Does Lutein & Zeaxanthin Decrease the Risk of Macular Degeneration?

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The current body of evidence suggests that lutein and zeaxanthin play a significant role in reducing the risk and progression of age-related macular degeneration. Clinical trials, systematic reviews, and mechanistic studies all support the beneficial effects of these carotenoids in protecting the retina from oxidative stress and inflammation. Increasing dietary intake of lutein and zeaxanthin through food sources or supplements may be a viable strategy for AMD prevention and management.

Age-related macular degeneration (AMD) is a leading cause of vision loss among older adults. The condition is characterized by the deterioration of the central portion of the retina, known as the macula, which is responsible for central vision. Recent research has focused on the potential protective effects of dietary carotenoids, particularly lutein and zeaxanthin, in reducing the risk and progression of AMD. This article reviews the current evidence on the role of these carotenoids in AMD prevention and management.

The Role of Lutein and Zeaxanthin

Lutein and zeaxanthin are xanthophyll carotenoids that accumulate in the retina, specifically in the macula, where they are known as macular pigments. These carotenoids are thought to protect the retina from oxidative stress and blue light-induced damage, which are major contributing factors to AMD.

Evidence from Clinical Trials

Several clinical trials have investigated the effects of lutein and zeaxanthin supplementation on AMD progression. The Age-Related Eye Disease Study 2 (AREDS2) is one of the most significant studies in this area. The study found that replacing beta carotene with lutein and zeaxanthin in the AREDS formulation reduced the risk of progression to late AMD. Specifically, the hazard ratio (HR) for progression to late AMD was 0.91 (95% CI, 0.84-0.99; P = .02) when comparing lutein/zeaxanthin with no lutein/zeaxanthin. Another report from the AREDS2 study showed that the hazard ratio for the development of late AMD was 0.90 (95% CI, 0.82-0.99; P = .04) for lutein/zeaxanthin supplementation compared to no supplementation.

Systematic Reviews and Meta-Analyses

A systematic review and meta-analysis evaluated the relationship between dietary intake of lutein and zeaxanthin and AMD risk. The analysis found that while dietary intake of these carotenoids was not significantly associated with a reduced risk of early AMD, it was significantly related to a reduction in the risk of late AMD (RR 0.74; 95% CI 0.57-0.97) and neovascular AMD (RR 0.68; 95% CI 0.51-0.92).

Mechanisms of Action

The protective effects of lutein and zeaxanthin are primarily attributed to their antioxidant properties and their ability to filter blue light. These carotenoids reduce photooxidation in the central retina, thereby protecting photoreceptor cells from oxidative damage. Additionally, lutein and zeaxanthin have been shown to modulate the expression of inflammation-related genes in retinal pigment epithelial cells, further contributing to their protective effects against AMD.

Dietary Sources and Bioavailability

Lutein and zeaxanthin are found in high concentrations in dark green leafy vegetables, such as kale and spinach, as well as in other foods like corn and egg yolks. The bioavailability of these carotenoids can be enhanced by consuming them with dietary fats. Studies have shown that dietary supplementation with lutein and zeaxanthin increases macular pigment optical density (MPOD), which is associated with improved visual function in patients with early AMD.

 


Does lutein & zeaxanthin decrease the risk of macular degeneration?

Kevin J O’Brien has answered Near Certain

An expert from University of Georgia in Psychology, Vision Sciences

Carotenoids are a group of pigments found in nature which are primarily produced by plants. Carotenoids can be classified as either carotenes (such as the familiar beta-carotene) or xanthophylls. There are three xanthophylls which are of particular in the context of macular degeneration. These are lutein (L), zeaxanthin (Z), and meso-zeaxanthin (MZ), which are all isomers of one another. Most xanthophylls in the human diet are not absorbed into serum. Of the ones that are absorbed into serum, L, Z, and MZ are the only ones we see in significant concentration in the retina. This accumulation, which is generally most dense in the fovea and typically absent outside of the macula, is known as the macular pigment (MP).

