• Age-relatedMacular Degeneration Beyond the Age-related Eye Disease Study II

    Stuart Richer, OD, MS, PhD, Lawrence Ulanski II, MD, Natalia A Popenko, MS, MD Candidate, Steven G. Pratt, MD, ABIHM, Dorothy Hitchmoth, OD, ABO, ABCMO, Paul Chous, MA, OD, Shana Patel, MS, MD Candidatec, Shivani Sockanathan, MS, MD Candidatec, Bill Sardi, BS

    Introduction

    Pharmacologic breakthroughs abound for treating acute neovascular age-related macular degeneration (AMD). However, for most patients with atrophic (dry) AMD, or when exudative (wet) AMD is treated with intravitreous anti–vascular endothelial growth factor (VEGF) agents, there is a common experience. That theme is a relentless progressive destruction of the photoreceptor Bruch membrane–retinal pigment epithelium (RPE) complex and neural retina with age. A plethora of emerging investigational, atrophic AMD agents address the compartmental processes of visual cycle modulation, neural growth/viability, inflammation, amyloid accumulation, alternative complement, antioxidants, and stem cells. However, AMD remains, at its essence, a chronic multifactorial disease of aging, under the influence of genes activated by supportive as well as
    destructive environmental influences.

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  • Retinal multispectral imaging of ‘sub-clinical’ capillary microaneurysms in non-diabetics correlates with insulin resistance

    Kerry M. Gelb, Stuart P. Richer, Cheryl N. Zimmer, Jerome Sherman, Jeffrey M. Gold

    Abstract

    Insulin resistance (IR), short of diabetes mellitus, negatively impacts retinal vessel health. The purpose of this study was to evaluate the correlation between the number of sub-clinical retinal micro-aneurysms (MA#) identifiable by highly sensitive 580 nm multi-spectral retinal imaging (MSI 580 nm) and serological and calculated IR measures. Thirty (n=19 M; n=11 F) non-diabetic optometrists (n=54 eyes), 53.5 ± 7.6 years of age, were imaged at a professional conference using multispectral imaging (MSI) of the retina (RHA, Annidis Corporation, Ottawa, Canada). A six parameter blood panel requisition: fasting glucose (FBS), 2 hr glucose (GTT) tolerance, HbA1c, fasting insulin, 2 hr insulin and 25 OH vitamin D liver reserve status were provided to each participant. MSI retinal images were reviewed and the MA# in the central 30 degrees were counted. The calculated clinical parameters used to diagnose IR were most highly correlated with retinal MA#, specifically insulin sensitivity. Subclinical MA#, less visible to non-spectral cameras but observed with multispectral imaging, correlate with insulin, pancreatic function and calculated measures of IR, more closely than FBS and vitamin D status. Future diabetes intervention research should focus upon MSI MA# and IR as actionable pre-diabetes and pre-retinopathy risk factors.

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  • Resveratrol Based Oral Nutritional Supplement Produces Long-Term Beneficial Effects on Structure and Visual Function in Human Patients

    Stuart Richer, Shana Patel, Shivani Sockanathan, Lawrence J. Ulanski II, Luke Miller and Carla Podella

    Abstract

    Background: Longevinex® (L/RV) is a low dose hormetic over-the-counter (OTC) oral resveratrol (RV) based matrix of red wine solids, vitamin D3 and inositol hexaphosphate (IP6) with established bioavailability, safety, and short-term efficacy against the earliest signs of human atherosclerosis, murine cardiac reperfusion injury, clinical retinal neovascularization, and stem cell survival. We previously reported our short-term findings for dry and wet age-related macular degeneration (AMD) patients. Today we report long term (two to three year) clinical efficacy.

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  • Observation of Human Retinal Remodeling in Octogenarians with a Resveratrol Based Nutritional Supplement

    Stuart Richer *, William Stiles, Lawrence Ulanski, Donn Carroll and Carla Podella

    Abstract:

    Purpose: Rare spontaneous remissions from age-related macular degeneration (AMD) suggest the human retina has large regenerative capacity, even in advanced age. We present examples of robust improvement of retinal structure and function using an OTC oral resveratrol (RV) based nutritional supplement called Longevinex® or L/RV (circa 2004, Resveratrol Partners, LLC, Las Vegas, NV, USA). RV, a polyphenolic phytoalexin caloric-restriction mimic, induces hormesis at low doses with widespread beneficial effects on systemic health. RV alone inhibits neovascularization in the murine retina. Thus far, published evidence includes L/RV mitigation of experimentally induced murine cardiovascular reperfusion injury, amelioration of human atherosclerosis serum biomarkers in a human Japanese randomized placebo controlled trial, modulation of micro RNA 20b and 539 that control hypoxia-inducing-factor (HIF-1) and vascular endothelial growth factor (VEGF) genes in the murine heart (RV inhibited micro RNA20b 189-fold, L/RV 1366-fold). Little is known about the effects of L/RV on human ocular pathology.

