From Medscape Education Clinical Briefs

High Intake of Omega-3 Enhances Vitamin A Effect in Retinitis

Pigmentosa CME
News Author: Janis C. Kelly
CME Author: Dsire Lie, MD, MSEd
Published online February 13, 2012
Clinical Context
According to the current study y !erson and colleagues, retinitis "ig#entosa $%&' has a
"re(alence o) * in +,,,, and a""ro-i#ately . #illion "eo"le are a))ected worldwide. &atients
ty"ically ha(e night lindness in adolescence and are (irtually lind y age /, years. Loss o)
(ision occurs ecause o) loss o) )unction o) cone and rod "hotorece"tors across the retina. 0hree
studies y the authors had "re(iously de#onstrated the e))icacy o) adding (ita#in A *1,,,,
234day )or slowing decline in (isual acuity, and high inta5e o) o#ega67 )atty acids with this
su""le#entation was )ound to slow the decline o) (isual acuity.
0his analysis o) data )ro# all 7 studies deter#ines the contriution o) high (s low o#ega67
dietary inta5e in reducing the rate o) (isual acuity decline in "atients with %&.
Study Synopsis and Perspective
Eating oily )ish such as sal#on . or 7 ti#es a wee5 can i#"ro(e the e))icacy o) daily (ita#in A
"al#itate $*1,,,, 234day' )or delaying (ision loss in "atients with %&, according to an article
"ulished online 8eruary *7 in the Archives of Ophthalmology.
Eliot L. !erson, MD, )ro# the !er#an69und Laoratory )or the Study o) %etinal Degenerations,
:ar(ard Medical School, Massachusetts Eye and Ear 2n)ir#ary, !oston, and colleagues re"ort
that in "atients with %& who ha(e long6chain o#ega67 inta5e a(eraging at least ,.., g4day,
annual distance (isual acuity declined +,; slower and central (isual )ield sensiti(ity declined
al#ost 1,; slower than in "atients with a diet low in those )atty acids. All o) the "atients were
also ta5ing *1,,,, 23 (ita#in A4day.
DHA Helps Rods Send Vitamin A to Cones
Dr. !erson told Medscape Medical News, <2t is well 5nown that i) the retina does not ha(e
su))icient (ita#in A, it will die. =e and others ha(e suggested that under daylight conditions,
rods gi(e cones (ita#in A (ia M>ller cells. 2nter"hotorece"tor retinoid inding "rotein $2%!&'
trans"orts (ita#in A etween these cells. %elease o) (ita#in A )ro# 2%!& re?uires
docosahe-aenoic acid $D:A', which is "resent in oily )ish.
<0hin5 o) the 2%!& as the @deli(eryA truc5 that deli(ers the (ita#in A )ro# the rods to the cones,
and that truc5 needs oil. %od degeneration leads to de)iciencies o) (ita#in A and o) D:A. 0his
could e-"lain why (ita#in A "lus an oily )ish diet ene)its "atients with %& @#ore than (ita#in
A aloneA. &atients are ad(ised to ta5e (ita#in A to re"lace their rods and to eat oily )ish to
enhance deli(ery o) (ita#in A to cones.<
%& a))licts aout * in +,,, "eo"le, ty"ically resulting in night lindness in adolescence, loss o)
"eri"heral (ision in young adulthood, tunnel (ision as the disease worsens, and (irtual lindness
y the ti#e a "atient turns /, years old.
Study Pools Data From !rials
Dr. !erson and colleagues conducted 7 #aBor studies in(ol(ing (ita#in A and %&. :e told
Medscape Medical News that a sugrou" analysis )or one o) those trials suggested that higher
le(els o) D:A #easured in erythrocyte cell #e#ranes correlated with etter "rotection )ro#
the (ita#in A ta5en. 2n the current study, the researchers "ooled data )ro# these 7 "rior trials and
analyCed dietary ?uestionnaires to see whether changes in %& "rogression in res"onse to (ita#in
A su""le#entation (aried de"ending on the "atientDs o#ega67 inta5e.
0he 7 clinical trials enrolled "atients with ty"ical %& )ro# *EF+ to *EE*, *EE/ to .,,*, and .,,7
to .,,F. A total o) 71G "atients were included in the current studyH all were ta5ing (ita#in A
"al#itate $*1,,,, 234day'.
<2 want to e#"hasiCe that this is (ita#in A "al#itate, not what is o)ten called (ita#in A in o(er6
the6counter (ita#ins, which is eta6carotene,< Dr. !erson said. <Also, 2 5now that clinicians
o)ten worry aout to-icity )ro# the *1,,,, 234day dose. 2n %& "atients with nor#al li(er
)unction, we ha(e seen no to-icity a)ter u" to .1 years o) continual use. :owe(er, it is i#"ortant
to re#e#er that "regnant wo#en should not ta5e (ita#in A doses higher than *,,,,, 23 due to
the ris5 o) )etal to-icity.<
According to the researchers, a "atient with %& who starts recei(ing (ita#in A y age 71 years
and eats an o#ega676rich diet $ie, * 6 . three6ounce ser(ings o) oily )ish4wee5' would e
e-"ected to "ush ac5 to age GE years the Early 0reat#ent Diaetic %etino"athy Study $E0D%S'
acuity decline )ro# 1, letters $e?ui(alent to .,47, on the Snellen chart' to .+ letters $e?ui(alent
to .,4*,, on the Snellen chart' that otherwise would e e-"ected y age /* years.
