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Epiretinal membranes are a disorder leading to metamorphopsia and loss in visual function. The gold standard in therapy is vitrectomy with membrane peeling, usually performed with chromovitrectomy. The aim of this study was to examine whether dyes containing lutein are capable of enhancing visualization of epiretinal tissue in intraoperative optical coherence tomography (iOCT).This was a prospective study that included 20 eyes of 20 patients with idiopathic epiretinal membranes scheduled for surgery. 23 G pars plana vitrectomy with intraoperative assistance of iOCT was performed in all cases. Staining of epiretinal membranes was performed with dyes containing trypan blue, brilliant blue G and lutein (tripledyne and dualdyne, both Kemin Industries Inc., USA).In all patients (n = 20), staining of epiretinal tissue was good, and crystalline lutein particles could be well depicted in iOCT compared to soluble lutein that does not enhance visualisation of epiretinal tissue in iOCT.The addition of lutein to commonly used dye formulations offers good staining properties and, in case of crystalline lutein, also enhances epiretinal tissue in iOCT.Epiretinale Membranen können zu Metamorphopsien und Sehverschlechterung führen. Der therapeutische „Goldstandard“ ist die Vitrektomie mit Membrane Peeling, die normalerweise mit Chromovitrektomiefarbstoffen durchgeführt wird. Ziel unserer Studie war es, zu untersuchen, ob Chromovitrektomiefarbstoffe mit Lutein die Darstellung von epiretinalem Gewebe in der intraoperativen optischen Kohärenztomografie (iOCT) verbessern können.Eine prospektive Studie mit 20 Augen von 20 Patienten, die aufgrund einer idiopathischen epiretinalen Gliose zur Operation geplant waren. Bei allen Patienten wurde eine 23-G-Pars-plana-Vitrektomie mit Membrane Peeling unter iOCT-Assistenz durchgeführt. Die Membranen wurden mit einem Chromovitrektomiefarbstoff, der Trypanblau, „brilliant blue G“ und Lutein enthielt (Tripledyne und Dualdyne, beide: Kemin Industries Inc., USA) vor dem Peeling gefärbt.Bei allen Patienten (n = 20) war die Färbung der Membranen gut; kristalline Luteinpartikel konnten im iOCT gut dargestellt werden, verglichen zu gelöstem Lutein, das epiretinales Gewebe im iOCT nicht verbessert darstellen konnte.Die Zugabe von Lutein zu Chromovitrektomiefarbstoffen ermöglicht bei Verwendung von kristallinem Lutein eine verbesserte Darstellung von epiretinalen Membranen im iOCT.

The aim of this article is the detailed consideration of the scientific opinion on the substantiation of health claims related to lutein and maintenance of vision, which was published by European Food Safety Authority (EFSA). The findings regarding the efficacy of lutein are important for the legal product classification. Thus, the second part of this paper will focus on products containing lutein regarding the demarcation between foodstuffs and drugs. These products are often used in ophthalmology and therefore the assessment of the legal product classification is also important to know for the attending ophthalmologists. Summing up, it is stated that the national and European law for placing products containing lutein on the market will be harmonised for reasons of clarity, transparency and legal certainty but also providing tighter admission requirements for these kinds of products.

