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New technology measures carotenoid level
The biophotonic carotenoid scanner takes a reading from the palm of the hand
A top retinal researcher recently said that age-related macular degeneration begins in the uterus.
Due to AMD’s slow progression, we rarely see drusen and retinal pigment epithelium changes prior to age 50, and visual loss typically occurs after age 60. But a patient’s genetic profile – already determined in utero – explains about 60% of the attributable risk of AMD and cannot yet be modified. The remaining 40% is due to epigenetics and environment, which can be manipulated.
Genetic considerations
Tens of thousands of optometric patients with early signs of AMD or strong family histories have had ArcticDx labs provide genetic analysis of cheek cells.
The results classify a patient as being in one of five macular risk categories: those in MR1 have only about a 3% chance of progressing to serious vision loss, while those in MR5 have about a 73% chance. It follows that patients in the higher risk categories need more frequent monitoring and optimum control of the environmental factors.
AREDS and pharmacogenetics
The Age-Related Eye Disease Study results set specific guidelines for patients with intermediate AMD but not for patients with early or no AMD. About 10% of the population has AMD at age 60, and about 25% has it at age 75; it is intuitive that early treatment at a younger age may protect millions of Americans from ever developing AMD, the leading cause of blindness in the U.S. But long-term scientific evidence for this approach is lacking at present.
The AREDS study demonstrated a 25% reduction in progression to vision loss in those treated compared to those in the control group. However, intermediate AMD patients with a specific genetic profile (high risk CFH alleles and low risk ARMS2 alleles) who take an AREDS supplement with 80 mg of zinc increase their risk of AMD progression and, hence, should be on a zinc free or reduced zinc nutraceutical.
Images: Sherman J
Eye carotenoids
The AREDS2 study recommends incorporation of lutein and zeaxanthin. However, of the 600+ carotenoids in nature, three are known to be concentrated in the macula: lutein, zeaxanthin and the only carotenoid documented to selectively concentrate in the fovea, mesozeaxanthin. The Mesozeaxanthin Ocular Supplementation Trials (Connolly et al.) recommend taking all three in a product such as MacuHealth (MacuHealth LLC). Recent evidence reveals that these carotenoids actually improve visual functions such as contrast sensitivity and result in glare reduction.
Low macular pigment optical density (MPOD), a measurement of the triplet carotenoids, has been associated with AMD. A study by Bernstein and colleagues found that premature infants had undetectable MPOD and unusually low serum lutein/zeaxanthin and skin carotenoid concentrations, suggesting that these infants are either deficient in carotenoids or suffering severe oxidative stress.
Carotenoids elsewhere
But carotenoids go well beyond the eye. Antioxidants neutralize the myriad free radicals in our environment that can wreak havoc to cell membranes and nuclear DNA in billions of our cells. Carotenoids are the antioxidant first line of defense.
A recent Harvard study reveals an association between high carotenoid levels and low risk of breast cancer (Han et al.). In a major Yale summary article, the authors conclude that carotenoids are a biomarker for good health (Mayne et al.).
Measuring carotenoids
Ophthalmic clinicians and many patients are preoccupied, perhaps correctly, with numbers. A typical physical exam will reveal a slew of numbers: weight, blood pressure, cholesterol level and HgA1c, but virtually never our carotenoid number. Traditional blood draws to measure serum carotenoids can cost $500.
Remarkably, carotenoid levels can now be assessed in 30 seconds by placing the palm on a small, sleek instrument. Sir C.V. Raman, a physicist from India, won the Nobel Prize for discovering that carotenoids, specifically, can convert blue light to green light. Using this phenomenon, the instrument gives a skin carotenoid score (SCS) proportionate to the number of carotenoid molecules in the stratum corneum of the palm. This number, ranging from under 10,000 to over 80,000, is highly correlated with serum carotenoid levels. As race and age do not affect measurement, there is no need for multiple databases.
Our first experience with the biophotonic carotenoid scanner was among the staff in a typical Manhattan optometric office. The lowest score (from a former student who appeared healthy) was explained by her diet: very high in greasy cheese fries and low in fruits and vegetables. Within a day of seeing our scores, our own eating habits changed: V8 juice in the place of Coke, and 10-vegetable soups at Hale and Hardy instead of pepperoni pizza.