<0here)ore, the treat#ent regi#en o) (ita#in A co#ined with an I67Jrich diet $K,.., g4d'
should #a5e it "ossile )or #any "atients with ty"ical retinitis "ig#entosa to retain oth (isual
acuity and central (isual )ield )or #ost o) their li(es,< the researchers conclude.
"europrotectin D# Mi$%t Also Play a Role
Nicolas 9. !aCan, MD, &hD, re(iewed the study )or Medscape Medical News. Dr. !aCan holds
the Ernest C. and L(ette C. Millere Endowed Chair o) %etinal Degenerations and is "ro)essor o)
o"hthal#ology, ioche#istry and #olecular iology, and neurology at the Louisiana State
3ni(ersity :ealth Sciences Center in New Nrleans.
<0his see#s a (ery well6designed and 6e-ecuted study. Dr. !erson has led in this area o) %&
research,< Dr. !aCan said.
:e also suggested another "ossile #echanis# o) action. <Nne "ossile #echanis# is that, as a
result o) high D:A inta5e, there is increased a(ailaility o) D:A )or neuro"rotectin D*
synthesis in the @retinal "ig#ent e"itheliu# $%&E'A and other retinal cells. @Neuro"rotectin D*A is
the )irst $D*' ioacti(e li"id deri(ed )ro# D:A that we identi)ied under conditions o) inco#ing
da#age. 2t is an endogenous "rotecti(e #ediator )or#ed to sustain ho#eostasis in the
%&E4"hotorece"tors and in rain cells.<
:e continued, <D:A elongs to the o#ega67 essential )atty acid )a#ily and is concentrated and
a(idly retained in the "hotorece"tors. 2t is the "recursor o) the "otent "roho#eostatic regulator
neuro"rotectin D*. Let our diet during the last se(eral decades has a re#ar5ale shortage in
o#ega67 )atty acids.<
%etina s"ecialist 9iuse""e Ouer?ues, MD, )ro# Creteil 3ni(ersity Eye Clinic in 8rance, agreed.
<2 a# ?uite co#"letely con(inced y @theA !erson et al data. Sure, there are all li#itations o) a
retros"ecti(e analysis ased on ?uestionnaires. N) note, they "resent a re(iew o) 7 rando#iCed
trials where all "atients were recei(ing (ita#in A, and the inta5e o) o#ega67 was calculated )ro#
the res"onses to )ood ?uestionnaires.<
&me$a' Also Helpful A$ainst Macular De$eneration
Eileen E. !irch, &hD, director o) the &ediatric Eye %esearch Laoratory at the %etina 8oundation
o) the Southwest and adBunct "ro)essor o) o"hthal#ology, 3ni(ersity o) 0e-as Southwestern
Medical Center, Dallas, said, <0he association etween dietary o#ega67 inta5e and rate o)
"rogression in retinitis "ig#entosa are intriguing. 0he study conclusion is ased on an analysis
o) aggregated data )ro# so#e grou"s o) "atients who "artici"ated in 7 earlier rando#iCed
clinical trials $%C0s' o) (ita#in A su""le#entation. :owe(er, ecause this is an oser(ational
analytical study ased on aggregated secondary data, it can "ro(ide only wea5 e#"irical
e(idence. Nonetheless, the "reli#inary e(idence could e used to guide hy"othesis )or a )uture
%C0.<
Dr. !irch added, <Natural dietary sources o) o#ega67 )atty acid $sal#on, tuna, and #ac5erel'
"ro(ide D:A and E&A, while #any o#ega67 su""le#ented )oods on the #ar5et today do not.
0he !erson et al study suggests that there #ay e a ene)it o) dietary inta5e o) D:A6 and E&A6
rich )oods )or "atients with retinitis "ig#entosa. 0he National Eye 2nstituteJs"onsored Age6
%elated Eye Disease Study %esearch 9rou" recently re"orted that there is also an association
etween dietary o#ega67 inta5e and "rogression o) age6related #acular degeneration. 0hey
concluded that, although an %C0 is needed )or de)initi(e conclusions, dietary o#ega67 inta5e is
an easily #odi)iale )actor that #ay in)luence the "rogression o) retinal disease.<
John &aul San9io(anni, ScD, is a sta)) scientist in the Clinical 0rials !ranch o) the National Eye
2nstitute and ser(es on central scienti)ic leadershi" and ad#inistrati(e co##ittees )or the Age6
%elated Eye Disease Study ., a +,,,6"erson clinical trial on o#ega67 long6chain "olyunsaturated
)atty acids $LC&38As' )or ad(anced age6related #acular degeneration. 2n an inter(iew with
Medscape Medical News, Dr. San9io(anni said, <0he re"ort "resents use)ul e(ent rates and
suggests that a see#ingly sa)e dietary inter(ention o) )oods rich in o#ega67 LC&38As can
attenuate the rate o) (ision loss in adults with retinitis "ig#entosa recei(ing (ita#in A, *1,,,,
234d.<
Dr. San9io(anni also noted that the asolute di))erence in the a(erage rate o) acuity loss etween
the grou"s with (s without high o#ega67 inta5e was aout ,.1 E0D%S chart letters "er year.
