Lately, there has been increased media attention on new research highlighting the benefits of alternative therapies for maintaining healthy vision. Whether it’s trying to manage the effects of damaging eye diseases or simply becoming proactive in preserving healthy vision, consumers are starting to focus on eye health ingredients.

Harry Rice, PhD, vice president of regulatory and scientific affairs for the Global Organization for EPA and DHA Omega-3 (GOED), Salt Lake City, UT, commented on omega 3s in particular. “In the last year, the body of evidence continued to grow in the areas of age-related macular degeneration (AMD) and Dry Eye Syndrome (DES)/Dry Eye Disease (DED),” he explained.

AMD is a disease associated with aging that gradually destroys sharp, central vision, needed for seeing objects clearly and for common daily tasks such as reading and driving. AMD affects one-third of all adults over age 40. It used to be that AMD targeted those over 75, but the disease has started to scale younger. With DES/DED tear glands produce fewer tears.

The March issue of Cornea offered promising results from a pilot trial of dry eye patients taking Advanced Vision Research’s (Woburn, MA) TheraTears Nutrition supplement. The trial demonstrated a reduction in dry eye symptoms and an increase in tear volume and tear flow for those patients taking TheraTears, which contains an optimized blend of medical grade essential omega 3 oils, including EPA and DHA, and flaxseed oil. 

According to Mr. Rice, since the beginning of 2011, results from two other well-publicized clinical studies involving eye health ingredients have been published in peer-reviewed journals. “The first study (Wojtowicz et al.) was a pilot study, but it is worth mentioning because the results suggest a dramatic effect for those suffering from dry eyes. In this study, an omega 3 supplement (compared to placebo) significantly increased tear production and tear volume,” he said.

A second study making headlines concluded that women who eat ample amounts of fish and, especially DHA and EPA, have a reduced risk of developing AMD. This last study, published online in the Archives of Ophthalmology, set out to examine whether or not the intake of omega 3 and omega 6 fatty acids and fish affect the incidence of AMD in women with no prior history of the disease.

According to the researchers in this study, “These prospective data from a large cohort of female health professionals without a diagnosis of AMD at baseline indicate that regular consumption of DHA, EPA and fish was associated with a significantly decreased risk of incident AMD and may be of benefit in primary prevention of AMD.”

Because this study was observational in nature, the authors are not ready to definitively associate a reduced risk of AMD with increased intake of fatty acids. They did, however, go so far as to say the evidence lends itself toward establishing a clinical trial.

Mr. Rice agreed. “While the results are promising, such findings need to be confirmed in double-blind, randomized, placebo-controlled trials. In addition to these two clinical trials, positive results from a handful of well-designed, well-executed pre-clinical (i.e., animal) studies have been published. It’s interesting to note that in the last year, six reviews have been published in peer-reviewed journals on the ocular benefits of omega 3s for eye health. Clearly, this is an area of research that is receiving a great deal of attention. In the coming years, we will likely see the publication of many studies in this area,” he said.

In fact, new data indicate a growing, albeit slowly, consumer interest in using natural solutions to improve eye health. The Natural Marketing Institute’s (Harleysville, PA) 2010 Health & Wellness Trends Database (HWTD) revealed that some 71% of consumers polled are concerned “a lot” about preventing vision/eye health problems. Additionally, 27% of consumers indicate that they, or someone in their household, is actively managing/treating vision/eye health problems. However, the number of consumers choosing supplements to support eye health remains small, at around 8%.

But that 8% is making a significant dent in terms of dollars and cents. Retail sales of omega 3 and 6 fatty acids (fish oil concentrate) supplements targeted at eye health, according to SPINSscan Natural, totaled more than $64 million for the 52 weeks ending February 19, 2011, representing an increase of 8% over the same period a year ago. (SPINS, Schaumburg, IL, is a market research and consulting firm for the natural products industry.)

The Evolving Role of Lutein

Lutein, said Katherine Bond, director of business development, Cyvex Nutrition, Irvine, CA, plays an important role in maintaining healthy vision because it neutralizes free radicals and increases the density of eye pigment, thereby shielding the eyes from the destructive effects of sunlight. The down side is the concentration of these pigments decreases with age and has to be supplemented through diet because the body does not synthesize these carotenoids, thus adding to the need for eye health supplements, she said.

