SERUM ANTIOXIDANTS AND AGE-RELATED MACULAR DEGENERATION IN A POPULATION-BASED CASE-CONTROL STUDY

Objective: To investigate relationships between levels of tocopherols and carotenoids in the serum and age-related macular degeneration (ARM D). Design: A nested case-control study within a population-based coho rt. Participants: Cases included a sample of subjects with retinal pig ment abnormalities with the presence of soft drusen (n = 127) or with late ARMD (geographic atrophy [n = 9]) or neovascular and exudative ma cular degeneration (n = 31). An equal number of controls (167 pairs) w ere selected from among participants in the Beaver Dam Eye Study. The controls had no photographic evidence of soft drusen, retinal pigment abnormalities, or late ARMD and were matched with cases for age, sex, and current smoking status. Data Collection: Presence and severity of ARMD were determined from masked grading of fundus photographs obtaine d from 1988 to 1990. Levels of individual carotenoids and tocopherols were determined in serum collected at the same time.Results: Average l evels of individual carotenoids were similar in cases and controls. Av erage levels of vitamin E (alpha-tocopherol) were lower in people with exudative macular degeneration (P = .03). However, the difference was no longer statistically significant after controlling for levels of c holesterol in the serum. Persons with levels of lycopene, the most abu ndant carotenoid in the serum, in the lowest quintile were twice as li kely to have ARMD. Levels of the carotenoids that compose macular pigm ent (lutein with zeaxanthin) in the serum were unrelated to ARMD. Conc lusions: Very low levels of one (lycopene) but not other dietary carot enoids or tocopherols were related to ARMD. Lower levels of vitamin E in subjects with exudative macular degeneration compared with controls may be explained by lower levels of serum lipids.