Abstract

Aim: The aim of this study was to evaluate the efficacy of micronutrient therapy for individuals with neovascular age-related macular degeneration (nAMD) who were unable to undergo intravitreal therapy due to the COVID-19 pandemic.

Material and Method: Patients diagnosed with neovascular age-related macular degeneration (nAMD) between March 2020 and July 2021, who were ineligible for intravitreal therapy, had their medical records reviewed retrospectively. Those who met the inclusion criteria were divided into two groups. Group-1 received regular micronutrition therapy for at least six months, while Group-2 did not. Variables including age, gender, duration without intravitreal treatment, intraocular pressure (IOP), best-corrected visual acuity (BCVA), and central macular thickness (CMT) were recorded. Data obtained were compared between the two groups.

Result: Of the 183 nAMD patients screened, 125 were excluded due to missing data or irregular use of micronutrition tablets. Of the 58 patients who met the inclusion criteria, 27 were included in Group-1 and 31 in Group-2. The BCVA and CMT values at the beginning of the pandemic were 0.69±0.72 logMAR, 343.6±106.4 µm, respectively, for Group-1; and 0.85±0.82 logMAR, 381.3±93.7 µm, respectively, for Group-2 (p value 0.211, 0.153 respectively). The BCVA and CMT values obtained at the first examination were 0.74±0.76 logMAR and 330.3±148 µm, respectively, for Group-1; and 1.39±1.30 logMAR and 396.0±151.7 µm, respectively for Group-2 (p<0.001 and p=0.102, respectively).

Conclusion: The administration of micronutrient therapy did not lead to significant changes in the central macular thickness (CMT) levels between the groups. However, it did slow down the progression towards a poor prognosis in terms of best-corrected visual acuity (BCVA). We believe that for individuals with non-alcoholic fatty liver disease, micronutrition therapy could potentially serve as an adjunctive treatment to intravitreal therapy. These findings highlight the importance of adequate micronutrient intake in the medical treatment of patients with neovascular age-related macular degeneration (nAMD).

Keywords: central macular thickness, micronutrition, neovascular age-related macular degeneration, visual acuity

Copyright and license

Copyright © 2025 The Author(s). This is an open-access article published by Bolu İzzet Baysal Training and Research Hospital under the terms of the Creative Commons Attribution License (CC BY) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Bozkurt E, Limon U, Tanındı Duman G, Seçgin Akçay Bİ, Toprak G. Assessment of the effectiveness of micronutrient therapy in patients with neovascular age-related macular degeneration unable to receive intravitreal therapy due to COVID-19 pandemic constraints. Northwestern Med J. 2025;5(2):85-92. https://doi.org/10.54307/2025.NWMJ.145

