A Combination of Lutein & Zeaxanthin Beneficially Associated with Age-Related Macular Degeneration Progression

by | Aug 24, 2022 | 2022, Eye Health, Lutein, Macular Degeneration, Zeaxanthin

Written by Taylor Woosley, Staff Writer. Observational findings of the Age-Related Eye Diseases Study 2 show that a direct analysis of lutein & zeaxanthin vs beta carotene resulted in an HR for late AMD of 0.85 (95% CI, 0.73-0.98; P=.02).

eye healthAge-related macular degeneration (AMD) is a leading cause of blindness and severe visual impairment, impacting approximately 30% of aged individuals1. It is a progressive retinal disease associated with factors such as oxidative stress and inflammation2. Individuals with AMD experience a loss of central vision as the disease progresses with drusen accumulation, photoreceptor death, and neovascularization in the macula3. Many factors may contribute to the development of AMD, such as genetics, systemic health, and environmental factors4.

Research has shown that ꙍ-3 fatty acids can provide protective benefits against AMD progression due to their anti-inflammatory, antiproliferative, and antioxidant properties5. ꙍ-3 fatty acids allow the renewal of the retinal pigment epithelium which is crucial for proper photoreceptor structure6. Additionally, carotenoids, such as lutein and zeaxanthin, protect the retina from short-wavelength blue light7. Lutein and zeaxanthin accumulate in the macula and prevent the generation of reactive oxygen species (ROS)8.

Chew et al. conducted an epidemiological follow-up study using data from the Age-Related Eye Disease Study 2 (AREDS2). The original AREDS assessed the effectiveness of the AREDS supplementation of vitamins, antioxidants, and zinc with copper in reducing the risk of late AMD progression. During the AREDS trial, 2 randomized controlled clinical trials noted that the beta carotene used in the supplementation increased the risk of lung cancer in subjects who were previous smokers. In the AREDS2, beta carotene was replaced with lutein and zeaxanthin in order to compare the rates of AMD progression and risk of lung cancer with the beta carotene supplementation.

The AREDS2 was a 5-year randomized controlled clinical trial with a total of 4203 participants. An additional follow-up study was offered to subjects (n=3882) and was conducted by telephone every 6 months for an additional 5 years to learn about any new occurrence related to lung cancer and late AMD. Primary outcomes of the study included development of lung cancer and time to progression to late AMD. A logistic regression model was used to assess the risk of lung cancer development. A Cox proportional hazards model was used to evaluate the progression to late AMD. Observational findings of the AREDS2 and follow-up study are as follows:

  • Lung cancer development for participants in the secondary randomization that excluded smokers reported an odds ratio of 1.82 (95% CI, 1.06-3.12; P=.03) for those assigned to beta carotene.
  • The OR for the risk of lung cancer development in former smokers vs non-smokers was 1.84 (95% CI, 1.07-3.16; P=.02).
  • When comparing those assigned to lutein & zeaxanthin vs not assigned to lutein & zeaxanthin, the HR for progression to late AMD by 10 years was 0.91 (95% CI, 0.84-0.99; P=.02).
  • For those assigned in the secondary randomizations to beta carotene, the comparison of lutein & zeaxanthin vs no lutein & zeaxanthin, the HR at 10 years was 0.80 (95% CI, 0.68-0.92; P=.002).
  • A direct comparison of those randomly assigned to lutein & zeaxanthin only vs those randomly assigned to beta carotene only in 1260 participants demonstrated an HR of 0.85 (95%CI, 0.73-0.98; P= .02), with a more favorable outcome for lutein & zeaxanthin over beta carotene.

Observational findings of the AREDS2 clinical trial follow-up study suggest that the use of lutein & zeaxanthin as a replacement for beta carotene was both effective and a safer option for participants. No statistically significant increase in lung cancer risk was noted with use of lutein & zeaxanthin, compared to beta carotene which almost doubled the risk of lung cancer in subjects. Furthermore, lutein & zeaxanthin may also provide additional benefits in preventing the progression to late AMD. Study limitations include the self-reported outcome measures of ocular outcomes and lung outcomes, the lack of ophthalmic images on all follow-up participants, and the potential lack of generalizability of the study.

Source: Chew, Emily Y., Traci E. Clemons, Elvira Agrón, Amitha Domalpally, Tiarnán DL Keenan, Susan Vitale, Claire Weber et al. “Long-term Outcomes of Adding Lutein/Zeaxanthin and ω-3 Fatty Acids to the AREDS Supplements on Age-Related Macular Degeneration Progression: AREDS2 Report 28.” JAMA ophthalmology (2022).

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Posted August 24, 2022.

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

References:

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