In the last two columns, Macular Pigment (MP)’s composition1, its function in blocking blue light, reducing oxidative stress and enhancing visual functions, and how it’s measured (MPOD) are reviewed2. In this column, the research results on supplementing all 3 macular carotenoids in human trials, and the ideal candidates for ocular nutrition will be discussed7-18.
Supplementation of all 3 Macular Carotenoids: Mesozeaxanthin, Zeaxanthin, Lutein
The best natural food source to obtain macular carotenoids are dark green leafy vegetables and orange-yellow fruit for lutein/zeaxanthin,3,4 and fish (fish skin of trout, salmon, sardine and trout flesh) for mesozeaxanthin5,6.
In an ideal world, we eat healthy and exercise daily, our food is not processed nor genetically modified, and our bodies provide carotenoid biosynthesis effectively. However, we all know that is not often the case. There are many ocular nutraceutical supplement choices on the market. Our patients depend on us to review the science, to prescribe evidence based formulas, to protect ocular health, to prevent the disease, and to educate the public.
In the last decade, numerous published human studies research results have shown that a formulation containing all three macular carotenoids is superior to alternative formulation:
• Increase MP, enhance visual function, lowers risk of AMD in healthy and diseased retinas7-12
• Benefit patients with Alzheimer’s disease13
• Lower the risk of nuclear cataract14,15,16
• Improve visual performance, sleep quality, physical symptoms in high screen-time users17
Photo 1. Lutein/Zeaxanthin amounts
Photo 2. Meso-zeaxanthin is produced at an industrial level from the lutein obtained from marigold flower petals18,19
Ideal Candidates for Ocular Nutrition Supplement
• Patients at risk and diagnosed with macular degeneration
• Patients getting cataract surgery
• Patients with diabetes, glaucoma, Alzheimer’s
• Patients who complain of glare or contrast sensitivity disability
• Patients with high visual demand occupations (pilot, athletes, military, police)
• Patients who are high digital screen users (young and old)
1. Shen Lee, Bridgitte. “The Three Musketeers of Macular Pigment”. Optometric Management. August (2017): https://www.optometricmanagement.com/newsletters/blue-light-bulletin/august-2017
2. Shen Lee, Bridgitte. “More about MP and MPOD”. Optometric Management. September (2017): https://www.optometricmanagement.com/newsletters/blue-light-bulletin/september-2017
3. Bone, R. A.; Landrum, J. T.; Friedes, L. M.; Gomez, C. M.; Kilburn, M. D.; Menendez, E.; Vidal, I.; Wang, W. (1997-02-01). "Distribution of lutein and zeaxanthin stereoisomers in the human retina". Experimental Eye Research. 64 (2): 211–218. ISSN 0014-4835. PMID 9176055.
4. Bone, R. A.; Landrum, J. T.; Hime, G. W.; Cains, A.; Zamor, J. (1993-05-01). "Stereochemistry of the human macular carotenoids". Investigative Ophthalmology & Visual Science. 34 (6): 2033–2040. ISSN 0146-0404. PMID 8491553.
5. Nolan, J. M.; Meagher, K.; Kashani, S.; Beatty, S. (2013-08-01). "What is meso-zeaxanthin, and where does it come from?". Eye(London, England). 27 (8): 899–905. ISSN 1476-5454. PMC 3740325
6. Prado-Cabrero, Alfonso; Beatty, Stephen; Stack, Jim; Howard, Alan; Nolan, John M. (2016). "Quantification of zeaxanthin stereoisomers and lutein in trout flesh using chiral high-performance liquid chromatography-diode array detection". Journal of Food Composition and Analysis. 50: 19–22. PMC 5055101
7. Akuffo, K. O.; Nolan, J. M.; Howard, A. N.; Moran, R.; Stack, J.; Klein, R.; Klein, B. E.; Meuer, S. M.; Sabour-Pickett, S. (2015-07-01). "Sustained supplementation and monitored response with differing carotenoid formulations in early age-related macular degeneration". Eye (London, England). 29 (7): 902–912. ISSN 1476-5454. PMC 4506345. PMID 25976647. doi:10.1038/eye.2015.64.
8. Loughman, James; Nolan, John M.; Howard, Alan N.; Connolly, Eithne; Meagher, Katie; Beatty, Stephen (2012-11-01). "The impact of macular pigment augmentation on visual performance using different carotenoid formulations". Investigative Ophthalmology & Visual Science. 53 (12): 7871–7880. ISSN 1552-5783. PMID 23132800. doi:10.1167/iovs.12-10690.
