Supplements for maculopathy: the mix of Omega 3, lutein and zeaxanthin works

Supplements for maculopathy: the mix of Omega 3, lutein, and zeaxanthin works

Nutrition also plays a role in age-related macular degeneration. But are there effective supplements for maculopathy? A new study seems to say yes and suggests their ingredients: Omega 3, lutein, and zeaxanthin.

A formulation based on lutein, zeaxanthin, and Omega 3 fatty acids could represent the future of supplements for maculopathy. This is suggested by a study published in the scientific journal JAMA Ophthalmology by a group of researchers coordinated by Volker Böhm, professor at the University of Jena (Germany), according to whom this particular mix of food-derived substances can increase the optical density of macular pigment in those affected by the dry form of age-related macular degeneration.

What is age-related macular degeneration

Age-related macular degeneration (AMD, Degenerazione Maculare Legata all’Età) is the most frequent cause of blindness in industrialized countries and accounts for 8.7% of blindness cases worldwide. It affects Europeans more than other populations, appears mostly after 60 years of age, and involves the central part of the retina, the macula; hence it is a maculopathy.

The macula is responsible for central vision; the portion affected by age-related macular degeneration is its most central part, the fovea, where vision is sharpest. For this reason, living with this condition strongly reduces quality of life: many daily activities require good central vision – for example, reading and driving. Consequently, age-related macular degeneration often has physical consequences (such as fractures due to falls) and psychological ones (particularly depression) which may seem unrelated to the eyes.

This maculopathy can manifest in two clinically very different forms.

• The exudative macular degeneration (or wet) leads to progressive blurring of central vision. Its worst form is characterized by the formation of particular vascularized structures beneath the retina, which can leak fluids and bleed.
• The dry age-related macular degeneration (the form studied by Böhm and collaborators) is caused by accumulation of extracellular material (such as lipids and inflammatory proteins) deposited beneath the retinal epithelium. The consequence is the loss of photoreceptors present in the retina itself. This form of AMD evolves more slowly but is also the most common (estimated to be about 90% of diagnosed AMD cases). It can also progress to exudative macular degeneration; the transition occurs in about 20% of cases.

Supplements for maculopathy: lutein, zeaxanthin, and Omega-3

As its name suggests, among the main risk factors for age-related macular degeneration is aging. In fact, it is a multifactorial disease caused by genetic and environmental factors. The latter also include nutrition.

An association has been found between AMD risk and high consumption of fats, particularly trans fats (those present in some margarines, certain industrial products, and some fried foods). Diets rich in fish and polyunsaturated Omega 3 fats (abundant in fish) have instead been associated with a lower risk of AMD.

Omega 3 fats are also known for their benefits for vision. The European Food Safety Authority (EFSA) – the body responsible for authorizing nutrient health claims on food and supplement labels – allows stating that DHA (docosahexaenoic acid, one of the biologically active Omega 3s) «contributes to maintaining normal visual capacities», provided the food or supplement contains at least 40 mg of DHA per 100 g and per 100 Kcal.

The link between visual health and nutrition can also be seen in the macular pigment studied by Böhm and collaborators, which is a substance composed of meso-zeaxanthin, zeaxanthin, and lutein, in the macula. All three of these molecules are carotenoids, like beta-carotene. Just as much fruit and vegetables containing beta-carotene have a yellow to orange color, the macular pigment is yellow; and just as beta-carotene is present in various foods, lutein and zeaxanthin are also food-derived substances.

Lutein, for example, is very abundant in spinach; it is also found in a famous Protected Designation of Origin (PDO), the Bronte pistachio, and in a well-known Protected Geographical Indication (PGI), the red radicchio of Treviso. Another good source is egg yolk, and it can also be obtained from tomatoes. Spinach and egg yolk also contain good amounts of zeaxanthin.

Böhm and collaborators’ study highlights the potential of these three substances (lutein, zeaxanthin and Omega 3) as ingredients of supplements for dry maculopathy. Their experiments involved 172 participants (all patients with dry maculopathy) who took supplements or a placebo. Participants were randomly divided into three groups:

• the first took the placebo;
• the second took daily 1 capsule of a supplement containing 10 mg lutein, 1 mg zeaxanthin, and typical marine-origin Omega 3s: DHA (100 mg) and eicosapentaenoic acid (EPA, 30 mg);
• the third took the same substances as the second group, but at double dose.

The study lasted 12 months, during which an association was found between supplementation and increased lutein and zeaxanthin in the blood. The optical density of macular pigment also increased in association with supplementation. In both cases, the increase was evident after just one month of taking supplements for dry maculopathy, after which both blood carotenoid levels and macular pigment optical density remained stably elevated. Doubling the dose also improved blood fat levels.

These results suggest that products containing a mixture of lutein, zeaxanthin, and Omega 3 may be useful eye supplements in case of maculopathy.

Maculopathy: how much and which Omega 3 in eye supplements?

According to EFSA guidelines, to ensure good visual capacity, it is necessary to take 250 mg of DHA per day. This requirement can be easily met by including marine-source DHA (present in fatty fish such as sardines and salmon) within a healthy and balanced diet, along with marine-origin Omega 3 supplements. Focusing on terrestrial sources (such as walnuts and flaxseeds) is not very useful because instead of DHA they provide its precursor (ALA, or alpha-linolenic acid), which unfortunately the human body does not efficiently convert into its beneficial derivatives for vision.

For the same reason, and in light of the results of this study that used marine-origin Omega 3, even those seeking eye supplements for maculopathy should focus on products obtained from ingredients such as fish oil, cod liver oil, krill oil, and algal oil – a great alternative for those who do not eat fish or fish derivatives.

Sources:

Arnold C et al. Macular xanthophylls and ω-3 long-chain polyunsaturated fatty acids in age-related macular degeneration: a randomized trial. JAMA Ophthalmol. 2013 May;131(5):564-72. doi: 10.1001/jamaophthalmol.2013.2851

 European Commission. Food and Feed Information Portal. Last viewed May 4, 2023

 Crea - AlimentiNUTrizione. Food composition tables. Last viewed May 4, 2023

 Fernandes AR et al. Exudative versus Nonexudative Age-Related Macular Degeneration: Physiopathology and Treatment Options. Int J Mol Sci. 2022 Mar; 23(5): 2592. doi: 10.3390/ijms23052592 

Ruia S and Kaufman EJ. Macular Degeneration. [Updated 2022 Aug 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560778/