Abstract
Objective: Age-related macular degeneration (ARMD) is the macular abnormality causing central vision loss in the elderly. One prevention for ARMD is the provision of antioxidants, such as lutein. Reduced form of glutathione (GSH) is a source of cysteine and sulfhydryl, playing a role in detoxification, transport, and metabolic processes. Both are prospected to have a synergistic effect in the prevention of ARMD. This study aimed to determine the efficacy of GSH addition in lutein supplementation to improve the contrast sensitivity of dry type ARMD patients.
 Methods: This randomized controlled trial was conducted at an eye hospital and a tertiary general hospital from April 2016 to June 2016. This study involved 22 dry ARMD patients. Subjects were randomized and divided into treatment groups with 20 mg lutein with the addition of 500 mg GSH and 20 mg lutein only, for 30 days. Contrast sensitivity measurement was performed with Lea Numbers® Low Contrast Flip Chart before and after the treatment. Contrast sensitivity was analyzed comparatively with paired t-test.
 Results: Contrast sensitivity improvement was observed in both the groups. Contrast sensitivity improvement of the group with additional GSH (3.62±1.44, p<0.05) was a 3-fold of the lutein group only (1.25±0.44, p>0.05). The result was statistically significant for the group treated with GSH addition.
 Conclusion: GSH addition in lutein supplementation provoked better contrast sensitivity improvement in dry ARMD patients.
Highlights
Age-related macular degeneration (ARMD) is a macular disorder characterized by one or more of several symptoms, namely drusen formation, retinal pigment epithelial (RPE) abnormalities in the form of hypopigmentation or hyperpigmentation, atrophic geography of retinal and choriocapillaris pigment epithelium involving the central part of the fovea, and neovascular maculopathy
This study aimed to determine the efficacy of GSH addition in lutein supplementation to improve the contrast sensitivity of dry type ARMD patients
In the treatment group of 20 mg lutein supplementation plus 500 mg GSH, there were more men compared to women, whereas in the group of 20 mg lutein, men and women were equal in number
Summary
Age-related macular degeneration (ARMD) is a macular disorder characterized by one or more of several symptoms, namely drusen formation, retinal pigment epithelial (RPE) abnormalities in the form of hypopigmentation or hyperpigmentation, atrophic geography of retinal and choriocapillaris pigment epithelium involving the central part of the fovea, and neovascular maculopathy (exudative). The World Health Organization estimated that currently 8 million people experiencing blindness were caused by ARMD [4,5]. Disorders in GSH circulation process did not rule out the possibility of GSH oral administration [6,7,8,9,10]. Carotenoids, in this case, lutein and zeaxanthin, possess antioxidant ability by improving macular pigment, which is believed to inhibit retinal damage due to oxidation by inhibiting the entry of blue light, reducing the risk of ARMD [11]
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