9. Meagher, Katherine A.; Thurnham, David I.; Beatty, Stephen; Howard, Alan N.; Connolly, Eithne; Cummins, Wayne; Nolan, John M. (2013-07-28). "Serum response to supplemental macular carotenoids in subjects with and without age-related macular degeneration". The British Journal of Nutrition. 110 (2): 289–300. ISSN 1475-2662. PMID 23211762. doi:10.1017/S0007114512004837.
10. Nolan, John M.; Akkali, Mukunda C.; Loughman, James; Howard, Alan N.; Beatty, Stephen (2012-08-01). "Macular carotenoid supplementation in subjects with atypical spatial profiles of macular pigment". Experimental Eye Research. 101: 9–15. ISSN 1096-0007. PMID 22652506. doi:10.1016/j.exer.2012.05.006.
11. Sabour-Pickett, Sarah; Beatty, Stephen; Connolly, Eithne; Loughman, James; Stack, Jim; Howard, Alan; Klein, Ronald; Klein, Barbara E.; Meuer, Stacy M. (2014-09-01). "Supplementation with three different macular carotenoid formulations in patients with early age-related macular degeneration". Retina (Philadelphia, PA). 34 (9): 1757–1766. ISSN 1539-2864. PMID 24887490. doi:10.1097/IAE.0000000000000174.
12. Thurnham, David I.; Nolan, John M.; Howard, Alan N.; Beatty, Stephen (2015-08-01). "Macular response to supplementation with differing xanthophyll formulations in subjects with and without age-related macular degeneration". Graefe's Archive for Clinical and Experimental Ophthalmology = Albrecht Von Graefes Archiv Für Klinische Und Experimentelle Ophthalmologie. 253 (8): 1231–1243. ISSN 1435-702X. PMID 25311651. doi:10.1007/s00417-014-2811-3.
13. John M. Nolana,∗, Ekaterina Loskutovaa, Alan Howardb,c, Riona Mulcahyd, Rachel Morana, Jim Stacka, Maggie Bolgerd, Robert F. Coene, Jessica Dennisona, Kwadwo Owusu Akuffoa, Niamh Owensa, Rebecca Powera, David Thurnhamf and Stephen Beattya “The Impact of Supplemental Macular Carotenoids in Alzheimer’s Disease: A Randomized Clinical Trial.” Journal of Alzheimer’s Disease (2015). ISSN 1387-2877 PMID 25408222
14. SanGiovanni JP, Chew EY, Clemons TE (September 2007). "The relationship of dietary carotenoid and vitamin A, E, and C intake with age-related macular degeneration in a case-control study: AREDS Report No. 22". Arch. Ophthalmol. 125 (9): 1225–32. PMID 17846363.
15. Moeller SM, Voland R, Tinker L, Blodi BA, Klein ML, Gehrs KM, Johnson EJ, Snodderly DM, Wallace RB, Chappell RJ, Parekh N, Ritenbaugh C, Mares JA (2008). "Associations between age-related nuclear cataract and lutein and zeaxanthin in the diet and serum in the Carotenoids in the Age-Related Eye Disease Study, an Ancillary Study of the Women's Health Initiative". Arch Ophthalmol. 126 (3): 354–64. PMC 2562026.
16. "Carotenoids". Micronutrient Information Center, Linus Pauling Institute, Oregon State University, Corvallis. July 2016. Retrieved 10 August 2017.
17. Stringham JM, Stringham NT, O’Brien KJ (2017) “Macular Carotenoid Supplementation Improves Visual Performance, Sleep Quality, and Adverse Physical Symptoms in Those with High Screen-Time Exposure”. Foods 2017, 6, 47; doi:10.3390/foods6070047
18. Torres-Cardona, M.D., Torres-Quiroga, J., (1996). Process for the isomerization of lutein. Industrial Organica, S.A. de C.V., Monterrey, Mexico, US.
19. Kumar, (2012). Xanthophyll Composition Containing Trans, Meso-Zeaxanthin, Trans, R, R-Zeaxanthin AND Trans, R, R-Lutein Useful For Nutrition and Health Care and A Process For Its Preparation.
Dr. Bridgitte Shen Lee earned an optometry degree from University of Houston College of Optometry in 1998. She is the CEO of Vision Optique and iTravelCE. She writes and lectures on the topics of Digital Eye Health, Dry Eye Disease, Anti-Aging Eye Care, Health Care Social Media, and Aesthetic Optometry.
Financial Disclosures: Johnson & Johnson Vision, Shire, Essilor, OCuSOFT, Guardion Health Sciences, Bausch & Lomb, Luxottica