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Age-Related Macular Degeneration and Vitamin D - many studies

14+ VitaminDWiki pages contain MACULAR or AMD in the title

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Survey of Ophthalmology Volume 66, Issue 2, March–April 2021, Pages 183-197 https://doi.org/10.1016/j.survophthal.2020.07.003
André Ferreira MD a b, Nisa Silva MD a, Maria João Furtado MD a, Ângela Carneiro MD, PhD c d, Miguel Lume MD a, José P. Andrade MD, PhD b e

Vitamin D may be implicated in the pathophysiology of several ocular diseases, but its role in age-related macular degeneration (AMD) remains uncertain. We sought to review systematically the existing evidence to evaluate the association between serum 25-hydroxyvitamin D 25(OH)D levels and AMD. A four-database search (PubMed, ISI Web of Science, Cochrane, and Scopus) was performed from inception to May 2020 using the MeSH terms: (“Macular Degeneration” OR “Age-related macular degeneration” OR “Retinal degeneration” OR “Macula lutea”) AND (“Vitamin D” OR “Ergocalciferols” OR “Cholecalciferol” OR “25-Hydroxyvitamin D”). Random-effects meta-analyses were performed to compute 1) the standard mean difference in 25(OH)D concentration between AMD and non-AMD patients and 2) the AMD risk according to serum 25(OH)D levels. Eighteen observational studies enrolling 75,294 patients after a selection process among 375 original abstracts were selected. No significant differences were found, but there appears to exist a trend for late AMD among subjects with a serum 25(OH)D level below 50 nmol/L (odds ratio, 1.8; 95% confidence interval: 1.00–3.24, P = 0.05). There is no clear evidence of a definitive association between serum 25(OH)D and AMD risk, mainly due to heterogeneity in study procedures and lack of longitudinal designs.

Age-related macular degeneration (AMD) is the leading cause of blindness in the industrialized countries and the third worldwide after glaucoma and cataract, according to the World Health Organization.45 A systematic review by Wong and coworkers showed a prevalence of 8.7% worldwide in 2014 and projected that 288 million people would have the disease in 2040.56 Recently, there were an estimated 67 million cases in Europe, and it was predicted that this number would increase by 15% by 2050.33 AMD has a high impact on the quality of life as it affects reading and computer use, driving, and face recognition, among others, and may be associated with depression.51

In the first stages, including both early and intermediate forms, AMD is characterized by the presence of drusen and pigmentary changes in the macular area, while late stages present one of two forms: 1) geographic atrophy with major loss of retinal pigment epithelium and choriocapillaris; 2) neovascular AMD, associated with macular neovascularization and fluid leakage.14 While the management of neovascular AMD has seen several qualitative advances in the last years, there is no effective treatment for early and intermediate stages and geographic atrophy.56 Therefore, the prevention and delay of AMD onset and the identification of modifiable risk factors are of prime relevance, as AMD presents as a burden to the public health-care systems for the next decades.8 Given its prevalence, even modest effects on the course of the disease may have significant qualitative and quantitative impacts.8

Although not fully understood, the pathophysiology of AMD is multifactorial, including genetic, environmental, inflammatory, and nutritional contributions.43 As such, lifestyle modifications, including the adoption of some dietary patterns,5,34,54 increased physical activity,4,36 and avoidance of smoking,9,28 seem to delay the onset and slow the progression of AMD, but do not prevent its development.8 In 2007, the first report of a possible protective association between serum vitamin D and AMD was published using the third National Health and Nutrition Examination Survey (NHANES III).46 Since then, several studies have emerged, but the results are contradictory.57 In 2016, two systematic reviews with a meta-analysis summarized the existing evidence,3,57 and one of these found a significant inverse association between serum vitamin D and late AMD.3 This possible association, if real, is highly relevant as vitamin D deficiency affects almost 15% of people older than 65 years.47 Several studies have shown that vitamin D levels and genetics may play a protective role in numerous ocular diseases affecting all segments, including refractive errors, diabetic retinopathy, dry eye, and uveitis48; however, the exact contribution of vitamin D serum levels to AMD remains unclear. Evidence has shown that vitamin D receptor and the enzymes CYP27B1 and CYP24A1 involved in vitamin D metabolism and pathways are present in the retina, retinal pigment epithelium, and choroid, supporting a possible role for this vitamin in the retina.15 Experimental studies demonstrated that vitamin D might decrease oxidative stress,52,53 inflammation,21,22 and angiogenesis,2 mechanisms that have been linked to AMD pathophysiology. Therefore, reduced serum levels might limit any protective effects of 25-hydroxy vitamin D 25(OH)D in the retina.

We review the existing evidence and perform a meta-analysis combining the individual studies to evaluate the overall effect of the association between serum vitamin D levels and AMD.

