In the news: Multicenter Study of Lutein & Antioxidants in Chronic CSC

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Central serous chorioretinopathy (CSC), the fourth most common nonsurgical retinal disease, is characterized by fluid build-up under the retina and distorted vision. The fluid is believed to come from the choroid, due to isolated or diffuse leaks in the retinal pigment epithelium (RPE). As a result, a small detachment forms under the retina, known as serous retinal detachment (SRD).

Far more common in men than women, the incidence of CSC in men is about 10 cases per 100,000 population. According to a review published just last month (1), type A behavior, high blood pressure, H. pylori infection, steroid or psycho-pharmacologic medication use, sleep disturbances, and autoimmune disease are likely risk factors.

Acute CSC generally affects individuals 30-50 years of age and tends to resolve spontaneously or with focal laser photocoagulation targeting the leaking spots, while SRD often relapses or persists at advanced ages. In these chronic cases, photo-receptors are impaired with RPE atrophy. This can result in distorted vision and/or gradual vision loss.

RCT of Lutein & Antioxidants in Chronic CSC

Based on preliminary studies of antioxidant and lutein supplementation in CSC, a team of Japanese researchers from 5 university hospitals conducted a multicenter controlled trial of these nutrients in chronic CSC (2).

One hundred chronic CSC patients (100 eyes) randomly received a supplement containing 15 mg lutein, 288 mg vitamin C, 150 mg vitamin E, 9 mg zinc, and 1.2 mg copper (total daily dose) or placebo for 6 months. “Chronic” CSC was defined as an eye with a symptomatic history of at least 6 months, visual acuity loss without other causal diseases, or hyper-autofluorescence reflecting long-standing SRD. Best-corrected visual acuity (BCVA) and subfoveal fluid height (via optical coherence tomography) were measured at baselines 1, 3 and 6 months.

Seventy-nine patients completed the study, and there were no differences between the groups at baseline. At 6 months, mean BCVA was significantly improved in the supplement group (p = 0.003), while no significant change was seen in the placebo group (p = 0.589). A 28.6% reduction in subfoveal fluid height was observed with supplementation (p = 0.028). In contrast, subfoveal fluid height was insignificantly reduced by 3.3% in the placebo group (p = 0.898). See Fig. 4.

The researchers theorize that antioxidants may protect the RPE from oxidative stress, improving the viability of RPE cells, and facilitating reconstruction of the blood-retinal barrier - thus helping to reduce subretinal fluid.

One limitation of this study is the small number of subjects and rate of drop out. The authors indicate that some patients dropped out to request an alternative medical treatment due to the lack of a reduction in SRD. While no statistically significant differences in remission rates between groups was seen, differences might have been apparent had a larger number of eyes been enrolled. Also, 6 months may not have been long enough to adequately assess visual outcomes.

Fig. 4. Mean reduction rate of serous retinal detachment (SRD) height. The mean SRD height was significantly decreased in the supplementation group as compared with the baseline measurement (p= 0.028, paired t-test), while the placebo group showed no significant change ( p = 0.898). Bar: standard error. M, months.

References

1. Liu B, et al. Risk factors for central serous chorioretinopathy: Systematic review and meta-analysis. Retina. 36:9-19, 2017.
2. Shinojima A, et al. A multicenter randomized controlled study of antioxidant supplementation with lutein for chronic central serous chorioretinopathy. Ophthalmologica. Published online: February 8, 2017