Of Vanishing Retinal Drusen and Oxysterols

Abstract

Aim: Spontaneous resolution of retinal drusen is a common occurrence in ophthalmology, but little is understood about the mechanistic pathophysiology of this phenomenon. Small molecules, taken orally, such as resveratrol (RV) and zeaxanthin (Z), resolve retinal drusen and amyloid protein, yet few clinicians are aware of this molecular, biochemical progress against the major degenerative disease(s) of ageing. Published Data: We highlight the mechanistic role of resveratrol (RV) in the cytochrome P450 enzymatic pathways of liver detoxification, as well as dosing considerations. RV has demonstrated utility in age-related macular degeneration (AMD) and has application in disorders of cognition (Alzheimer's Disease) and age-related hearing loss. We highlight the clinical evidence for the use of an epigenetic RV nutraceutical matrix called Longevinex®, and the xanthophyll carotenoid zeaxanthin. Longevinex® has been employed against retinal drusen, with resulting normalisation of retinal anatomy, Amsler Grid field loss (scotomas) and distortions of the central visual field (metamorphopsia). Implications: The published evidence for RV and Z resolving structural and functional deficits in AMD is presented. The xanthophyll carotenoid zeaxanthin has now been demonstrated, in a larger population clinical trial, to resolve drusen beyond normal expectation. Both RV and Z have also both shown to induce denser macular pigment, and such small molecules likely play a role in multisensory degeneration(s) of ageing. Conclusion: Previously described “spontaneous resolution” of drusen may have an unappreciated biological mechanism(s). The adjunct and complimentary wound healing benefits of RV and Z remain clinically underutilised in age-related retinal and neuro-degeneration associated diseases of ageing, while the complications of chronic ophthalmologic anti-vascular endothelial growth factor intravitreal injections emerge as problematic.