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Paul S Bernstein, Aruna Gorusupudi, rene Choi, Mohsen Sharifzadeh, Werner Gellermann; A Clinical Trial of Zeaxanthin Supplementation in Patients with MacTel. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3851.
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© ARVO (1962-2015); The Authors (2016-present)
One of the earliest manifestations of macular telangiectasia type II (MacTel) is an anomalous redistribution of the macular carotenoid pigment from the normal peaked distribution centered at the fovea to a ring-shaped pattern. Previous attempts to normalize the macular pigment distribution with high-dose lutein supplementation have been unsuccessful in MacTel patients. We hypothesized that supplementation with zeaxanthin might be more successful because its retinal distribution peaks more sharply at the fovea in the normal eye relative to lutein’s retinal distribution.
We enrolled eight MacTel patients in a two-year, open-label, randomized zeaxanthin supplementation clinical trial (ClinicalTrials.gov identifier: NCT01354093). Subjects were randomly assigned to receive 10 or 20 milligrams/day of zeaxanthin (ZeaVision EyePromise). Complete eye examinations, serum carotenoid analysis, and retinal imaging with color photography, OCT, and blue light autofluorescence (Heidelberg Spectralis) were conducted every six months.
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 regions with no change in visual acuity. These inner retinal crystals disappeared several months after discontinuing her 20 mg zeaxanthin supplement, but they eventually reappeared after restarting at a lower 10 mg daily dose.
Zeaxanthin supplementation enhanced the anomalous ring-shaped pattern of macular pigment in MacTel patients, but it failed to re-establish a normal peaked distribution at the fovea. This response is consistent with a postulated redistribution of binding proteins for lutein and zeaxanthin in MacTel patients. One subject developed a novel, reversible crystalline maculopathy in response to zeaxanthin supplementation that was reminiscent of canthaxanthin crystalline maculopathy.
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