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Hernandez
Rich Hernandez

NUFD 119

Professor Silena Jacobson

30 November 2020

Introduction

Age related macular degeneration (or AMD) is the foremost cause of irreparable vision

loss in the U.S. of people 65+ years of age or older, which make up the quickest growing

segment of the U.S. population.1 Between two decades, 2000-2010 and 2010-2020, the amount

of people 65+and older in the U.S. rose from 35 million to just over 53 million. This amounts to

a massive 53% increase.2 AMD is caused by the progressive decline of the retina at the back of

the eye. The retina processes the images we see and sends them via the optic nerve to the brain.

The retina’s central portion, known as the macula and more specifically-the fovea, is responsible

for the sharpest visual acuity of our eyes.3 Although the public health importance of AMD is

known, currently there is no cure for the disease, and our knowledge of the history of the disease

is limited. The known involvement of risk factors for AMD could provide hints about its origin

and possible approaches for intervention.1 Consumption of antioxidant-rich foods or

supplements, specifically lutein and zeaxanthin, can improve the MPOD of patients with AMD.

(Thesis)

Current Research

Evidence has indicated that AMD patients have reduced MPOD, or macular pigment

ocular density. The risk of AMD may be reduced by way of consumption of antioxidant-rich

foods and supplements. Antioxidants that have been shown to be beneficial to eye health and

reduce the instances of eye-related diseased include Vitamin C and E, anthocyanins, flavonoids
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and carotenoids. Reduced MPOD has been associated to several additional risk factors such as

regular aging, smoking, iris shade, obesity and genetics which include familial AMD.4 Numerous

studies have been conducted in the area of antioxidant consumption and the progression of or

risk of AMD.

Data from several extensive studies, including the Carotenoids in Age-Related Eye

Disease Study (CAREDS), the Blue Mountain Eye Study, and the Age-Related Eye Disease Study

(AREDS), signify that minimal dietary intake of the carotenoids Lutein and zeaxanthin is

correlated to the risk of developing AMD while the aforementioned antioxidants can slow the

progression in those with whom AMD is already present.4 Lutein and zeaxanthin are carotenoids

with proven anti-inflammatory properties. An extensive body of data shows that lutein and

zeaxanthin have numerous positive effects on ocular health. Specifically, lutein has been shown

to improve or even stop AMD. However, there is correspondingly conflicting data regarding

lutein effectiveness in prompting favorable effects on health and there is no univocal data

concerning the most appropriate recommendation for daily lutein supplementation.5

Based on the understanding of antioxidant minerals, carotenoids and vitamins examined

above, the National Eye Institute initiated the Age-Related Eye Disease Study (AREDS) in 1990.

This RCT was intended to gauge the effect of high doses of zinc and certain antioxidant vitamins

in the development and progression of advanced AMD in older population. The AREDS

formulation was selected on the expert recommendations of ophthalmologists and biochemists

who evaluated clinical trials and epidemiologic figures at a collection of seminars funded by the

National Eye Institute. The carotenoids lutein and zeaxanthin, recognized to be existing in the

retina of the eye, were strong contenders for addition in the original AREDS design, but they

were not commercially accessible when the AREDS was offered.6

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In 2001, the AREDS study results were published and the formulation rapidly became the

standard of care for AMD patients. Because of an increase in lung cancer rates due to almost half

the AMD participants being smokers or former smokers, the formulation for AREDS was

adjusted to exclude beta-carotene and AREDS2 was commenced in 2006 to assess the effect of

the inclusion of lutein and zeaxanthin to the original formulation. The outcomes were more

impressive when the participants receiving the AREDS2 formulation displayed a substantial

reduction in the rate of progression of their AMD in contrast with the group assigned the original

AREDS formulation. Even though both AREDS and AREDS2 were intended to lengthen the idea

of antioxidant supplementation in AMD subjects, more research is needed to determine whether

or not lutein plus zeaxanthin supplementation ought to be recommended to a younger and

healthier population.6

Vitamin A, lutein and zeaxanthin are vital components in the retina of the eye. Although

various studies proved the protective properties of these nutrients against AMD, a few clinical

trials and studies found negative results as an impediment of AMD. In majority of the studies,

vitamin and mineral supplementations failed to drastically recover eye condition and did not

successfully diminish the risk of AMD. Conversely, vitamins C and E and selenium work as

antioxidants in decreasing the cellular oxidative stress on the retina. Anthocyanins have

encouraging effects in reducing the risk of AMD. Based on studies, dietary carotenoids showed

positive outcomes, except for just two documented studies. One study showed almost no

significant outcome of daily beta-carotene supplementation compared to placebo, and another

study found no substantial rise in MPOD in post-menopausal women supplemented daily with

lutein and zeaxanthin.7

Conclusions
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Although no current treatment can restore lost vision due to AMD, it is imperative to

offer patients numerous treatments to immediately slow or halt the progression of AMD and

minimize further damage to the macula. As society ages, the shared risk of developing AMD

remains at the forefront of study and continuing research in this area shows great promise for the

future of patients suffering from this condition. With AMD's pervasiveness projected to double

by 2050, more research needs to be conducted in order to fully stop or even “cure” this disease.

We know the AREDS2 study showed promising results surrounding the progression of AMD in

patients who already have the disease; however, more research is needed in this area to

eventually find a suitable correlation between the formulation and a possible establishment of a

DRI of lutein and zeaxanthin in order to strongly suggest a measurable defense against

developing AMD.
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References

1. Age-Related Eye Disease Study Research Group. (2000). Risk factors associated with age-

related macular degeneration: A case-control study in the age-related eye disease study:

age-related eye disease study report number 3. Ophthalmology (Rochester, Minn.),

107(12), 2224–2232. https://doi.org/10.1016/S0161-6420(00)00409-7

2. Current Population Reports

Population Projections of the United States by Age, Sex, Race, and Hispanic Origin:

1995–2050, Series P25–1130, United States Bureau of the Census, Washington, DC

(1996)

3. What is Macular Degeneration? - AMDF. (2017, December 20). Retrieved November 28,

2020, from https://www.macular.org/what-macular-degeneration

4. Weigert, Günther, Kaya, Semira, Pemp, Berthold, Sacu, Stefan, Lasta, Michael, Werkmeister,

René Marcel, Dragostinoff, Nikolaus, Simader, Christian, Garhöfer, Gerhard, Schmidt-

Erfurth, Ursula, & Schmetterer, Leopold. (2011). Effects of lutein supplementation on

macular pigment optical density and visual acuity in patients with age-related macular

degeneration. Investigative Ophthalmology & Visual Science, 52(11), 8174–8178.

https://doi.org/10.1167/iovs.11-7522
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5. Buscemi, Silvio, Corleo, Davide, Di Pace, Francesco, Petroni, Maria, Satriano, Angela, &

Marchesini, Giulio. (2018). The Effect of Lutein on Eye and Extra-Eye Health. Nutrients,

10(9), 1321. https://doi.org/10.3390/nu10091321

6. Gorusupudi, A., Nelson, K., & Bernstein, P. S. (2017). The Age-Related Eye Disease 2 Study:

Micronutrients in the Treatment of Macular Degeneration. Advances in nutrition

(Bethesda, Md.), 8(1), 40–53. https://doi.org/10.3945/an.116.013177

7. Khoo, Hock, Ng, Hui, Yap, Wai-Sum, Goh, Henri, & Yim, Hip. (2019). Nutrients for

Prevention of Macular Degeneration and Eye-Related Diseases. Antioxidants, 8(4), 85.

https://doi.org/10.3390/antiox8040085
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