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Outcome of Off-Label AREDS 2 Supplementation for the Treatment of Macular Degeneration in Non-Proliferative Idiopathic Type 2 Macular Telangiectasia

Authors Berger TA, Manry MW, Lindsell LB, Osher JM, Miller DM, Foster RE, Riemann CD, Petersen MR, Sisk RA

Received 21 December 2020

Accepted for publication 18 February 2021

Published 15 March 2021 Volume 2021:15 Pages 1133—1143


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Tyler A Berger,1 Matthew W Manry,1,2 Lucas B Lindsell,1,2 James M Osher,1,2 Daniel M Miller,1,2 Robert E Foster,1,2 Christopher D Riemann,1,2 Michael R Petersen,1,2 Robert A Sisk1– 3

1Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA; 2Cincinnati Eye Institute, Cincinnati, OH, USA; 3Abrahamson Pediatric Eye Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

Correspondence: Robert A Sisk
Cincinnati Eye Institute, 1945 CEI Drive, Cincinnati, OH, 45242, USA
Fax +1 513-569-3904
Email [email protected]

Purpose: To evaluate if off-label Age-Related Eye Disease Study 2 (AREDS2) supplementation prevents visual and anatomical deterioration in non-proliferative Idiopathic Macular Telangiectasia Type 2 (IMT2).
Patients and Methods: This is a single-center retrospective, comparative study of 82 IMT2 eyes treated with AREDS2 from January 1st, 2013 to January 1st, 2018. The study analysis consisted of a non-comparative arm, which included all AREDS2 eyes, and a comparative arm (27 AREDS2 and 42 untreated eyes) that only included eyes with complete follow-up data. Eyes were evaluated at baseline, 12 and 24 months. Better/worse eye sub-analysis was performed in the comparative study arm. Primary outcomes were best corrected visual acuity (BCVA) and optical coherence tomography (OCT) anatomical characteristics including largest cavitation diameter, central macular thickness (CMT), and length of ellipsoid zone (EZ) loss at 24 months.
Results: In the non-comparative arm, AREDS2 eyes showed stable BCVA (0.28 ± 0.18 logMAR at baseline vs 0.26 ± 0.19 logMAR at 24 months; p = 0.35) and OCT anatomical features after 24 months of supplementation. In the comparative arm, BCVA mean difference was greater for untreated eyes at 24 months (− 0.09 ± 0.15 vs 0.03 ± 0.11 logMAR; p = < 0.001). AREDS2 eyes had decreased cavitary diameter and EZ loss compared to untreated eyes at the study endpoint (p = 0.01 and p = 0.02, respectively). CMT remained stable for both cohorts throughout the study. For better/worse eye analysis, untreated eyes had worse BCVA at 24 months in both better and worse eyes (both p = 0.01). For anatomical outcomes, increases in both EZ loss (p = 0.04) and cavitary diameter (p = 0.001) among untreated eyes were only significant for eyes with worse baseline BCVA.
Conclusion: Our results suggest that off-label AREDS2 supplementation in non-proliferative IMT2 may prevent anatomical and visual deterioration in a subset of eyes.

Keywords: antioxidant, AREDS2, carotenoid supplementation, ellipsoid zone loss, lutein, idiopathic macular telangiectasia, macular telangiectasia, juxtafoveal macular telangiectasia, parafoveal telangiectasia, retinal vascular disease

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