James M. Stringham

Macular pigment and visual performance under glare conditions.

Purpose. Many parameters of visual performance (e.g., contrast sensitivity) are compromised under glaring light conditions. Recent data indicate that macular pigment (MP) is strongly related to improvements in glare disability and photostress recovery based on a filtering mechanism. In this study, we assessed the causality of this relation by supplementing lutein and zeaxanthin for 6 months while measuring MP, glare disability, and photostress recovery. Methods. Forty healthy subjects (mean age = 23.9) participated in the study. Subjects were followed for 6 months and assessed at baseline, 1, 2, 4, and 6 months. Spatial density profiles of MP were measured using heterochromatic flicker photometry. Disability glare was measured using a 1 degree-diameter circular grating surrounded by a broadband glare source (a xenon-white annulus). The intensity of the annulus (11 degree inner and 12 degree outer diameters) was adjusted by the subject until the grating target was no longer seen. For the photostress recovery experiment, the time required to detect a 1 degree-diameter grating stimulus after a 5-s exposure to a 2.5 &mgr;W/cm2, 5 degree-diameter disk was recorded. Subjects were tested under central viewing and eccentric viewing (10 degree temporal retina) conditions. Results. At the baseline time point, MP optical density (OD) at 30′ eccentricity ranged from 0.08 to 1.04, and was strongly correlated with improved visual performance in the two glare tasks. After 6 months of lutein (L) and zeaxanthin (Z) supplementation, average MPOD (at 30′ eccentricity) had increased from 0.41 to 0.57, and was shown to significantly reduce the deleterious effects of glare for both the visual performance tasks assessed. Conclusions. MP is strongly related to improvements in glare disability and photostress recovery in a manner strongly consistent with its spectral absorption and spatial profile. Four to 6 months of 12 mg daily L + Z supplementation significantly increases MPOD and improves visual performance in glare for most subjects.

The glare hypothesis of macular pigment function.

Purpose. Discomfort and reduced visual performance due to glaring light conditions are common complaints for most individuals. Past studies have shown that macular pigment (MP) reduces discomfort due to glare. In this study, we evaluated whether MP was related to visual performance under glare conditions. Methods. Thirty-six healthy subjects participated (age range, 18 to 41). Spatial profiles of MP optical density were measured using heterochromatic flicker photometry with a Newtonian-view macular densitometer. Photostress recovery and grating visibility under veiling conditions were assessed in a Maxwellian-view optical system. Both experiments used six monochromatic lights (from 440 to 620 nm) and a broadband xenon white. For the veiling glare experiment, subjects fixated a 1°-diameter disk containing a black and white 100% contrast grating stimulus. The intensity of an annulus (the glare source) with an 11° inner and 12° outer diameter was adjusted by the subject until the grating stimulus was no longer seen. For the photostress recovery experiment, the time required to detect a 1°-diameter grating stimulus (detailed above) after a 5-s exposure to a 2.5 &mgr;W/cm2, 5°-diameter disk was recorded. Both central and eccentric (10° temporal retina) viewing conditions were assessed. Results. MP at 30′ eccentricity ranged from 0.08 to 1.04 OD, and was found to dramatically reduce the deleterious effects of glare. Visual thresholds under glare conditions were strongly related to MP density (e.g., r = 0.76, p = 0.0001 when using white light). Photostress recovery time, after exposure to xenon-white light, was significantly shorter for subjects with higher MP levels (r = −0.79, p = 0.0001). Both photostress recovery and veiling glare functions were well-described by the photopic spectral sensitivity function (V&lgr;). Conclusions. MP is strongly related to improvements in glare disability and photostress recovery in a manner consistent with its spectral absorption and spatial profile.

