Yellow corneal ring associated with vitamin supplementation for age-related macular degeneration.

PURPOSE: To report the first described cases of peripheral yellow corneal rings secondary to vitamin supplementation for age-related macular degeneration (ARMD). DESIGN: Retrospective single-center case series. PARTICIPANTS: The eyes of 4 patients taking vitamin supplementation for ARMD were examined at the University of Pittsburgh Medical Center Department of Ophthalmology between January 2010 and April 2011. METHODS: We reviewed the medical records of 4 patients with peripheral corneal rings receiving vitamin supplementation for ARMD. MAIN OUTCOME MEASURES: The presence of peripheral yellow corneal rings, skin findings, and serum carotene levels. RESULTS: Each patient had circumferential, yellow, peripheral corneal rings and exhibited subtle yellowing of the skin most notable on the palms. Serum carotene levels were normal in 2 of the 3 patients and markedly elevated in the last patient in whom it was measured. CONCLUSIONS: It is unclear at this time how to counsel patients with this ocular finding. We suspect that these rings are more common than generally appreciated because they may have a subtle appearance or be misdiagnosed as arcus senilis. We suggest that a formal study be performed on a cohort of patients taking vitamin supplementation for macular degeneration that specifically screens for yellow rings and measures serum carotene levels when they are identified.