MP can only be derived from diet, as humans do not produce their own carotenoids. Two features of MP are of interest with regards to macular degeneration. First, all 3 components of MP are anti-oxidants, which means their presence in the tissue of the macula helps to reduce oxidative damage. This is particularly important, as the retina is, for its size, the most metabolically active tissue in the human body and thus has a high level of oxygen consumption, making it vulnerable to oxidative stress. Second, all 3 components of MP are selective filters of shorter wavelengths in the visible spectrum. Shorter wavelengths of light carry more energy, and thus cause more energetic damage to the retina (hence the “blue light hazard”). Between reducing oxidative stress and reducing energetic damage from visible light, MP offers significant protective effects to the macula.

The largest examination of the protective effects of L & Z supplementation in recent years is most likely the AREDS 2 (Age Related Eye Disease Study 2), about which details can be found here: https://nei.nih.gov/areds2

Other recent publications which may be of interest are “Intakes of Lutein, Zeaxanthin, and Other Carotenoids and Age-Related Macular Degeneration During 2 Decades of Prospective Follow-up” by Wu (2015), “Effect of Lutein and Zeaxanthin on Macular Pigment and Visual Function in Patients with Early Age-related Macular Degeneration” by Ma et al (2012).

In recent years, the market for L & Z supplements has grown dramatically, and options span a wide price range. If you are comparing two or more supplement options based purely on L or Z content (or the total amount between the two), you can find the concentration per dose (typically this is reported in milligrams, but be aware that some supplements will list it in micrograms), multiply that by the number of doses per bottle, and divide the price by the result. This will provide you the price per milligram, which may inform your decisions. Naturally, before starting or modifying any dietary supplementation, you should consult your health care provider(s).

 

Does lutein & zeaxanthin decrease the risk of macular degeneration?

Rajalekshmy Shyam has answered Likely

An expert from Indiana University Bloomington in Biochemistry, Ophthalmology

There is decrease in advancement of AMD with the consumption of lutein and zeaxanthin. A large study, AREDS2, sponsored by the National Eye Institute showed that the addition of lutein and zeaxanthin can in fact reduce the progression of AMD significantly. You can find more information here – https://nei.nih.gov/areds2/PatientFAQ

 

Does lutein & zeaxanthin decrease the risk of macular degeneration?

João Varela has answered Likely

An expert from University of Algarve in Microbiology

This question is a loaded one, because it actually is not that simple. I agree with what Kevin has said to a large degree, but the question itself should be refined. In general, if you are healthy and have a healthy diet that is rich in carotenoids, you should be fine and you would not need any dietary supplements. This has been shown in several clinical studies (e.g., AREDS2) that usually carotenoid-containing supplements do not prevent significantly macular degeneration if you have a healthy diet or you are in the early stages of age-related macular degeneration. However, they seem to be beneficial to patients with intermediate- to advanced age-related degeneration. Thus, the answer depends on whom you are talking about.

 

Does lutein & zeaxanthin decrease the risk of macular degeneration?

Victoria M Flood has answered Likely

An expert from University of Sydney in Population Biology, Dietetics, Geriatrics

Lutein and zaaxanthin (LZ) are carotenoids found in the pigment of our retina, which likely have an important role in protecting our macula, acting as antioxidants to protect against oxidative damage to the eye. We know from observation studies of older people over time, those who consume larger amounts of LZ in their diet, from foods such as dark green leafy vegetables, are less likely to develop macular degeneration. More recently a randomised trial tested supplements with LZ and found they were able to slow the degeneration of the macula, in particular where diet Is low in LZ. This study implies that if you consume afequate amounts of LZ from diet, then taking a supplement may not add additional benefit, but may be good for some people. It would be good if your mother could seek advice from her health professionals for more taylored advice.

 

Does lutein & zeaxanthin decrease the risk of macular degeneration?

Paul S Bernstein has answered Likely

An expert from Moran Eye Center, University of Utah in Ophthalmology, Biochemistry

In my clinical practice, I follow the evidence-based AREDS2 guidelines for lutein and zeaxanthin supplementation in patients with intermediate and advanced AMD.  Benefits of supplementation are less certain for the “worried well” with positive family histories of AMD, so I emphasize diets rich in carotenoids rather than supplementation.  The fact that lutein and zeaxanthin are specifically concentrated in the human macula certainly suggests their importance in ocular physiology and prevention of disease. 

