Posterior Segment Age-related Macular Degeneration


Macular Pigment Density Measurement in Patients with Age-related Macular Degeneration


Jens Dawczynski,1 Susanne Jentsch,2 Dietrich Schweitzer,2 Martin Hammer2 and Jürgen Strobel3


1. Professor and Associate Director, Department of Ophthalmology, University Hospital Leipzig; 2. Research Fellow; 3. Professor and Head, Department of Ophthalmology, University Hospital Jena


Abstract


Macular pigment is key to the healthy eye. Direct determination of macular pigment optical density using single-wavelength reflectometry with a fundus camera has allowed to identify changes in macular pigmentation in patients with dry or exudative macular degeneration. This approach could be useful for individualised patient follow-up, particularly in those with age-related macular degeneration.


Keywords Macular pigment, age-related macular degeneration, macular pigment optical density, long-term follow-up, individual patient monitoring


Disclosure: The authors have no conflicts of interest to declare. Received: 20 September, 2011 Accepted: 4 October, 2011 Citation: European Ophthalmic Review, 2011;5(2):141–2 Correspondence: Jens Dawczynski, Associate Director, Department of Ophthalmology, University Hospital Leipzig, Liebigstr. 10-14, 04103 Leipzig, Germany. E: jens.dawczynski@medizin.uni-leipzig.de


Support: The publication of this article was funded by Carl Zeiss Meditec.


Macular pigment, which consists of lutein and zeaxanthin, is a key component of the protective system of the retina.1


significance within the antioxidant protective system, macular pigment also has a direct influence on contrast sensitivity.2


In addition to its It is


therefore reasonable to conduct routine and objective clinical follow-up of ophthalmology patients, especially those with degenerative macular diseases.3


The components of macular pigment can have a possible positive influence on the course of age-related macular degeneration (AMD).4,5


However, clearly


A procedure developed by Schweitzer and colleagues, the single-wavelength reflectometry method, is now commercially available in a fundus camera (VISUCAM 200® and VISUCAM 500®, Carl Zeiss Meditec AG). It represents a particularly simple, objective and reproducible way of determining MPOD.9


The results


are comparable to those obtained by the two-wavelength autofluorescence method.9


There are distinct individual differences in macular pigment optical density (MPOD) between patients: those with a lower intake of lutein and zeaxanthin tend to exhibit lower MPOD values than those with a higher intake of lutein and zeaxanthin.6


defined standard MPOD values do not yet exist and, therefore, long-term individual follow-up is of great importance. Furthermore, direct determination of the macular pigment is necessary. Indirect determination – for example via changes in fundus autofluorescence alone – does not appear promising as a prognostic tool.7


Procedures for Determining Macular Pigment Optical Density


Both objective and subjective procedures for determining MPOD are currently available.3,8


With respect to their practical applicability,


these procedures feature substantial differences in the duration of examination, glare for patients and demands on eye fixation behaviour. For broad-scale use, there is a particular need for a simple and accurate method that can also be performed on less co-operative patients.


© TOUCH BRIEFINGS 2011


Investigations in Three Patients Using a VISUCAM 500 Fundus Camera Figures 1A–F show fundus images and MPOD analyses of three patients; Figures 1A and B show the fundus image and MPOD analysis of a healthy patient with relatively high values; by contrast, Figures 1C and D show the fundus image and MPOD analysis of a patient with dry AMD, and Figures 1E and F show the fundus image and MPOD analysis of a patient with exudative AMD. The results of the investigations are displayed graphically as spatial distribution profiles, and also as measured values (mean optical density, maximum optical density, volume and area) in Table 1. The images were captured and analysed using a VISUCAM 500.


MPOD variations are evident in the patients with macular changes. Generally diminished MPOD values can be observed in the patient with dry AMD and the patient with exudative AMD.


Significant variations within an individual eye are obvious, as revealed by distinct areas of high and low MPOD. These observations are supported by a recent study that determined significant


141


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76