June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Macular pigment response to carotenoid supplementation in patients with open angle glaucoma: the ENIGMA trial.
Author Affiliations & Notes
  • James Loughman
    Centre for Eye Research Ireland, Technological University Dublin, Dublin, Dublin, Ireland
  • Colm J O'Brien
    Mater Misericordiae University Hospital, Dublin, Ireland
  • John S Butler
    Centre for Eye Research Ireland, Technological University Dublin, Dublin, Dublin, Ireland
  • Ian Flitcroft
    Centre for Eye Research Ireland, Technological University Dublin, Dublin, Dublin, Ireland
  • Ekaterina Loskutova
    Centre for Eye Research Ireland, Technological University Dublin, Dublin, Dublin, Ireland
  • Footnotes
    Commercial Relationships   James Loughman, None; Colm O'Brien, None; John Butler, None; Ian Flitcroft, None; Ekaterina Loskutova, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 2953. doi:
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      James Loughman, Colm J O'Brien, John S Butler, Ian Flitcroft, Ekaterina Loskutova; Macular pigment response to carotenoid supplementation in patients with open angle glaucoma: the ENIGMA trial.. Invest. Ophthalmol. Vis. Sci. 2021;62(8):2953.

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      © ARVO (1962-2015); The Authors (2016-present)

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  • Supplements
Abstract

Purpose : Recent investigations have demonstrated that macular pigment (MP is lower in glaucomatous eyes. MP exhibits specific biological qualities which may confer neuro-protective and functional benefits in glaucoma. The European Nutrition In Glaucoma Management (ENIGMA) trial was designed to evaluate, for the first time, the MP response to supplementation in glaucoma.

Methods : ENIGMA (NCT04460365) comprised a randomized, placebo controlled, double masked trial. Individuals with open angle glaucoma, VA < 0.3, no other ocular disease, and no history of dementia were eligible for inclusion. Participants were randomized in a 2:1 ratio to receive a dietary carotenoid supplement [10mg lutein (L), 10mg meso-zeaxanthin (meso-Z) and 2mg zeaxanthin (Z)], or placebo for 18 months. MPOD was measured at baseline, 6, 12 and 18 months by dual-wavelength autofluorescence using Heidelberg Spectralis.

Results : 62 participants were enrolled, 44 assigned to treatment and 18 to placebo. No baseline differences between groups were observed (P > 0.05 for all -Table 1). Repeated measures ANOVA showed that sqrt MPOD volume differed significantly for the interaction between treatment and time [F(3,111)= 31.718690, p < 0.001] with a significant effect of time [F(3,111)= 71.277135, p < 0.001] and no significant effect of treatment [F(1,37)= 2.642403, p =0.112]. Post hoc tests with Bonferroni correction revealed a significant difference between baseline MPOD and MPOD at each timepoint (6, 12 and 18 months) in the treatment group only (Fig 1). There was a significant difference in MPOD volume between the treatment and placebo group at 12 and 18 months.

Conclusions : ENIGMA is the first study to demonstrate that MP levels can be augmented in glaucomatous eyes by carotenoid supplementation, which represents an important pre-cursor to any functional or health-related benefits that may accrue. From a neuro-protective perspective, oxidative stress and chronic inflammation are key pathways of tissue damage involved in glaucoma. As potent antioxidant and anti-inflammatory nutrients, L, Z and meso-Z supplementation to increase MPOD might support retinal ganglion cells and confer protection by preventing the pathophysiological cascades of oxidative stress and inflammation in glaucoma.

This is a 2021 ARVO Annual Meeting abstract.

 

Table 1: Participant demographics, baseline and 18-month follow up data

Table 1: Participant demographics, baseline and 18-month follow up data

 

Fig 1: Change in MPOD Volume from baseline in treatment and placebo groups.

Fig 1: Change in MPOD Volume from baseline in treatment and placebo groups.

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