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Night Vision and Carotenoids (NVC): A Randomized Placebo Controlled Clinical Trial on Effects of Carotenoid Supplementation on Night Vision in Older Adults
September 2021
Stuart Richer1,2,*, Steven Novil1, Taylor Gullett2, Avni Dervishi2, Sherwin Nassiri2, Co Duong2,Robert Davis3 and Pinakin Gunvant Davey4,*
- Captain James A Lovell Fed Health Care Facility, North Chicago, IL 60064, USA; livonlivon@yahoo.com
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA; taylor.gullett@my.rfums.org (T.G.); avni.dervishi@my.rfums.org (A.D.); sherwin.nassiri@my.rfums.org (S.N.); co.duong@my.rfums.org (C.D.)
- Davis Eye Care Associates, Oak Lawn, IL 60453, USA; eyemanage@aol.com
- College of Optometry, Western University of Health Sciences, Pomona, CA 91766, USA
* Correspondence: Stuart.Richer1@va.gov (S.R.); contact@pinakindavey.com (P.G.D.)
Abstract: Twilight and low luminance levels are visually challenging environments for the elderly, especially when driving at night. Carotenoid rich diets are known to increase macular pigment optical density (MPOD), which in turn leads to an improvement in visual function. It is not known whether augmenting MPOD can lead to a decrease in vision related night driving difficulties. Additionally, it is unknown if carotenoid supplementation provides additional measurable benefits to one’s useful field of view (UFOV) along with a decreased composite crash risk score. The aim of the study was to evaluate changes in night vision function and UFOV in individuals that took carotenoid vitamin supplements for a six-month period compared to a placebo group. Methods: A prospective, randomized, double-blind, six-month trial of a 14 mg zeaxanthin/7 mg lutein-based supplement was carried out. Participants were randomized into active or placebo group (approx 2:1). Results: n = 33 participants (26 males/7 females) participated with 93% capsule intake compliance in the supplemented group (n = 24) and placebo group (n = 9). MPOD (mean/standard error SE) in the active group increased in the Right eye from 0.35 density units (du)/0.04 SE to 0.41 du/0.05 SE; p < 0.001 and in the Left eye from 0.35 du/0.05 SE to 0.37 du, p > 0.05). The supplemented group showed significant improvements in contrast sensitivity with glare in both eyes with improvements in LogMAR scores of 0.147 and 0.149, respectively (p = 0.02 and 0.01, respectively), monocularly tested glare recovery time improved 2.76 and 2.54 s, respectively, (p = 0.008 and p = 0.02), and we also noted a decreased preferred luminance required to complete visual tasks (p = 0.02 and 0.03). Improvements in UFOV scores of divided attention (p < 0.001) and improved composite crash risk score (p = 0.004) were seen in the supplemented group. The placebo group remained unchanged. Conclusions: The NVC demonstrates that augmenting MPOD in individuals with difficulty in night vision showed measurable benefits in numerous visual functions that are important for night vision driving in this small sample RCT. Additionally, we observed an improvement in UFOV divided attention test scores and decreased composite risk scores.
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Mini-review Article Of Vanishing Retinal Drusen and Oxysterols
October 2018
Stuart Richer1,2 *, Sherwin Nassiri2, Avni Dervishi2, Harsh Patel2, Anish Bhandari2 and William Stiles1
1 Captain James A Lovell Federal Health Care Center, North Chicago, IL 60064, USA.
2 Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA.ABSTRACT
Aim: Spontaneous resolution of retinal drusen is a common occurrence in ophthalmology, but little is understood about the mechanistic pathophysiology of this phenomenon. Small molecules, taken orally, such as resveratrol (RV) and zeaxanthin (Z), resolve retinal drusen and amyloid protein, yet few clinicians are aware of this molecular, biochemical progress against the major degenerative disease(s) of ageing.
