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Indre Bielskus, Lily Dasso, Nicholas Maxwell Pfahler, Claire Brom, Stephanie Aman, Zibute Zaparackas, Nicholas J Volpe, Paul A Knepper; Macular drusen size and location: The metrics of macular drusen response to curcumin. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1213. doi: https://doi.org/.
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Age-related macular degeneration (AMD) is a common ocular disease and the leading cause of vision loss in people over 60. It is characterized by the presence of drusen, which act as a marker for the progression of the disease process. Large drusen (>125μm), in particular, are a well-documented risk factor associated with the disease process. Notably, beta-amyloid (Aβ) is reported to accumulate in drusen. Aβ is a damage-associated molecular pattern (DAMP) which binds to innate immune receptor toll like receptor 4 (TLR4). This pilot study tested the hypothesis that oral administration of curcumin, a TLR4 inhibitor, would reduce the number and volume of drusen in the three regions of the macula—fovea, parafovea and perifovea.
Three AMD patients voluntarily elected to test the effects of curcumin (1330mg BID). Retinal images were obtained using the OCT-Heidelberg program at three time points: baseline, two months, and four months. Each druse was localized to one of three macular regions and classified by size: small (<63μm), medium (63-124μm), and large (>125μm). Volume measurements of individual drusen were taken and compared over time. Two-tailed Student's t-test was used for statistical analysis.
In all three subjects, drusen volume decreased after four months. Notably, both medium and large drusen significantly decreased in two subjects. In subject 001, large drusen (n=100) volume decreased by an average of 64.8% (p<0.0001). In subject 002, medium drusen (n=92) volume decreased by an average of 38.21% (p < 0.0001), and large drusen (n=76) volume decreased by an average of 44.59% (p<0.0001). While curcumin had an effect on drusen volume in subject 003, the decrease did not reach significance by 4 months. An overview of the data is shown in Tables 1 and 2.
Oral curcumin administration decreased macular drusen volume over 4 months in three subjects with AMD. The mode of action of curcumin encompasses the vascular component of AMD as well as the turnover of extracellular components of drusen such as Aβ. Although the pilot study is limited in subjects and duration, the marked decrease in drusen volume suggests that curcumin has potential as a novel treatment.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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