Section snippets
This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines41 and the Cochrane Collaboration Guidelines for reporting meta-analyses.24 ….

Literature search procedures
The study selection process is shown in a flow diagram (Fig. 1). The whole search process retrieved 375 original abstracts, 23 of which met the inclusion criteria. After full-text review, 5 were excluded because serum vitamin D level was not an outcome (n = 4) or diseases other than AMD were reported (n = 1). The remaining 18 studies were included in this review.10, 11, 12,16,18,20,27,29, 30, 31,35,37, 38, 39, 40,42,46,50 Important details regarding the methods and results were extracted from….

Our analysis does not confirm the possible inverse association between serum vitamin D levels and AMD, mostly due to substantial heterogeneity across individual studies. Further subgroup analyses were performed to examine the associations between serum vitamin D levels and stratum of AMD severity, including early AMD and late AMD, but neither associations were statistically significant. However, there appears to exist a trend for late AMD among subjects with serum vitamin D below 50 nmol/L…..

There is no clear evidence of an inverse association between serum 25(OH)D and AMD risk, mainly due to heterogeneity in study procedures and lack of longitudinal designs. Further longitudinal studies are needed, ideally taking both genetic and environmental factors into account, to clarify the role of serum vitamin D on AMD pathophysiology. If an association between vitamin D deficiency and AMD is proven, this might influence further supplementation strategies that, so far, do not include….

Search process
A systematic review was performed to search for studies regarding the association between AMD and serum vitamin D levels from inception to May 2020 in the following four databases: PubMed (https://www.ncbi.nlm.nih.gov/pubmed), ISI Web of Science (http://www.isiwebofknowledge.com), Cochrane Central Register of Controlled Trials (https://www.cochranelibrary.com), and Scopus (https://www.scopus.com). The words or medical head subjects used were (“Macular Degeneration” OR “Age-related macular….

Declarations of interest: None. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Conflicts of interest: The authors declare that there are no conflicts of interest.
References (57) online

Several possible ways that Vitamin D can prevent or treat AMD – Poland 2019

Can vitamin D protect against age-related macular degeneration or slow its progression? - Review
Acta Biochimica Polonica Vol. 66 No. 2 (2019) DOI: https://doi.org/10.18388/abp.2018_2810

  • Kai Kaarniranta Department of Ophthalmology, University of Eastern Finland, Kuopio 70211, Finland and Department of Ophthalmology, Kuopio University Hospital, Kuopio 70029, Finland
  • Elzbieta Pawlowska Department of Orthodontics, Medical University of Lodz, 92-216 Łódź, Poland;
  • Joanna Szczepanska Department of Pediatric Dentistry, Medical University of Lodz, 92-216 Łódź, Poland
  • Aleksandra Jablkowska Department of Infectious and Liver Diseases, W. Bieganski Hospital, 91-347 Łódź, Poland
  • Janusz Błasiak Department of Molecular Genetics, Faculty of Biology and Environmental Protection, University of Lodz, 90-236 Łódź, Poland https://orcid.org/0000-0001-9539-9584

Dietary vitamin D plays an important role in maintaining proper vision. Age-related macular degeneration (AMD) is a complex eye disease with unknown pathogenesis. Studies on dietary supplementation and AMD occurrence and progression have produced conflicting results. In its advanced stage, AMD may be associated with apoptosis, pyroptosis or necroptosis of retinal cells. Vitamin D has been reported to play a role in modulating each of these programmed death pathways. Vitamin D is a modulator of the immune system and it acts synergistically with two members of the regulators of complement activation family H and I, whose specific variants are the most important genetic factors for AMD pathogenesis. Angiogenesis is an essential component of the neovascular form of AMD, the most devastating type of the disease and vitamin D is reputed to possess antiangiogenic properties. Cellular DNA damage response is weakened in AMD patients and so it is another process that can be modulated by vitamin D. Finally, impaired autophagy is claimed to play a role in AMD and emerging evidence suggests that vitamin D can influence autophagy. Therefore, several pathways of vitamin D metabolism and AMD pathogenesis overlap, suggesting that vitamin D could modulate the course of AMD.
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Nutrients 2017, 9(10), 1120; https://doi.org/10.3390/nu9101120

In recent years, the relationship between vitamin D and health has received growing attention from the scientific and medical communities. Vitamin D deficiencies have been repeatedly associated with various acute and chronic diseases, including age-related macular degeneration (AMD). Its active metabolite, 1α,25-dihydoxy vitamin D, acts as a modulator of cell proliferation, differentiation and apoptosis, and cumulative data from experimental and observational studies suggest that relatively a lower vitamin D status could be a potential risk factor for the development of early and/or late AMD. Herein, we made a narrative review of the mechanisms linking a potential role of vitamin D with the current concepts of AMD pathophysiology.
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Turks with AMD have 1/2 the level of Vitamin D - Sept 2021

