Reprinted from American Optometric Association (AOA)
Cataracts and age-related macular degeneration (AMD) are the leading causes of visual impairment and acquired blindness in the U.S, affecting millions of aging Americans. Nutrition is one promising way to prevent or delay the progression of these diseases.
Lutein and Zeaxanthin
Two carotenoids, lutein (pronounced loo-teen) and zeaxanthin (pronounced zee-uh-zan-thin), are antioxidants that are located in the eye. Green leafy vegetables, as well as other foods such as eggs, contain these important nutrients. Many studies have shown that lutein and zeaxanthin reduce the risk of chronic eye diseases, including AMD and cataracts.
Benefits to Eye Health
Lutein and zeaxanthin filter harmful high-energy blue wavelengths of light and help protect and maintain healthy cells in the eyes. Of the 600 carotenoids found in nature, only these two are deposited in high quantities in the retina (macula) of the eye.
The amount of lutein and zeaxanthin in the macular region of the retina is measured as macular pigment optical density (MPOD). Recently, MPOD has become a useful biomarker for predicting disease and visual function.
Unfortunately, the human body does not naturally make the lutein and zeaxanthin it needs. This is why eating green vegetables is important. Getting daily amounts of lutein and zeaxanthin through your diet or nutritional supplements can help maintain good eye health.
Lutein, Zeaxanthin and Cataracts
The crystalline lens (the natural lens in the eye) primarily collects and focuses light on the retina. To do this throughout your life, the lens must remain clear. Oxidation of the lens is a major cause of cataracts, which cloud the lens.
Antioxidant nutrients neutralize free radicals (unstable molecules) that are associated with oxidative stress and retinal damage. This is why the antioxidants lutein and zeaxanthin likely play a role in preventing cataracts. In fact, a recent study demonstrated that higher dietary intake of lutein and zeaxanthin and vitamin E was associated with a significantly decreased risk of cataract formation.
Lutein, Zeaxanthin and AMD
There is a lot of evidence that lutein and zeaxanthin reduce the risk of AMD. In fact, in the Age-Related Eye Disease Studies (AREDS and AREDS2), the National Eye Institute found that taking certain nutritional supplements every day reduces the risk of developing late AMD. Beyond reducing the risk of eye disease, separate studies have shown that lutein and zeaxanthin improve visual performance in AMD patients, cataract patients and people in good health.
Daily Intake*
Vitamin C
Vitamin C (ascorbic acid) is an antioxidant found in fruits and vegetables.
Scientific evidence suggests vitamin C lowers the risk of developing cataracts. Risk factors for cataracts include smoking, diabetes and steroid use, which deplete the eye’s lens of vitamin C.
Also, when taken with other essential nutrients, vitamin C can slow the progression of age-related macular degeneration (AMD) and visual acuity loss. AMD is the leading cause of blindness in people over age 55 in the Western world. The number of people with AMD is expected to triple by 2025.
Benefits to Eye Health
Vitamin C helps promote healthy capillaries, gums, teeth, cartilage and the absorption of iron. Almost all cells of the body depend on it, including those of the eye, where it is concentrated in all tissues. Vitamin C also supports the health of blood vessels in the eye.
Our bodies do not create all of the vitamin C we need. This is why daily intake of vitamin C through diet, nutritional supplements, or fortified foods and beverages is important for maintaining good eye health.
Vitamin C and Cataracts
Numerous studies have linked vitamin C intake and decreased risk of cataracts. In one study, women taking vitamin C for 10 years or more experienced a 64 percent reduction in the risk of developing nuclear cataracts. Researchers estimate that by delaying the onset of cataracts for 10 years, half of cataract-related surgeries could be averted.
Other research showed that women taking a daily supplement with a dosage of 364 mg experienced a 57 percent reduction in their risk of certain types of cataracts.
Taking a supplement with at least 300 mg/day of vitamin C appears to help prevent cataract development.