Until recently, consumers looking for an eye health supplement often first turned to lutein, a $2 million category in the natural channel (or a combined natural/conventional channel total of nearly $23 million), according to SPINS. But the role of lutein alone is looking like a thing of the past as several new introductions add other helpful nutrients to the product mix.

Besides lutein, some of the other top ingredient performers in the market include astaxanthin, beta-carotene, blueberry, fish oil concentrate and vitamin A.

Data from NMI’s 2008 HWTD study placed lutein as the number one ingredient consumers associated with eye health. Responding to a question about which nutrients consumers would like to have more of in their diet, 18% of NMI respondents said they want more lutein.

In March, experts convened in Schloss Hohekammer, Germany to laud the vital role of lutein in eye health. The conference, titled “Lutein and its Benefits to Eye Health,” was sponsored by DSM Nutritional Products Europe Ltd. and Kemin Industries, Inc. DSM markets Kemin’s FloraGLO lutein, which is naturally derived from Marigold flowers, and OPTISHARP zeaxanthin, which are contained in many consumer eye health supplements. These ingredients are also being tested in the National Eye Institute’s AREDS2 study for their role in AMD.

At a Boston, MA, conference, titled “New Developments in Carotenoid Research,” also held in March, Dr. Randy Hammond from the University of Georgia presented studies showing that lutein and zeaxanthin from the diet and from supplements are preferentially accumulated in the macula where they function to filter out damaging blue light to protect the visual receptors and to enhance visual performance, reported James Elliott, PhD, director nutritional science, Global Nutritional Science at DSM Nutritional Products, Parsippany, NJ. Those ingredients, he said, increase visual performance by significantly reducing the discomfort of glare, reducing the recovery time from photostress and increasing color contrast.

He pointed to Bausch + Lomb’s (Madison, NJ) PreserVision Eye Vitamin and Mineral Supplement Age-Related Eye Disease Study 2 (AREDS2) formula as an example. The product, launched last year, builds on the original, clinically proven AREDS formula, replacing beta-carotene with lutein and zeaxanthin and adding omega 3 fatty acids.

Today, however, “…Customers are upgrading their older lutein formulas to include more effective levels of lutein, with a goal to give consumers more efficacious dosages versus just ‘fairy dust’ levels, which [was previously the case],” offered Hiren Doshi, business development director, OmniActive Health Technologies, Short Hills, NJ.

From OmniActive comes Lutemax 20/20, an ingredient that provides enhanced levels of zeaxanthin and lutein isomers for convenient and more beneficial nutrient availability to the eyes.

Last year Valensa International, Eustis, FL, introduced Eye Pro MD, a new eye health formulation combining the carotenoids astaxanthin, lutein and zeaxanthin, along with a proprietary omega 3/phospholipid delivery system and vitamin D3. The formulation was developed based on results from the CARMIS clinical trial (Carotenoids and Antioxidant in Age Related Maculopathy Italian Study), reported in the journal Ophthalmology in 2008, as well as other studies. Astaxanthin is known to cross the blood-brain/blood-retina barrier and preferentially reside in the central foveal region of the macula. Published research points to astaxanthin’s dramatic reduction of light-induced oxidative stress, which damages cells and associated cellular mechanisms.

The Right Combination

Combining established ingredients such as lutein with newcomers like marine oils has become a major trend in the industry, according to Laura Troha, brand management and marketing communications manager, Cognis Nutrition & Health, now part of BASF, Florham Park, NJ. “Ingredient combinations [represent] a trend we can expect to continue. Researchers are finding that nutrients such as lutein and omega 3s may be beneficial in preventing or reducing the life-altering effects of AMD, for example,” she noted. “As consumers become savvier in their purchasing decisions, they will be examining the product labels more closely to understand the claims and dosage information.”

In agreement was EPAX AS’ (Aalesund, Norway) strategic business development and sales manager, Baldur Hjaltason, who pointed out that lutein and DHA both have important functions in the retina, preventing damage from light and oxidation by free radicals. Therefore, he said, a combination of lutein and DHA are very important ingredients in any eye health formula.

EPAX is concentrating on the effects of DHA on eye health with its EPAX 1050TG offering. The ingredient contains a minimum 430 mg/g of DHA. To that end, EPAX 1050TG, Mr. Hjaltason said, is well supported in the Archives of Ophthalmology study where regular consumption of DHA, EPA and fish was associated with 35-45% lower risk of AMD.