<A ,.16letter (ariation is well within the le(el o) #easure#ent error and natural $within6suBect'
(ariation in "er)or#ance on the E0D%S acuity "rotocol. 2t would e hel")ul to 5now #ore aout
#easure#ent "ro"erties o) the E0D%S within the la e-a#ining the study "artici"ants.
Assu#ing the re"orted "rogression rates )or acuity loss are accurate, we would e-"ect an a(erage
*,6letter loss $. chart lines, ,.1 log units' across each decade in cohorts re"orting inta5es o)
o#ega67 @LC&38AsA P .,, #g4d. 0he 8DA has used a *16letter $7 chart lines' acuity loss as a
clinically #eaning)ul #easure o) e))icacy in drug studies,< Dr. San9io(anni said.
Ho( to Help Patients Sustain Compliance
Dr. !erson told Medscape Medical News that )or "atients with %& who ha(e nor#al li(er
)unction, his asic reco##endation is (ita#in A *1,,,, 234day and . to 7 ser(ings o) sal#on or
other oily )ish each wee5. <2) a "atient cannot eat oily )ish, we ad(ise * Neuro#ins D:A .,, #g
gelca" "er day,< he said. :e warned that "atients should e ad(ised to chec5 the D:A
concentration e)ore ta5ing "roducts that are Bust called <o#ega67< su""le#ents, as #any
contain relati(ely little D:A.
Maintaining co#"liance )or #any decades re#ains a clinical challenge. Dr. !erson said that he
has )ound that e-"laining to "atients why oth (ita#in A and o#ega67 are needed can i#"ro(e
co#"liance. <E(eryone can understand the analogy o) o#ega67 as the deli(ery truc5 hel"ing
ring (ita#in A )ro# the rods to the cones,< he said. <0hey ?uic5ly gras" that (ita#in A hel"s
re"lace their rods, and eating oily )ish hel"s deli(ery o) (ita#in A )ro# the rods to cones.<
Study Hi$%li$%ts
%esearchers conducted the 7 clinical trials on "atients with %& )ro# *EF+ to *EE*, *EE/
to .,,*, and .,,7 to .,,F.
2n each trial, eligile "atients were ree-a#ined / to F wee5s a)ter the screening
e-a#ination and then annually therea)ter during treat#ent with (ita#in A *1,,,, 234day.
&atients were e(aluated under the sa#e test conditions in all 7 trials and co#"leted the
=illett )ood )re?uency ?uestionnaire at screening and annually at )ollow6u" (isits.
0he inta5e o) long6chain o#ega67 )atty acids was deter#ined, along with other nutrients.
%esearchers otained the a(erage inta5e )or each indi(idual y a(eraging the inta5e )or
all e-a#inations.
. categories o) o#ega67 inta5e were recogniCed: ,.., g4day or higher $high inta5e' and
less than ,.., g4day $low inta5e'.
An o#ega676rich diet is e?ui(alent to one to two 76ounce ser(ings o) oily )ish "er wee5.
At each (isit, an ocular e-a#ination was "er)or#ed, including a #easure o) E0D%S
distance acuity at 7.. #eters. A)ter dilation, Snellen retinal acuity was #easured with use
o) a 9uyton6Min5ows5i retinal "otential acuity #eter, which y"assed a central cataract.
0he E0D%S chart contained 1 letters o) co#"arale di))iculty, and a di))erent set o)
letters was used )or testing each eye.
0he E0D%S was scored )or distance (isual acuity as the total nu#er o) letters identi)ied.
A nu#eric chart was used to #easure retinal acuity and was trans)or#ed to a natural log
scale.
A slit6la#" e-a#ination was "er)or#ed to ?uanti)y the area o) "osterior suca"sular
cataracts, i) "resent.
A )undus e-a#ination with an o"hthal#osco"e was also conducted.
Eyes with a Snellen distance acuity o) less than .,4*,, at aseline were e-cluded )ro#
analysis.
8ield testing was conducted with use o) di))erent #ethodsH hence, )ield data were not
included in analysis.
All "atients in the 7 trials recei(ed (ita#in A "al#itate *1,,,, 234day. No signi)icant
di))erences in retinol le(els were seen a#ong those with high (s low o#ega67 inta5e.
8ollow6u" occurred )or a #ean o) + to / years in each study.
Mean age o) the "artici"ants was 7/ years in the high6inta5e grou" and 77 years in the
low6inta5e grou".
11; to /,; o) "artici"ants were #en, and #ean ody #ass inde- was .1.G 5g4#
.
.
Nne ?uarter o) cases were o) do#inant genetic ty"e, *.; to */; were recessi(e, and G;
to *,; were Q6lin5ed.
Mean annual rates o) decline o) oth distance and retinal acuity were slower a#ong
"atients with high (s low dietary o#ega67 inta5e.