References

  1. Bressler NM, Bressler SB, Fine SL. Neovascular (Exudative) Age-Related Macular Degeneration. Retina. 2006; 2: 1075-113. https://doi.org/10.1016/B978-0-323-02598-0.50067-7
  2. Jonas JB, Cheung CMG, Panda-Jonas S. Updates on the Epidemiology of Age-Related Macular Degeneration. Asia Pac J Ophthalmol (Phila). 2017; 6(6): 493-7.
  3. Ferris FL, Wilkinson CP, Bird A, et al. Clinical classification of age-related macular degeneration. Ophthalmology. 2013; 120(4): 844-51. https://doi.org/10.1016/j.ophtha.2012.10.036
  4. Klein R, Peto T, Bird A, Vannewkirk MR. The epidemiology of age-related macular degeneration. Am J Ophthalmol. 2004; 137(3): 486-95. https://doi.org/10.1016/j.ajo.2003.11.069
  5. Klein R, Klein BE, Jensen SC, Mares-Perlman JA, Cruickshanks KJ, Palta M. Age-related maculopathy in a multiracial United States population: the National Health and Nutrition Examination Survey III. Ophthalmology. 1999; 106(6): 1056-65. https://doi.org/10.1016/S0161-6420(99)90255-5
  6. Gorusupudi A, Nelson K, Bernstein PS. The Age-Related Eye Disease 2 Study: Micronutrients in the Treatment of Macular Degeneration. Adv Nutr. 2017; 8(1): 40-53. https://doi.org/10.3945/an.116.013177
  7. Sangiovanni JP, Agrón E, Meleth AD, et al. {omega}-3 Long-chain polyunsaturated fatty acid intake and 12-y incidence of neovascular age-related macular degeneration and central geographic atrophy: AREDS report 30, a prospective cohort study from the Age-Related Eye Disease Study. Am J Clin Nutr. 2009; 90(6): 1601-7. https://doi.org/10.3945/ajcn.2009.27594
  8. Nagineni CN, Raju R, Nagineni KK, et al. Resveratrol Suppresses Expression of VEGF by Human Retinal Pigment Epithelial Cells: Potential Nutraceutical for Age-related Macular Degeneration. Aging Dis. 2014; 5(2): 88-100. https://doi.org/10.14366/AD.2014.050088
  9. AREDS2 Research Group; Chew EY, Clemons T, et al. The Age-Related Eye Disease Study 2 (AREDS2): study design and baseline characteristics (AREDS2 report number 1). Ophthalmology. 2012; 119(11): 2282-9. https://doi.org/10.1016/j.ophtha.2012.05.027
  10. Wong WL, Su X, Li X, et al. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis. Lancet Glob Health. 2014; 2(2): e106-16. https://doi.org/10.1016/S2214-109X(13)70145-1
  11. Merle BMJ, Colijn JM, Cougnard-Grégoire A, et al. Mediterranean Diet and Incidence of Advanced Age-Related Macular Degeneration: The EYE-RISK Consortium. Ophthalmology. 2019; 126(3): 381-90. https://doi.org/10.1016/j.ophtha.2018.08.006
  12. Dharamdasani Detaram H, Mitchell P, Russell J, Burlutsky G, Liew G, Gopinath B. Dietary zinc intake is associated with macular fluid in neovascular age-related macular degeneration. Clin Exp Ophthalmol. 2020; 48(1): 61-8. https://doi.org/10.1111/ceo.13644
  13. Pugazhendhi A, Hubbell M, Jairam P, Ambati B. Neovascular Macular Degeneration: A Review of Etiology, Risk Factors, and Recent Advances in Research and Therapy. Int J Mol Sci. 2021; 22(3): 1170. https://doi.org/10.3390/ijms22031170
  14. Age-Related Eye Disease Study 2 (AREDS2) Research Group; Chew EY, Clemons TE, et al. Secondary analyses of the effects of lutein/zeaxanthin on age-related macular degeneration progression: AREDS2 report No. 3. JAMA Ophthalmol. 2014; 132(2): 142-9. https://doi.org/10.1001/jamaophthalmol.2013.7376
  15. Seddon JM, Ajani UA, Sperduto RD, et al. Dietary carotenoids, vitamins A, C, and E, and advanced age-related macular degeneration. Eye Disease Case-Control Study Group. JAMA. 1994; 272(18): 1413-20.
  16. Nolan JM, Stack J, O' Donovan O, Loane E, Beatty S. Risk factors for age-related maculopathy are associated with a relative lack of macular pigment. Exp Eye Res. 2007; 84(1): 61-74. https://doi.org/10.1016/j.exer.2006.08.016
  17. Querques G, Benlian P, Chanu B, et al. Nutritional AMD treatment phase I (NAT-1): feasibility of oral DHA supplementation in age-related macular degeneration. Eur J Ophthalmol. 2009; 19(1): 100-6. https://doi.org/10.1177/112067210901900115
  18. Souied EH, Delcourt C, Querques G, et al. Oral docosahexaenoic acid in the prevention of exudative age-related macular degeneration: the Nutritional AMD Treatment 2 study. Ophthalmology. 2013; 120(8): 1619-31. https://doi.org/10.1016/j.ophtha.2013.01.005
  19. Tan JS, Wang JJ, Flood V, Rochtchina E, Smith W, Mitchell P. Dietary antioxidants and the long-term incidence of age-related macular degeneration: the Blue Mountains Eye Study. Ophthalmology. 2008; 115(2): 334-41. https://doi.org/10.1016/j.ophtha.2007.03.083
  20. Keenan TD, Agrón E, Mares J, et al. Adherence to the Mediterranean Diet and Progression to Late Age-Related Macular Degeneration in the Age-Related Eye Disease Studies 1 and 2. Ophthalmology. 2020; 127(11): 1515-28. https://doi.org/10.1016/j.ophtha.2020.04.030
  21. Dharamdasani Detaram H, Liew G, Russell J, et al. Dietary antioxidants are associated with presence of intra- and sub-retinal fluid in neovascular age-related macular degeneration after 1 year. Acta Ophthalmol. 2020; 98(7): e814-9. https://doi.org/10.1111/aos.14394