Published Data: We highlight the mechanistic role of resveratrol (RV) in the cytochrome P450 enzymatic pathways of liver detoxification, as well as dosing considerations. RV has demonstrated utility in age-related macular degeneration (AMD) and has application in disorders of cognition (Alzheimer’s Disease) and age-related hearing loss. We highlight the clinical evidence for the use of an epigenetic RV nutraceutical matrix called Longevinex®, and the xanthophyll carotenoid zeaxanthin. Longevinex® has been employed against retinal drusen, with resulting normalisation of retinal anatomy, Amsler Grid field loss (scotomas) and distortions of the central visual field (metamorphopsia).
Implications: The published evidence for RV and Z resolving structural and functional deficits in AMD is presented. The xanthophyll carotenoid zeaxanthin has now been demonstrated, in a larger population clinical trial, to resolve drusen beyond normal expectation. Both RV and Z have also both shown to induce denser macular pigment, and such small molecules likely play a role in multisensory degeneration(s) of ageing.
Conclusion: Previously described “spontaneous resolution” of drusen may have an unappreciated biological mechanism(s). The adjunct and complimentary wound healing benefits of RV and Z remain clinically underutilised in age-related retinal and neuro-degeneration associated diseases of ageing, while the complications of chronic ophthalmologic anti-vascular endothelial growth factor
intravitreal injections emerge as problematic. -
Statins, Caloric Restriction and Longevinex® in a One-eyed Patient with Macular Drusen
September 2018
Anish Bhandari1*, Mansi Katkar1, Stuart Richer2 and William Stiles3
1 Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago,IL 60064, USA.
2 Chicago Medical School, Rosalind Franklin University of Medicine and Science, Family & Preventive Medicine, Captain James A Lovell Federal Health Care Center, North Chicago, IL 60064, USA.
3 Captain James A Lovell Federal Health Care Center, North Chicago, IL 60064, USAABSTRACT
Aims: Evaluate the effects of Longevinex®, Statins, and caloric restriction in a one-eyed patient with Dominant Drusen.
Presentation of Case: A 44-year old male patient with OD congenital amblyopia (20/800 VA) and persistent OS confluent drusen (20/20 VA) (Dominant Drusen) was prescribed AREDS I supplementation for 13 years, with stabile vision and retinal exams. Subsequently, the patient developed worrisome OS Amsler grid distortion along with OS sub-retinal drusenoid deposits (SDD) and retinal architecture disruption.
Discussion: A significant increase in the drusen-free macular area (DFMA) of the patient occurred following 2 years of statin drugs and weight reduction and 4 years daily intake of a caloric restriction mimetic nutrient capsule. Only the Longevinex® red wine matrix nutrient complex resulted in complete Amsler grid resolution and sustainable normalisation of his retinal SD-OCT architecture.
Conclusion: This case provides a longitudinal perspective on a novel therapy for SDD amelioration with promising results. Within the context of previously published research on Longevinex®, this approach potentially provides an efficient, cost effective, and compassionate strategy for patients at risk for AMD as well.
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Improved Visual Acuity and Retinal Integrity with Resveratrol Based Supplementation in Patients with Macular Degeneration
December 2017
Diyana Ivanova1, Stuart Richer2 and Anish Bhandari3
1Chicago College of Optometry, Midwestern University, Downers Grove, IL, USA
2Captain James A Lovell Federal Health Care Facility, North Chicago, IL, USA
3Rosalind Franklin University of Medicine & Science, Chicago Medical School, North Chicago, IL, USAAbstract
These case reports evaluate oral supplementation with a resveratrol based red wine supplement, containing vitamin D3 and labile iron binding inositol hexaphosphate. We appraised function Visual Acuity (VA) and Structure Domain Optical Coherence Tomography (SDOCT) in 3 geriatric patients with atrophic AMD, without clinical alternatives. One female and two males (ages 96, 84, and 85 respectively) were treated under compassionate care guidelines and prescribed Longevinex® (a resveratrol based oral supplement), on a case-by-case-basis. Snellen VA was measured at every visit and photos/SDOCT were also taken to document and track retinal changes. Continual improved VA and retinal integrity were observed. Persistent enhancement is noted on follow up for all patients, continuing for several years for the 96-year-old, thus far. Low dose, low molecular weight nutraceutical molecules can render benefits in the aged with atrophic AMD. Improvement of subjective visual function and retinal integrity is consistent with our previous published reports, as well as reports across several medical disciplines, on the effectiveness of supplementation with a resveratrol-based nutraceutical. This account supports restoration of photoreceptor/RPE function, when other measures have been exhausted by a retinal specialist.
