Macular Pigment Distribution Responses to High-Dose Zeaxanthin Supplementation in Patients With Macular Telangiectasia Type 2

Abstract

Purpose Analysis of macular pigment (MP) amount and distribution in patients with macular telangiectasia type 2 (MacTel) receiving oral zeaxanthin supplementation in a randomized, open-label interventional trial. Methods Eight MacTel patients were randomized to 10 mg or 20 mg of zeaxanthin per day. At each visit, the subjects were examined including best corrected visual acuity (BCVA), contrast sensitivity (CS), fundus biomicroscopy, color fundus photography (CFP), autofluorescence imaging (AFI), optical coherence tomography (OCT), and serum carotenoid levels. Patients were assessed at baseline and after 6, 12, 18, and 24 months of zeaxanthin supplementation. MP concentration was analyzed and calculated from AFI obtained at 488 nm excitation wavelength. Serum carotenoid levels were obtained using high-performance liquid chromatography (HPLC). Results The majority of subjects had definite increases in intensity of the macular pigment’s hypofluorescent ring, but none of them deposited macular pigment centrally at the fovea. Although some patients noted subjective improvements in vision, no objective improvements could be documented, and there were no changes in foveal OCT features. Yellowish, hypofluorescent crystals appeared in one subject’s macular region with no change in visual acuity. These inner retinal crystals disappeared several months after discontinuing her 20 mg zeaxanthin supplement. Conclusion Based on our study, zeaxanthin supplementation does not result in any visual benefit in patients with MacTel, and does not re-establish a normal peaked distribution of macular pigment in the fovea. One subject developed a novel, reversible crystalline maculopathy in response to zeaxanthin supplementation that was reminiscent of canthaxanthin crystalline maculopathy.

Fluorescence Lifetime Imaging Ophthalmoscopy (FLIO) of Macular Pigment

“…The ring is enhanced in AFI images from patients regularly using lutein and zeaxanthin supplementation. 5 , 33 , 34 In SSC FLIO images, we see short FAF lifetimes surrounding the MacTel area. This is depicted in Figure 1 D.…”

Contrast sensitivity and visual acuity under low light conditions in macular telangiectasia type 2

“…Second, supplementation with lutein and zeaxanthin showed no change in central accumulation in two independent studies 18. It is not surprising that Choi et al 25 were not able to find a correlation between contrast sensitivity and macular pigment in their study, which only included eyes with complete loss of central macular pigment (‘MPOD class 3’). Although macular pigment supplementation was shown to increase the optical density at 5°–7° eccentricity, this change is unlikely to influence contrast sensitivity, as the latter is usually tested within the central 10° and not beyond.…”

Review of clinical approaches in fluorescence lifetime imaging ophthalmoscopy

“…They show very low levels and an accumulation in a ring-shaped manner around MacTel area. 77,102,[169][170][171][172][173][174][175] At this point, there is no treatment of MacTel available, and intravitreal injections of steroids or anti-VEGF have not been successful, [176][177][178] but ciliary neurotrophic factor may be beneficial and is currently being investigated. Therefore, the call for a reliable imaging modality to diagnose the disease at early stages is increasing.…”