0he #ean rates o) decline o) distance (isual acuity were 6,.1E letters "er year in the high
o#ega67 inta5e grou" and 6*.,, letters "er year in the low o#ega67 inta5e grou" $P R .
,,*'.
8or retinal (isual acuity, the #ean rates o) decline were *.1; "er year in the high o#ega6
7 inta5e grou" and ..F; "er year )or the low o#ega67 dietary inta5e grou" $P R .,7'.
8or e-a#"le, i) a "atient with %& started (ita#in A su""le#entation y age 71 years and
eats an o#ega67Jrich diet $e?ui(alent to one to two 76ounce ser(ings o) oily )ish "er
wee5' with an E0D%S acuity o) 1, letters $.,47, on the Snellen chart', the E0D%S
acuity would decline to .+ letters $.,4*,, on a Snellen chart' y age GE years. :owe(er,
i) this "atient recei(ed (ita#in A ut consu#ed a low o#ega67 diet, the E0D%S acuity
would decline to .+ letters y age /* years.
0he authors noted that the ene)it o) high o#ega67 inta5e was li#ited to (isual acuity and
central )ield "reser(ation.
0he )re?uency o) cataract increase was si#ilar in the . grou"s at + to / years and was
*,; to **;.
A(erage cataract dia#eter increased y ,.,G ## in the high o#ega67 inta5e grou" and
y ,.*+ ## in the low o#ega67 inta5e grou", ut the di))erence was not signi)icant.
0he di))erence in the rate o) decline o) the re#aining cone electroretinogra# a#"litude
was si#ilar in the . grou"s.
0he authors concluded that high6dose o#ega67 inta5e in the diet (s a low6dose inta5e,
when gi(en with (ita#in A *1,,,, 234day, is associated with delayed "rogression o)
(isual acuity decline y *F years in "atients with %&.
Clinical )mplications
A high dose o) o#ega67 )atty acids in the diet with (ita#in A at *1,,,, 234day is
associated with a delay in the "rogression o) (isual acuity decline in "atients with %&.
A high dose o) o#ega67 )atty acids in the diet with (ita#in A at *1,,,, 234day is not
associated with the rate o) de(elo"#ent or siCe o) cataracts.
From Medscape Education Clinical Briefs
Asupan tin$$i &me$a' Menin$*at*an Pen$aru% Vitamin A di
retinitis pi$mentosa
&enulis: Janis C. Kelly
&enulis CME: Dsire Lie, MD, MSEd
+eadaan Clinical
Menurut studi saat ini oleh !erson dan re5an, retinitis "ig#entosa $%&' #e#ili5i
"re(alensi dari * dari +,,,, dan se5itar . Buta orang seluruh dunia ter5ena. &asien iasanya
#e#ili5i raun senBa "ada #asa re#aBa dan ha#"ir uta "ada usia /, tahun. Kehilangan
"englihatan terBadi 5arena hilangnya )ungsi )otorese"tor 5erucut dan atang di retina. 0iga
"enelitian oleh "enulis seelu#nya #enunBu55an e)e5ti(itas dari "ena#ahan (ita#in A *1.,,,
23 4 hari untu5 #e#"erla#at "enurunan 5etaBa#an (isual, dan asu"an tinggi o#ega67 asa#
le#a5 dengan su"le#entasi ini dite#u5an untu5 #e#"erla#at "enurunan 5etaBa#an (isual.
Analisis data dari se#ua 7 "enelitian #enentu5an 5ontriusi dari tinggi (s rendah asu"an
o#ega67 rendah dala# #engurangi ting5at "enurunan 5etaBa#an (isual "ada "asien dengan %&.
Asu"an tinggi o#ega67 #ening5at5an "engaruh Mita#in A "ada retinitis "ig#entosa.
Studi Sinopsis dan Perspe*tif
Ma5an i5an er#inya5 se"erti sal#on . atau 7 5ali se#inggu da"at #ening5at5an
e)e5ti(itas harian (ita#in A "al#itat $*1.,,, 23 4 hari' untu5 #enunda 5ehilangan "englihatan
"ada "asien dengan %&, #enurut seuah arti5el yang diterit5an *7 8eruari dala# Archives of
Ophthalmology.
Eliot L. !erson, MD, dari Laoratoriu# !er#an69und untu5 Studi degenerasi retina,
:ar(ard Medical School, Massachusetts Eye dan Ear 2n)ir#ary, !oston, dan re5an #ela"or5an
ahwa &ada "asien dengan %etinitis &ig#entosa dengan asu"an rata6rata o#ega67 rantai "anBang
setida5nya ,,., g 4 hari, Bara5 5etaBa#an "englihatan tahunan turun +,; leih la#at dan
sensiti(itas idang "usat (isual yang #enurun ha#"ir 1,; leih la#at dari "ada "asien dengan
diet rendah asa# le#a5 terseut. Se#ua "asien Buga #eng5onsu#si (ita#in *1.,,, 23 4hari .
DHA Mem,antu sel ,atan$ men$irim vitamin A *e sel *erucut
Dr !erson #engata5an 5e"ada Medsca"e Medical News, <:al ini Buga di5etahui ahwa
Bi5a retina tida5 cu5u" #e#ili5i (ita#in A, ia a5an #ati Ka#i dan lain6lain #enunBu55an ahwa
dala# 5ondisi siang hari, atang #e#eri5an 5erucut (ita#in A #elalui sel M>ller.
