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Paul S. Bernstein, Mohsen Sharifzadeh, Aihua Liu, Igor Ermakov, Kelly Nelson, Xiaoming Sheng, Cynthia Panish, Bonnie Carlstrom, Robert O. Hoffman, Werner Gellermann; Macular Pigment Imaging in Infants and Children Using the RetCam. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5873.
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While the role of the macular pigment carotenoids in the prevention of age-related macular degeneration has been extensively studied in adults, comparatively little is known about the physiology and function of lutein and zeaxanthin in the developing eye. The paucity of information relates in part to the particular challenges of measuring macular pigment levels in children (lack of cooperation and low levels of lipofuscin autofluorescence). We therefore developed a protocol using the RetCam to measure macular pigment optical density (MPOD) and distributions in infants and children.
We used blue light reflectance to image the macular pigment in premature babies at the time of ROP screening and in children under age seven who were undergoing examinations under anesthesia for other reasons. We correlated the MPOD with skin carotenoid levels measured by resonance Raman spectroscopy, serum carotenoids measured by HPLC, and dietary carotenoid intake.
We enrolled 38 infants and children ranging from preterm to age seven. In subjects with measurable MPOD in both eyes, right and left eyes correlated strongly (r=0.97; P<0.0001), and reproducibility upon repeat testing on a separate day in six subjects was 100%. MPOD correlated significantly with age (r=0.60; P=0.0003) and with skin carotenoid levels (r=0.44; P=0.04) but not with dietary intake (r=0.27; P=0.26) or serum carotenoids (r=0.06; P=0.78). Skin carotenoid levels correlated significantly with age (r=0.41; P=0.04), diet (r=0.71; P=0.0042), and serum levels (r=0.84; P<0.0001). All premature infants had undetectable macular pigment, and most had unusually low serum and skin carotenoid concentrations.
The RetCam can reliably measure MPOD in infants and children. Our most remarkable finding is the undetectable MPOD in pre-term infants. This may be due in part to foveal immaturity, but the very low levels of serum and skin carotenoids suggest that these infants are carotenoid deficient as a consequence of low dietary intake and/or severe oxidative stress. The potential value of carotenoid supplementation in the prevention of ROP and other disorders of prematurity should be a fruitful direction for further investigation.
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