Vitamin C and Age-Related Macular Degeneration (AMD)
The landmark Age-Related Eye Disease Study (AREDS), sponsored by the National Eye Institute, linked AMD and nutrition. The study showed that people at high risk for the disease who took 500 mg/day of vitamin C, along with beta-carotene, vitamin E and zinc supplementation, slowed the progression of advanced AMD by about 25 percent and visual acuity loss by 19 percent. Other studies have confirmed these results.
Daily Intake*
The U.S. Food and Drug Administration (FDA) recommends that men get 90 mg/day of vitamin C and women get 75 mg/day.
However, people under stress need more vitamin C than the recommended daily allowance. These groups include smokers, alcoholics, diabetics, pregnant or breast-feeding women, older adults, athletes, and people with chronic diseases who experience environmental stress from heat, cold or radiation. There is little scientifically documented risk in taking higher doses of vitamin C, except for diarrhea.
Food Sources
Vitamin C is found almost exclusively in fruits and vegetables, including citrus fruits such as oranges, lemons, grapefruit and limes. The table above lists foods known to be high in vitamin C. Also, the USDA Nutrient Database offers comprehensive nutritional information on more than 8,000 raw and prepared foods.
If you are not getting enough vitamin C through diet alone, consider adding a vitamin C supplement to your daily routine. However, always consult with a health care professional before taking supplements.
*At this time, the AOA is unaware of any studies that have examined interactions between medications and vitamin C. The AOA also is not aware of any adverse health reports from interactions between medications and vitamin C. However, the AOA recommends consulting with a health care professional before taking any supplement.
Vitamin E
Research has shown that vitamin E, found in nuts, fortified cereals and sweet potatoes, can protect cells of the eyes from damage. This damage is caused by unstable molecules called free radicals, which break down healthy eye tissue. When this happens, the risks for age-related macular degeneration (AMD) and cataract formation increase.
Worldwide, more than 25 million people are affected by AMD. In the Western world, AMD is the leading cause of blindness in people over age 55. The number of people with AMD is expected to triple by 2025 as the population ages.
Benefits to Eye Health
Studies indicate that vitamin E reduces the progression of AMD and cataract formation. Vitamin E also plays a significant role in the immune system, the health of cell membranes, DNA repair and other metabolic processes.
The human body does not create the vitamin E it needs. This is why daily intake of vitamin E through your diet or nutritional supplements is important for good eye health.
Vitamin E and Cataracts
Studies have indicated adding vitamin E to the diet can delay cataract formation. A recent study demonstrated that higher dietary intakes of lutein and zeaxanthin along with vitamin E significantly decreased the risk of cataracts.
Vitamin E and Age-Related Macular Degeneration (AMD)
The landmark Age-Related Eye Disease Study (or AREDS), sponsored by the National Eye Institute, established that AMD is linked to nutrition. The study showed that a 400 IU/day intake of vitamin E, taken with beta-carotene, vitamin C and zinc supplementation, slows the progression of AMD by about 25 percent in individuals at high risk for the disease. Seven smaller studies have confirmed these results.
In adults, symptoms of vitamin E deficiency include nerve damage, muscle weakness, poor coordination, involuntary movement of the eyes and breaking of red blood cells leading to anemia.
Vitamin E is a fat-soluble supplement that should not be taken in excess by anyone taking supplements or medications that have blood-thinning qualities. Always consult with a health care professional before beginning a supplementation regimen.
Most Western diets are low in vitamin E, which can be found in nuts, vegetable oils, peanut butter, fortified cereals and sweet potatoes. The table below lists foods high in vitamin E antioxidants.
*At this time, the AOA is unaware of any studies that have examined interactions between specific medications and vitamin E. The AOA also is not aware of any adverse health reports from interactions between specific medications and vitamin E. However, the AOA recommends consulting with a health care professional before taking any supplement.
Omega-3: DHA and EPA
Dietary fat is an important source of energy and a necessary part of the human diet. Fatty acids, a component of fat molecules, are important in keeping our eyes healthy.
