What is the role of lutein and zeaxanthin supplements in the prevention of Age-related Macular Degeneration (AMD)?

From the Guidelines

Lutein and zeaxanthin supplements are recommended for preventing age-related macular degeneration (AMD) progression, particularly for individuals at high risk, as evidenced by the AREDS2 formulation 1. The role of lutein and zeaxanthin supplements in preventing AMD is supported by recent guidelines, which suggest that these carotenoids can help reduce the risk of disease progression and associated vision loss 1.

Key Points to Consider

• A typical effective dose is 10 mg of lutein and 2 mg of zeaxanthin daily, taken with food to enhance absorption since these are fat-soluble nutrients.
• Many commercial eye health supplements contain these carotenoids in the recommended amounts, often marketed as "AREDS2 formula" supplements.
• These carotenoids work by accumulating in the macula where they act as antioxidants and filter harmful blue light, protecting the delicate photoreceptor cells from oxidative damage.
• They also reduce inflammation in the retina, which is a key factor in AMD progression.

Important Considerations

• While supplements are beneficial, especially for those at higher risk of AMD (family history, smoking, advanced age), they should complement rather than replace a diet rich in leafy greens, yellow/orange vegetables, and egg yolks, which naturally contain these nutrients.
• Consult with an eye care professional before starting supplements, particularly if you have existing eye conditions or are taking other medications.
• Early treatment of AMD is associated with a more favorable prognosis, and anti-vascular endothelial growth factor (VEGF) treatment given within 2 years after diagnosis of neovascular AMD in non-Hispanic white patients has been shown to reduce legal blindness and visual impairment 1.

High-Risk Groups

• Individuals at high risk for AMD progression, such as those with a family history, smokers, and advanced age, should be considered for the AREDS2 formulation.
• An estimated 8 million persons at least 55 years old in the United States have monocular or binocular intermediate AMD or monocular advanced AMD, and they should be considered for the AREDS2 formulation 1.

From the Research

Role of Lutein and Zeaxanthin in AMD Prevention

• Lutein and zeaxanthin are dietary carotenoids that have been investigated for their use in promoting visual health, particularly in the prevention of Age-related Macular Degeneration (AMD) 2, 3, 4, 5, 6.
• The mechanism of protection that lutein and zeaxanthin confer is unknown, but two mechanisms have been hypothesized: they may protect the macula and photoreceptor outer segments throughout the retina from oxidative stress and play a role in an antioxidant cascade that safely disarms the energy of reactive oxygen species 5.
• Several studies have been conducted to assess the relationship between plasma levels of lutein and zeaxanthin and the risk of developing AMD, and have yielded conflicting results 2, 4.
• Increased dietary intake of or supplementation with lutein and zeaxanthin was found to result in increased plasma levels, which were positively and significantly associated with macular pigment optical density 2, 6.
• Limited data have suggested that supplementation may also improve visual function, with one study showing that supplementation with lutein, zeaxanthin, and omega-3 long-chain polyunsaturated fatty acids resulted in a significant increase in macular pigment optical density and an improvement in best-corrected visual acuity in patients with non-exudative AMD 6.

Optimal Dose and Clinical Benefit

• The optimal dose of lutein and zeaxanthin for the prevention or treatment of AMD has not yet been defined 2.
• A definite association between lutein and zeaxanthin supplementation and clinical benefit has yet to be shown, but it may still be an appropriate cautionary measure for patients at high risk for developing AMD 2, 3.
• One study found that supplementation with a fixed combination of lutein, zeaxanthin, omega-3 long-chain polyunsaturated fatty acids, and antioxidants resulted in a considerable increase in macular pigment optical density, with no difference in accumulation between two different dosages 6.

Association with Reduced Risk of AMD

• High dietary intakes of omega-3 fatty acids and macular pigments lutein/zeaxanthin are associated with lower risk of prevalence and incidence in AMD 3.
• The Age-Related Eye Disease study (AREDS) showed a beneficial effect of high doses of vitamins C, E, beta-carotene, and zinc/copper in reducing the rate of progression to advanced AMD in patients with intermediate AMD or with one-sided late AMD, and the AREDS-2 study suggested that lutein and zeaxanthin may substitute beta-carotene due to its potential relationship with increased lung cancer incidence 3.