To the Editor:
We read the article recently published in Eye titled “Could the AREDS formula benefit patients with glaucoma?” by Sethi A. and Vajaranant, T.S with great interest [1]. The authors have considered multiple studies examining how components of the AREDS and AREDS2 formulas affect patients with primary open angle glaucoma.
The authors state that there is no evidence supporting any beneficial effect of treatment with beta-carotene for patients with glaucoma.
We disagree. A recent review published in this journal suggests that vitamin A may have a role to play in the treatment of normal tension glaucoma (NTG), by increasing intracranial pressure (ICP) [2]. Multiple studies have found lower ICP in patients with NTG and lowering ICP experimentally induces glaucomatous optic nerve changes [2, 3]. Vitamin A is a proposed causal factor in intracranial hypertension, (specifically all-trans-retinoic acid), and may increase ICP [4]. Vitamin A may reduce the risk of developing glaucoma by increasing ICP and reducing stress forces on the optic nerve at the lamina cribrosa.
Additionally, serum retinol has been shown to be lower in patients with NTG. It is unclear whether this is a causative finding, but the authors also found a positive correlation between serum retinol and optic nerve sheath diameter [5]. Optic nerve sheath diameter is strongly correlated with ICP, so it could be that the pathophysiology behind lower serum retinol concentrations in NTG is related to ICP.
Therefore, although Sethi A et al. found no link between dietary beta-carotene and glaucoma, there is evidence that supports a link via the affect of vitamin A on ICP, and subsequent stress forces on the optic nerve head.
Author contributions
AN researched the articles and around the topic, wrote the original draft and revised for final submission. AJB encouraged AN to research around the topic, contributed to the concept of the letter, provided critical feedback and approved the final version to be published.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
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