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Nutraceuticals for dry age-related macular degeneration: a case report based on novel pathogenic and morphological insights

R. Pinelli, M. Bertelli, E. Scaffidi, M. Polzella, F. Fulceri, F. Biagioni, F. Fornai


Age-related macular degeneration represents the main retinal disorder leading to irreversible blindness in people over the age of 50 in the Western World. Here we describe a case report, which suggest that specific nutraceutical compounds may exert beneficial effects on the progression of dry age-related macular degeneration (AMD), an eye disease with no approved treatment or cure. Specific antioxidants, such as lutein, resveratrol and Vaccinium Myrtillus, which are known to reduce the risk of developing AMD, when co-administered alone, were supplemented to diet of an informed patient suffering from dry AMD. The case report indicates an improvement of visual acuity and a long lasting decrease in druse volume and number. The concomitant intake of lutein, resveratrol and Vaccinium Myrtillus when administered for six months produced a marked decrease in the drusen observed at OCT at the 6-month follow-up. At this time interval, the patient experienced a noticeable improvement in visual acuity, a decrease in eye strain, more color contrast, higher visual definition. The case report indicates the potential benefit for a non-invasive treatment with improved quality of vision in dry AMD. A larger population followed over a long-term period is warranted. The support of nutraceuticals could therefore offer a new non-invasive, adverse-effect- free which may restore the pathology affecting the cross talk between choroid and retinal cells. The results of this case report are discussed within the frame of molecular mechanisms synergizing site-specifically at the anatomical border between the outer retina and inner choroid.


age-related macular degeneration; neurodegeneration; autophagy; lutein; Vaccinium Myrtillus; resveratrol; anthocyanins; antioxidants; carotenoids

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Abu-Amero K.K., Kondkar A.A., Chalam K.V. Resveratrol and Ophthalmic Diseases. Nutrients, 8: 200, 2016.

Ambati J., Fowler B.J. Mechanisms of age-related macular degeneration. Neuron, 75: 26-39, 2012.

Bergen A.A., Arya S., Koster C., Pilgrim M.G., Wiatrek-Moumoulidis D., van der Spek P.J., Hauck S.M., Boon C.J.F., Emri E., Stewart A.J., Lengyel I. On the origin of proteins in human drusen: The meet, greet and stick hypothesis. Prog. Retin. Eye Res., 70: 55-84, 2019.

Bola C., Bartlett H., Eperjesi F. Resveratrol and the eye: activity and molecular mechanisms. Graefes Arch. Clin. Exp. Ophthalmol., 252: 699-713, 2014.

Bowes Rickman C., Farsiu S., Toth C.A., Klingeborn M. Dry age-related macular degeneration: mechanisms, therapeutic targets, and imaging. Invest. Ophthalmol. Vis. Sci., 54: 68-80, 2013.

Bungau S., Abdel-Daim M.M., Tit D.M, Ghanem E., Sato S., Maruyama-Inoue M., Yamane S., Kadonosono K. Health Benefits of Polyphenols and Carotenoids in Age-Related Eye Diseases. Oxid. Med. Cell. Longev. 2019: 9783429, 2019.

Buscemi S., Corleo D., Di Pace F., Petroni M.L., Satriano A., Marchesini G. The Effect of Lutein on Eye and Extra-Eye Health. Nutrients, 10: 1321, 2018

Congdon N., O'Colmain B., Klaver C.C., Klein R., Muñoz B., Friedman D.S., Kempen J., Taylor H.R., Mitchell P. Causes and prevalence of visual impairment among adults in the United States. Arch. Ophthalmol., 122: 477-485, 2004.

Chen F.K., Agelis L.E., Peh K.K., Teong J., Wong E.N. Factors Contributing to Discrepancy Between Visual Acuity Fractions Derived From a Snellen Chart and Letter Scores on the Early Treatment Diabetic Retinopathy Study Chart. Asia Pac. J. Ophthalmol. (Phila), 3: 277-285, 2014.

Datta S., Cano M., Ebrahimi K., Wang L., Handa J.T. The impact of oxidative stress and inflammation on RPE degeneration in non-neovascular AMD. Progress Prog. Retin. Eye Res., 60: 201-218, 2017.

deJong, P.T. Age-related macular degeneration. N. Engl. J. Med., 355: 1474-1485, 2006.

Donoso L.A., Kim D., Frost A., Callahan A., Hageman G. The role of inflammation in the pathogenesis of age-related macular degeneration. Surv. Ophthalmol., 51: 137-152, 2006.

Forte R., Cennamo G., Finelli M.L., Bonavolontà P, de Crecchio G., Greco G.M. Combination of flavonoids with Centella asiatica and Melilotus for diabetic cystoid macular edema without macular thickening. J. Ocul. Pharmacol. Ther. 27: 109-113, 2011.

Kaarniranta K., Sinha D., Blasiak J., Kauppinen A., Veréb Z., Salminen A., Boulton M.E., Petrovski G. Autophagy and heterophagy dysregulation leads to retinal pigment epithelium dysfunction and development of age-related macular degeneration. Autophagy, 9, 973-984, 2013.