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Restoration of Central Macular Pigment Dip with Dietary RR Zeaxanthin Supplementation in Patients with AMD
July 2017
Abstract
Objective: Low macular pigment optical density (MPOD) is a major risk factor for age-related macular degeneration (AMD). This paper investigates the impact of 8 mg dietary RR zeaxanthin (Z) supplementation on MPOD distribution and the associated effect on macular scotomas in patients with a central foveal dip in their macular pigment spatial profile.
Methods: This is a retrospective review of The Zeaxanthin and Visual Function RCT (FDA IND 78, 973) with respect to the relation between low levels of MPOD and increased risk of age-related macular degeneration (AMD). We retrospectively examine the effect of daily supplementation of 8 mg of dietary Z on n=4 patients having a baseline central foveal dip in their MPOD distribution. The testing modalities used were a 7⁰ 3D specular reflectance and the associated kinetic 20° macular visual fields.
Results: Over a 12-month period, all four patients showed a progressive increase in central peak restoration with related kinetic and/or Amsler grid visual field data.
Conclusion: The initial results demonstrate marked improvement in macular pigment architecture and overall visual function after 12 months of Z supplementation. These results warrant a prospective clinical trial with a larger number of subjects to investigate the role of Z in central dip amelioration.Keywords: Zeaxanthin; Meso-zeaxanthin; AMD; Central foveal dip; Scotomas; Macular pigment optical density
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Longevinex® Improves Human Atrophic AMDPhotoreceptor / RPE Mediated Dark Adaptation
May 2017
British Journal of Medicine and Medical Research Article >>
Stuart Richer, OD, PhD; Lawrence Ulanski II, MD ; Anish Bhandari, MSc, MS1; and Natalia Popenko
MS3Captain James A. Lovell Federal Health Care Facility & RFUMS, • North Chicago, IL ; UIC Eye & Ear Infirmary • Chicago, ILAbstract
PURPOSE: Gradual photoreceptor/ RPE deterioration in AMD is common, irrespective of AREDS I/II supplement risk reduction, orintra-vitrealanti-VEGF pharmacology.We evaluated dark adaptation (DA) in atrophic AMD patients, a broad measure of photoreceptor / RPE health, with / without an epigenetic caloric-restriction modulator (Longevinex® www.longevinex.com).
OBJECTIVE: BaselineclinicalDA threshold (log DB), time (min), and fixation (%) were taken for patients with established atrophic AMD (n=14 eyes; 6 M / 1 F; ages 64 -89 years), using the AdaptDx® (www.maculogix.com), with pupil dilation and best refraction. Following prescription of Longevinex® 1 capsule qdAM, DA was repeated, with each eye’s response considered independent.
RESULTS: All but 2 eyes improved in one or more DA parameters, with 3 cases showing improvement by retinal macula SD OCT. Expected vs. actual (worse vs. same/better), by eye, was significant by Chi Square, P <0.01. Additional factors affecting DA: smoking, alcohol, elevated CRP and statins were retrospectively evaluated.
CONCLUSION: These first cases of DA stability / improvement are consistent with previous beneficial effects of Longevinex® such as enhanced choriocapillariscirculation. DA is the earliest functional AMD sign and a prime candidate for “AMD prevention”. This work merits expansion to controlled studies -
Age-relatedMacular Degeneration Beyond the Age-related Eye Disease Study II
November 2016
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
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Retinal multispectral imaging of ‘sub-clinical’ capillary microaneurysms in non-diabetics correlates with insulin resistance
July 2016
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
October 2014
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
May 2013
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.
Macular degeneration breakthrough