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Micronutrients play an important role in function and health maintenance for the eye. Especially lutein, zeaxanthin and omega-3 fatty acids perform remarkable functions: lutein together with zeaxanthin forms the macular pigment, these carotenoids filter out the damaging blue light component from the sunlight as well as the ultraviolet light which leads to improved contrast sensitivity and less problems with screen glare. Furthermore, the macular pigment has antioxidant and anti-inflammatory effects. The omega-3 fatty acids also possess anti-inflammatory effects and, when converted into neuroprotectin, they protect against oxidative induced apoptosis in the retina. They are also responsible for the fluidity and supply to the photoreceptor membrane. These properties are important for the prevention and treatment of degenerative eye diseases like age-related macular degeneration. However, older people are often not sufficiently supplied of micronutrients in their diet. Because the supply of nutrients can hardly be achieved by dietary change, the additional intake in the form of food supplements is useful in this age group. Scientific studies have shown the positive effects of supplementation with micronutrients such as lutein/zeaxanthin, vitamin C, vitamin E, zinc and omega-3 fatty acids, docosahexaenoic acid and eicosapentaenoic acid (DHA and EPA). Currently available nutritional products are based in part on the ingredients of the ARED study (Age Related Eye Disease Study). According to more recent studies formulations containing lutein and omega-3 fatty acids in physiologically meaningful doses without additional beta-carotene should be preferred. 10 to 20 mg of lutein and zeaxanthin represent a safe daily dose Regarding to the context above, beta-carotene in high doses plays a minor role to the eye and is especially critical for the health of smokers. This paper summarises the functions of the presented micronutrients in the eye and can assist ophthalmologists in advising their patients.

Determination of the optical density of the macular pigment may be used for an assessment of the efficacy of oral lutein supplementation in patients with dry AMD. Beside subjective methods like heterochrome flicker photometry, objective methods like the 2-wavelength auto-fluorescence method and the 1-wavelength reflection method are in clinical use today. Both methods show comparable results. For a long-term assessment of the efficacy of oral lutein supplementation, different parameters like mean and maximal optical density as well as the integral over optical density on all pixels ("volume") should be used. The parameter volume often increases also in cases in which other parameters do not change anymore. The 1-wavelength reflection method is used for the newly initiated LUTEGA study. This study will investigate the long-term effects of a fixed lutein/omega-3-fatty acid combination on the optical density in patients with dry AMD.

Due to increased life expectancy the number of people with age-related diseases like age-related macular degeneration (AMD) will grow. Currently AMD is incurable and only a few therapeutic strategies are available. Therefore prevention becomes more important. Protective effects related to eye health are discussed for the two carotenoids lutein and zeaxanthin. Meanwhile both substances are offered as food supplements to a great extent. Both carotenoids lutein and zeaxanthin are accumulated in the retina, especially in the macula lutea. They are able to absorb blue light, which damages photoreceptors and pigmentary epithelium. Due to their antioxidative properties they can reduce changes in membrane permeability via quenching reactive oxygen species and free radicals. Research studies suppose lutein and zeaxanthin may contribute to improvement of vision in patients with AMD and other eye diseases. Based on the scientific rationale, these carotenoids may be effective in the prevention of age-related eye diseases. However, this issue has to be examined in a differentiated way.

How long do the elevated concentrations of macular pigment persist after stopping supplementation with lutein and zeaxanthin?One hundred eight (108) probands with and without age-related macular degeneration (68 female, 40 male, age 51-87 years) received a supplement containing 12 mg lutein and 1 mg zeaxanthin once per day (Ocuvite lutein) for 6 months. Analysis of macular pigment optical density (MPOD) was performed during the period of supplementation and again 3, 6, and 9 months following discontinuation of the supplement. A control group of 28 subjects received no dietary supplement.At baseline, the mean MPOD at 0.5 degrees was 0.50 in the supplemented group. Following supplementation, values rose, and 3 months after discontinuation of supplementation the highest levels of MPOD0.5 degrees (0.59 ODU) were detected (increase of +0.1 ODU, (p0.001). Six months after supplement discontinuation, a slight decrease of mean MPOD0.5 degrees appeared (to 0.54 ODU), followed again by a slight increase 3 months later (to 0.57 ODU). An increment of MPOD0.5 degrees in the control group was not significant (0.03 ODU, p=0.15).Supplementation of lutein and zeaxanthin leads to an increase of MPOD0.5 degrees . This effect outlasts the duration of intake, and 9 months after supplementation was stopped, the mean MPOD0.5 degrees was still elevated compared with baseline levels. A longer follow-up subsequent to stopping supplementation might clarify whether the values decrease over time or whether a plateau of elevated MPOD levels is reached. High doses of lutein and zeaxanthin seem to be necessary to increase macular pigment density in the retina; afterwards, the amount of carotenoids needed to maintain high concentrations seems to be covered by daily food.

