Reply to Green-Gomez et al. Comment on "Richer et al. Night Vision and Carotenoids (NVC): A Randomized Placebo Controlled Clinical Trial on Effects of Carotenoid Supplementation on Night Vision in Older Adults. Nutrients 2021, 13, 3191".

We welcome the additional reviews and insights of Green-Gomez, Roche and Nolan [...].

Night Vision and Carotenoids (NVC): A Randomized Placebo Controlled Clinical Trial on Effects of Carotenoid Supplementation on Night Vision in Older Adults.

Twilight and low luminance levels are visually challenging environments for the elderly, especially when driving at night. Carotenoid rich diets are known to increase macular pigment optical density (MPOD), which in turn leads to an improvement in visual function. It is not known whether augmenting MPOD can lead to a decrease in vision related night driving difficulties. Additionally, it is unknown if carotenoid supplementation provides additional measurable benefits to one's useful field of view (UFOV) along with a decreased composite crash risk score. The aim of the study was to evaluate changes in night vision function and UFOV in individuals that took carotenoid vitamin supplements for a six-month period compared to a placebo group. METHODS: A prospective, randomized, double-blind, six-month trial of a 14 mg zeaxanthin/7 mg lutein-based supplement was carried out. Participants were randomized into active or placebo group (approx 2:1). RESULTS: n = 33 participants (26 males/7 females) participated with 93% capsule intake compliance in the supplemented group (n = 24) and placebo group (n = 9). MPOD (mean/standard error SE) in the active group increased in the Right eye from 0.35 density units (du)/0.04 SE to 0.41 du/0.05 SE; p < 0.001 and in the Left eye from 0.35 du/0.05 SE to 0.37 du, p > 0.05). The supplemented group showed significant improvements in contrast sensitivity with glare in both eyes with improvements in LogMAR scores of 0.147 and 0.149, respectively (p = 0.02 and 0.01, respectively), monocularly tested glare recovery time improved 2.76 and 2.54 s, respectively, (p = 0.008 and p = 0.02), and we also noted a decreased preferred luminance required to complete visual tasks (p = 0.02 and 0.03). Improvements in UFOV scores of divided attention (p < 0.001) and improved composite crash risk score (p = 0.004) were seen in the supplemented group. The placebo group remained unchanged. CONCLUSIONS: The NVC demonstrates that augmenting MPOD in individuals with difficulty in night vision showed measurable benefits in numerous visual functions that are important for night vision driving in this small sample RCT. Additionally, we observed an improvement in UFOV divided attention test scores and decreased composite risk scores.

Weight-for-Age Percentile as a Pediatric Predictor of Emergency Department Outcome.

This study is a retrospective cohort study that examines the association between weight-for-age percentile and pediatric admission incidence from the emergency department (ED) for all diagnoses. The charts of 1432 pediatric patients under 18 years with ED visits from 2013 to 2015 at a tertiary children's hospital were reviewed. Analyses of subject age/weight stratifications were performed, along with ED disposition, reason for visit, and Emergency Severity Index (ESI). Multivariable logistic regression models were used to evaluate the independent effect of weight-for-age percentile on ED disposition while controlling for age, ESI, and reason for visit. Underweight subjects were more likely to be admitted than their normal weight counterparts when analyzed overall (odds ratio [OR] = 2.58, P < .01) and by age: less than 2.0 years of age (OR = 2.04, P = .033), between 2.01 and 6.0 years of age (OR = 8.60, P = .004), and between 6.01 and 13.0 years of age (OR = 3.83, P = .053). Younger age (OR = 0.935, P < .001) and higher acuity (OR = 3.49, P < .001) were also significant predictors of admission. No significant associations were found between weight and likelihood of admission for patients older than 13.01 years or between overweight/obese weight categories and admission for any age subgroups. This study suggests that underweight children younger than 13 years are at higher risk to be admitted from the ED than their normal weight, overweight, and obese counterparts. Even when controlling for other key factors, such as the ESI, a lower weight-for-age percentile was a reliable predictor of hospitalization.