Which is a More Effective Eye Supplement for Macular Disease: Lutein With or Without Omega-3 Fatty Acid?

By Ms Cher Huiyun Joanna
DipOptom(S’pore), BSc in Optom(Hons)(UK), MPhil(UK)

Lutein (L) and zeaxanthin (Z), two types of xanthophyll carotenoids found in the macula and collectively known as macular pigment (MP), are believed to prevent macular diseases such as aged-related macular degeneration (AMD). Researchers have hypothesized that L supplementation can increase MP density which protects the macula by its antioxidant properties and blue light filtration.1

Docosahexaenoic acid (DHA) (a type of polyunsaturated fatty acid) and eicosapentaenoic acid (EPA) are structural components of the retina. Therefore, some researchers have speculated that adding DHA and EPA into L may further slow the progression of AMD.2

Wolf-Schnurrbusch and colleagues2 found that AMD patients taking L + omega-3 polyunsaturated fatty acid supplements have a significantly lower MP increment and plasma L compared to subjects taking L-only supplement. Other researchers have shown that omega-3 fatty acid can reduce the bioavailability of L to blood and macula, while olive oil (a type of monounsaturated fatty acid) may increase L uptake.3-5

The Age-Related Eye Disease Study 2 (AREDS2) demonstrated that AMD patients who took L and Z, used to substitute beta-carotene (vitamin A) in the new multivitamin formulation, had more reduction in AMD progression and vision loss compared to those who received supplements without L and Z. AMD patients who took L + Z with DHA + EPA did not show further reduction in AMD progression compared to those who took L + Z supplement.6

In conclusion, L supplement has a beneficial effect on macular health and visual function. Omega-3 fatty acid may reduce the blood and macular absorption of L and is thus not recommended to be taken together with L.

References

  1. Snodderly DM. Evidence for protection against age-related macular degeneration by carotenoids and antioxidant vitamins. Am J Clin Nutr. 1995; 62(suppl):1448S-61S.
  1. Wolf-Schnurrbusch U T K, Zinkernagel M S, Munk M R, Ebneter A, Wolf S. Oral Lutein supplementation enhances macular pigment density and contrast sensitivity but not in combination with polyunsaturated fatty acids. Invest Ophthal Vis Sci. 2015; 56:8069-8074.
  1. Goltz SR, Campbell WW, Chitchumroonchokchai C, Failla ML, Ferruzzi MG. Meal triacylglycerol profile modulates post prandial absorption of carotenoids in humans. Mol Nutr Food Res. 2012; 56:866-877.
  1. Lakshminarayana R, Raju M, Keshava Prakash MN, Baskaran V. Phospholipid, oleic acid miscelles and dietary olive oil influence the lutein absorption and activity of antioxidant enzymes in rats. Lipids. 2009; 44:799-806.
  1. Nidhi B, Mamatha BS, Baskaran V. Olive oil impreoves the intestinal absorption and bioavailability of lutein in lutein-deficient mice. Eur J Nutr. 2014; 53:117-126.
  1. Chew EY, Clemons TE, SanGiovanni JP et al. Lutein and zeaxanthin and omega-3 fatty acids for age-related macular degeneration. The age-related eye disease study 2 (AREDS 2), randomized clinical trial. JAMA. 2013; 309(19):E1-E11.