Die altersabhängige Makuladegeneration (AMD), eine fortschreitende Degeneration der Makula, ist die häufigste Ursache für eine Erblindung über dem 65. Lebensjahr. Der Pathomechanismus ist noch weitgehend unbekannt. Wir untersuchten, ob die Serumspiegel von Lutein (L) und Zeaxanthin (Z), die beiden wichtigsten Komponenten des Makulären Pigmentes, mit der Prävalenz der AMD in Zusammenhang stehen. Die Münsteraner Altern- und Retina-Studie (MARS) untersuchte an 1060 Probanden (20,8% ohne AMD, 48,5% frühe AMD, 30,7% späte AMD), welche Faktoren die Progression der AMD determinieren. Die Serumspiegel von L und Z waren deutlich mit den Lipiden und dem BMI assoziiert, während nur schwache Korrelationen mit dem Alter gefunden wurden. Niedrige L- und Z-Werte fanden sich bei Diabetes, Beziehungen zu Geschlecht und Rauchstatus gab es nicht. Unter Personen, die L- und/oder Z-haltige Supplemente einnahmen, war der Medianwert der Carotinoide signifikant erhöht. Bei nicht substituierten Studienteilnehmern fanden sich nach Adjustierung für die wesentlichen Confounder weder für die Luteinspiegel im Serum noch für den Zeaxanthinwert konsistente Zusammenhänge mit dem Schweregrad der AMD.

Man vermutet einen protektiven Effekt des makulären Pigments (MP), bestehend aus Lutein (L) und Zeaxanthin (Z), im Hinblick auf die Altersabhängige Makuladegeneration (AMD). In dieser Arbeit wurden die optische Dichte des MP (MPOD) mittels Zweiwellenlängen-Methode des Autofluoreszenz-Imaging bei Probanden von MARS, einer prospektiven Studie zur AMD-Progression, zentral (0,5°) und peripher (2,0°) gemessen und MPOD-Determinanten bestimmt (n=376). Untersucht wurden Zusammenhänge zwischen MPOD und Alter, Geschlecht, Rauchen, Blutdruck, Body-Mass-Index (BMI), Parametern von Lipidstoffwechsel und Inflammation, L- bzw. Z-Serumwerten, L-Supplementation sowie Vorliegen einer AMD. Alter, weibliches Geschlecht, systolischer Blutdruck, BMI und Rauchen wurden als unabhängige Determinanten der MPOD bei 0,5° bzw. 2,0° identifiziert. L- und Z-Serumspiegel und L-Supplementierung waren eng mit der MPOD verbunden. Der hypothetische, inverse Zusammenhang des MP mit der AMD wurde nicht bestätigt.

Demographic developments in Europe and North America are causing an increase of age-related diseases. Age-related macular degeneration (AMD) is one of the leading causes of severe central visual acuity loss in elderly people and seems to be an economic problem, too. There is evidence that oxidative damage is an important factor for exacerbation of AMD. Macular pigment with its antioxidative effect may serve as"natural sunglasses" filtering the blue light acting as a possible source of photooxidative damage to the neurosensory retina. The macular pigment consists mostly of lutein and zeaxanthin. These micronutrients from the group of carotenoids, as is the case for vitamins (vitamins C, E, and beta-carotene), cannot be synthesized in mammals and that is the reason why the role of micronutrition or its supplementation and its correlation to AMD progression has been discussed for years. The results of currently published studies are often contradictory. At present there are no results from randomized controlled studies confirming that supplementation of lutein and zeaxanthin can reduce the risk for AMD. Several epidemiological studies investigating the impact of antioxidants and omega-3 fatty acids on the incidence of AMD provided conflicting results.Up to now, AREDS is the largest randomized controlled study investigating the effect of supplementation of antioxidants, zinc, and copper on the progression of AMD. AREDS showed a significant effect of this supplementation in some particular groups of patients with AMD. The supplementation of lutein and omega-3 fatty acids is not toxic but a positive effect has not been proven by randomized studies.