 

Does lutein & zeaxanthin decrease the risk of macular degeneration?

Johannes von Lintig has answered Likely

An expert from Case Western Reserve University in Ophthalmology, Nutrition, Biochemistry

Primates, including humans, have evolved mechanisms to accumulate zeaxanthin and lutein in the central parts of the retina. These macula pigments possess unique physical and chemical properties as antioxidants and filters of damaging blue light. Additionally, these pigments enhance visual performance by increasing visual acuity and and contrast sensitivity.

Age-related macula degeneration (AMD), is a medical condition which may result in blurred or no vision in the center of the visual field. The etiology of the disease is multi-factorial and is influenced by environment and genetics. Epidemiological studies support a protective influence of dietary zeaxanthin and lutein for advanced AMD. Moreover, conditions that are associated with lower macula pigment density in the eyes are considered as risk factors for AMD. Thus, it seems to be plausible that dietary lutein and zeaxanthin can decrease the overall risk of AMD. 

 

Does lutein & zeaxanthin decrease the risk of macular degeneration?

John G Lawrenson has answered Unlikely

An expert from City University of London in Epidemiology, Ophthalmology

Although the risk reduction achieved by increasing consumption of lutein and zeaxanthin (either through diet or supplementation) is biologically plausable, research evidence does not currently provide strong support for this recommendation.

 

Does lutein & zeaxanthin decrease the risk of macular degeneration?

Jennifer R Evans has answered Unlikely

An expert from London School of Hygiene and Tropical Medicine in Epidemiology

Vitamins and other nutrients are important for health, including eye health. Lutein and zeaxanthin are found in the back of the eye and are likely to have a protective role. To answer the question whether taking lutein and zeaxanthin supplements decreases the risk of developing macular degeneration, we need to compare what happens for people who take lutein and zeaxanthin supplements and people who do not, and we need a fair comparison. Robust studies are ones where people are randomly allocated to supplement or placebo and followed up to see whether they develop macular degeneration.

As far as I am aware, there are no robust studies that demonstrate conclusively that lutein and zeaxanthin supplements prevent macular degeneration. We updated our Cochrane review on antioxidant vitamins and the prevention of age-related macular degeneration (AMD) last year and found no studies that compared the risk of AMD in people taking lutein and zeaxanthin supplements with the risk of AMD in people taking placebo. DOI: 10.1002/14651858.CD000253.pub4.

There are more studies of the effect of these supplements in people who already have AMD. One robust study (AREDS) compared a mixture of antioxidant vitamins (C, E and beta-carotene) plus zinc with placebo. People with AMD taking this supplement, known as the AREDS formula, were less likely to progress to advanced disease and vision loss compared to people taking placebo. However, this supplement did not contain lutein or zeaxanthin. In a later study (AREDS2) the investigators modified the AREDS formula to include lutein and zeaxanthin and compared this to the AREDS formula without lutein and zeaxanthin. There was little or no difference between these groups in risk of progression of AMD to advanced disease. In subsequent analysis of this study, the authors of AREDS2 suggest that lutein and zeaxanthin could replace beta-carotene in the AREDS formula. There are a handful of smaller studies of lutein and zeaxanthin for people with AMD, but they are not large enough to provide useful information on the progression of the disease. The AREDS supplement has only been evaluated in people with AMD – there are no published studies of this supplement in the general population to prevent AMD. More information can be seen in our Cochrane review on progression of AMD which was updated last year. DOI: 10.1002/14651858.CD000254.pub4

It is worth noting that the data from AREDS suggest that there would be approximately 4 fewer cases of progression to late AMD for every 1000 people with very early signs of AMD, if they take the combination of vitamins used in that study. We don’t know what happens in people without AMD, but their risk of progression to late AMD is likely to be even lower than people with early signs of the disease. This means that the chances of benefiting will be even lower. It is also worth noting that the results of AREDS are not universally recognised as conclusive evidence – for example the National Institute for Health and Clinical Excellence in the UK did not make a recommendation on vitamin supplements in their latest guidance for macular degeneration.

