Effect of supplementation with lutein and zeaxanthin on visual performance, development and progression of age-related macular degeneration.

Lutein and zeaxanthin help with night vision, distance vision, close vision and color vision.

Lutein and zeaxanthin are macular carotenoids of dietary origin. Lutein is the main pigment in macula and together with its isomer zeaxanthin are also known as macular pigments or zanthophylls. There is large body of scientific evidence on eye health benefits of macular pigments, which have been tested in many clinical studies including the AREDS2 clinical study that showed benefits of lutein and zeaxanthin in reducing the risk of progression of age-related macular degeneration.

According to reports by British Nutrition Foundation (BNF), natural carotenoids lutein and zeaxanthin may help protect against poor eye health in later life.

Lutein is a naturally occurring pigment found in dark green leafy vegetables such as spinach, kale and collard greens. Lutein is thought to act as an antioxidant and photoprotectant. It plays an important protecting role in our eye by acting as a kind of natural sun block protecting the retina against damaging effects of too much light. Because free radicals may play a role in macular degeneration, the effect of lutein on eye is also attributable to its antioxidant property, protecting retina from damaging effect of light.

It is well established that low dietary intake of lutein/zeaxanthin is inversely associated with development of Age-related Macular Degeneration (AMD).

Experiments have shown that regular consumption of lutein at 10 mg/day can increase the macular pigment optical density (MPOD) in the eye, which may potentially reduce the risk for development of AMD. Lutein supplementation also stabilized visual acuity, and increased vision related quality of life in patients with AMD. No evidence of harmful side effect was found in many of the related studies.

Individuals using lutein supplements experienced significant improvements in several objective measurements of visual function including glare recovery, contrast sensitivity, and visual acuity compared to individual who took only placebo.

These in vitro findings support the epidemiologic evidence that dietary supplements may act as factors that modulate processes implicated in AMD pathogenesis and its progression.

Lutein may also be useful for treatment of retinitis pigmentosa, an inherited form of eye disease that causes progressive vision loss.

Despite the importance of eye health benefits of xanthophylls, recent data suggest that dietary intake levels of these two pigments declined in Europe and the US. The average American ingests about one to two mg of lutein daily, supporting the discussion for daily supplementation with lutein at levels of 6 to 10 mg daily.

It is important to remember that our body cannot synthesize lutein and zeaxanthin, and they need to be supplied through a balanced diet or by a nutritional supplement. Despite the beneficial effects of macular pigments, their dietary intake levels declined in Europe and the US. Fortunately, dietary supplementation by lutein and zeaxanthin can help increase serum and macular levels of these important carotenoids.

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Selected references on benefits of lutein  zeaxanthinin age-related macular degeneration (AMD):

1- Johnson EJ, Chung HY, Caldarella SM, Snodderly DM. (2008). The influence of supplemental lutein and docosahexaenoic acid on serum, lipoproteins, and macular pigmentation. Am J Clin Nutr 87:1521-529.
2- Chucair AJ, Rotstein NP, Sangiovanni JP, During A, Chew EY, Politi LE. (2007). Lutein and zeaxanthin protect photoreceptors from apoptosis induced by oxidative stress: relation with docosahexaenoic acid. Invest Ophthalmol Vis Sci 48:5168-5177.
3- Rotstein NP, Politi LE, German OL, Girotti R. (2003). Protective effect of docosahexaenoic acid on oxidative stress-induced apoptosis of retina photoreceptors. Invest Ophthalmol Vis Sci 44: 2252-2259.
4- Landrum JT, Bone RA, Kilburn MD. (1997). The macular pigment: a possible role in protection from age-related macular degeneration. Adv Pharmacol 38:537-556.
5- Huang LL, Coleman HR, Kim J, de Monasterio F, Wong WT, Schleicher RL, Ferris FL 3rd, Chew EY. (2008). Oral supplementation of lutein/zeaxanthin and omega-3 long chain polyunsaturated fatty acids in persons aged 60 years or older, with or without AMD. Invest Ophthalmol Vis Sci 49:3864-3869.
6-Richer S, Devenport J, Lang JC. (2007). LAST II: Differential temporal responses of macular pigment optical density in patients with atrophic age-related macular degeneration to dietary supplementation with xanthophylls. Optometry (St Louis, Mo ) 78: 213-219.
7- Richer S, Stiles W, Statkute L, Pulido J, Frankowski J, Rudy D, Pei K, Tsipursky M, Nyland J. (2004). Double-masked, placebo-controlled, randomized trial of lutein and antioxidant supplementation in the intervention of atrophic age-related macular degeneration: the Veterans LAST study (Lutein Antioxidant Supplementation Trial). Optometry 75:216-230.
8-Trieschmann M, Beatty S, Nolan JM, Hense HW, Heimes B, Austermann U, et al. (2007). Changes in macular pigment optical density and serum concentrations of its constituent carotenoids following supplemental lutein and zeaxanthin: the LUNA study. Exp Eye Res 84:718-728.
9- Parisi V, Tedeschi M, Gallinaro G, Varano M, Saviano S, Piermarocchi S; CARMIS Study Group. (2007). Carotenoids and antioxidants in age-related maculopathy italian study: multifocal electroretinogram modifications after 1 year. – Ophthalmology 115: 324-333.e2.
10- Bahrami H, Melia M, Dagnelie G. (2006). Lutein supplementation in retinitis pigmentosa: PC-based vision assessment in a randomized double-masked placebo-controlled clinical trial. BMC Ophthalmol 6:23-35.
11-Bartlett H, Eperjesi F. (2004). An ideal ocular nutritional supplement? Ophthalmic Physiol Opt 24:339-49.
12- Barker, FM. (2010) Dietary supplementation: effects on visual performance and occurrence of AMD and cataracts. Current Medical Research & Opinion 26: 2011–2023.