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  • The importance of vitamin D in systemic and ocular wellness

    Stuart P. Richera, Joseph J. Pizzimenti

    Abstract

    Vitamin D is good for bones and teeth. It may also have a role in preventing andtreating diabetes, certain cancers, atherosclerosis, multiple sclerosis, hip fractures and ocularconditions such as age-related macular degeneration.

    © 2012 Spanish General Council of Optometry. Published by Elsevier España, S.L. All rightsreserved.

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  • Retinal Spectral Domain Optical Coherence Tomography in Early Atrophic Age-Related Macular Degeneration (AMD) and a New Metric for Objective Evaluation of the Efficacy of Ocular Nutrition

    Stuart Richer, Jane Cho, William Stiles, Marc Levin, James S. Wrobel, Michael Sinai and Carla Thomas

    Abstract:

    Purpose: A challenge in ocular preventive medicine is identification of patients with early pathological retinal damage that might benefit from nutritional intervention. The purpose of this study is to evaluate retinal thinning (RT) in early atrophic age-related macular degeneration (AMD) against visual function data from the Zeaxanthin and Visual Function (ZVF) randomized double masked placebo controlled clinical trial (FDA IND #78973).

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  • Macular Re-pigmentation Enhances Driving Vision in Elderly Adult Males with Macular Degeneration

    Stuart Richer, Dong-Wouk Park, Rachel Epstein, James S. Wrobel and Carla Thomas

    Abstract

    Background:

    The risk of injury or fatality (driver, passenger or pedestrian) associated with motor vehicle accidents has been determined to increase with age, as a result of age-related declines in vision, motor and cognitive functioning. Elderly drivers with age related macular degeneration are particularly vulnerable to sensory visual impairment when driving at night, as they suffer declines in both Contrast sensitivity (CS) and Glare recovery (GR).

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  • Molecular medicine in ophthalmic care

    Stuart Richer, O.D., Ph.D., William Stiles, M.D., Carla Thomas

    Background

    Lipofuscin is the most consistent and phylogenically constant morphologic marker of cellular aging. Autofluorescence of the A2E fluorophore within retinal pigment epithelial (RPE) lipofuscin affords the opportunity for noninvasive evaluation of age- and disease-related pathophysiological changes in the human retina. It is being used in National Eye Institute/Age-Related Eye Disease Study II to evaluate age-related macular degeneration (AMD) geographic atrophy expansion. Experiments show lipofuscin can be reversed in cell culture and animal models in heart, brain, spinal cord, and retinal tissues, using an array of antioxidants and iron chelators.

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  • LAST II: Differential temporal responses of macular pigment optical density in patients with atrophic agerelated macular degeneration to dietary supplementation with xanthophylls(abstract)

    Stuart Richer, O.D., Ph.D., Jenny Devenport, Ph.D., and John C. Lang, Ph.D.

    Background

    Age-related macular degeneration (ARMD) is the leading cause of vision loss in aging Western societies. The objective of the Lutein Antioxidant Supplementation Trial (LAST) was to determine whether specific dietary interventions increased macular pigment optical density (MPOD) and visual function in patients with atrophic ARMD. The current objective of LAST II is to discern those specific characteristics that increase MPOD, i.e., that might differentiate a responder from a nonresponder.

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  • Double-masked, placebo-controlled, randomized trial of lutein and antioxidant supplementation in the intervention of atrophic age-related macular degeneration: the Veterans LAST study (Lutein Antioxidant Supplementation Trial)(abstract)

    Stuart Richer, O.D., Ph.D.; William Stiles, M.D., J.D.; Laisvyde Statkute, M.D.; Jose Pulido, M.D.; James Frankowski, M.S., Ph.D. candidatea,; David Rudy, M.D., M.P.H.c; Kevin Pei, B.S.; Michael Tsipursky, M.S.; and Jill Nyland, R.N.

    Background

    Age-related macular degeneration (ARMD) is the leading cause of vision loss in aging Western societies. The objective of the lutein antioxidant supplementation trial (LAST) is to determine whether nutritional supplementation with lutein or lutein together with antioxidants, vitamins, and minerals, improves visual function and symptoms in atrophic ARMD.

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