Associations Between Vitamin D Intake and Progression to Incident Advanced Age-Related Macular Degeneration

• Published in: Investigative ophthalmology & visual science 2017-09, Vol.58 (11), p.4569-4578
• Main Authors: Merle, Bénédicte M J, Silver, Rachel E, Rosner, Bernard, Seddon, Johanna M
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Clinical and Epidemiologic Research; Diet; Diet Records; Dietary Supplements; Disease Progression; Energy Intake; Female; Follow-Up Studies; Geographic Atrophy - epidemiology; Geographic Atrophy - prevention & control; Humans; Incidence; Male; Middle Aged; Nutritional Physiological Phenomena; Prospective Studies; Risk Factors; Vitamin D - administration & dosage; Vitamins - administration & dosage; Wet Macular Degeneration - epidemiology; Wet Macular Degeneration - prevention & control
• ISSN: 1552-5783; 0146-0404; 1552-5783
• DOI: 10.1167/iovs.17-21673

There is growing evidence of the importance of nutrition in age-related macular degeneration (AMD), but no prospective studies have explored the impact of vitamin D. We evaluated the association between vitamin D intake and progression to advanced AMD. Among 2146 participants (3965 eyes), 541 (777 eyes) progressed from early or intermediate AMD to advanced disease (mean follow-up: 9.4 years) based on ocular imaging. Nutrients were log transformed and calorie adjusted. Survival analysis was used to assess associations between incident advanced disease and vitamin D intake. Neovascular disease (NV) and geographic atrophy (GA) were evaluated separately. Combined effects of dietary vitamin D and calcium were assessed based on high or low consumption of each nutrient. There was a lower risk of progression to advanced AMD in the highest versus lowest quintile of dietary vitamin D intake after adjustment for demographic, behavioral, ocular, and nutritional factors (hazard ratio [HR]: 0.60; 95% confidence interval [CI]: 0.43-0.83; P trend = 0.0007). Similar results were observed for NV (HR: 0.59; 95% CI: 0.39-0.89; P trend = 0.005) but not GA (HR: 0.83; 95% CI: 0.53-1.30; P trend = 0.35). A protective effect was observed for advanced AMD among participants with high vitamin D and low calcium compared to the group with low levels for each nutrient (HR: 0.67; 95% CI: 0.50-0.88; P = 0.005). When supplement use was considered, the effect was in the protective direction but was not significant. A diet rich in vitamin D may prevent or delay progression to advanced AMD, especially NV. Additional exploration is needed to elucidate the potential protective role of vitamin D and its contribution to reducing visual loss.