Meeting a growing population’s vision concerns requires innovating ingredients, tackling delivery challenges and arming with education.

The World Health Organization (WHO) reports that more than 285 million people in the world are visually impaired, 39 million of which are blind, while 246 million have moderate to severe visual impairment. It is also predicted that without extra interventions, these numbers will rise to 75 million blind and 200 million visually impaired by the year 2020. And according to Lighthouse International, the main causes of blindness are cataract, glaucoma and age-related macular degeneration (AMD). Approximately 25-30 million people suffer symptoms of AMD worldwide.

Eye health is a growing concern for Americans. According to Sloan Trends’ TrendSense, eye health ranks fourth as the greatest health concern for U.S. adults, while vision health ranks eighth among parents’ health concerns for their children. In addition, the National Eye Institute reports that the global cost of vision loss due to all causes is estimated to reach nearly $3 trillion for the 733 million people living with low vision and blindness worldwide.

The vision health market is growing, not only because Baby Boomers are getting older, but the rise in hand-held technology is widening the market’s demographic. While many Baby Boomers see a decline in their vision health as they age, constantly staring at laptops, smartphones and tablets have caused vision issues for those much younger. “The new age epidemic of computer-related eye fatigue is a growing concern among Baby Boomers and younger ‘videophiles’ alike, so there is a real value in offering an ingredient to combat this,” said Joe Kuncewitch, national sales manager for New Jerseybased AstaReal, Inc. 

“We are seeing a new set of vision concerns emerge as a result of early and heavy use of computers and other electronic devices,” added Abhijit Bhattacharya, president of OmniActive Health Technologies, Inc. in New Jersey. “Individuals are constantly at their monitors and handheld devices, resulting in eye fatigue and strain.

People tend to not think about their vision health until it is too late.” 

Standout Ingredients 

As far as the stars of the vision health category, lutein and zeaxanthin remain the standouts. Both can be found in green leafy vegetables as well as eggs. According to Kathy Maurer, senior marketing manager, eye nutrition for DSM Nutritional Products, LLC in New Jersey, lutein and zeaxanthin are carotinoid pigments found in significant quantities in the macula of the eye or the central portion of the retina. “These pigments are responsible for filtering harmful blue light which can damage the macula,” she said. “Depletion of these macular pigments occurs with repeated, unprotected exposure to sunlight and with age can lead to AMD, the leading cause of visual impairment and blindness in adults over the age of 65 years.” 

Iowa-based Kemin Industries began manufacturing and marketing FloraGLO Lutein, the crystalline form of free lutein in 1994. In 2008, Kemin and DSM joined forces working under an exclusive strategic alliance. Kemin supplies FloraGLO brand lutein exclusively through DSM and DSM globally commercializes FloraGLO brand lutein products through distributors and directly to customers. “FloraGLO Lutein has been a mainstay in the ocular vitamin category for many years and has had a place on the packaging of many of the most popular products on the market,” said Alex Fink, marketing director for Kemin. “It has been there because FloraGLO is the most trusted lutein brand of leading researchers.” 

Kemin’s newest offering is ZeaONE Zeaxanthin, a naturally sourced dietary zeaxanthin ingredient. According to Fink, like FloraGLO Lutein, ZeaONE is the same “free” form as is found naturally in the diet. It is sourced from marigolds and provides the clinically proven benefits of the zeaxanthin nutrient, “the way nature intended.” 

Omniactive’s Lutemax 2020 combines lutein and zeaxanthin isomers into a single source with a wide variety of delivery options. The levels of zeaxanthin isomers in Lutemax 2020 are higher than in most commercial forms, which allow formulators to include more nutritionally relevant amounts in their products. According to the company, the ingredient’s specific ratio helps address common inadequacies in the diet to support healthy visual function and macular health. Lutemax 2020 also has FDA-notified GRAS (generally recognized as safe) acceptance.

OmniActive offers two additional premium standalone lutein options, Lutemax Free Lutein and Lutemax Lutein Esters, as well as OmniXan, zeaxanthin from paprika, a natural wholefood U. S. grown source that has long been a part of the human diet. OmniXan delivers high-quality zeaxanthin in a variety of delivery platforms for use in dietary supplements, functional foods and beverage applications.

Beyond lutein and zeaxanthin, betacarotene, vitamins A, C and E, omega-3s, bilberry extract and astaxanthin are among the ingredients that have been utilized in supporting vision health. “Initially, anthocyanins extracted from European bilberry (Vaccinium myrtillus L. ) were among the first to be used to protect the eyes. The berries were first used by royal pilots to improve their night vision,” explained Carol Cheow, general manager of California-based Cactus Botanics Limited, who noted that zeaxanthin is the company’s latest and most successful ingredient. “In recent years, the most exciting carotenoids are zeaxanthin and lutein, which have strong science supporting vision health applications, specifically to support the structure and function of the macula.”

Meanwhile, DSM provides a full portfolio of vitamins, minerals, carotenoids and omega-3s that support eye health including FloraGLO Lutein, OPTISHARP Zeaxanthin, as well as lifesDHA and Meg-3.

Like lutein and zeaxanthin, astaxanthin is another carotenoid important for vision health that is found in Haematococcus pluvialis, a type of dark red microalgae, as well as in yeast, salmon, trout, krill, shrimp, crayfish and crustaceans. According to a 2009 study published in the journal Chemical Research in Toxicology, researchers found that taking astaxanthin supplements may reduce the risk of developing cataracts.