Association between age-related macular degeneration and 25(OH) vitamin D levels in the Turkish population
Arq Bras Oftalmol. 2021 Sep 10;S0004-27492021005007206. doi: 10.5935/0004-2749.20220002
Naciye Kabataş 1, Aysun Şanal Doğan 1, Mevlüt Yılmaz 1, Emrah Utku Kabataş 1, Tolga Biçer 1, Sinan Çalışkan 1, Osman Çelikay 1, Fatma Uçar 2, Canan Gürdal 1

Purpose: Age-related macular degeneration is the most common cause of blindness in developed countries, and several factors have been attributed for its etiology. This study was conducted to explore the relationship between serum vitamin D levels and age-related macular degeneration.

Methods: We retrospectively analyzed the data of 114 patients with age-related macular degeneration. A total of 102 patients who did not have any other diseases than refractive error were allocated to the control group. The best-corrected visual acuity, fundus findings, and spectral domain optical coherence tomography findings were analyzed. Patients were allocated to groups based on the Age-related Eye Disease Study classification. Serum 25(OH) vitamin D levels were measured. The central foveal thickness and the subfoveal choroidal thickness were measured by optical coherence tomography.

Results: The 25(OH) vitamin D levels in age- and gender-matched patients with age-related macular degeneration and in healthy subjects were 14.6 ± 9.8 and 29.14 ± 15.1 ng/ml, respectively. The age-related macular degeneration group had significantly lower vitamin D levels than the control group (p>0.001). The subfoveal choroidal thickness was lower in patients with age-related macular degeneration (p>0.001). The 25(OH) vitamin D level showed a weak positive correlation with choroidal thickness (r=0.357, p=0.01). When the level of 25(OH) vitamin D was evaluated according to the stages of age-related macular degeneration, it was found to be lower in the advanced-stage disease (p=0.01). The risk for the development of choroid neovascular membrane and subretinal fibrosis was found to increase with decreased vitamin D levels.

Conclusions: Significantly decreased levels of 25(OH) vitamin D in advanced-stage age-related macular degeneration suggest a significant correlation existing between vitamin D deficiency and age-related macular degeneration development. Further studies are required to examine whether vitamin D supplementation has an effect on the development and progression of age-related macular degeneration.

Decreased both visual acuity and contrast in those with lower vitamin D - June 2023

Wiad Lek . 2023;76(5 pt 2):1173-1178. doi: 10.36740/WLek202305206 PDF behind paywall
Tetiana M Komarova 1, Oksana P Vitovska 1, Yulia I Komisarenko 1, Sibylle K Scholtz 2

Objective: The aim: Determination of vitamin D level and its connection with visual functions in patients with age-related macular degeneration, dry form.

Patients and methods: Materials and methods: We analyzed the data of studies (25(OH)D3 levels (nmol/l), LogMAR visual acuity and Logarithmic contrast sensitivity) of 2 groups of women of postmenopausal age: 1 group (58 people - 58 eyes) - patients with age-related macular degeneration (dry form) - study group; 2 group (29 people - 29 eyes) - people without ophthalmic pathology - control group.

Results: Results: In the study group,

  • 37 patients (63,8%) had vitamin D deficiency,
  • 21 people (36,2%) had vitamin D insufficiency.

In the control group, these figures were

  • 69% and
  • 31%, respectively.

These indicators were defined as low (the normal supply of vitamin D is considered to be 100 nmol/l and more).

Visual acuity due to ETDRS chart in the

  • study group was
    • 0,22±0,04 (in patients with vitamin D deficiency) and
    • 0,12±0,03 (in patients with vitamin D insufficiency),
  • in the control group -
    • 0,13±0,04 and
    • 0,05±0,04 respectively.

In the control group, the logarithmic values of contrast sensitivity (log CS) were

  • 1,58±0,04 log CS (in patients with vitamin D deficiency) and
  • 1,62±0,02 log CS (in patients with vitamin D insufficiency).

For patients from the study group, these figures were reduced to

  • 0,98±0,1 log CS and
  • 1,10±0,06 log CS respectively.

Conclusions: Patients with age-related macular degeneration, dry form, have low levels of vitamin D, with a predominance of its deficiency. It has been determined that with age-related macular degeneration, functional losses are observed when perceiving objects of low contrast.

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Vision problems having many studies on VitaminDWiki

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19699 AMD Poland.jpg admin 27 Jun, 2023 63.03 Kb 339
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19697 AMD 2017_CompressPdf.pdf admin 27 Jun, 2023 493.89 Kb 185