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Measuring macular pigment in the office

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Macular pigment optical density (MPOD) is a measurement of the attenuation of blue light by macular pigment and is related to the amount of lutein and zeaxanthin in the macula.

Epidemiology studies generally used serum carotenoid levels or dietary surveys to group patients for statistical analyzes, but there is ample evidence that these methods are, at best, weak indicators of actual tissue levels in the macula. Thus, there is considerable interest in incorporating various noninvasive techniques to measure the amount and corresponding spatial distribution of the macular carotenoids to enhance research and clinical care for populations at risk for vision loss from age-related macular degeneration.

Optical density levels typically encountered in the center of the human macula vary between 0 and 1. Because lutein and zeaxanthin have been associated with a protective role against AMD and cataract, it is reasonable to infer that central MPOD levels could be an indicator of AMD risk. In fact, some studies have shown that healthy individuals have higher central MPOD levels than those afflicted with AMD.

There are two commercially available units designed to test MPOD: the QuantifEye (ZeaVision, Chesterfield, Mo.) and the MacuScope (Marco, Jacksonville, Fla.). Both units use heterochromic flicker photometry, which presents alternate wavelength stimulus both centrally and paracentrally to the macula. Flicker perception differentials determine levels of macular pigment, and therefore risk of developing AMD. The cost of both units is comparable, and they can be purchased independent of any nutritional supplements.

It should be noted that some studies have indicated that macular pigment appears to be reduced in obese subjects, those with a higher body fat percentage and females. This implies that one or more of these attributes may reduce the visual and ocular effects of lutein or zeaxanthin supplementation. So, speaking to patients about weight factors and its affect on ocular health is not beyond the primary eye care practitioner. It also argues for prescriptive carotenoid dosing, rather than single-dose recommendations for all patients.

• Disclosure: Dr. Anshel has no relevant financial interests to disclose.