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Enrichment of macular pigment, and its impact on vision and blindness

Final Report Summary - CREST (Enrichment of macular pigment, and its impact on vision and blindness)

The Central Retinal Enrichment Supplementation Trials (CREST) was designed to test if enrichment of key nutrients present at the back of the human eye results with improvements in vision and quality of life in the general population and in patients with an eye disease known as age-related macular degeneration (AMD). The idea behind CREST was that nutrients at the back of the eye are important because they optimize light filtration and antioxidant capacity at a specialized part of the retina. This part of the retina is known as the macula. The macula is responsible for 90% of our vision, including central and colour vision. Previous research has shown that the macular contains nutrients known as carotenoids. From the 700 carotenoids available in nature, and 50 which form part of the human diet, only three are located at the macula, where they are referred to as macular pigment. These carotenoids are known as lutein, zeaxanthin and meso-zeaxanthin. Macular pigment is important for eye health and visual function because it has antioxidant and light filtering properties. The CREST researchers previously identified that meso-zeaxanthin, the carotenoid which forms the central part of macular pigment, is a key carotenoid because it has the strongest antioxidant properties, and because it forms the central part of macular pigment. The CREST researchers previously identified that patients at risk of AMD were deficient in central macular pigment (i.e. meso-zeaxanthin). As part of the ERC funded CREST study, the Principal Investigator (Professor John Nolan) hypothesized that supplementation with high amounts of meso-zeaxanthin in combination with lutein and zeaxanthin would enhance visual function in participants with AMD and in participants free of retinal disease. To test this, the CREST research team designed gold standard clinical trials to study the impact of enrichment of macular pigment on visual function (how well we see) in participants with AMD (CREST AMD) and in participants free of retinal disease (CREST Normal).
The results from these trials have been amazing. In brief, we have shown (see Nolan et al 2016; Enrichment of Macular Pigment Enhances Contrast Sensitivity in Subjects Free of Retinal Disease: Central Retinal Enrichment Supplementation Trials - Report 1) that we can take participants who have no eye problems, increase their macular pigment level, and improve their vision. These findings have dramatic implications for vision related quality of life. For example, we are saying that we can take military personnel, sports people and enhance their vision. The report from CREST Normal has already been viewed by over 40,000 readers. For the CREST AMD trial, we have confirmed the importance of enrichment (increase) of macular pigment in patients with early AMD. This data, which is currently under review at a top ophthalmology journal (Ophthalmology) has shown 75% of measures of vision performed in the trial are significantly improved following supplementation with these carotenoids. This finding is particularly important in patients with this disease, because a normal course of events results with deterioration in vision whereas here we have enhanced vision. The many positive implications from this discovery relate to direct impact on the patient and indirect costs associated with blindness due to AMD. The importance of CREST is that we now have a suggested standard of care for vision in patients with and free of AMD. CREST confirms how we can optimize our macular pigment and what this means for visual function.