Scheie Eye Institute, University of Pennsylvania
Age-related macular degeneration is the leading cause of legal blindness in older Americans. Therefore, it’s important to decrease the risk as much as possible. This article discusses lutein and zeaxanthin, micronutrients found in many fruits and vegetables, and how they may help to protect the macula.
The age-related eye disease studies (AREDS) showed that supplementation with certain micronutrients reduces the risk of progression from intermediate age-related macular degeneration to the advanced stage by 25 percent. Also, a diet rich in fruits and vegetables, as well as twice-weekly meals of fat-rich fish like salmon, sardines, tuna, or mackerel is associated with decreased risk.
There have been two AREDS studies. AREDS1 showed that 15 milligrams (mg) of beta carotene, 500 mg of vitamin C, 400 IU of vitamin E, 80 mg of zinc oxide, and 2 mg of cupric oxide reduced the risk of disease progression. AREDS2 tested the substitution of 10 mg of lutein and 2 mg of zeaxanthin for beta carotene. This substitution did not diminish the effectiveness of the formula and was especially helpful for people who had low-level consumption of lutein and zeaxanthin in their diet.
Beta carotene, lutein, and zeaxanthin are all specific types of phytochemicals (micronutrients from plants) called carotenoids, which are structurally related to vitamin A. Our bodies do not make these micronutrients; however, plants make them, in part, to serve as antioxidants* that protect them from potentially harmful sunlight. When we eat lutein and zeaxanthin, they are transported to the retina, where they are thought to protect against light-induced damage. There’s normally enough lutein and zeaxanthin in the macula, the central part of the retina, to turn this part yellow. In fact, the full name of the macula is macula lutea, which means yellow spot. It has been shown that taking lutein and zeaxanthin supplements leads to increased levels of these antioxidants in the macula.
Foods such as egg yolk (go easy due to cholesterol), yellow corn, orange or yellow peppers, kale, broccoli, spinach, kiwi, grapes, zucchini, and squash have high levels of lutein and/or zeaxanthin.
For people without macular degeneration, the above foods are a good way to decrease the risk of AMD. For those with early macular degeneration, the AREDS2 vitamins are recommended. AREDS1 formula vitamins are no longer recommended as the AREDS2 formula is at least as good, and the beta carotene in AREDS1 increases the risk of lung cancer in current smokers and perhaps also in past smokers.
Family members of people with macular degeneration often ask whether they should take AREDS2 vitamins or lutein/zeaxanthin. While these are safe to take during at least five years (the duration of the AREDS2 study), it is not known whether it would be safe to take them for several decades. Therefore, it is recommended that family members eat foods containing high levels of lutein and zeaxanthin rather than take supplements. These foods also contain hundreds of other phytochemicals that are likely to be helpful.
Clinical studies have shown that taking the right combination of nutritional supplements can be beneficial in the fight against Age Related Macular Degeneration, or AMD. One study, known as the Age-Related Eye Disease Study (AREDS), has shown that multi-vitamins rich in nutrients called antioxidants, plus eye vitamins and minerals, can actually reduce the risk of progression of moderate to advanced AMD, and its associated vision loss. Vitamins C, E, and A, are nutrients rich in antioxidants. They are most abundant in dark, green, leafy vegetables such as spinach, red foods such as peppers, and orange foods such as carrots. While eating foods rich in antioxidants may help, the AREDS study also offers indications that people at higher risk of AMD, should take additional nutritional supplements of zinc and copper. Newer research has shown that supplements of Zeaxanthin (Zee-en-zan-thehn) and Lutein (Loo-teen), are also important for AMD risk reduction. Clinical studies have shown that among those AMD patients most at risk, taking the prescribed combination of nutritional eye vitamin supplements, can help preserve eye health, and reduce the risk of having the disease progress to a more advanced stage. Ask your eye care professional which multi-nutritional eye vitamins are right for you.
* Oxidative stress is a disturbance in the balance between the production of very reactive oxygen-containing molecules that can adversely interact with other molecules inside our cells, and our body’s ability to neutralize these molecules. It can be caused by bright light, a poor diet with not enough antioxidants, and too much iron in the retina. The resulting inflammation can contribute to a number of age-related diseases, including age-related macular degeneration. Antioxidants are molecules present in cells that can prevent these harmful reactions.
Joshua Dunaief, MD, received his BA magna cum laude in Biology from Harvard (1987), MD/PhD from Columbia College of Physicians and Surgeons (1996), completed ophthalmology residency at the Wilmer Eye Institute, Johns Hopkins in 2000, and medical retina fellowship at Scheie Eye Institute, University of Pennsylvania in 2004.
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