisches Problem dar.

Es gibt zahlreiche Hinweise, dass oxidativer Stress die Entwicklung der AMD begünstigt. Da das energiereiche blaue Licht an der neurosensorischen Netzhaut zu photooxidativen Schäden führen kann, ist das makuläre Pigment (MP) durch seinen Filtereffekt und seine antioxidative Wirkung für den Schutz der zentralen Netzhaut von hoher Bedeutung und wird oft als „natürliche Sonnenbrille“ bezeichnet. Das MP ist biochemisch eine Anreicherung von Lutein und Zeaxanthin. Diese Mikronährstoffe, genauso wie Vitamine mit antioxidativer Wirkung (vor allem Vitamin C, E und β-Karotin) können von Säugetieren nicht synthetisiert werden. Deswegen wird die Bedeutung der Ernährung bzw. der Supplementation für die Entstehung und Progression der AMD schon seit Jahren diskutiert.

Die Ergebnisse der bisher publizierten Studien, die den Zusammenhang zwischen MP und AMD untersuchten, sind widersprüchlich. Ein positiver Einfluss der Supplementation von Lutein und Zeaxanthin wurde bis jetzt in keiner randomisierten placebokontrollierten Studie nachgewiesen. Die therapeutische Beeinflussung der AMD durch einen erhöhten Konsum von Antioxidantien und ω-3-Fettsäuren (die in Meeresfischen vorkommen) wurde in den diesen Studien kontrovers bewertet.

Die bis jetzt größte abgeschlossene randomisierte placebokontrollierte Studie, die einen signifikanten Einfluss der Supplementation von Antioxidantien, Zink und Kupfer auf bestimmte Formen der AMD nachwies, ist die ARED Studie. Sie empfiehlt diese Supplementation nur für klar definierte Risikogruppen. Die Gabe von Lutein und ω-3-Fettsäuren ist nicht toxisch, aber bisher nicht durch randomisierte Studien abgesichert.

Abstract

Demographic developments in Europe and North America are causing an increase of age-related diseases. Age-related macular degeneration (AMD) is one of the leading causes of severe central visual acuity loss in elderly people and seems to be an economic problem, too. There is evidence that oxidative damage is an important factor for exacerbation of AMD. Macular pigment with its antioxidative effect may serve as“natural sunglasses” filtering the blue light acting as a possible source of photooxidative damage to the neurosensory retina. The macular pigment consists mostly of lutein and zeaxanthin. These micronutrients from the group of carotenoids, as is the case for vitamins (vitamins C, E, and β-carotene), cannot be synthesized in mammals and that is the reason why the role of micronutrition or its supplementation and its correlation to AMD progression has been discussed for years.

The results of currently published studies are often contradictory. At present there are no results from randomized controlled studies confirming that supplementation of lutein and zeaxanthin can reduce the risk for AMD. Several epidemiological studies investigating the impact of antioxidants and ω-3 fatty acids on the incidence of AMD provided conflicting results.

Up to now, AREDS is the largest randomized controlled study investigating the effect of supplementation of antioxidants, zinc, and copper on the progression of AMD. AREDS showed a significant effect of this supplementation in some particular groups of patients with AMD. The supplementation of lutein and ω-3 fatty acids is not toxic but a positive effect has not been proven by randomized studies.

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Abb. 1

Abbreviations

AMD:

Altersabhängige Makuladegeneration, „age-related macular degeneration“

ARED(S):

Age-Related Eye Disease (Study)

ARM:

Age-related maculopathy

CNV:

Choroidale Neovaskularisationen

CuO:

Kupferoxid

DGE:

Deutsche Gesellschaft für Ernährung

DHA:

Docosahexaensäure

EDCCS:

Eye Disease Case-Control Study

EPA:

Eicosapentaensäure

GRAS:

Generally recognised as safe

L:

Lutein

LAST:

Lutein Antioxidant Supplementation Trial

MP:

Makuläres Pigment

MPD:

Makulapigmentdichte

POLA:

Pathologies Oculaires Liées à l’Age

RPE:

Retinales Pigmentepithel

USDA:

United States Department of Agriculture

VECAT:

Vitamin E, Cataract, and Age-related Maculopathy Trial

Vit.:

Vitamin

XBP:

Xanthophyll-binding-Protein

Z:

Zeaxanthin

ZnO:

Zinkoxid

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  1. Klinik und Poliklinik für Augenheilkunde, Universität Leipzig, Liebigstraße 10–14, 04103, Leipzig, Deutschland

    M. Rehak &  P. Wiedemann

  2. Universitäts-Augenklinik, Olomouc, Tschechien

    E. Fric

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Rehak, M., Fric, E. & Wiedemann, P. Lutein und Antioxidantien zur Prävention der AMD. Ophthalmologe 105, 37–45 (2008). https://doi.org/10.1007/s00347-007-1602-1

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