Florida, NY-based Pharmline has been involved in eye health ingredients for several years through long-term partnerships with Industrial Organica SA (Mexico) and EPAX. “But 2011 might be the year where a less recognized carotenoid pigment establishes itself as a key dietary ingredient in the prevention of AMD,” said Pharmline’s brand manager, Greg Berthomieu. He went on to point out that three carotenoids constitute the macula lutea (yellow spot) in the human retina: lutein, 3R,3’R zeaxanthin (RR-Z) and 3R,3’S or meso-zeaxanthin (MZ).

“All these pigments are found in nature, in our diet and are safe in dosages used in dietary supplements, but it is important to acknowledge their differences, and this is especially true for the two zeaxanthin isomers (RR-Z and MZ) that are very often classified under the same ‘zeaxanthin’ term. Recent new research from the University of Utah Medical School reveals that the protective effect of the combination of MZ, lutein and RR-Z is more potent than any of those carotenoids individually,” he explained.

Further, according to Mr. Berthomieu, this suggests synergistic antioxidant effects between these pigments. However, when compared individually, he said MZ seems to be the one providing the strongest antioxidant protection, which might be the reason MZ is the most concentrated pigment in the central part of the macula.

Offering another view, Melanie Bush, science/quality communications, Artemis International, Fort Wayne, IN, said, “With the onslaught of electronic devices—computers, smartphones, Kindles, I-Pads, etc.—we are becoming a culture that is dependent on video display terminals (VDT) and there is no end to this trend in sight. As a result, we are suffering from increased vision stress and fatigue.”

The American Optometric Association (AOA) reports that “computer-vision syndrome” affects more than 70% of the approximately 143 million Americans who work on a computer on a daily basis. “We may likely see age-related vision deterioration diseases like AMD starting to affect even younger eyes as they are subjected to stress and fatigue on a daily basis. Luckily, black currant may provide some much-needed relief,” Ms. Bush said.

In fact, a human pilot study conducted in 2000 by Nakaishi and his team of researchers concluded that black currant anthocyanins showed improvement in VDT-induced visual fatigue as well as dark adaptation. “Since then, we are seeing an increase in black currant products being formulated for vision support, many in combination with bilberry,” said Ms. Bush. Linnea, Inc. provides standardized black currant extracts under its Artemis line of high-anthocyanin berry extracts, among other vision supporting ingredients.

Similarly, Cyvex Nutrition, offers a black currant extract that is Generally Recognized As Safe (GRAS). “In the past, eye health formulas have focused more on carotenoids, particularly on lutein and zeaxanthin because they are both naturally present in macula of the human eye. However, an optimized way to protect one’s eyes is to have another antioxidant-rich source that is scientifically supported to have a positive effect on the eye, in addition to lutein and zeaxanthin,” said Cyvex’s Ms. Bond.

ZMC-USA, The Woodlands, TX, carries a wide range of eye health ingredients, including vitamins A, E and beta-carotene, as well as lutein and zeaxanthin. The latter two ingredients were recognized in the August 2008 issue of Journal of Lipid Research. The study showed the protein SR-B1, or scavenger receptor class B, type 1, plays a central role in transporting lutein and zeaxanthin from the bloodstream to cells in the eye.

Study author Earl Harrison, introduced the xanthophylls lutein and zeaxanthin, along with beta- carotene, to human retinal pigment epithelial cells. The cells absorbed much more of the xanthophylls than the beta-carotene, which was predicted from previous experiments. Most notably, absorption of the two xanthophylls was reduced by 41-87% when the SR-B1 protein was blocked. This, Mr. Harrison concluded, helped to explain the process by which these nutrients are transported to the retina—findings that may lead to methods for slowing the progression of macular degeneration.

Astaxanthin offers a health benefit for asthenopia (i.e., eye fatigue) supported by research. In fact, Fuji Health Science, Burlington, NJ, has sponsored 10 human clinical studies demonstrating this benefit by showing the positive effect of natural astaxanthin on accommodation and visual acuity. The mechanism of action for this benefit is the improved endurance and resulting performance of the tiny muscles of the eye known as the ciliary body.

Steve Siegel, vice president of marketing and sales, Ecuadorian Rainforest, Belleville, NJ, said the trends in eye health formulas include omega 3 supplements, as well as a variety of new supplements that pair two powerful eye health foods, such as spinach and collard greens, or carrots and turnips. Researchers, Mr. Siegel said, are also pointing toward the mineral zinc.

