Guide to Choosing Nutritional
Supplements for Vision

By Shereen Jegtvig, Certified Nutrition Specialist (CNS);
contributions and review by Gary Heiting, OD

Eye supplements can help you get enough of the valuable nutrients you need each day for healthy vision. But keep in mind that taking vision vitamins each day doesn't mean you can abandon a healthy diet or indulge in too much junk food.

Eye supplements are designed to do what their name suggests: they supplement a healthy diet to make sure you get all the nutrients you need for good eyesight.

What is a "Healthy Diet" for Good Vision?

According to the Dietary Guidelines for Americans developed by the U.S. Department of Health and Human Services and the Department of Agriculture, a healthful diet:

• Emphasizes fruits, vegetables, whole grains and fat-free or low-fat milk and milk products
• Includes lean meats, poultry, fish, beans, eggs and nuts
• Is low in saturated fats, trans fats, cholesterol, salt (sodium) and added sugars

But it's common knowledge that most Americans don't eat enough fruits, vegetables and other nutrient-rich foods, opting instead for high-calorie, low-nutrient alternatives that can be harmful to the body, including the eyes.

Taking a daily multivitamin and mineral supplement can help fill in the nutritional gaps in a less-than-optimal diet and may help protect you from degenerative diseases, including eye diseases such as macular degeneration and cataracts.

AREDS: Eye Supplements Reduce Risk of Macular Degeneration

The Age-Related Eye Disease Study (AREDS) was a major eye nutrition study conducted in the 1990s and sponsored by the National Eye Institute (NEI), one of the Federal government's National Institutes of Health.

The AREDS was designed to:

• Investigate the natural history and risk factors of age-related macular degeneration (AMD) and cataracts.
• Evaluate the effect of high doses of antioxidants and zinc on the progression of AMD and cataracts.

Results from the AREDS showed that a combination of high levels of antioxidant vitamins A, C and E (in combination with the mineral zinc) significantly reduces the risk of advanced macular degeneration and its associated vision loss.

A diet containing plenty of fruits and vegetables can help you enjoy a lifetime of good vision.

The doses used in the study were:

• Vitamin C - 250 mg
• Vitamin E - 400 IU
• Vitamin A (as beta-carotene) - 15 mg
• Zinc (as zinc oxide) - 80 mg
• Copper (as cupric oxide) - 2 mg

(Copper was added to the formula because high doses of zinc are associated with copper deficiency).

Although these same nutrients had no significant effect on the development or progression of cataracts in the AREDS, more recent research suggests the development of cataracts is associated with oxidative changes in the eye, and antioxidant eye vitamins may indeed help reduce the risk of cataracts.

As a follow-up to the original Age-Related Eye Disease Study, the NEI is sponsoring AREDS2, a new multi-center study designed to assess the effects of eye supplements containing high doses of lutein, zeaxanthin and/or omega-3 fatty acids for the treatment of macular degeneration and cataracts.

Approximately 4,000 people between the ages of 50 and 85 are participating in AREDS2. Enrollment in the study concluded in June 2008, and the participants will be followed for five to six years.

Recommended Ingredients in Vision Supplements

As research continues on the benefits of vision supplements in reducing the risk of eye problems (and perhaps in optimizing visual acuity in healthy eyes), it seems wise to supplement your diet with a daily "vision multivitamin" that contains many, if not all, of the following ingredients.

Most of these vitamins and other nutrients play a key role in reducing the risk or slowing the progression of degenerative diseases, including chronic eye problems.

Eye supplements can help fill in nutritional gaps in a less-than-perfect diet.

• Vitamin A and beta-carotene. Vitamin A (and its precursor, beta-carotene) is necessary for night vision, wound healing and proper functioning of the immune system. Beta-carotene was part of the AREDS formula.
• Vitamin B complex (including vitamins B1, B2, B3, B5, B6, B12 folic acid, biotin and choline). B complex vitamins may help reduce chronic inflammation and prevent elevated homocysteine levels in the blood, which have been associated with vascular problems affecting the retina. B vitamins also may play a role in reducing the risk of macular degeneration and in the treatment of uveitis, a common cause of blindness.
• Vitamin C. This potent antioxidant was part of the AREDS formula, and other research suggests vitamin C is associated with reduced risk of cataracts.
• Vitamin D. Recent literature suggests vitamin D deficiency is widespread, especially during winter months in cold climates. Research suggests vitamin D is associated with a lower risk of macular degeneration.
• Vitamin E. Another component in the AREDS formula, vitamin E has been associated with reduced risk of cataracts in other studies.
• Lutein and zeaxanthin. These carotenoids and macular pigments may reduce the risk of macular degeneration and cataracts.
• Phytochemical antioxidants. Plant extracts, such as those from ginkgo biloba and bilberry, contain phytochemicals, which appear to provide protection from oxidative stress in the entire body, including the eyes.
• Omega-3 essential fatty acids. These essential nutrients may reduce the risk of dry eyes and may have other eye health benefits as well.
• Bioflavonoids. Found in many fruits and vegetables, bioflavonoids appear to help the body absorb vitamin C for higher antioxidant efficiency.