Salix-Extrakte sind seit jeher für ihre gute analgetische und antiinflammatorische Wirkung, insbesondere bei rheumatischen Beschwerden bekannt. Die negative Wirkung von Xanthinoxidase ist besonders für Rheumapatienten von Bedeutung. Dieses Enzym produziert reaktive Sauerstoffspezies und es entsteht oxidativer Stress am Ort der Entzündung. Die oxidative Hyaluronsäuredepolymerisation ist ebenfalls eine Begleiterscheinung rheumatischer Krankheitsverläufe. Die antioxidative Wirkung verschiedener Salix-Extrakte wurde im Xanthin/Xanthinoxidase-System durch KMB-Spaltung, Hydroxylaminoxidation und Hemmung der Xanthinoxidaseaktivität gemessen. Es konnten deutliche Unterschiede zwischen verschiedenen Extrakten in ihrem antioxidativem Verhalten ermittelt werden. Salicylsäure und Brennesselextrakt zeigten keine Wirkung, ein Auszug aus Teufelskralle erwies sich als moderates Antioxidans. Eine Hemmung der oxidativen Hyaluronsäuredepolymerisation war ebenfalls konzentrationsabhängig durch verschiedene Salix-Extrakte möglich. Der Teufelskrallenextrakt wirkte der Fragmentierung etwas effektiver entgegen als Salicylsäure. Im Zuge dieser Arbeit konnten neue mögliche Wirkmechanismen in Bezug auf die analgetische und antiinflammatorische Wirkung von Salix-Extrakten aufgezeigt werden. Ein Zusammenhang zwischen dem Gesamtsalicingehalt und der Wirkung kann so gut wie ausgeschlossen werden. Es kommen aufgrund des Verhaltens der Unterfraktionen eines Salix-Extraktes andere hydrophilere oder lipophilere Substanzen, wie z.B Flavonoide, in Frage. Dies ist insbesondere für die heute übliche Standardisierung von Salix-Extrakten auf Gesamtsalicinwerte von Bedeutung. Carotinoide wie Lycopin oder Lutein gelangen immer mehr ins wissenschaftliche Interesse, da man ihnen positive Effekte bei Erkrankungen wie AMD oder Prostatakrebs, zuspricht. Die Oxidation von Lipoproteinen geringer Dichte (LDL) spielt eine Schlüsselrolle bei der Atherogenese. Das Verhalten von Lycopin und Lutein wurde während der kupferinduzierten LDL-Oxidation anhand der Bildung konjugierter Diene (Lipidperoxidation) und der Abnahme der Tryptophanfluoreszenzintensität (Proteinoxidation) untersucht. Die beiden Carotinoide lagen in zwei verschiedenen Formulierungen vor, zum einen kristallin (i.A. als PBS-Suspension), zum anderen als Solubilisat. Die Zugabe der verschiedenen Formulierungen kurz vor Reaktionsstart zum Ansatz zeigte nur im Fall des Luteins eine geringe antioxidative Wirkung. Nach Vorinkubation des Plasmas mit den Solubilisaten, konnten sowohl Lycopin als auch Lutein im LDL angereichert werden. Die Verwendung der jeweiligen Suspension führte hingegen zu keinem Erfolg. Ein deutlicher antioxidativer Effekt war selbst bei hoher Anreicherung nicht zu erkennen. Der Zusatz eines hydrophilen Antioxidans (Rutin) führte zu einem ausgeprägten Synergismus im Fall der Lipidperoxidation. Die Proteinoxidation konnte nur additiv beeinflußt werden. Salix extracts show good analgesic and antiinflammatory properties in degenerative diseases of joints, e.g. arthritis, but less is know about the mode of action. In rheumatoid diseases the oxidative depolymerisation of hyaluronic acid is a side effect and xanthine oxidase causes oxidative stress. The antioxidant activity of different Salix extracts (21), a nettle extract, a devil´s claw extract and salicylic acid was determined using the xanthine/xanthine oxidase system. The inhibition of enzyme activity, the oxidation of KMB to ethene and hydroxylamine to nitrite were measured. Additionally, the oxidative depolymerisation of hyaluronic acid by Fenton-type oxidants and its inhibition by the above mentioned compounds was acquired. The Salix extracts showed different antioxidant capacities in the test systems, but this behaviour did not correlate with the total salicin content. The main antioxidant effect was provoked by subfractions containing more hydrophilic or lipophilic compounds, e.g. flavonoids. The nettle extract and salicylic acid were only weak antioxidants, the devil´s claw extract was a moderate one compared to the Salix extracts. In particular, a possible new mode of action concerning the analgesic and antiinflammatory activities in vivo was highlighted for the protective effects in case of the oxidative depolymerisation of hyaluronic acid. Carotenoids like lutein or lycopene are supposed to have beneficial effects in AMD or prostate cancer, respectively. The oxidation of low-denstiy lipoproteins (LDL) plays a crucial role in atherogenesis. In this work, the antioxidant activity of lutein and lycopene in copper-induced LDL oxidation was examined monitoring the protein part (loss of tryptophan fluorescence) and the lipid core (formation of conjugated dienes). The carotenoids were used as a suspension or in form of solubilisates and added to the assay achieving only a little protective effect in case of lutein solubilisate. Furthermore, the plasma was incubated with the carotenoids before isolating LDL. Only using solubilisates, an obvious enrichment of LDL with lutein or lycopene was possible. But even these enriched LDL particles displayed no antioxidant activity. However, combining carotenoid enriched LDL with a hydrophilic antioxidant like rutin, a synergistic protection of LDL from oxidation in case of lipid peroxidation and an additive effect in case of protein oxidation was determined. From this point of view, antioxidants should not only be assessed by their single antioxidant activity, but also by their combination effects with other compounds.

