Macular Pigment in Aging and Disease

 描述(由申请人提供)：这项建议的目的是评估黄斑色素(MP)水平作为老年性黄斑变性(AMD)发展的可改变的风险标志，以及随着年龄的增长更广泛的神经视网膜和视觉功能丧失。一些先前的证据表明，由饮食中的类胡萝卜素叶黄素、玉米黄质和中玉米黄质组成的MP会随着年龄的增长而下降，保存MP可能有助于降低患眼病和/或视力丧失的风险，这些疾病随着我们年龄的增长而变得更加常见。这之前还没有在大型纵向研究中进行过评估。MP光密度(MPOD)可以简单、非侵入性地测量。因此，MPOD评估可能有助于筛查那些有较高年龄相关性视力缺失风险的中年人。用于评估MPOD的设备已经适用于临床，但需要解决MPOD与AMD和视力丧失的纵向关系的证据，才能对它们的适当使用提出建议。如果MPOD预测AMD和/或与年龄或疾病相关的视力丧失，那么早期评估将允许针对个体测试各种预防措施以降低风险，包括那些会增加黄斑色素的措施。通过对年龄相关眼病研究(CAREDS)队列中的胡萝卜素进行前瞻性跟踪研究，可以低成本获得解决纵向数据差距的证据。在2001-2004年间，对1791名妇女进行了mPod、评估AMD的眼底照片和视力测量。在妇女健康倡议中，这一队列的年度后续行动确保了后续行动的低损失，记录了死亡率和新的慢性病(包括常见的与年龄有关的眼病)，并提供了广泛的营养、遗传、生活方式和健康数据。13年后将进行后续访问，以提供第二套眼底照片，以记录MPOD与AMD发病和/或进展的关系。其次，还将研究基线的MPOD与后续结构和功能老化措施的关系。结构测量包括使用光谱域光学相干断层扫描(SD-OCT)对视网膜厚度的新测量，跨越几个层和区域。功能测量包括基线和随访之间的视力损失，以及在随访时获得的额外二级测量。第三，将获得跟踪时MPOD水平的测量，以便首次直接纵向估计MPOD随年龄下降的情况，并提供机会来探索在基线和随访期间，初始MPOD较高的女性以及叶黄素和玉米黄质摄入量较高的女性，与年龄相关的平均下降是否较低。这项拟议的研究将构成黄斑色素与衰老、年龄相关性视力丧失和AMD之间关系的最大和最长的现有研究，从而促进了解类胡萝卜素在保护视力方面的作用所需的知识，并为临床指南提供信息。

 DESCRIPTION (provided by applicant): The purpose of this proposal is to evaluate macular pigment (MP) levels as a modifiable risk marker for the development of age-related macular degeneration (AMD), and more generalized loss of neural retina and vision function with age. Some previous evidence suggests that MP, comprised of the dietary carotenoids lutein, zeaxanthin and meso-zeaxanthin, declines with age, and that preserving MP might help reduce risk for developing eye diseases and/or vision loss which become more common as we age. This has not been previously evaluated in large longitudinal studies. MP optical density (MPOD) can be simply and non-invasively measured. Therefore, MPOD assessment might be useful in screening to identify individuals, in middle-age, who are at higher risk for age-related vision los. Devices to assess MPOD are already adapted for clinical use, but evidence addressing longitudinal relationships of MPOD to AMD and vision loss is needed to make recommendations about their appropriate use. If MPOD predicts AMD and/or age- or disease-related vision loss, then early assessment would permit the targeting of individuals for testing a variety of preventive measures to lower risk, including those which would increase macular pigment. Evidence to address the gap in longitudinal data can be obtained at low cost by conducting a prospective follow-up study in the Carotenoids in Age-Related Eye Disease Study (CAREDS) cohort. MPOD, fundus photographs to assess AMD, and visual acuity measures were previously obtained in 1,791 women in 2001-2004. Annual follow-up of this cohort, in the Women's Health Initiative, assures low loss to follow up, documents mortality and new chronic diseases (including common age-related eye diseases), and provides extensive nutritional, genetic, lifestyle, and health data. Follow-up visits thirteen years later will be conducted to provide a second set of fundus photographs to document the relationships of MPOD to AMD incidence and/or progression. Second, MPOD at baseline will also be studied in relation to measures of structural and functional aging at follow-up. Structural measures include new measures of the thickness of the retina, across several layers and regions, using spectral domain optical coherence tomography (SD-OCT). Functional measures include the loss of visual acuity between baseline and follow-up, and additional secondary measures obtained at follow-up. Third, measures of MPOD levels at follow-up will be obtained to permit the first direct longitudinal estimate of MPOD declines with age, and to provide an opportunity to explore whether average age-related declines are lower in women with higher initial MPOD, and in women with higher intakes of lutein and zeaxanthin, between baseline and follow-up. The proposed research will constitute the largest and longest extant investigation of relationships of macular pigment to aging, age-related vision loss, and AMD, thereby advancing knowledge needed to understand the role of carotenoids in preserving vision with age and informing clinical guidelines.