Impact of Dietary Antioxidant Supplements on Atrophic Lesion Progression in Stargardt Disease: A Retrospective Observational Study.

Purpose: To investigate whether supplementation with dietary antioxidants has an effect on the yearly progression rate of atrophic lesions in autosomal recessive Stargardt disease (STGD1), as derived from fundus autofluorescence (FAF). Methods: Retrospective study of patients with molecularly confirmed STGD1 aged ≥ 6 years at baseline and presence of an atrophic lesion of ≥ 250 μm in diameter, who underwent FAF imaging between 01/01/2010 and 10/31/2023. Patients were grouped into supplement takers and nontakers based on the daily intake of lutein, zeaxanthin, saffron, and N-acetylcysteine. Baseline and follow-up FAF images were graded by two readers. Variables assessed included total area of decreased FAF (DAF) and effective lesion size of total DAF, calculated as a square root transformation. Annual atrophy growth rates were calculated for both subgroups and compared. Results: A total of 53 eyes of 53 patients were enrolled. Thirty-three patients were categorized as supplement takers (mean age 34 ± 20.3 years, 57.6% female) and 20 patients as nontakers (mean age 29.5 ± 16.6 years, 65% female). Mean growth rates of DAF were 0.61 ± 0.72 mm²/year for supplement takers and 0.49 ± 0.55 mm²/year for nontakers (p=0.9). The mean observation period was 2 years (range 0.5-5.6) and 4.5 years (range 1-10.3), for supplement takers and for nontakers, respectively. Conclusion: Supplementation with dietary antioxidants did not result in a slower progression rate of DAF lesions in STGD1. Further investigation with randomized trials is needed for evidence-based use of antioxidant supplements for the disease.