It is thought that a high optical density of xanthophyll has a protective effect against the development of aggregated macular degeneration. The aim of this study was to investigate whether an increase of the optical density of xanthophyll in the macula after a supplementation of lutein can be proven by objective methods. Most methods applied for the determination of the macular pigment require the co-operation of the proband and the ability for foveal fixation.Imaging spectrometry and the evaluation of laser scanner images taken at 488 nm will be presented. In contrast to psychophysical methods, both methods are independent of the patients ability for foveal fixation.Even by evaluation of laser scanner images taken as in fluorescence angiography but without inserting the blocking filter, the 2-dimensional distribution of xanthophyll can be determined. In 10 probands taking 6 mg lutein daily over 40 days, an increase of the optical density could be determined at least in some probands. The optical density reached a plateau 30 days after starting the supplementation of lutein.The assumed protective effect of xanthophyll against age-related macular degeneration can be influenced by supplementation of lutein under objective control.

The present concepts of the pathogenesis of AMD include cumulative light damage by oxidative processes in the macular photoreceptors as environmental co-factor for the development of AMD. The direct causative connection of this hypothesis has still to be established but wide circumstantial evidence from epidemiological and basic scientific investigations are strongly supportive. Macular pigment consisting of lutein and zeaxanthin through there ability to filter light and by direct antioxidative properties, has been proposed as the most effective protective factor in the central retina ("natural sun glasses") and could be important to reduce light induced oxidative retinal damage. The observation, that with age and especially in eyes with AMD lower concentrations of macular pigment could be found, can be interpreted that low macular pigment concentrations may be associated with higher risk for AMD. Through dietary intake and eventually with supplementation the concentration of macular pigment can be increased, and analysis of the correlation between macular pigment and AMD may be important to characterise a possible influenceable AMD risk factor.