2nter"hotorece"tor retinoid #engi5at "rotein $2%!&' #engang5ut (ita#in A antara sel6sel ini.
&ele"asan (ita#in A dari 2%!& #e#erlu5an asa# docosahe-aenoic $D:A', yang ada "ada i5an
er#inya5.
<&i5ir5an 2%!& seagai @"engiri#anA tru5 yang #e#eri5an (ita#in A dari atang 5e
5erucut, dan tru5 yang "erlu #inya5. Degenerasi atang #enyea5an 5e5urangan (ita#in A
dan D:A. 2ni isa #enBelas5an #enga"a (ita#in A dan i5an er#inya5 #enguntung5an "asien
dengan %& @leih dari (ita#in A saBaA. &asien disaran5an untu5 #engonsu#si (ita#in A untu5
#engganti5an sel atangnya dan #a5an i5an er#inya5 untu5 #ening5at5an "engiri#an dari
(ita#in A 5e 5erucut. <
%& #eni#"a se5itar * dari +,,, orang, iasanya #enga5iat5an raun senBa "ada #asa
re#aBa, 5ehilangan "englihatan "eri)er di #asa dewasa #uda, (isi terowongan saat "enya5it
erta#ah "arah, dan 5eutaan (irtual "ada saat "asien erusia /, tahun.
Pen$umpulan Studi Data Dari Perco,aan
Dr !erson dan re5an #ela5u5an 7 "enelitian esar yang #eliat5an (ita#in A dan %&.
Dia #engata5an 5e"ada !erita Medis Medsca"e ahwa seuah su5elo#"o5 #enganalisa salah
satu "ercoaan #enunBu55an ahwa 5adar D:A yang tinggi diu5ur dala# #e#ran sel eritrosit
er5orelasi dengan "erlindungan yang leih ai5 dari (ita#in A yang di5onsu#si. Dala# studi
saat ini, "ara "eneliti #engu#"ul5an data dari 7 "ercoaan seelu#nya dan #enganalisis
5uesioner diet untu5 #elihat a"a5ah "eruahan dala# "er5e#angan %& dala# #eres"on
(ariasi su"le#en (ita#in A tergantung "ada asu"an o#ega67 "asien.
0iga uBi 5linis #enda)tar5an "asien dengan %& 5has *EF+6*EE*, *EE/ sa#"ai .,,*, dan
.,,7 sa#"ai .,,F. Seanya5 71G "asien diliat5an dala# "enelitian ini, se#ua #eng5onsu#si
(ita#in A "al#itat $*1.,,, 23 4 hari'.
<Saya ingin #ene5an5an ahwa ini adalah (ita#in A "al#itat, u5an a"a yang sering
diseut (ita#in A eta5aroten,< 5ata Dr !erson. <Juga, saya tahu ahwa do5ter sering 5hawatir
tentang to5sisitas dari dosis *1.,,, 23 4 hari. &ada "asien %& dengan )ungsi hati yang nor#al,
5ita telah #elihat tida5 ada 5eracunan setelah sa#"ai .1 tahun "enggunaan er5elanButan.
Na#un, "enting untu5 diingat ahwa "ere#"uan ha#il tida5 oleh #eng5onsu#si (ita#in A
dosis leih tinggi dari *,.,,, 23 5arena risi5o to5sisitas Banin. <
Menurut "ara "eneliti, "asien dengan %& yang #ulai #eneri#a (ita#in A "ada usia 71
tahun dan #a5an diet 5aya o#ega67 $yaitu, * 6 . ons tiga "orsi i5an er#inya5 4 #inggu'
dihara"5an a5an #ene5an sa#"ai usia GE tahun
Early Treatment Diabetic Retinopathy t!dy "ETDR# "enurunan 5etaBa#an dari 1,
huru) $setara dengan .,47, di nellen chart ' sa#"ai .+ huru) $setara dengan .,4*,, di nellen
chart ' yang seharusnya da"at dihara"5an "ada usia /* tahun.
<Karena itu, reBi#en "engoatan (ita#in A di5o#inasi5an dengan diet 5aya o#ega67 $K
,,., g 4 hari' harus #e#ung5in5an agi anya5 "asien dengan retinitis "ig#entosa 5has untu5
#e#"ertahan5an 5edua 5etaBa#an (isual dan "usat (isual untu5 seagian esar hidu" #ere5a ,
<"ara "eneliti #enyi#"ul5an.
"europrotectin D# -u$a Bisa Berperan
Nicolas 9. !aCan, MD, &hD, #engulangi 5e#ali studi untu5 !erita Medis Medsca"e.
Dr !aCan #e#egang C. Ernest dan L(ette C Millere seagai Ketua degenerasi retina dan
#eru"a5an "ro)esor o"hthal#ology, io5i#ia dan iologi #ole5ular, dan neurologi di
3ni(ersitas "usat il#u "engetahuan 5esehatan agian Lousiana di New Nrleans.