Tips When Buying Vision Supplements

Generally, you will save money when choosing vision supplements if you purchase a multivitamin, rather than buying each vitamin and nutrient separately.

Popular eye multivitamins include:

• ICaps (Alcon, Inc.)
• Ocuvite PreserVision (Bausch & Lomb)
• Oculaire (Biosyntrx, Inc.)
• MacuTrition (Advanced Vision Research, Inc.)

There are many other brands as well.

When choosing eye supplements, make sure you read their labels carefully and follow these guidelines:

1. Check for an expiration date to make sure the supplement you are purchasing is fresh. Make sure the seal on the bottle has not been broken.
2. Check the serving size. Do you need to take only one tablet, or do you need to take two or more each day to get the percentages of the Daily Value of each ingredient listed? ("Daily Value" or "DV" is a basis for labeling nutrient content that the FDA began to require of food processors and manufacturers in the 1990s. It is not necessarily a recommended intake, since it is based on general measurements of the population at large, and different people require different amounts of nutrients.)
3. Capsules often are better absorbed than hard tablets and may cause less stomach upset.
4. The best eye supplements contain quality ingredients that have high bioavailability, meaning your body can absorb them easily. For example, the natural form of vitamin E (D-alpha-tocopherol) is roughly twice as active in the human body as the artificial form (DL-alpha-tocopherol).
5. Avoid eye supplements that contain dairy products, corn or wheat as fillers, especially if you have allergies or other intolerance problems. The most reputable companies typically will formulate their supplements without unnecessary fillers.

To make sure you are getting a reputable brand, choose one of the popular eye supplements listed above or consult a knowledgeable nutrition store clerk, nutritionist or health professional.

Precautions When Taking Eye Supplements

While dietary supplements, including eye supplements, generally are safe and beneficial, you should follow a few precautions. If you are pregnant or nursing or are taking blood thinners (anti-coagulants), speak to your doctor before using any type of nutritional supplements.

Even though vision supplements are a non-prescription item, do not exceed the dosage instructions on the bottle, to reduce the risk of toxicity or drug reactions.

Sources:

A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta-carotene, and zinc for age-related macular degeneration and vision loss. Archives of Ophthalmology. October 2001.

Vitamins for chronic disease prevention in adults: scientific review. Journal of the American Medical Association. June 2002.

Folic acid, pyridoxine, and cyanocobalamin combination treatment and age-related macular degeneration in women. Archives of Internal Medicine. February 2009.

Low vitamin B6 and folic acid levels are associated with retinal vein occlusion independently of homocysteine levels. Atherosclerosis. May 2008.

Prevention of endotoxin-induced uveitis in rats by benfotiamine, a lipophilic analogue of vitamin B1. Investigative Ophthalmology & Visual Science. May 2009.

Long-term vitamin C supplement use and prevalence of early age-related lens opacities. American Journal of Clinical Nutrition. October 1997.

Association between vitamin D and age-related macular degeneration in the Third National Health and Nutrition Examination Survey, 1988 through 1994. Archives of Ophthalmology. May 2007.

Long-term nutrient intake and 5-year change in nuclear lens opacities. Archives of Ophthalmology. April 2005.

Dietary carotenoids, vitamins C and E, and risk of cataract in women. Archives of Ophthalmology. January 2008.

Plasma antioxidant vitamins and carotenoids and age-related cataract. Ophthalmology. November 2001.

Associations between age-related nuclear cataract and lutein and zeaxanthin in the diet and serum in the carotenoids in the Age-Related Eye Disease Study (CAREDS), an ancillary study of the Women's Health Initiative. Archives of Ophthalmology. March 2008.

Topical omega-3 and omega-6 fatty acids for treatment of dry eye. Archives of Ophthalmology. February 2008.

Flavonoids protect retinal ganglion cells from ischemia in vitro. Experimental Eye Research. February 2008.

Possible contraindications and adverse reactions associated with the use of ocular nutritional supplements. Ophthalmic and Physiological Optics. May 2005.

[Page updated May 2009]