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• W4256348840 abstract "We thank Çalişkan and Gürdal for their interest in our paper, in which we reported that lower macular pigment optical density (MPOD) was a feature of foveal-involved glaucoma.1Siah W.F. Loughman J. O'Brien C. Lower macular pigment optical density in foveal-involved glaucoma.Ophthalmology. 2015; 122: 2029-2037Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar Çalişkan and Gürdal have suggested that factors such as iris color, cataract surgery, and exposure to light should have been addressed in our paper, despite their acknowledgement that the effect of such factors on MPOD remains controversial. Although not reported in our manuscript, we did analyze our data with respect to both lens status and iris color. We would, therefore, like to take this opportunity to address their queries and to clarify our decisions with regard to the discussion in our manuscript. In our study, 12 of the 85 subjects (14%) with valid MPOD data were pseudophakic (all with a clear intraocular lens implant because blue-filtering intraocular lenses were excluded from the study), including 3 of 33 subjects (9%) in the “Fovea-Not-involved” subgroup and 9 of 52 subjects (17%) in the “Fovea-Involved” subgroup. There was no difference in MPOD at any retinal eccentricity according to lens status. Furthermore, incorporating lens status into the general linear model analysis revealed no impact of cataract surgery on MPOD status between the “Fovea-Not-involved” and “Fovea-Involved” subgroups. The decision not to include any cataract surgery data was based first on the small sample of pseudophakic participants herein, and second on data published by Nolan et al2Nolan J.M. O'Reilly P. Loughman J. et al.Augmentation of macular pigment following implantation of blue light-filtering intraocular lenses at the time of cataract surgery.Invest Ophthalmol Vis Sci. 2009; 50: 4777-4785Crossref PubMed Scopus (42) Google Scholar relating to the effect of cataract surgery on MPOD. Although Çalişkan and Gürdal cite Demirel et al, that study did not explicitly omit the effect of diet as a confounding factor. More important, however, that cross-sectional study provides a lower level of evidence relative to the randomized controlled trial reported by Nolan et al,2Nolan J.M. O'Reilly P. Loughman J. et al.Augmentation of macular pigment following implantation of blue light-filtering intraocular lenses at the time of cataract surgery.Invest Ophthalmol Vis Sci. 2009; 50: 4777-4785Crossref PubMed Scopus (42) Google Scholar in which MPOD was shown to remain stable at 1 year postoperatively in those who underwent cataract surgery and implantation of a clear intraocular lens implant. Data on iris color was collected from 83 subjects during the study, who were categorized into dark (n = 23) and light (n = 60) irides. No effect of iris color (dark vs light irides) was observed at any retinal eccentricity. As with cataract surgery, iris color had no impact on MPOD status between “Fovea-Not-involved” and “Fovea-Involved” subgroups in the general linear model analysis. The iris color data were not included in our manuscript because it was assumed (and proven) not to be an important confounding variable. The effect of iris color on MPOD is conflicting.3Hammond Jr., B.R. Fuld K. Snodderly D.M. Iris color and macular pigment optical density.Exp Eye Res. 1996; 62: 293-297Crossref PubMed Scopus (109) Google Scholar, 4Loughman J. Nolan J.M. Howard A.N. et al.The impact of macular pigment augmentation on visual performance using different carotenoid formulations.Invest Ophthalmol Vis Sci. 2012; 53: 7871-7880Crossref PubMed Scopus (89) Google Scholar It should be noted that the Irish population is predominantly white, which was reflected in our study sample with only 3 subjects of non-white descent (1 African, 1 Indian, and 1 South Asian ethnicity). Ethnic origin, therefore, was not a factor in our study. Last, we would like to point out that the paper by Darzins et al as referenced by Çalişkan and Gürdal did not indicate that “excessive exposure to light may affect MPOD levels” as otherwise suggested. On the contrary, Darzins et al reported that sun exposure was greater in control subjects compared with those with age-related macular degeneration but did not study MPOD status. There is a paucity of information on light exposure on MPOD, and it is typically never reported in macular pigment studies. Contrary to Çalişkan and Gürdal's suggestion that it might be a confounding factor, Wenzel et al5Wenzel A.J. Fuld K. Stringham J.M. Light exposure and macular pigment optical density.Invest Ophthalmol Vis Sci. 2003; 44: 306-309Crossref PubMed Scopus (18) Google Scholar in fact reported that MPOD seemed to be unaffected by light exposure. Accurate data pertaining to historic light exposure are very difficult to capture, and given the absence of any proven link to MPOD status, were not included in the current study. Re: Siah et al.: Lower macular pigment optical density in foveal-involved glaucoma (Ophthalmology 2015;122:2029-37)OphthalmologyVol. 123Issue 7PreviewWe read with interest the recent paper by Siah et al.1 The authors examined the relationship between macular pigment optical density (MPOD) and structural parameters of the macula and optic nerve head in glaucomatous eyes using optical coherence tomography and found that a statistically significant difference in MPOD between the “fovea-not-involved” and “fovea-involved” ganglion cell complex subgroups at all retinal eccentricities. In a general linear model analysis, although foveal involvement (“fovea-not-involved” vs “fovea-involved” subgroups) had a significant effect on MPOD, factors including age, years diagnosed with glaucoma, smoking status, and body mass index had no effect on MPOD. Full-Text PDF" @default.
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