Carotenoids and Antioxidants in Age-Related Maculopathy Italian Study: Multifocal Electroretinogram Modifications after 1 Year

Parisi, Vincenzo; Tedeschi, Massimiliano; Gallinaro, Geltrude; Varano, Monica; Saviano, Sandro; Piermarocchi, Stefano; CARMIS Study Group,

doi:10.1016/j.ophtha.2007.05.029

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Volume 115, Issue 2 , Pages 324-333.e2, February 2008

Carotenoids and Antioxidants in Age-Related Maculopathy Italian Study:

Multifocal Electroretinogram Modifications after 1 Year

Presented at: Association for Research in Vision and Ophthalmology Annual Meeting, April/May 2006, Fort Lauderdale, Florida, and American Academy of Ophthalmology–Asia Pacific Academy of Ophthalmology Joint Meeting, November 2006, Las Vegas, Nevada.

Vincenzo Parisi, MD
- Fondazione G. B. Bietti–Istituto di Ricovero e Cura a Carattere Scientifico, Roma, Italy.
- Correspondence to Dr Vincenzo Parisi, Fondazione per l’Oftalmologia G. B. Bietti–IRCCS, Via Livenza 3, 00199 Roma Italy.
Massimiliano Tedeschi, MD
- Fondazione G. B. Bietti–Istituto di Ricovero e Cura a Carattere Scientifico, Roma, Italy.
Geltrude Gallinaro, BSc
- Fondazione G. B. Bietti–Istituto di Ricovero e Cura a Carattere Scientifico, Roma, Italy.
Monica Varano, MD
- Fondazione G. B. Bietti–Istituto di Ricovero e Cura a Carattere Scientifico, Roma, Italy.
Sandro Saviano, MD
- Ospedali Riuniti, Trieste, Italy.
Stefano Piermarocchi, MD
- Dipartimento di Oftalmologia, Università di Padova, Padova, Italy.
CARMIS Study Group
- Dipartimento di Oftalmologia, Università di Padova, Padova, Fondazione G. B. Bietti–IRCCS, Roma, Italy.
- Clinica Oculistica A. O. Ospedali Riuniti, Trieste, Ospedale Ca’ Foncello, Treviso, Centro Teclo, Verona, Italy.

Received 23 November 2006; received in revised form 3 May 2007; accepted 4 May 2007. published online 22 August 2007.

Available online: August 22, 2007.

Objective

To evaluate the influence of short-term carotenoid and antioxidant supplementation on retinal function in nonadvanced age-related macular degeneration (AMD).

Design

Randomized controlled trial.

Participants

Twenty-seven patients with nonadvanced AMD and visual acuity ≥0.2 logarithm of the minimum angle of resolution were enrolled and randomly divided into 2 age-similar groups: 15 patients had oral supplementation of vitamin C (180 mg), vitamin E (30 mg), zinc (22.5 mg), copper (1 mg), lutein (10 mg), zeaxanthin (1 mg), and astaxanthin (4 mg) (AZYR SIFI, Catania, Italy) daily for 12 months (treated AMD [T-AMD] group; mean age, 69.4±4.31 years; 15 eyes); 12 patients had no dietary supplementation during the same period (nontreated AMD [NT-AMD] group; mean age, 69.7±6.23 years; 12 eyes). At baseline, they were compared with 15 age-similar healthy controls.

Methods

Multifocal electroretinograms in response to 61 M-stimuli presented to the central 20° of the visual field were assessed in pretreatment (baseline) conditions and, in nonadvanced AMD patients, after 6 and 12 months.

Main Outcome Measures

Multifocal electroretinogram response amplitude densities (RAD, nanovolt/deg²) of the N1–P1 component of first-order binary kernels measured from 5 retinal eccentricity areas between the fovea and midperiphery: 0° to 2.5° (R1), 2.5° to 5° (R2), 5° to 10° (R3), 10° to 15° (R4), and 15° to 20° (R5).

Results

At baseline, we observed highly significant reductions of N1–P1 RADs of R1 and R2 in T-AMD and NT-AMD patients when compared with healthy controls (1-way analysis of variance P<0.01). N1–P1 RADs of R3–R5 observed in T-AMD and NT-AMD were not significantly different (P>0.05) from controls. No significant differences (P>0.05) were observed in N1–P1 RADs of R1–R5 between T-AMD and NT-AMD at baseline. After 6 and 12 months of treatment, T-AMD eyes showed highly significant increases in N1-P1 RADs of R1 and R2 (P<0.01), whereas no significant (P>0.05) change was observed in N1–P1 RADs of R3–R5. No significant (P>0.05) changes were found in N1–P1 RADs of R1–R5 in NT-AMD eyes.

Conclusions

In nonadvanced AMD eyes, a selective dysfunction in the central retina (0°–5°) can be improved by the supplementation with carotenoids and antioxidants. No functional changes are present in the more peripheral (5°–20°) retinal areas.