Effects of Milk vs Dark Chocolate Consumption on Visual Acuity and Contrast Sensitivity Within 2 Hours

Rabin, Jeff; Karunathilake, Nirmani; Patrizi, Korey

doi:10.1001/jamaophthalmol.2018.0978

Cited by 18 publications

(51 citation statements)

References 15 publications

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“…The rationale of Field et al [18] as to why no retinal or choroidal perfusion changes were observed in our study or that of Siedlecki et al [20] is that it may be due to the fact that dark chocolate improves performance on visual and cognitive tasks by increasing cerebral blood flow. This could possibly also explain the results of Rabin et al [19].…”

Section: Discussionmentioning

confidence: 61%

“…The blood concentration of flavonoids is dose-dependent and reaches its highest level at two to three hours from the ingestion of cocoa [18]. Field et al [18] reported an improvement of cognitive and visual function following consumption of cocoa flavonoids, and recently Rabin et al [19] reported that dark chocolate improves contrast sensitivity and visual acuity for up to two hours after ingestion. These authors suggested that this could be linked to augmentation of blood flow and increased availability of oxygen.…”

Section: Discussionmentioning

confidence: 99%

“…In ophthalmology, consumption of flavonoid-rich cocoa has been associated with visual function and contrast sensitivity enhancement [18][19][20]. The blood concentration of flavonoids is dose-dependent and reaches its highest level at two to three hours from the ingestion of cocoa [18].…”

Section: Discussionmentioning

confidence: 99%

“…Caffeine could have altered the effect of flavonoids on the retinal and choroidal circulation. In the studies by Taubert et al [10], Rabin et al [19], and Siedlecki et al [20], the possible caffeine content of the products used is neither mentioned nor discussed. This could, in part, explain the conflicting results.…”

Section: Discussionmentioning

confidence: 99%

“…On the effect of polyphenols on visual function, there have been contrasting reports [18][19][20]. Rabin et al [19], in 2018, reported improved contrast sensitivity within two hours of chocolate consumption, whereas Siedlecki et al [20] did not find visual acuity or contrast sensitivity improvements at two hours from chocolate ingestion in a similar study in 2019. In this second study, the authors also performed optical coherence tomography angiography (OCT-A) but did not find any significant effect of dark chocolate on retinal perfusion.…”

Section: Introductionmentioning

confidence: 99%

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Short-Term Effects of Dark Chocolate on Retinal and Choriocapillaris Perfusion in Young, Healthy Subjects Using Optical Coherence Tomography Angiography

et al. 2020

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1) Aim: Contrasting results have been published on the effect of dark chocolate on visual function. The aim of this study was to evaluate retinal and choriocapillaris perfusion, using optical coherence tomography angiography (OCT-A), and visual function in healthy subjects following dark chocolate ingestion. (2) Methods: This prospective randomized study was carried out on 18 healthy young subjects at the St. Andrea Hospital, Sapienza, University of Rome. Visual acuity assessment and a complete ophthalmologic examination were carried out at baseline. In session one, each subject was randomized to eat either a 100 g dark chocolate bar or a 100 g white chocolate bar. In session two, the opposite chocolate was given to each participant. OCT-A and best corrected visual acuity (BCVA) were performed before the chocolate was eaten and repeated 1, 2, and 3 h after that. Retinal vessel density and choriocapillaris flow area were assessed. (3) Results: 18 patients with a mean (SD) age of 26.3 (1.5) years were included. No significant differences between dark or white chocolate were found when evaluating foveal density (%), whole density (%), choriocapillaris flow area, and BCVA. (4) Conclusions: Dark chocolate did not result in significant changes in retinal perfusion and choriocapillaris flow area. However, given the results of other studies showing the positive effects of flavonoids on visual function, further studies are warranted using pure chocolate without other components such as caffeine that can potentially affect results. Furthermore, we cannot rule out the possible benefits of higher doses of flavonoids in dietary supplementation over a more extended period and in a larger patient population.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Short-Term Effects of Dark Chocolate on Retinal and Choriocapillaris Perfusion in Young, Healthy Subjects Using Optical Coherence Tomography Angiography

et al. 2020

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Effects of Flavanol-Rich Dark Chocolate on Visual Function and Retinal Perfusion Measured With Optical Coherence Tomography Angiography