<:al ini ta#"a5nya studi yang dirancang dan dila5sana5an sangat ai5 . Dr !erson telah
#e#i#"in "enelitian %& di daerah ini,< Kata Dr !aCan. 2a Buga #enyaran5an #e5anis#e
tinda5an lain yang #e#ung5in5an. <Salah satu #e5anis#e yang #ung5in adalah ahwa, seagai
a5iat dari asu"an D:A tinggi, ada "ening5atan 5etersediaan D:A untu5 sintesis neuro"rotectin
D* di @e"itel "ig#en retina $%&E'A dan sel retina lainnya. @Neuro"rotectin D*A Adalah yang
li"id ioa5ti) "erta#a $D*' yang erasal dari D:A yang diidenti)i5asi dala# 5ondisi 5erusa5an
yang #asu5. ini adalah #ediator "elindung endogen dientu5 untu5 #e#"ertahan5an
ho#eostasis dala# %&E 4 )otorese"tor dan dala# sel ota5. <
2a #elanBut5an, <D:A 5e"unyaan o#ega67 asa# le#a5 esensial dan ter5onsentrasi dan
sering di"ertahan5an dala# )otorese"tor. 2ni adalah "ertanda dari neuro"rotectin D* regulator
"roho#eostati5 er5e5uatan esar. Na#un "ola #a5an 5ita sela#a eera"a de5ade tera5hir
#engala#i 5elang5aan luar iasa dala# o#ega67 asa# le#a5. <
S"esialis retina 9iuse""e Ouer?ues, MD, dari Klini5 Mata 3ni(ersitas Crteil di &rancis,
setuBu. <Saya cu5u" ya5in se"enuhnya "ada !erson et al Data. 0entu, ada segala 5eteratasan
analisis retros"e5ti) erdasar5an 5uesioner. Dari catatan, #ere5a #enyaBi5an ulang dari 7
"ercoaan aca5 di #ana se#ua "asien #eneri#a (ita#in A, dan asu"an o#ega67 dihitung dari
res"on 5uesioner #a5anan. <
&me$a' -u$a Bermanfaat Mela(an De$enerasi ma*ula
Eileen E. !irch, &hD, dire5tur Laoratoriu# &enelitian Mata Ana5 di Layasan %etina
!arat Daya dan "ro)esor o)tal#ologi, 3ni(ersitas 0e-as !arat Daya &usat Medis, , Dallas,
#engata5an, <:uungan antara diet asu"an o#ega67 dan ting5at 5e#aBuan dala# retinitis
"ig#entosa adalah #enari5. Kesi#"ulan dari studi ini didasar5an "ada analisis 5u#"ulan data
dari eera"a 5elo#"o5 "asien yang er"artisi"asi dala# 7 uBi 5linis aca5 $randomi$ed clinical
trials %R&Ts# terhada" su"le#entasi (ita#in A seelu#nya. Na#un, 5arena ini #eru"a5an studi
analiti5 oser(asional erdasar5an 5u#"ulan data se5under , 2ni hanya da"at #e#eri5an u5ti
e#"iris le#ah. Mes5i"un de#i5ian, u5ti awal da"at diguna5an untu5 #e#andu hi"otesis untu5
%C0 #asa de"an.<
Dr !irch #ena#ah5an, <su#er #a5anan ala#i asa# le#a5 o#ega67 $sal#on, tuna,
dan #ac5erel' #e#eri5an D:A dan E&A, se#entara anya5 #a5anan su"le#en o#ega67 di
"asaran saat ini . &ara Studi !erson et al #enunBu55an ahwa #ung5in ada #an)aat dari asu"an
#a5anan 5aya D:A dan E&A untu5 "asien dengan retinitis "ig#entosa. 2nstitusi Mata Nasional
yang dis"onsori 9ru" "enelitian &enya5it #ata erhuungan dengan usia, aru6aru ini
#ela"or5an ahwa ada Buga huungan antara diet asu"an o#ega67 dan "er5e#angan yang
er5aitan dengan degenerasi #a5ula ter5ait usia $A%MD'. Mere5a #enyi#"ul5an ahwa,
#es5i"un seuah %C0 di"erlu5an untu5 5esi#"ulan yang "asti, diet asu"an o#ega67 #udah
di#odi)i5asi )a5tor yang da"at #e#"engaruhi "er5e#angan "enya5it retina. <
John &aul San9io(anni, ScD, adalah seorang sta) il#uwan di Caang uBi 5lini5 dari
2nstitusi Mata Nasional dan #elayani di "usat 5e"e#i#"inan il#iah dan 5o#ite ad#inistrasi
untu5 Studi &enya5it #ata ter5ait usia. +,,, orang "ercoaaan 5linis dengan o#ega67 rantai
"anBang asa# le#a5 ta5 Benuh ganda $LC&38As' untu5 5e#aBuan er5aitan degenerasi #a5ula
ter5ait usia. Dala# wawancara dengan !erita #edis Medsca"e, Dr San9io(anni er5ata,
<La"oran ini #enyaBi5an ang5a 5eBadian erguna dan #enunBu55an ahwa inter(ensi diet yang
ta#"a5nya a#an dari #a5anan yang 5aya o#ega67 LC&38As da"at #engurangi ting5at
5ehilangan "englihatan "ada orang dewasa dengan retinitis "ig#entosa yang #eneri#a (ita#in
A, *1.,,, 23 4 hari. <
Dr San9io(anni Buga #encatat ahwa "eredaan #utla5 dala# ting5at rata6rata
5ehilangan 5etaBa#an antara 5elo#"o5 dengan (s tan"a tinggi asu"an o#ega67 adalah se5itar
agan E0D%S ,,1 huru) "er tahun.
