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 mm 2 /year for supplement takers and 0.49 ± 0.55 mm 2 /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.