National Institutes of Health

July 2002

Claims made about an association between lutein and eye health are speculative and should be viewed with caution. The possible benefits of lutein for the eye remain uncertain.

Certain foods contain antioxidants -- molecules that can help maintain healthy cells and tissues in the eye. One category of these antioxidants, called carotenoids, may play a role in maintaining eye health as well as overall health. One of these carotenoids -- lutein -- is concentrated in the retina and lens of the eye.

There is little definitive scientific evidence at this time to support claims that taking supplements containing lutein can decrease the risk of developing advanced age-related macular degeneration (AMD), a blinding eye disease, or cataract. However, a number of studies intended to examine trends in a population -- and not hard medical evidence -- suggest a link between lutein and decreased risk of eye disease:

· In 1994, a National Eye Institute (NEI)-supported study indicated that consumption of foods rich in carotenoids -- particularly green, leafy vegetables such as collard greens, kale, and spinach -- was associated with a reduced risk of developing AMD.1

· In 1999, data from the Nurses Health Study showed a reduced likelihood of cataract surgery with increasing intakes of lutein and another carotenoid --zeaxanthin. 2

· In 1999, the Health Professionals Follow-up Study found a trend toward a lower risk of cataract extraction with higher intakes of lutein and zeaxanthin. 3

· In 1999, a follow-up to an NEI-supported population-based study -- called the Beaver Dam Study -- concluded that people with diets higher in lutein and zeaxanthin had a lower risk of developing cataract. 4

· In 2001, data from the Third National Health and Nutrition Examination Survey reported that higher intakes of lutein and zeaxanthin among people ages 40-59 may be associated with a reduced risk of advanced AMD. 5

Conversely, in 1998, the Beaver Dam Study found no significant association between the risk of either early or advanced AMD in groups that had either the highest intakes of lutein and zeaxanthin or the lowest intakes of lutein and zeaxanthin. The study researchers caution that generally, the consumption of lutein and zeaxanthin in this population may have been too low to have had an impact on the risk of AMD. 6,7

These conflicting data make it clear that the relationship between lutein and eye health needs to be examined more closely before conclusions can be drawn.

So What's Next for Lutein?

The NEI is investigating the role of nutrition -- including the effects of lutein -- in eye disease. Specifically, the NEI is:

· Conducting a pilot study to see how well lutein is absorbed into the bloodstream in people over age 60. This is a first step in testing this substance as a possible treatment for AMD. The pilot study is not designed to treat AMD; its purpose is to help determine the best dose of lutein oral supplements in people over age 60. This dose of lutein can then be separately tested in humans as a possible treatment for AMD.

· Supporting a study that compares the intake of lutein and zeaxanthin with the likelihood of developing AMD and/or cataract. Researchers explain that results from this study -- called the Carotenoids and Age-Related Eye Disease in Women's Health Study -- will help health professionals make dietary recommendations regarding the benefit of eating diets rich in lutein and zeaxanthin. Study results will also provide information needed to conduct clinical trials that can evaluate the effectiveness of lutein and zeaxanthin supplements on the progression of age-related eye disease.

The Role of Nutrition in Eye Disease Prevention

In October 2001, the NEI published the results of a seven-year study -- called the Age-Related Eye Disease Study (AREDS) -- that showed that a high-dose combination of vitamin C, vitamin E, beta-carotene, and zinc significantly reduces the risk of developing advanced stages of AMD by about 25 percent. These high levels of antioxidants and zinc are the first effective treatment to slow the progression of AMD. The nutrients are not a cure for AMD, nor will they restore vision already lost from the disease. But they are playing a vital role in helping people at high risk for developing advanced AMD keep their vision. In the same study, the antioxidant and zinc combination showed no significant effect on the development or progression of cataract.

Lutein was not part of this study because during the AREDS planning stages in the early 1990s, lutein and zeaxanthin were not commercially available.

1 Seddon, Johanna M., MD, et al, "Dietary Carotenoids, Vitamins A, C, and E, and Advanced Age-Related Macular Degeneration," JAMA, Vol. 272, No. 18, November 1994, pgs. 1413-1420.

2 Chasen-Taber et al., "A Prospective Study of Carotenoid and Vitamin A Intakes and Risk of Cataract Extraction in US Women," American Journal of Clinical Nutrition, 1999, Vol. 70, pgs. 509-516.

3 Brown et al., "A Prospective Study of Carotenoid Intake and Risk of Cataract Extraction in US Men," American Journal of Clinical Nutrition, 1999, Vol. 70, pgs. 517-524.

4 Lyle et al., "Serum Carotenoids and Tocopherols and Incidence of Age-Related Nuclear Cataract," American Journal of Clinical Nutrition, 1999, Vol. 69, pgs. 272-277.

5 Mares-Perlman et al., "Lutein and Zeaxanthin in the Diet and Serum and Their Relation to Age-Related Maculopathy in the Third National Health and Nutrition Examination Survey," American Journal of Epidemiology, 2001, Vol. 153, No. 5, pgs. 424-432.

6 Mares-Perlman et al., "Association of Zinc and Antioxidant Nutrients With Age-Related Maculopathy," Archives of Ophthalmology, 1996, Vol. 114, No. 8, pgs. 991-997.

7 VandenLangenberg et al., "Associations Between Antioxidant and Zinc Intake and the 50-Year Incidence of early Age-Related Maculopathy in the Beaver Dam Eye Study," American Journal of Epidemiology, 1998, Vol. 148, No. 2, pgs. 204-14.