<Seuah (ariasi ,,1 huru) ai5 dala# ting5at 5esalahan "engu5uran dan ala#i $dala#6
suBe5' (ariasi dala# 5inerBa "ada "roto5ol 5etaBa#an E0D%S. 2ni a5an sangat #e#antu untu5
#engetahui leih anya5 tentang si)at "engu5uran dari E0D%S dala# laoratoriu# #e#eri5sa
"eserta "enelitian. Dengan asu#si la"oran ang5a 5e#aBuan atas 5ehilangan 5etaBa#an yang
a5urat, 5ita a5an #enghara"5an 5ehilangan rata6rata *, huru) $. garis gra)i5, ,,1 unit log' di
setia" de5ade dala# la"oran 5ohort terhada" asu"an o#ega67 @LC&38AsA P.,, #g 4 hari. 8DA
telah diguna5an hilangnya 5etaBa#an *16huru) $7 garis gra)i5' seagai u5uran 5linis yang erarti
terhada" 5eerhasilan dala# "enelitian oat, <5ata Dr San9io(anni.
Cara untu* Mem,antu Pasien Memperta%an*an Pemenu%an
Dr !erson #engata5an 5e"ada !erita Medis Medsca"e ahwa untu5 "asien dengan %&
yang #e#ili5i )ungsi hati yang nor#al, re5o#endasi dasarnya adalah (ita#in A *1.,,, 23 4 hari
dan . sa#"ai 7 "orsi sal#on atau i5an er#inya5 lainnya setia" #inggu. <Ji5a "asien tida5 isa
#a5an i5an er#inya5, 5a#i saran5an * Neuro#ins D:A .,, gelca" #g "er hari,< 5atanya. Dia
#e#"eringat5an ahwa "asien harus disaran5an untu5 #e#eri5sa 5onsentrasi D:A seelu#
#enga#il "rodu5 yang hanya diseut <o#ega67< su"le#en, 5arena anya5 #engandung D:A
relati) sedi5it.
Me#"ertahan5an "e#enuhan sela#a eera"a de5ade teta" #eru"a5an tantangan 5linis.
Dr !erson #engata5an ahwa ia telah #ene#u5an ahwa #enBelas5an 5e"ada "asien #enga"a
5edua (ita#in A dan asa# le#a5 o#ega67 di"erlu5an da"at #ening5at5an "e#enuhan. <Se#ua
orang isa #e#aha#i analogi dari o#ega67 seagai tru5 "engantar #e#antu #e#awa
(ita#in A dari atang 5e 5erucut,< 5atanya. <Mere5a ce"at #e#aha#i ahwa (ita#in A
#e#antu #engganti atang #ere5a, dan #a5an i5an er#inya5 #e#antu "engiri#an (ita#in
A dari atang 5e 5erucut.<
+ilasan Studi
&ara "eneliti #ela5u5an 7 "ercoaan 5linis "ada "asien dengan %& dari *EF+ sa#"ai
*EE*, *EE/ sa#"ai .,,*, dan .,,7 sa#"ai .,,F.
Dala# setia" "ercoaan, "asien yang #e#enuhi syarat di"eri5sa ulang / sa#"ai F
#inggu setelah "e#eri5saan s5rining dan 5e#udian setia" tahun sela#a "engoatan
dengan (ita#in A *1.,,, 23 4 hari.
&asien die(aluasi "ada 5ondisi "enguBian yang sa#a di se#ua 7 "ercoaan dan
#enyelesai5an 5uesioner )re5uensi #a5anan =illett "ada s5rining dan setia" tahun "ada
5unBungan tinda5 lanBut.
Asu"an rantai "anBang o#ega67 asa# le#a5 ditentu5an, ersa#a dengan nutrisi lainnya.
&ara "eneliti #e#"eroleh asu"an rata6rata untu5 setia" indi(idu dengan rata6rata asu"an
untu5 se#ua "e#eri5saan.
. 5ategori asu"an o#ega67 yang dia5ui: ,,., g 4 hari atau leih tinggi $asu"an tinggi' dan
5urang dari ,,., g 4 hari $asu"an rendah'.
Diet 5aya o#ega67 setara dengan *6. 76ons "orsi #inya5 i5an "er #inggu.
&ada setia" 5unBungan, "e#eri5saan #ata dila5u5an, ter#asu5 u5uran 5etaBa#an Bara5
E0D%S seesar 7,. #eter. Setelah "elearan, Snellen 5etaBa#an retina diu5ur dengan
#engguna5an #eter 5etaBa#an 9uyton6Min5ows5i retina "otensial, yang dilewati
5atara5 "usat.