The aim of this study was to evaluate prospectively whether there are differences in spectrometrically measurable parameters of the fundus between patients with early and late age-related maculopathy (ARM), the children of the ARM patients (F1 generation) and normals.Using the "Jenaer Imaging Spectrometer", retinal oxygen saturation, xanthophyll, and intrinsic fluorescence were measured; the spatial distribution of xanthophyll was determined using the Rodenstock SLO 101 model.Xanthophyll is reduced in late ARM as compared to the F1 generation and the control group (alpha0.01). The different fluorescence spectra, measured at shortwave and at longwave excitation, suggest the presence of more than one fluorophore. Furthermore, the components of the fluorophores seem to be different between patients with ARM and their F1 generation. The longwave autofluorescence is age-dependent only in late ARM (r2 = 0.81). For the first time, we found an alteration in oxygen saturation in retinal vessels in patients with ARM.Xanthophyll is reduced only in late ARM. Autofluorescence and oxygen saturation are different between ARM patients, the F1 generation and normals, however, we were not able to identify a genetically based predisposition concerning the parameters studied.

We investigated fundus autofluorescence in vivo using a novel scanning laser ophthalmoscope.A total of 550 patients with various retinal diseases were examined and compared with normal eyes. Autofluorescence was detected after excitation with an argon blue laser (488 nm), and emission was recorded with a short wavelength cut off above 500 nm.Reduced autofluorescence was observed in the foveal and parafoveal region due to retinal xanthophyll, along the retinal vessels, at the optic nerve head and in areas with atrophy of the retinal pigment epithelium (RPE). Autofluorescence intensity was increased either focally or diffusely in certain degenerative (AMD) or genetically determined retinal diseases (e.g., Stargardt's disease, Best's disease).These findings are in accordance with the view that in vivo fundus autofluorescence originates at the level of the RPE and suggest that it is derived from lipofuscin.

The recommended daily intake is currently either 2 mg of beta-carotene (recommended by DGE, Germany, in addition to 1.0 (0.8) mg retinol-equivalents for vitamin A requirement) or 5-6 mg of beta-carotene (recommended by NCI, USA). The present studies were carried out to investigate to what extent a balanced diet prepared using household or cafeteria methods contributes to achieve the desired intake. Beta-carotene and other carotenoids in the total daily diet samples were determined by RP-HPLC. In addition to beta-carotene, in decreasing quantity lutein, alpha-carotene, antheraxanthin, lycopene, zeaxanthin, neoxanthin, beta-cryptoxanthin, alpha-cryptoxanthin and violaxanthin were estimated. The intake of beta-carotene (carotenoids) ranged from 0.2 to 9.7 mg/d (0.7-16.5 mg/d) with mean values (median) of 1.1 mg/d for beta-carotene and 3.9 mg/d for carotenoids based on results from investigations of 39 total daily diet samples. The recommended daily intake can only be achieved by consuming (100-200 g/d) of vegetables und fruits with a particularly high carotenoid content. Kale (34.8), red peppers (27.4), parsley (25.7), spinach (17.3), lamb's lettuce (16.0), carrots (15.8) and tomatoes (12.7) headed the list of vegetables with more than 10 mg/100 g. In the case of fruit, papayas (3.8), grapefruits (3.6), nectarines (2.9) and apricots (2.6) were pre-eminent with more than 2 mg/ 100 g. The results distinguish between provitamin A and non-provitamin A carotenoids. In addition the contents of beta-carotene and lutein are shown.

The conditions for an optimal ophthalmic coagulating system are derived from the absorption spectra of xanthophyll, melanin and hemoglobin. Coagulation is effected by a dye laser with two dyes. The continuously tunable range of 570 nm to 680 nm opens up new horizons in photocoagulation of the retina.