Summary
Aufgrund der pathogenetischen Vorstellungen über die Entstehung einer AMD (altersabhängige
Makuladegeneration) wird auf einer genetisch prädisponierenden Grundlage oxidativen
Prozessen in der Netzhaut und metabolischen Limitierungen im retinalen Pigmentepithel
eine wesentliche Rolle zugesprochen. In einer großen prospektiven klinischen Studie
(ARED-Study) wurde nach kombinierter Verabreichung von Vitamin C (550 mg), Vitamin
E (400 IU), β-Carotin (15 mg) sowie Zink (80 mg) und Kupfer (2 mg) ein protektiver
prophylaktischer Effekt auf die Progression der AMD und den Sehverlust bei Personen
mit bilateralen weichen Drusen bzw. einseitiger später AMD im Partnerauge nachgewiesen.
Über einen Zeitraum von fünf Jahren konnte das Risiko der Entstehung einer späten
AMD mit konsekutivem Sehverlust um ca. 25 % gesenkt werden.
Neben diesen Substanzen wird dem makulären Pigment (MP), bestehend aus Lutein und
Zeaxanthin, durch dessen filternden Effekt und die direkte antioxidative Wirkung eine
Schutzfunktion gegen oxidative Prozesse in der zentralen Netzhaut zugesprochen. So
wurden bei AMD-Patienten niedrige Konzentrationen an MP gefunden. Da Lutein und Zeaxanthin
nur über die Nahrung aufgenommen werden und durch eine entsprechende Ernährung oder
Supplementation eine Erhöhung der MP-Konzentration erreicht werden kann, wäre das
MP ein beeinflussbarer Risikofaktor für die Entstehung einer AMD. Dies muss in weiteren
Studien aber noch differenzierter bestätigt werden.
Summary
Next to genetic predisposition, oxidative damage in the retina and limitations of
the metabolism of the retinal pigment epithelium is believed to play a major role
in the pathogenesis of age-related macular degeneration (AMD). In a large prospective
randomized clinical intervention trial (ARED-Study) in patients with either bilateral
large drusen or fellow eyes in patients with unilateral late AMD, a protective effect
was observed by administration of a combination of vitamin C (500 mg), vitamin E (400
IU), β-carotene (15 mg), zinc (80 mg) and copper (2 mg) with regard to the progression
of the development of late AMD and future visual loss. The 5year risk of disease progression
could be decreased by 25 %. In addition to these antioxidative substances, macular
pigment (MP) consisting of lutein and zeaxanthin is suggested to have a potential
preventing role limiting the oxidative damage to the central retina by absorption
of blue light in the inner retina and by direct antioxidative properties in the outer
retina. Patients with early AMD were shown to have more often lower concentrations
of MP and, therefore, insufficient concentration of MP in the central retina may be
an important but modifiable risk factor for AMD. Lutein and zeaxanthin are normally
supplied only by dietary intake. Therefore, increase of its concentration in the retina
by special dietary regimens, but also by supplementation, may be a worthwhile approach.
But, before supplementation can be recommended, replication of these results in further
clinical studies seems necessary.
Schlüsselwörte
AMD - Makuladegeneration - makuläres Pigment - Antioxidantien - Spurenelemente - Risikofaktoren
Key words
Eye - macular degeneration - macular pigment - antioxidants - trace elements - lutein
- zeaxanthin
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Prof. Dr. Daniel Pauleikhoff
Augenabteilung des St. Franziskus Hospitals
Hohenzollernring 74
D-48145 Münster
eMail: dapauleikhoff@muenster.de