Two families of essential fatty acids exist in nature: omega-3 and omega-6. These essential fatty acids help support the cardiovascular, reproductive, immune and nervous systems. They also help the brain develop and the sensory systems mature.
Research has shown that two omega-3 fatty acids—docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)—are important for proper visual development and retinal function.
DHA and EPA Omega-3 Fatty Acids and Eye Health
DHA is found in the highest concentration in the retina, suggesting it has an important function there. EPA is used in the production of DHA in the body.
Studies in pre-term and full-term infants suggest that getting enough omega-3 fatty acids in the diet is essential for optimal visual development. A number of studies have shown that animals that do not get enough DHA in their diets suffer visual impairment and degradation of the retina.
Dry eye syndrome also has been linked to omega-3 deficiency. Additionally, low levels of DHA and EPA have been associated with diabetic retinopathy, age-related macular degeneration (AMD) and retinopathy of prematurity.
The typical American diet includes 1.6 grams per day of omega-3 fatty acids. EPA and DHA usually comprise 6 percent to 12 percent of this value (0.1-0.2 grams per day). This level is well below the American Heart Association’s recommended 0.5-1.0 grams per day of EPA + DHA. According to the U.S. Food and Drug Administration, consuming up to 3 grams per day of DHA and EPA is generally considered safe.
Food Sources
EPA and DHA are concentrated in fatty fish and other seafood. In addition, you can take omega-3 fatty acid supplements in oil or capsule form.  For individuals who choose not to consume fish, vegetarian DHA is commercially manufactured from microalgae.
Animals can convert very small amounts of DHA through consumption of a-linolenic acid, an omega-3 fatty acid found in plants, animals and milk.
*At this time, the AOA is unaware of any studies that have examined interactions between specific medications and essential fatty acids. The AOA also is not aware of any adverse health reports from interactions between specific medications and essential fatty acids. However, the AOA recommends consulting with a health care professional before taking any supplement.
Zinc
Zinc is an essential trace mineral, or “helper molecule.” It plays a vital role in bringing vitamin A from the liver to the retina in order to produce melanin, a protective pigment in the eyes. Zinc is highly concentrated in the eye, mostly in the retina and choroid, the vascular tissue layer under the retina.
Impaired vision, such as poor night vision and cloudy cataracts, has been linked to zinc deficiency. A person with too little zinc in their body is also at risk for alopecia (loss of hair from eyebrows and eyelashes), mental sluggishness and increased susceptibility to infection.
Benefits to Eye Health
People at high risk for age-related macular degeneration (AMD), or who are already experiencing the early stages of AMD, may benefit from increased zinc intake. The human body does not produce the zinc it needs, so daily intake of zinc through diet, nutritional supplements, or fortified foods and beverages is important for the maintenance of good eye health. Red meat, seafood, poultry, eggs, wheat germ, mixed nuts, black-eyed peas, tofu and beans contain zinc.
Zinc and AMD
The landmark Age-Related Eye Disease Study (AREDS), sponsored by the National Eye Institute, established that AMD is linked to nutrition. The study showed that individuals at high risk for AMD could slow the progression of advanced AMD by about 25 percent and visual acuity loss by 19 percent by taking 40-80 mg/day of zinc, along with certain antioxidants. Taking higher levels of zinc may interfere with copper absorption, which is why the AREDS study also included a copper supplement.
However, high doses of zinc may upset the stomach. Therefore, a follow-up study, AREDS2, which is currently in progress, is testing a more moderate dose of 25 mg/day.
Daily Intake*
The U.S. Food and Drug Administration (FDA) recommends 11 mg/day of zinc for men and 8 mg/day for women.
For those at high risk for AMD, the AREDS study showed that higher levels of zinc (40-80 mg/day) is beneficial. Zinc supplementation has been known to interfere with copper absorption, so it is strongly recommended that people taking zinc also take 2 mg/day of copper.
Food Sources include red meat, seafood, poultry, eggs, wheat germ, mixed nuts, black-eyed peas, tofu and beans.

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