A 55-year-old male ophthalmologist amazingly scored 29,000 four times in the span of 3 months, attributed to his lack of lifestyle changes. On the other hand, a 22-year-old optometry student changed her score from 38,000 to 58,000 in 6 weeks. Her entire household conscientiously replaced processed snacks with fruits and doubled their intake of greens.
Our recommendation to those patients with less than admirable SCS is to reduce free radicals (i.e., stop smoking), improve diet, reduce weight and stress, and increase exercise and sleep when indicated. For some, the easier approach is to choose and consume proven nutraceuticals.
We find that few patients are able to make and sustain the necessary diet and lifestyle changes to improve their SCS score to an optimal range. Therefore, we recommend that patients supplement with nutraceuticals and work on improving their SCS to over 50,000.
Pharmanex, a major producer of nutraceuticals, did not develop the scanner but purchased distribution rights from researchers at the University of Utah, a prestigious scientific facility where the first artificial heart was invented. Pharmanex produces several products that have double-blind studies demonstrating their effectiveness at significantly improving carotenoids levels within 6 weeks. The company also guarantees that consumption of its products increases SCS in 2 months or Pharmanex refunds the entire cost.
Take-home pearls
In summary, patients with AMD or a family history of such deserve genetic testing for both the classification of a macular risk category and risk assessment of 80 mg of zinc consumption. The MR category 1 to 5 can be used to approximate the number of visits per year. Those in category 5 are generally evaluated five times a year, primarily in an attempt to detect and treat choroidal neovascular membranes in a timely manner.
Many clinicians recommend a nutraceutical with ocular carotenoids. In patients with or without AMD, a suboptimal SCS leads to recommendations of lifestyle changes and possibly products such as LifePak Nano vitamins by Pharmanex. Absorption is crucial, and those products using nanotechnology that chaperone carotenoid molecules across gut barriers are key to higher SCS. Thus far, only one optometrist with a very good diet had relatively low scores, which we believe is related to a malabsorption disorder.
Patients deserve to know the importance of the carotenoids to good health and disease prevention. The benefits include a lower risk of blindness from AMD; improved vision by increasing contrast sensitivity and reducing glare; and lower risk of various cancers, diabetes, cardiovascular disorders and even Alzheimer’s disease. The same genetic profile (high risk CFH alleles and low ARMS2 alleles) linked to both AMD and a higher risk of progression for those on high dose zinc is known to also increase the risk of Alzheimer’s.
- References:
- Awh CC, et al. Ophthalmology. 2013;doi:10.1016/j.ophtha.2013.07.039.
- Bernstein PS, et al. Invest Ophthalmol Vis Sci. 2013;6:4034-4040. doi:10.1167/iovs.13-11891.
- Connolly EE, et al. Invest Ophthalmol Vis Sci. 2010;51(13). http://iovs.arvojournals.org/article.aspx?articleid=2369179.
- Han J, et al. Cancer Res. 2003;63:8536-8541. doi:10.1186/bcr1355.
- Loughman J, et al. Invest Ophthalmol Vis Sci. 2012;53:7871-7880. doi:10.1167/iovs.12-10690.
- Mayne ST, et al. Arch Biochem Biophys. 2013;539:163-170. doi:10.1016/j.abb.2013.06.007.
- Raman R, et al. Eye (London). 2012;26(7):950-957. doi:10.1038/eye.2012.69.
- Rapp J, et al. Advanced Ocular Care. 2014:39-40.
- For more information:
- Jerome Sherman, OD, FAAO, a member of the Primary Care Optometry News Editorial Board, is a Distinguished Teaching Professor at the State University of New York College of Optometry and in private practice at the Eye Institute and Laser Center. He can be reached at j.sherman@sunyopt.edu.
- Brenda Tan is a student at the State University of New York College of Optometry and plans on graduating in 2019.
Disclosure: Sherman is a consultant and paid lecturer for MacuHealth. He has signed a contract with Pharmanex to lease and distribute the scanner. Tan reports no relevant financial disclosures.