The specific eye health ingredients available from Ecuadorian Rainforest include apricots, carrots, sweet potatoes, collard greens, kale, spinach, papaya, red bell pepper and cantaloupe.

Looking Ahead

A great deal of research is centered on diseases of the eye, which affect an already aging or aged population. However, with many of the diseases trending younger, most experts believe it’s never too soon to start thinking about eye health.

“Eye health should be considered along with many other health parameters from infancy forward,” said Angela Dorsey-Kocklar, RD, product manager, BI Nutraceuticals, Long Beach, CA. “Eye health for children should be focused more on building good vision and preventing eye conditions/diseases, whereas eye health for Baby Boomers and seniors may focus more on maintaining vision status or treating problems that have developed.”

BI offers a wide range of ingredients to cover eye health strains, including ocular stress arising from the glare of video/monitor screens. BI’s grape seed extract, for example, is said to help to decrease some of this stress.

A range of ingredients like bilberry and Pycnogenol also show potential in the vision health area. The latter, produced by Geneva, Switzerland-based Horphag Research, is extracted from pine bark. Current research on this ingredient suggests its mechanism of action is to supply antioxidant protection to the retina (with documented synergistic effects in combination with lutein) and strengthening retinal capillaries and blood circulation.

As for bilberry, there is a folklore account of British Royal Airforce pilots consuming bilberry preserves during World War II and reporting improved night vision. “Whether there is documented proof of this story is debatable, but there are indications that anthocyanins—the bluish pigment in bilberry and blueberry—may provide important protection for vision,” explained Hartley Pond, vice president of sales for Van Drunen Farms/Futureceuticals, Momence, IL.

Wild bilberry (Vaccinium myrtillus) and its cousin wild blueberry (Vaccinium angustifolium), both ingredients available from Futureceuticals, are rich in anthocyanins. The retina contains a purple pigment, visual purple, and an anthocyanin-rich diet may help maintain retina health. Beyond anecdotes, Mr. Pond said studies have shown that bilberry extracts improve night vision in pilots, drivers and air-traffic controllers.

NMI’S HWTD from 2009 revealed that 39% of consumers concerned about preserving vision health would be interested in functional foods; a close second to supplements. In one instance, Ecuadorian’s Mr. Siegel recalled an experiment published in the Journal of Agricultural and Food Chemistry where a high-lutein wheat and corn flour was used to prepare lutein-enriched baked goods, with “reasonable amounts” of the carotenoid still measurable in the final products.

“Despite the significant losses of lutein during processing, the developed fortified baked products still contained reasonable concentrations (up to 1.0 mg/serving) of lutein and would hold promise for the development of high-lutein functional foods,” he said, quoting researchers from Guelph Food Research Centre, Agriculture and Agri-Food Canada.

In the same vein, Cognis Nutrition and Health, together with BASF, offers Xangold natural lutein esters for functional beverage development. “Waters with added lutein esters, for example, are gaining in popularity,” said Ms. Troha. “We work with our customers to create new products from conception to market based on our extensive range of science-based ingredients that address today’s most pressing eye health concerns.”

Coca-Cola’s Glaceau Vitamin Water “Focus” SKU contains lutein for eye health and is one of the top selling products in that line. “Historically the market for eye health has been around dietary supplements—largely because of the benefits around age-related eye disease. However with emerging science around visual performance (as with lutein and zeaxanthin), and its applications in activities of daily living…we can expect a younger audience for this market,” explained Aparna Parikh, MBA, RD, DSM’s senior marketing manager, FloraGLO Lutein and OPTISHARP Zeaxanthin.

Maintaining a cautiously optimistic stance, BI Nutraceuticals’ Ms. Dorsey-Kocklar said the reason behind the scarcity of functional foods for eye health is likely two-fold: most ingredients and formulas are popular in the dietary supplement space and are most often focused on the condition of AMD. Also, there are not many food or beverage products that have yet positioned themselves around eye health specifically. This is probably because eye health is not as high a priority compared to some other benefits like healthy hearts and joints, which consumers can achieve with foods, she said.

Further, Ms. Dorsey-Kocklar said the many options for quick-fix corrective procedures for the eyes, do not endear consumers to make long-term change with food choices.

There could also be a lack of understanding or association between foods/nutrients and eye health. “That said, with the paucity of functional food products proffering eye health on the market, this does give a manufacturer a first-mover advantage if they put a product on the market first and capture the most engaged and loyal consumers,” she concluded.  

References furnished upon request.