Lutein, zeaxanthin, vitamin C and age related maculopathy in the EUREYE study

Purpose: To investigate the association of lutein, zeaxanthin and vitamin C with age related maculopathy Methods: 4760 randomly sampled people aged 65 and over participated in an eye examination and risk factor assessment in seven study centres across Europe (Norway, Estonia, UK, France, Italy, Greece and Spain). Two non-simultaneous stereoscopic colour fundus images centred on the macula were taken for each eye, using a field of 350. All images were graded at a single reading centre using the International ARM Epidemiological Study Group classification and stratified into 5 exclusive stages based on the grading in the worst eye. Peripheral venous blood samples were collected from each participant and analysed in a central laboratory. Lutein and zeaxanthin were analysed by reverse phase HPLC and vitamin C by an enzyme-based assay in plasma stabilized with metaphosphoric acid. Multinomial modelling for clustered data, adjusted for potential confounders, was used to assess the associations (relative risk ratios RRR) of fifths of the antioxidants with stage of ARM and with the lowest decile of the distribution. Results: In either age and sex adjusted or fully adjusted analyses there were no significant trends for lutein, zeaxanthin or vitamin C with early ARM or with AMD. The lowest decile of vitamin C (<12.2 {micro}mol/L) was in the range associated with biochemical depletion and suggested a small adverse association with AMD (RRR= 1.36, 95% CI 0.88 to 2.10). Similar effects were observed also for the lowest decile of zeaxanthin and a weaker association for lutein. People with the lowest levels of both vitamin C and zeaxanthin were at highest risk of AMD (RRR=2.67, 95% CI 1.17 to 6.06), p=0.03. Conclusions: In a European population, we found no evidence to support an important association across the full distribution of vitamin C, lutein or zeaxanthin levels with stage of ARM. A high risk for AMD was observed for a small proportion of people with very low levels of antioxidants.