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Br J Ophthalmol 83:867-877 doi:10.1136/bjo.83.7.867
  • Perspective

Macular pigment and age related macular degeneration

  1. S BEATTY,
  2. M BOULTON,
  3. D HENSON
  1. University Department of Ophthalmology, Manchester Royal Eye Hospital
  2. Department of Optometry and Vision Science, University of Manchester Institute of Science and Technology
    1. H-H KOH,
    2. I J MURRAY
    1. University Department of Ophthalmology, Manchester Royal Eye Hospital
    2. Department of Optometry and Vision Science, University of Manchester Institute of Science and Technology
    1. Mr S Beatty, Manchester Royal Eye Hospital, Oxford Road, Manchester M13 9WH.

      The yellow coloration of the macula lutea is attributable to the presence of macular pigment in the axons of its photoreceptors.1 In the 1980s several investigators demonstrated that macular pigment consists of the xanthophyll isomers, lutein and zeaxanthin.2 3 Although the role of the macular pigment remains uncertain, several functions have been hypothesised and these include reduction of the effects of light scatter and chromatic aberration on visual performance,4 5 limitation of the damaging photo-oxidative effects of blue light through its absorption,6-8 and protection against the adverse effects of photochemical reactions because of the antioxidant properties of the carotenoids.9 10

      Age related macular degeneration (AMD) is the leading cause of visual loss in people over the age of 65 years in the Western world.11 Although the aetiopathogenesis of AMD remains a matter of debate, there is a growing body of evidence to indicate that oxidative damage plays a role.12-14 Consequently, the possibility that the absorption characteristics and antioxidant properties of macular pigment confer protection against AMD has been postulated.10 15 A proved protective effect of macular pigment may be of therapeutic value, as it has recently been reported that human macular pigment can be augmented with dietary modification.16

      In this article we review the current literature germane to macular pigment and AMD, and examine the evidence that retinal carotenoids are protective against AMD.

      Historical background

      The absorption of blue light by the macular pigment was first described in 1866 by Max Schultze who concluded: “Therefore, under an otherwise equal organisation, a retina without a yellow spot would see more blue light than one with such a spot”.17 He believed that absorption of the “most refractable violet” reduced chromatic aberration, but also hypothesised that macular pigment might provide some protection against the hazards …