The Role of Nutritional Factors in Transitioning between Early, Mid and Late Stages of Age-Related Macular Degeneration

Abstract

Purpose : Transitions between different severity stages of age related macular degeneration (AMD) are not completely captured by traditional survival models with an endpoint of advanced AMD. Therefore, we aimed to explore the transition from early and intermediate AMD to higher severity stages and to determine the contributions of nutritional factors to these transitions.

Methods : AMD severity groups (based on a 12 step severity scale) were used to classify non-advanced eyes from the Age-Related Eye Disease Study longitudinal cohort. Eyes at baseline with early or intermediate AMD [severity groups 2 (scales 2 – 4) or 3 (scales 5 – 8)] were included. Progression was defined as eyes advancing to higher severity groups, confirmed across 2 consecutive visits over a 5 year follow-up period. Foods known to be associated with progression to advanced AMD (leafy greens, fish) and nutrients [lutein/zeaxanthin (LZ), omega3] were included with our latest predictive model (AUC_{5 yrs.}=0.94). Data were collected from food frequency questionnaires and ranked into sex-specific quintiles of servings per week for food and calorie-adjusted intake per day for nutrients. A genetic risk score (GRS) was computed from beta estimates of 12 loci from 9 genes from our predictive model, adjusted for age, sex and race. We ran Cox proportional hazards analyses for food and nutrient models separately accounting for inter-eye correlation, demographics, lifestyle factors, multivitamin intake, AREDS treatment groups, baseline macular status, family history of AMD, caloric intake and GRS.

Results : Among 2697 eyes in severity groups 2 or 3 at baseline, 616 progressed to higher severity groups over 5 years (22.8%). In our diet only model, Hazard Ratio (HR) _{leafy greens ≥ 1.4 cups/week vs. none} = 0.75, 95% Confidence Interval (CI) = 0.59 – 0.96 (P = 0.02), and HR _{Fish ≥ two 4 oz. servings/ week vs. < 2} = 0.79, CI = 0.65 – 0.95 (P = 0.01), when considered concurrently, adjusting for other covariates. In our nutrient only model, HR _{LZ ≥ 2 mg/day vs. < 2mg} = 0.76; CI = 0.60 – 0.96 (P = 0.02), and HR _{Omega3 ≥ 0.1g/day vs. < 0.1g} = 0.85_; CI = 0.71 – 1.01 (P = 0.06), accounting for both nutrients and covariates.

Conclusions : It is important to emphasize healthy dietary choices and nutrient intake during the earlier transition stages of AMD to delay disease progression to advanced stages.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.