Spatial Profile of Macular Pigment and Its Relationship to Foveal Architecture

PURPOSE Macular pigment (MP) is composed of two dietary carotenoids, lutein and zeaxanthin, and a carotenoid generated by the retina, meso-zeaxanthin. There is large intersubject variability in peak optical density, spatial profile, and lateral extent of macular pigment, and it has been suggested that foveal architecture may play a role in this variability. This study is an initial investigation of the relationship between the spatial profile of macular pigment and foveal architecture. METHODS Sixty normal subjects were enrolled (one was eventually excluded). The spatial profile of macular pigment optical density (MPOD) was measured by customized heterochromatic flicker photometry (cHFP). High-resolution macular thickness maps were obtained by optical coherence tomography. Four parameters were analyzed: (1) minimum foveal thickness (MFT) at the intersection of six radial scans; (2) central foveal thickness (CFT) averaged over the central 1 mm of the fovea; (3) foveal width identified as the region lacking a nerve fiber layer; and (4) foveal width measured from crest to crest. Lifestyle and vision information were obtained by questionnaire. RESULTS The mean +/- SD MPOD at 0.25 degrees eccentricity was 0.49 +/- 0.23 and at 0.5 degrees eccentricity, 0.41 +/- 0.21. A first-order decreasing exponential function accounted for most of the variance of the MP profile averaged across subjects (r(2) = 0.99). MPOD measured at 0.25 degrees was unrelated to both measures of foveal thickness for the entire study group (r = 0.03, P = 0.81, and r = -0.08, P = 0.57, respectively). Similarly, MPOD measured at 0.5 degrees was unrelated to foveal thickness in the entire study group (r = 0.12, P = 0.36 and r = -0.05, P = 0.71, respectively). However, when analyzed separately in the nonwhite subjects, the relationship between MPOD at 0.25 degrees and MFT was positive and significant (r = 0.59, P = 0.01), but remained unrelated to CFT (r = 0.20, P = 0.41). Similarly, in the nonwhite subjects, the relationship between MPOD at 0.5 degrees and MFT was positive and significant (r = 0.68, P < 0.01), but again was unrelated to CFT (r = 0.23, P = 0.32). There was no significant relationship between MPOD and either measure of foveal thickness in the white subjects. In the entire study group, there was a positive and significant relationship between foveal width and MPOD averaged across the fovea (r = 0.41, P < 0.01) and between foveal width and MP integrated across the fovea (r = 0.41, P < 0.01). CONCLUSIONS Foveal MP was positively and significantly related to foveal width in the entire study group. This relationship may be determined by the greater length of the cone axons (Henle fibers) in wider foveas. MPOD was unrelated to foveal thickness in the white subjects. However, in the nonwhite subjects there was a positive association between MFT and MPOD at the 0.25 degrees and 0.5 degrees eccentricities, suggesting that other personal characteristics modulate the MPOD-retinal thickness relationship.

Macular pigment optical density and photophobia light threshold

Light absorption by macular pigment may attenuate visual discomfort, or photophobia, for targets composed of short-wavelength light. Macular pigment optical density (MPOD) and photophobia light thresholds were measured psychophysically in 10 subjects. The energy necessary to induce photophobia for a short-wavelength target relative to a long-wavelength target was linearly related to MPOD, as well as estimates of peak MPOD and integrated macular pigment. In four subjects who consumed lutein supplements, increases in MPOD corresponded to increases in photophobia light thresholds. Light absorption by macular pigment appears to influence the amount of short-wavelength light necessary to elicit photophobia.

The Influence of Dietary Lutein and Zeaxanthin on Visual Performance

The idea that normal constituents of the diet can influence visual function is not new. As early as 1782, Buzzi identified the yellow of the macula and Schulze (1866) specifically postulated that the yellow pigments led to improvements in human vision. These pigments were later found to be derived from dietary lutein and zeaxanthin that are known to be oxygenated carotenoids (xanthophylls). Walls and Judd (1933) postulated that these yellow intraocular pigments could improve visual performance by absorbing light scattered both within (for example, glare) and outside of the eye (increasing visual range by absorbing blue light scattered in the atmosphere), and by improving spatial vision through enhancing contrast and reducing chromatic blur. In this article, evidence for these ideas is reviewed with particular emphasis towards more recent data on glare effects.

Macular pigment optical density at four retinal loci during 120 days of lutein supplementation

Background:  Increased consumption of lutein and zeaxanthin has been shown to increase macular pigment optical density (MPOD) in some individuals. Most interventions either obtained infrequent measures of MPOD or measured MPOD at a single retinal locus.

Compensation for light loss due to filtering by macular pigment: relation to hue cancellation.

Background:  A long‐standing question in colour vision research is how the visual system is able to correct for the significant absorbance of short wave light by the crystalline lens and macular pigment (MP). Such compensation must be required in order to maintain colour constancy across the retina where MP levels are changing quickly and dramatically.

