***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose To compare the impact of sustained supplementation using different macular carotenoid formulations on macular pigment ( MP ) and visual function in early age-related macular degeneration ( AMD ) . Patients and methods Sixty-seven subjects with early AMD were r and omly assigned to : Group 1 ( 20 mg per day lutein ( L ) , 0.86 mg per day zeaxanthin ( Z ) ; Ultra Lutein ) , Group 2 ( 10 mg per day meso-zeaxanthin ( MZ ) , 10 mg per day L , 2 mg per day Z ; Macushield ; Macuhealth ) , Group 3 ( 17 mg per day MZ , 3 mg per day L , 2 mg per day Z ) . MP was measured using customised heterochromatic flicker photometry and visual function was assessed by measuring contrast sensitivity ( CS ) and best-corrected visual acuity ( BCVA ) . AMD was grade d using the Wisconsin Age-Related Maculopathy Grading System ( AREDS 11-step severity scale ) . Results At 3 years , a significant increase in MP from baseline was observed in all groups at each eccentricity ( P<0.05 ) , except at 1.75 ° in Group 1 ( P=0.160 ) . Between 24 and 36 months , significant increases in MP at each eccentricity were seen in Group 3 ( P<0.05 for all ) , and at 0.50 ° in Group 2 ( P<0.05 ) , whereas no significant increases were seen in Group 1 ( P>0.05 for all ) . At 36 months , compared with baseline , the following significant improvements ( P<0.05 ) in CS were observed : Group 2—1.2 , 6 , and 9.6 cycles per degree ( c.p.d . ) ; Group 1—15.15 c.p.d . ; and Group 3—6 , 9.6 , and 15.15 c.p.d . No significant changes in BCVA , or progression to advanced AMD , were observed . Conclusion In early AMD , MP can be augmented with a variety of supplements , although the inclusion of MZ may confer benefits in terms of panprofile augmentation and in terms of CS enhancement BACKGROUND The relation between intakes of total fat and specific types of fat and  age-related macular degeneration ( AMD )  remains unclear . OBJECTIVE Our objective was to examine prospect ively the association between fat intake and AMD . DESIGN We conducted a prospect i ve follow-up study of participants in the Nurses ' Health Study and the Health Professionals Follow-up Study . At baseline ( 1984 for women and 1986 for men ) , the study included 42743 women and 29746 men aged > or = 50 y with no diagnosis of AMD who were followed until 1996 .  Fat intake  was assessed with a food-frequency question naire . RESULTS We accrued 567 patients with AMD with a visual loss of 20/30 or worse . The pooled multivariate relative risk ( RR ) for the highest compared with the lowest quintile of total fat intake was 1.54 ( 95 % CI : 1.17 , 2.01 ; P for trend = 0.008 ) . Linolenic acid was positively associated with risk of AMD ( top versus bottom quintile of RR : 1.49 ; 95 % CI : 1.15 , 1.94 ; P for trend = 0.0009 ) . Docosahexaenoic acid had a modest inverse relation with AMD ( top versus bottom quintile of RR : 0.70 ; 95 % CI : 0.52 , 0.93 ; P for trend = 0.05 ) , and > 4 servings of fish/wk was associated with a 35 % lower risk of AMD compared with < or = 3 servings/mo ( RR : 0.65 ; 95 % CI : 0.46 , 0.91 ; P for trend = 0.009 ) . CONCLUSIONS Total fat intake was positively associated with risk of AMD , which may have been due to intakes of individual fatty acids , such as linolenic acid , rather than to total fat intakes per se . A high intake of fish may reduce the risk of AMD Background The primary objective of LUTEGA is to determine the long-term effect of a supplementation with fixed combination of lutein , zeaxanthin , omega-3-longchain-polyunsaturated-fatty-acids ( O-3-LCPUFAs ) and antioxidants on macular pigment optical density ( MPOD ) in patients with non-exudative age-related macular degeneration ( AMD ) . Methods The LUTEGA study is a double-blind , placebo-controlled clinical trial . 