Supplement intake and plasma nutritional biomarkers reduce risk for second eye progression in age-related macular degeneration.

Abstract

Purpose : To determine the cumulative incidence rate of second eye progression in patients with unilateral neovascular age-related macular degeneration (nAMD) over 10 years follow-up; and to study the effect of supplement use, genetic variants, and plasma nutritional biomarkers on second eye progression.

Methods : This is a historical prospective cohort study.
We selected 240 patients nAMD in one eye and non-advanced AMD in the second eye. We performed multivariate Cox regression survival analysis for second eye progression. Variables included in the model were the intake of supplements, a genetic risk score (GRS) based on 52 AMD-associated variants, and 24 plasma nutritional biomarkers, including levels and ratios of fatty acids (FA), polyunsaturated fatty acids (PUFA), monounsaturated fatty acids (MUFA), saturated fatty acids (SFA), omega-3 fatty acids (FAω3), omega-6 fatty acids (FAω6), docosahexaenoic acids (DHA), linoleic acid (LA), and levels of carotenoids, α-carotene, β-carotene, α-lycopene, β-lycopene, β-cryptoxanthin, lutein, zeaxanthin, retinol and vitamin E. The main outcome measure was the development of nAMD in the second eye.

Results : The cumulative incidence rates for second-eye progression to nAMD were 8%, 15%, 25%, 45%, 58% and 68% after 1-, 2-, 3-, 5-, 7-, and 10-years follow-up respectively, showing a declining trend in the progression rate after five years. Supplement use was protective for second eye progression (HR 0.6, P=0.010). Patients with a GRS>4 were at higher risk for progression compared to patients with a GRS<0 (HR 6.7, P=0.021). The highest quartiles of DHA/FA ratio (>1.20) and zeaxanthin level (>0.75 μmol/L) were found to be protective for second eye progression compared to the lowest quartiles (HR 0.5, P=0.025 and HR 0.5, P=0.019, respectively). Supplement use was no longer significantly associated with second eye progression after correction for plasma DHA/FA ratio and zeaxanthin levels.

Conclusions : The risk of second eye progression in patients with unilateral nAMD is 10% per year in the first 5 years, and declines to approximately 5% per year after 5 to 10 years. Patients should consider taking supplements and adhere a healthy lifestyle to pursue high plasma DHA/FA ratio and zeaxanthin levels in order to reduce the risk of second eye progression and remain eyesight for a longer period.

This is a 2021 ARVO Annual Meeting abstract.