9ra)i5 E0D%S ter5andung 1 huru) 5esulitan seanding, dan satu set yang ereda dari
huru) yang diguna5an untu5 "enguBian setia" #ata.
&ara E0D%S dis5or untu5 Bara5 5etaBa#an (isual seagai Bu#lah huru) teridenti)i5asi.
Seuah gra)i5 nu#eri5 diguna5an untu5 #engu5ur 5etaBa#an retina dan
ditrans)or#asi5an 5e s5ala logarit#a ala#i.
&e#eri5saan slit6la#" dila5u5an untu5 #engu5ur idang 5atara5 suca"sular "osterior,
Bi5a ada.
&e#eri5saan )undus dengan o)tal#os5o" Buga dila5u5an.
Mata dengan 5etaBa#an Bara5 Snellen 5urang dari .,4*,, "ada awal di5eluar5an dari
analisis.
3Bi coa la"angan dila5u5an dengan #engguna5an #etode yang ereda, dengan itu,
data la"angan tida5 di#asu55an dala# analisis.
Se#ua "asien dala# 7 "ercoaan #eneri#a (ita#in A "al#itat *1.,,, 23 4 hari. 0ida5
ada "eredaan yang signi)i5an "ada ting5at retinol terlihat di antara #ere5a dengan tinggi
(s rendah asu"an o#ega67.
0inda5 lanBut terBadi sela#a rata6rata + sa#"ai / tahun dala# studi #asing6#asing.
%ata6rata usia "eserta adalah 7/ tahun "ada 5elo#"o5 tinggi asu"an dan 77 tahun "ada
5elo#"o5 rendah asu"an.
11; sa#"ai /,; "eserta adalah la5i6la5i, dan rata6rata inde5s #assa tuuh adalah .1,G
5g4#..
Se"ere#"at dari 5asus adalah ti"e geneti5 do#inan, *.; sa#"ai */; adalah resesi), dan
G; sa#"ai *,; yang ter5ait6Q.
%ata6rata ang5a tahunan "enurunan Bara5 dan 5etaBa#an retina leih la#at antara "asien
dengan tinggi (s rendah asu"an #a5anan o#ega67.
0ing5at rata6rata "enurunan 5etaBa#an "englihatan Bara5 adalah 6,.1E huru) "er tahun
"ada 5elo#"o5 asu"an tinggi o#ega67 dan 6*.,, huru) "er tahun "ada 5elo#"o5 asu"an
o#ega67 yang rendah $& R .,,*'.
3ntu5 5etaBa#an (isual retina, ting5at rata6rata "enurunan adalah *,1; "er tahun "ada
5elo#"o5 asu"an tinggi o#ega67 dan .,F; "er tahun untu5 5elo#"o5 asu"an rendah
o#ega67 $& R .,7'.
Misalnya, Bi5a seorang "asien dengan %& #ulai su"le#entasi (ita#in A "ada usia 71
tahun dan #a5an diet 5aya o#ega67 $setara dengan *6. 76ons "orsi #inya5 i5an "er
#inggu' dengan 5etaBa#an E0D%S dari 1, huru) $., 4 7, di chart Snellen', 5etaBa#an
E0D%S a5an turun sa#"ai .+ huru) $.,4*,, "ada gra)i5 Snellen' "ada usia GE tahun.
Na#un, Bi5a "asien ini #eneri#a (ita#in A teta"i #eng5onsu#si diet o#ega67 yang
rendah, 5etaBa#an E0D%S a5an turun sa#"ai .+ huru) "ada usia /* tahun.
&ara "enulis #encatat ahwa #an)aat dari asu"an tinggi o#ega67 teratas "ada
5etaBa#an (isual dan "elestarian la"angan "usat.
8re5uensi "ening5atan 5atara5 adalah seru"a "ada . 5elo#"o5 "ada + sa#"ai / tahun
dan *,; sa#"ai **;.
Dia#eter 5atara5 rata6rata #ening5at seesar ,,,G ## "ada 5elo#"o5 asu"an tinggi
o#ega67 dan dengan ,,*+ ## "ada 5elo#"o5 asu"an o#ega67 yang rendah, teta"i
"eredaannya tida5 signi)i5an.
&eredaan ting5at "enurunan a#"litudo electroretinogra# 5erucut yang tersisa adalah
seru"a "ada . 5elo#"o5.
&ara "enulis #enyi#"ul5an ahwa dosis tinggi asu"an o#ega67 dala# #a5anan (s
asu"an dosis rendah, Bi5a dieri5an dengan (ita#in A *1.,,, 23 4 hari, ter5ait dengan
"er5e#angan "enundaan "enurunan 5etaBa#an (isual dengan *F tahun "ada "asien
dengan %&.
)mplementasi +lini*
Dosis tinggi dari o#ega67 asa# le#a5 dala# #a5anan dengan (ita#in A "ada *1.,,, 23
4 hari di5ait5an dengan "enundaan dala# "er5e#angan "enurunan 5etaBa#an (isual
"ada "asien dengan %&.

Dosis tinggi dari o#ega67 asa# le#a5 dala# #a5anan dengan (ita#in A "ada *1.,,, 23
4 hari tida5 ter5ait dengan laBu "er5e#angan atau u5uran 5atara5.