172 patients with non-exudative AMD were enrolled and r and omized to three treatment arms . Supplementation included either once ( dosage D1 ) or twice daily ( dosage D2 ) of 10 mg L / 1 mg Z/ O-3-LCPUFAs ( thereof 100 mg DHA , 30 mg EPA)/ antioxidants , or placebo ( P ) . After best-corrected visual acuity ( BCVA ) test , blood sample was collected and MPOD was measured using the 1-wavelength-reflection method and recording reflection images at 480 nm ( modified VisucamNM/FA , Carl Zeiss Meditec , Germany ) . During 1 year of intervention , AMD patients were followed up after 1 , 3 , 6 and 12 months . 145 AMD patients ( D1 = 50 , D2 = 55 , P = 40 ) completed the study . Results After 12 months of intervention , the MPOD parameters ( volume , area , maxOD , meanOD ) increased significantly in treatment arms D1 and D2 ( p < 0.001 ) . Volume of MPOD showed the highest within-group difference and increased significantly in D1 and D2 , and decreased significantly in P ( p = 0.041 ) . Between-group comparison of absolute changes of all MPOD parameters were significantly different between D1 and P as well as D2 and P with p < 0.001 at end point ( t = 12 ) . BCVA , measured in log MAR , improved in D1 and in D2 ( p < 0.001 ) . After 12 months of intervention , the mean improvement in BCVA was significant in D2 ( p = 0.006 ) and D1 ( p = 0.038 ) compared to P. Conclusions The supplementation of L , Z , O-3-LCPUFAs and antioxidants result ed in considerable increase in MPOD . There was no difference in accumulation of MPOD between both dosages . Thus , we believe that the used supplementation with L and Z seems to reach a saturation level in retinal cell structure . Additionally , the constant supplementation of L , Z , O-3-LCPUFAs and antioxidants in AMD patients seems to be useful , because MPOD reduces without supplementation . We conclude that the supplementation caused an increase of MPOD , which results in an improvement and stabilization in BCVA in AMD patients . Thus , a protective effect on the macula in AMD patients is assumed Abstract Purpose : The Central Retinal Enrichment Supplementation Trials ( CREST ) aim to investigate the potential impact of macular pigment ( MP ) enrichment , following supplementation with a formulation containing 10 mg lutein ( L ) , 2 mg zeaxanthin ( Z ) and 10 mg meso-zeaxanthin ( MZ ) , on visual function in normal subjects ( Trial 1 ) and in subjects with early age-related macular degeneration ( AMD ; Trial 2 ) . Methods : CREST is a single center , double-blind , r and omized clinical trial . Trial 1 ( 12-month follow-up ) subjects are r and omly assigned to a formulation containing 10 mg L , 10 mg MZ and 2 mg Z ( n = 60 ) or placebo ( n = 60 ) . Trial 2 ( 24-month follow-up ) subjects are r and omly assigned to a formulation containing 10 mg L , 10 mg MZ , 2 mg Z plus 500 mg vitamin C , 400 IU vitamin E , 25 mg zinc and 2 mg copper ( Intervention A ; n = 75 ) or 10 mg L and 2 mg Z plus 500 mg vitamin C , 400 IU vitamin E , 25 mg zinc and 2 mg copper ( Intervention B ; n = 75 ) . Contrast sensitivity ( CS ) at 6 cycles per degree represents the primary outcome measure in each trial . Secondary outcomes include : CS at other spatial frequencies , MP , best-corrected visual acuity , glare disability , photostress recovery , light scatter , cognitive function , foveal architecture , serum carotenoid concentrations , and subjective visual function . For Trial 2 , AMD morphology , reading speed and reading acuity are also being recorded . Conclusions : CREST is the first study to investigate the impact of supplementation with all three macular carotenoids in the context of a large , double-blind , r and omized clinical trial BACKGROUND Individuals with early or intermediate stages of age-related macular degeneration ( AMD ) make up a large , growing segment of the elderly population . Evidence is sparse regarding modifiable factors that may decrease the risk of progression to the advanced forms of AMD . OBJECTIVE To advise patients with a high risk for advanced forms of AMD about preventive measures through our evaluation of the relationship