Khoo H.E., Ng H.S., Yap W.S., Goh H.J.H, Yim H.S. Nutrients for prevention of macular degeneration and eye-related diseases. Antioxidants (Basel), 8: E85, 2019

Jager R.D., Mieler W.F., Miller J.W. Age-Related Macular Degeneration. N. Engl. J. Med, 358: 2606-2617, 2008.

Jarrett S.G., Boulton M.E. Consequences of oxidative stress in age-related macular degeneration. Mol. Aspects. Med., 33: 399-417, 2012.

Johnson A.T., Dooly C.R., Simpson C.R. Generating the Snellen Chart by computer. Comput Methods Programs Biomed., 57: 161-166, 1998.

Mares J., Lutein and Zeaxanthin Isomers in Eye Health and Disease. Annu. Rev. Nutr., 36: 571-602, 2016.

Munia I., Gafray L., Bringer M.A., Goldschmidt P., Proukhnitzky L., Jacquemot N., Cercy C., Ramchani Ben Otman K., Errera M.H., Ranchon-Cole I. Cytoprotective Effects of Natural Highly Bio-Available Vegetable Derivatives on Human-Derived Retinal Cells. Nutrients, 12: E879, 2020.

Natoli R., Zhu Y., Valter K., Bisti S., Eells J., Stone J. Gene and noncoding RNA regulation underlying photoreceptor protection: microarray study of dietary antioxidant saffron and photobiomodulation in rat retina. Mol. Vis. 16: 1801-1822, 2010;

Neal S.E., Buehne K.L., Besley N.A., Yang P., Silinski P., Hong J., Ryde I.T., Meyer J.N.,

Jaffe G.J. Resveratrol Protects Against Hydroquinone-Induced Oxidative Threat in

Retinal Pigment Epithelial Cells. Invest. Ophthalmol. Vis. Sci. 61: 32, 2020.

Pascolini D., Mariotti S.P., Pokharel G.P., Pararajasegaram R., Etya'ale D., Négrel A.D., Resnikoff S. 2002 Global update of available data on visual impairment: a compilation of population-based prevalence studies. Ophthalmic. Epidemiol. 11: 67-115, 2004.

Pawlowska E., Szczepanska J., Koskela A., Kaarniranta K., Blasiak J. Dietary Polyphenols in Age-Related Macular Degeneration: Protection against Oxidative Stress and Beyond. Oxid. Med. Cell. Longev., 2019: 9682318, 2019.

Richer S., Patel S., Sockanathan S., Ulanski L.J., Miller L., Podella C. Resveratrol based oral nutritional supplement produces long-term beneficial effects on structure and visual function in human patients. Nutrients, 6: 4404–4420, 2014.

Riva A., Togni S., Franceschi F., Kawada S., Inaba Y., Eggenhoffner R., Giacomelli L. The effect of a natural, standardized bilberry extract (Mirtoselect®) in dry eye: a randomized, double blinded, placebo-controlled trial. Eur. Rev. Med. Pharmacol. Sci., 21: 2518-2525, 2017.

Rudolf M., Malek G., Messinger J.D., Clark M.E, Wang L., Curcio CA. Sub-retinal drusenoid deposits in human retina: organization and composition. Exp. Eye. Res., 87:402-408, 2008.

Schink A., Neumann J., Leifke A.L., Ziegler K., Fröhlich-Nowoisky J., Cremer C., Thines E., Weber B., Pöschl U., Schuppan D., Lucas K. Screening of herbal extracts for TLR2- and TLR4-dependent anti-inflammatory effects. PLoS One, 13: e0203907, 2018.

Seddon J. Epidemiology of age-related macular degeneration. pp. 1039-1050. In: Schachat A. (Eds). Retina. Philadelphia, Pa: St. Louis: Mosby, 2001.

Tao Y., Chen T., Yang G.Q., Peng G.H., Yan Z.J., Huang Y.F. Anthocyanin can arrest the cone photoreceptor degeneration and act as a novel treatment for retinitis pigmentosa. Int. J. Ophthalmol., 9: 153-158, 2016.

Su D., Greenberg A., Simonson J.L., Teng C.C., Liebmann J.M., Ritch R., Park S.C. Efficacy of the Amsler Grid Test in Evaluating Glaucomatous Central Visual Field Defects. Ophthalmology, 123:737-43, 2016.

Untea A.E., Varzaru I., Panaite T.D., Gavris T., Lupu A., Ropota M. The Effects of Dietary Inclusion of Bilberry and Walnut Leaves in Laying Hens' Diets on the Antioxidant Properties of Eggs. Animals (Basel), 10: E191, 2020.

Wang Y., Zhao L., Lu F., Yang X., Deng Q., Ji B., Huang F. Retinoprotective Effects of Bilberry Anthocyanins via Antioxidant, Anti-Inflammatory, and Anti-Apoptotic Mechanisms in a Visible Light-Induced Retinal Degeneration Model in Pigmented Rabbits. Molecules, 20: 22395-22410, 2015.

Zarbin M., Sugino I., Townes-Anderson E. Concise Review: Update on Retinal Pigment Epithelium Transplantation for Age-Related Macular Degeneration. Stem. Cells. Transl. Med., 8: 466-477, 2019.



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