et al. 2019

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IMPORTANCE A recently reported randomized clinical trial suggested beneficial effects of vasodilating flavanols in dark chocolate on visual function without objective quantification of retinal perfusion. OBJECTIVE To assess the effects of dark chocolate flavanols on subjective visual function and retinal perfusion objectively quantified on optical coherence tomography (OCT) angiography. DESIGN, SETTING, AND PARTICIPANTS This randomized, masked double-blind crossover clinical trial analyzed 22 healthy participants at the Department of Ophthalmology, Ludwig-Maximilians-University Munich, Germany, in July 2018. Analysis was intention to treat. Analysis began in July 2018. INTERVENTIONS Participants were randomized to consume 20 g of dark chocolate containing 400 mg of flavanols or 7.5 g of milk chocolate. Two hours later, visual function and retinal perfusion on OCT angiography were evaluated. Systemic blood pressure was measured to rule out artifacts on OCT angiography. MAIN OUTCOMES AND MEASURES The primary end point was macular retinal perfusion quantified as vessel density on OCT angiography. The secondary end point was subjective visual function (Early Treatment Diabetic Retinopathy Study visual acuity, Pelli-Robson chart, and Mars chart contrast sensitivity). RESULTS All 22 participants (13 women [59.1%]; mean [SD] age, 27.3 [11.1] years) completed the trial.No relevant differences in baseline parameters between groups were identified. No change in the primary outcome measure, retinal perfusion, could be detected after consumption of dark vs milk chocolate (superficial plexus 48.0% vs 47.5%, treatment effect: −0.59 [95% CI, −2.68 to 1.50], P = .56; deep plexus 54.1% vs 54.0%, treatment effect: −1.14 [95% CI, −4.01 to 1.73], P = .42). No differences in changes in the secondary outcome parameters Early Treatment Diabetic Retinopathy Study visual acuity, Pelli-Robson chart, or Mars chart contrast sensitivity could be detected. Potentially confounding effects of changes in blood pressure were excluded. CONCLUSIONS AND RELEVANCEIn contrast to a previous similarly sized randomized clinical trial reporting beneficial effects on visual function, no short-term effects of flavanol-rich dark chocolate on automatically assessed retinal blood flow on OCT angiography or subjective visual function were observed in this study. As this small trial does not rule out the possibility of benefits, further trials with larger sample sizes would be needed to rule in or out possible long-term benefits confidently.TRIAL REGISTRATION German Clinical Trials Register identifier: DRKS00015065

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Does Dark Chocolate Enhance Visual Function?

Bernstein

2019

JAMA Ophthalmol

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Forget Carrots, Study Finds Dark Chocolate Can Improve Vision," "A Bit of Dark Chocolate Might Sweeten Your Vision," and "Dark Chocolate Linked to Enhanced Visual Acuity": these are just a few of the online headlines that appeared online after JAMA Ophthalmology published an article by Rabin and colleagues 1 reporting a small randomized clinical trial on the short-term effects of milk chocolate vs dark chocolate on visual acuity and contrast sensitivity in healthy human volunteers. 1 Now, just about a year later, JAMA Ophthalmology is publishing a similar-sized study from Siedlecki and colleagues 2 using nearly the same methods along with objective imaging methods that reports that they could not replicate the positive contrast sensitivity results of the previous article. Undoubtedly, there will be another round of online posts saying that dark chocolate does not improve vision and the general public will be left confused as to whether an easy and pleasant nutritional intervention is good for their eyes.From a clinical research standpoint, both studies were well designed and conducted to determine whether chocolatederived flavanols can promote enhanced visual function. Both were randomized crossover studies that used appropriate methods. The first study would have benefited from a doubleblind design to preclude investigator bias. The negative conclusions of the second study are more convincing because of their addition of optical coherence tomography angiography as an objective corollary method to go with the subjective contrast sensitivity and visual acuity measurements, but critics could argue that there is not yet any proof that improving macular perfusion actually enhances visual performance in healthy human participants. Both studies are affected by the unavoidable complication that a nutritional intervention with a wholefood product can never completely mask the participants who can easily taste the difference between dark and milk chocolate. The abstract from Siedlecki et al 2 concludes, "Further trials

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Effects of Milk vs Dark Chocolate Consumption on Visual Acuity and Contrast Sensitivity Within 2 Hours

Cited by 18 publications

References 15 publications

Short-Term Effects of Dark Chocolate on Retinal and Choriocapillaris Perfusion in Young, Healthy Subjects Using Optical Coherence Tomography Angiography

Short-Term Effects of Dark Chocolate on Retinal and Choriocapillaris Perfusion in Young, Healthy Subjects Using Optical Coherence Tomography Angiography

Effects of Flavanol-Rich Dark Chocolate on Visual Function and Retinal Perfusion Measured With Optical Coherence Tomography Angiography

Does Dark Chocolate Enhance Visual Function?

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