between dietary fat intake and the progression of early or intermediate AMD to the advanced stages of the disease associated with visual loss . DESIGN A prospect i ve cohort study with an average follow-up time of 4.6 years . SETTING A hospital-based clinical retinal practice specializing in macular degeneration . Patients The 261 participants were aged 60 years and older and had some sign of nonexudative AMD and visual acuity of 20/200 or better in at least 1 eye . Main Outcome Measure Progression to advanced AMD , which was defined as having geographic atrophy or neovascular disease . RESULTS Higher total  fat  intake increased the risk of progression to the advanced forms of AMD , with a relative risk ( RR ) of 2.90 ( 95 % confidence interval , 1.15 - 7.32 ) for the highest fat-intake quartile relative to the lowest fat-intake quartile , after controlling for other factors ( P trend = .01 ) . Animal fat intake was associated with a 2-fold increased risk of progression ( RR , 2.29 for the highest quartile compared with the lowest quartile ; 95 % confidence interval , 0.91 - 5.72 ) , although the trend for increasing risk with higher animal fat intake was not significant ( P=.09 ) . Higher vegetable fat intake had a stronger relationship with increased risk of AMD progression with an RR of 3.82 ( 95 % confidence interval , 1.58 - 9.28 ) for the highest quartile compared with the lowest quartile ( P trend = .003 ) . Saturated , monounsaturated , polyunsaturated , and transunsaturated fats increased the likelihood of progression ( RR , 2.09 and P trend = .08 ; RR , 2.21 and P trend = .04 ; RR , 2.28 and P trend = .04 ; RR , 2.39 and P trend = .008 , respectively ) . Higher fish intake was associated with a lower risk of AMD progression among subjects with lower linoleic acid intake . Processed baked goods , which are higher in some of these fats , increased the rate of AMD progression approximately 2-fold , and nuts were protective . CONCLUSIONS Among individuals with the early or intermediate stages of AMD , total and specific types of fat intake , as well as some fat-containing food groups , modified the risk of progression to advanced AMD . Fish intake and nuts reduced risk . Since advanced AMD is associated with visual loss and reduced quality of life , these preventive measures deserve additional research and greater emphasis Purpose To evaluate the dynamic remodeling of drusen in subjects with unilateral neovascular age-related macular degeneration ( AMD ) receiving a three-year course of oral docosahexaenoic acid ( DHA ) or placebo .  Setting Institutional setting . Methods Three hundred subjects with age-related maculopathy and neovascular AMD in the fellow eye were r and omly assigned to receive either 840 mg/day DHA or placebo for 3 years . Main outcome measures of this post-hoc sub-group analysis were progression of drusen number , total diameter , and total area on fundus photography , and their association with DHA supplementation , socio-demographic and genetic characteristics . Results Drusen progression was analyzed in 167 subjects that did not develop CNV ( 87 that received DHA and 80 that received placebo ) . None of the drusen remodeling outcomes were significantly associated with DHA supplementation . Total drusen diameter reduction in the inner subfield was significantly associated with age ( older patients : r = -0.17 ; p = 0.003 ) . Women showed a tendency to decreased total drusen diameter in the inner subfield with CFH polymorphism ( p = 0.03 ) , where women with TT genotype tended to have a greater reduction in drusen diameter than other genotypes ( CC and CT ) . Drusen area in the inner subfield was more reduced in older patients ( r = -0.17 ) and in women ( p = 0.01 ) . Drusen number showed no significant trends . Conclusions Dynamic drusen remodeling with net reduction in drusen 
    Output:
    
The results of this meta- analysis demonstrated that fish consumption can reduce AMD risk .