This discussion has related to supplements only. A healthy diet with plenty of fruit and vegetables will have many benefits. 

 

Does lutein & zeaxanthin decrease the risk of macular degeneration?

El-Sayed M Abdel-Aal has answered Likely

An expert from Agriculture and Agri-Food Canada in Food Science

Several recent and reliable studies have shown that lutein and zeaxanthin are linked with reduced risk of age-related macular degeneration (ADM) and cataracts. In fact, lutein and zeaxanthin are the principal pigments found in the yellow spot of the human retina. They provide several protective functions, including the protection of the macula from damage by blue light and combating harmful reactive oxygen species as being antioxidants. Oxidative stress, aging and smoking are known to cause cataracts and AMD. Other antioxidants such as vitamin C and zinc have also been associated with reduced risk of cataracts and AMD.

Lutein and zeaxanthin are carotenoid pigments that impart yellow or orange color to various common foods such as cantaloupe, pasta, corn, carrot, orange/yellow pepper, egg yolk, and green leafy vegetables (kale, spinach, and broccoli). They are also available as dietary supplements. Since the human body can’t synthesize carotenoids they must be provided in the diet. But, the efficacy of lutein and zeaxanthin to exert its physiological effects is subject to its bioavailability and uptake by tissues. It is important to consider not only the amount of lutein and zeaxanthin in a food or supplement but also their bioavailability or uptake by human tissues. Egg yolk is a good example for food that contains high amount of bioavailable lutein.

 

Does lutein & zeaxanthin decrease the risk of macular degeneration?

Masoumeh Jorjani has answered Likely

An expert from Shahid Beheshti University of Medical Sciences in Pharmacology

Zeaxanthin and xanthophylls such as lutein are important carotenoids in the human retina macular pigment. Patients with age related ophthalmologic diseases have lower xanthophylls density in the retina; zeaxanthin and dietary lutein levels are possibly inversely associated with the risk of retinal diseases and cataracts.

 

Does lutein & zeaxanthin decrease the risk of macular degeneration?

Sajad Fakhri has answered Likely

An expert from Shahid Beheshti University of Medical Sciences in Neurobiology

As we mentioned in a part of our article “Astaxanthin: A Mechanistic Review on its Biological Activities and Health benefits “, I think that “Zeaxanthin and xanthophylls such as lutein are important carotenoids in the human retina macular pigment. Their retinal concentration is associated with age related macular degeneration. Patients with age related ophthalmologic diseases have lower xanthophylls density in the retina; zeaxanthin and dietary lutein levels are possibly inversely associated with the risk of retinal diseases and cataracts”.

 

Does lutein & zeaxanthin decrease the risk of macular degeneration?

David I.  Thurnham has answered Likely

An expert from Ulster University in Nutrition

The simple answer is yes. I would qualify that answer by saying that the source of the two xanthophylls should be from food. i.e. green vegetables, some fruits and egg yolks. Some foods also contain meso-zeaxanthin (MZ) but the main source of MZ is from lutein via endogenous synthesis in the eye.

I specify food rather than supplements as the intake of lutein should be a lifelong habit as there are many other important substances in food (some known and some unknown) which may also be important for MZ synthesis and/or to provide other health benefits.

 

Does lutein & zeaxanthin decrease the risk of macular degeneration?

Jaromír Lachman has answered Likely

An expert from Czech University of Life Sciences Prague in Phytology, Physiology

My simple answer is generally yes. These two xanthophylls, lutein and zeaxanthin are contained in green vegetables, main crops in nutrition, like corn (Zea mays), cereals and potatoes with yellow-grained endosperm cereal cultivars, yellow-fleshed potato tubers, etc. I think that their role is protective and rather protective against the risk of AMD. I prefer the intake in vegetables, fruits, juices and other kinds of foods, but of course in food supplements they can be many times concentrated. You can obtain more information about the latest research about  at e.g. Sciencedirect. com.

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