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 supplements for maculopathy that are effective? 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 be the future of supplements for maculopathy. This is suggested by a study published in the scientific journal JAMA Ophtalmology by a group of researchers coordinated by Volker Böhm, professor at the University of Jena (Germany), that this particular mix of food-derived substances may 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 (also known as AMD, or Age-Related Macular Degeneration) is the most common cause of blindness in industrialized countries and 8.7 percent of blindness cases worldwide. It affects Europeans more than other populations, appears predominantly after the age of 60, and involves the central part of the retina, the macula; hence it is a maculopathy.

The macula is responsible for central vision; the part affected in age-related macular degeneration is its most central portion, the fovea, the one where vision is sharpest. That's why living with this condition greatly reduces the quality of life: the daily activities that require good central vision are many-for example, reading and driving. And because of this, age-related macular degeneration often has physical consequences (such as fractures from falls) and psychological consequences (particularly depression) that seemingly might have little to do with the eyes.

This maculopathy can manifest itself in two profoundly different clinical forms.

•  Exudative (or wet) macular degeneration leads to progressive blurring of central vision. Its worst form is characterized by the formation of special vascularized structures beneath the retina, which can leak fluid and bleed.
• Dry age-related macular degeneration (the one studied by Böhm and coworkers) is caused by the accumulation of extracellular material (such as lipids and inflammatory proteins) that is deposited beneath the retinal pigment epithelium. The consequence of this accumulation is the loss of the photoreceptors present in the retina itself. This form of AMD is the slowest evolving, but also the most common (estimated to correspond to 90 percent of diagnosed cases of AMD). It can also progress to exudative macular degeneration; the transition occurs in about 20 percent of cases.

Supplements for maculopathy: lutein, zeaxanthin and Omega-3

As its very name suggests, among the main risk factors for age-related macular degeneration isaging. In fact, it is a multifactorial disease determined by genetic and environmental factors. The latter also includediet.

Indeed, an association has been found between the risk of DMLE and high consumption of fats, particularly trans fats (those found in some margarines, some industrial products, and some fried foods). In contrast, diets rich in fish and Omega 3 polyunsaturated fats (of which fish is rich) have been associated with a lower risk of DMLE.

In fact, Omega 3 fats are also known for their vision benefits. The European Food Safety Authority (Efsa)-which is the body in charge of authorizing nutrient benefit claims that can be used on food and food supplement labels-allows the claim that DHA (docosahexaenoic acid, one of the biologically active Omega 3s) "contributes to maintaining normal visual abilities," as long as the food or supplement in question contains at least 40 mg of DHA per 100 g per 100 Kcal.

The link between vision health and nutrition can also be seen in the macular pigment studied by Böhm and collaborators, which is a substance composed of meso-zeaxatin, zeaxanthin and lutein, in the macula. All three of these molecules are carotenoids, like beta-carotene. Just as many fruits and vegetables containing beta-carotene have a color between yellow and orange, the macular pigment is also 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 well-known PDO, pistachio di bronte, and in an equally well-known PGI, red radicchio from Treviso. Another good source is egg yolk, and it can also be taken in tomatoes. Spinach and egg yolk also contain good amounts of zeaxanthin.

The study by Böhm and coworkers highlights the potential of these three substances(lutein, zeaxanthin, and Omega 3) as ingredients in supplements for dry maculopathy. Their experiments involved 172 participants (all patients with dry maculopathy) taking either supplements or a placebo. Specifically, the participants were randomly divided into three groups:

• The former took the placebo;
• the second took 1 capsule daily of a supplement containing 10 mg of lutein, 1 mg of zeaxanthin and the Omega 3s typical of marine sources: DHA (100 mg) and eicosapentaenoic acid (EPA, 30 mg);
• the third took the same substances taken by the second group, but in double the dose.

The study continued for 12 months, during which an association between supplementation and increased blood lutein and zeaxanthin was found. Macular pigment optical density also increased in association with supplementation. In both cases, the increase was evident as early as one month of taking the supplements for dry maculopathy, after which both blood levels of carotenoids 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 for maculopathy.

Maculopathy: how many and which Omega 3s in eye supplements?

According to Efsa guidance, 250 mg of DHA per day is needed to ensure good visual acuity. This requirement can be easily met by including within a healthy and balanced diet, which includes sources of DHA (found in fatty fish such as sardines and salmon), Omega 3 supplements of marine origin. Targeting land-based sources (such as walnuts and flaxseed) does not make much sense, because instead of DHA they bring its precursor (ALA, or alpha-linolenic acid), which unfortunately the human body cannot efficiently convert into its vision-beneficial derivatives.

For the same reason, and in light of the results of this study, which predicted the use of marine-derived Omega 3s, those looking for eye supplements against maculopathy should also focus on products made from ingredients such asfish oil, cod liver oil,krill oil, andalgal oil-an excellent alternative for those who do not eat fish and fish products.

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

 Create - FoodNUTrition. Tables of food composition. 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/