Compensation for light loss resulting from filtering by macular pigment : Relation to the S-cone pathway

Purpose. Macular pigment (MP) filters short-wavelength light before it reaches the visual pigments. At peak absorbance (460 nm), transmission of light through MP can range from almost 100% transmission to as little as 3%. As a result of the uneven topographic distribution of MP, spatial nonuniformities in visual perception would result if the visual system did not compensate for filtering differences across the central retina. This study characterizes compensation for different densities of MP. Methods. Sixteen young subjects (aged 24–40 years) with a wide range of MP density were studied. Increment thresholds were measured at 440 and 500 nm in the center of the fovea and at 6° to 7° eccentricity using conditions chosen to isolate the &pgr;-1 mechanism. For six of the subjects, increment thresholds were also obtained for eccentricities of 1°, 1.75°, and 3°. MP density was measured using heterochromatic flicker photometry at the same locations as the increment thresholds. Results. Peak sensitivity of the short-wavelength pathway across the central retina was constant despite MP density differences as large as 1.0 log unit. Conclusions. These results suggest that the visual system increases gain of the S-cone pathway to offset light absorption by MP.

Macular Pigment and Visual Performance in Low-Light Conditions.

PURPOSE By reducing rod intrusion and improving efficiency of neural signaling throughout the visual system, macular pigment (MP) could improve many aspects of visual performance in low-light level conditions. Our study examined this possibility for a variety of visual performance parameters, including spatial resolution, dark adaptation kinetics, and color detection. METHODS Twenty-seven subjects participated in the study. Spatial profiles of MP optical density (MPOD) were determined by using heterochromatic flicker photometry. Mesopic- and scotopic-adaptation level experiments were conducted in Maxwellian view. RESULTS Subjects with higher MPOD required significantly lower contrast to detect the mesopic-level resolution targets; this effect became stronger with increasing spatial frequency. Dark adaptation recovery times were significantly faster as a function of MPOD (by nearly 2 minutes for the lowest mesopic-level task [high versus low MPOD]; P < 0.001). Absolute scotopic thresholds were also significantly associated with MPOD (P < 0.001). Macular pigment optical density was inversely associated with detection of yellow (P < 0.001), and, paradoxically, approached a significant positive correlation with the detection of blue (P = 0.06). CONCLUSIONS Macular pigment appears to enhance visual function in low-light conditions. Based on the results of this study, it can be said that MP extends the range of foveal vision into lower light. Additionally, MP appears to enhance dark adaptation kinetics, which suggests that increased MPOD leads to more efficient photopigment regeneration. The findings of the color detection portion of the study are suggestive of an active compensatory mechanism that offsets absorption by MP in order to maintain normal color perception.

Supplementation with macular carotenoids reduces psychological stress, serum cortisol, and sub-optimal symptoms of physical and emotional health in young adults

Purpose: Oxidative stress and systemic inflammation are the root cause of several deleterious effects of chronic psychological stress. We hypothesize that the antioxidant and anti-inflammatory capabilities of the macular carotenoids (MCs) lutein, zeaxanthin, and meso-zeaxanthin could, via daily supplementation, provide a dietary means of benefit. Methods: A total of 59 young healthy subjects participated in a 12-month, double-blind, placebo-controlled trial to evaluate the effects of MC supplementation on blood cortisol, psychological stress ratings, behavioural measures of mood, and symptoms of sub-optimal health. Subjects were randomly assigned to one of three groups: placebo, 13 mg, or 27 mg / day total MCs. All parameters were assessed at baseline, 6 months, and 12 months. Serum MCs were determined via HPLC, serum cortisol via ELISA, and macular pigment optical density (MPOD) via customized heterochromatic flicker photometry. Behavioural data were obtained via questionnaire. Results: Significant baseline correlations were found between MPOD and Beck anxiety scores (r = −0.28; P = 0.032), MPOD and Brief Symptom Inventory scores (r = 0.27; P = 0.037), and serum cortisol and psychological stress scores (r = 0.46; P < 0.001). Supplementation for 6 months improved psychological stress, serum cortisol, and measures of emotional and physical health (P < 0.05 for all), versus placebo. These outcomes were either maintained or improved further at 12 months. Conclusions: Supplementation with the MCs significantly reduces stress, cortisol, and symptoms of sub-optimal emotional and physical health. Determining the basis for these effects, whether systemic or a more central (i.e. brain) is a question that warrants further study.