“It has been demonstrated that astaxanthin concentrates in the iris-ciliary muscle of the eye which may contribute to improvement of ciliary body function via increased blood flow to this area and reduced muscular fatigue,” explained AstaReal’s Kuncewitch. “Although similar in structure to its carotenoid cousins lutein and zeaxanthin, astaxanthin functions on a different level and in a different area of the eye.” 

AstaReal, Inc. offers AstaREAL brand natural astaxanthin in two percent powder and 10 percent oil extract forms. “We have conducted more than 50 peerreviewed, published studies on this most potent carotenoid and we lead the industry in research and intellectual property on astaxanthin,” Kuncewitch said. “For ocular well-being, AstaReal astaxanthin has significantly demonstrated the beneficial effect of reducing eye fatigue, improving accommodation (focus) and enhancing visual acuity.”

AREDS2 & LUTEGA 

While the search for the newest ingredient to combat vision health is ongoing, according to Cheow, it is the tried and tested ingredients that will stay true. “We believe that the truly effective ingredients will never lose momentum,” she said. “They may be outshined only when more effective or potent natural ingredients proven by highly credible research appear on the market.” 

Recently, two studies support the benefits of supplements in eye health. The Age-Related Eye Disease Study 2 (AREDS2) is a multi-center, multi-factorial, randomized, control-group trial seeking to determine if adding lutein/zeaxanthin, omega-3s or a combination of both could improve upon the positive results found in the original AREDS study and further help decrease the risk of developing advanced age-related eye diseases, such as AMD and cataracts. Two articles, the first on AMD and the second on age-related cataracts, were simultaneously published online in the journals JAMA and JAMA Ophthalmology, respectively.

“Millions of older Americans take nutritional supplements to protect their sight without clear guidance regarding benefit and risk,” said National Eye Institute (NEI) Director Paul A. Sieving, MD, PhD. “This study clarifies the role of supplements in helping prevent advanced AMD, an incurable, common and devastating disease that robs older people of their sight and independence.” 

The original AREDS study, published in 2001, demonstrated that a dietary supplement formulation (known as the AREDS formulation) of vitamins C and E, beta-carotene, zinc and copper helped reduce the risk of AMD by 25 percent. Further analysis of the AREDS study suggested that the use of a multivitamin may delay the progression of cataracts.

“Without question, one of the most important events happened in 2013 with the release of the ARED2 study from the National Institutes of Health (NIH) National Eye Institute (NEI). Results from AREDS2 reported an 18 percent reduction in progression to advanced AMD in subjects who received 10 mg FloraGLO Lutein and 2 mg zeaxanthin, in addition to an AREDS supplement without beta carotene compared to the original AREDS supplement with beta carotene,” said Kemin’s Fink. “This reduction in progression to advanced AMD is even greater (26 percent) in study subjects with the lowest intake of lutein and zeaxanthin in their diet, which is more representative of the general U.S. population.”

In the second study, Long Term Effects of Lutein/Zeaxanthin and Omega-3- Supplementation on Optical Density of AMD Patients (LUTEGA), 72 individuals with nonexudative (dry form) AMD were recruited to evaluate the effects of the administration of either a capsule containing 10+1 mg of lutein and zeaxanthin and 100 mg DHA + 30 mg EPA or twice these dosages (20/2/200/60) on the plasma xanthophyll concentrations and fatty acid profiles, antioxidant capacity in plasma and optical density of the macular pigment. The results demonstrate that the study supplementation significantly improved the plasma antioxidant capacity, circulating macular xanthophyll levels and the optical density of the macular pigment.

“The two most recent studies are the LUTEGA and AREDS2,” agreed DSM’s Maurer. “Both support the growing evidence that nutrients such as lutein, Zeaxanthin and omega-3 fatty acids can attenuate the risk and or progression of age-related eye diseases.” 

Delivery & Awareness 

According to DSM’s Maurer, even though supplements dominate the vision health category, as more consumers are taking preventative measures, more functional foods and beverages will be developed as alternative delivery options.

However, OmniActive’s Bhattacharya noted that one of the challenges of eye health ingredients such as lutein and zeaxanthin isomers has been stabilizing them for use in finished products. “The very same properties that give carotenoids protective benefits are also what makes them unstable when exposed to elements such as light and air,” Bhattacharya said. “In addition, consumers are interested in a variety of delivery systems other than tablets, capsules and soft gels. The use of gummies and powders continues to increase, and ingredient forms providing the appropriate stability and function are critical to successful products.” 

Because the demographic for vision health continues to widen as consumers take more interest in preventative eye care, the category will continue to grow. And according to Bhattacharya, when it comes to companies’ ingredient credibility and communicating their message to the public, it is important to create educational programs that support the scientific community as well as the consumer population.

In March, OmniActive launched a consumer educational campaign called Lutein for Every Age. According to the company, the focus of the campaign is to raise awareness of the importance of early and consistent lutein intake to help maintain proper eye health throughout a person’s life. The campaign’s goal is to help consumers understand how to take a proactive approach to maintaining healthy vision and learn about lutein’s role in skin and cognitive health as well as overall wellness.

“Healthy vision is important not only because of the associated health care costs, but also because of the impact it has on your life,” concluded Maurer. “Consumer’s today are taking a more proactive rather than reactive approach when it comes to maintaining healthy vision.” 

Report Links Health Care Savings to Vision Supplements

Astudy from Frost & Sullivan suggests that the use of supplements containing lutein and zeaxanthin could result in $7.4 billion in health care savings in the U.S. between now and the year 2020.

The study, “Smart Prevention— Health Care Cost Savings Resulting from the Targeted Use of Dietary Supplements,” examines the link between the use of key dietary supplements and the reduction of health care costs associated with four separate disease-related conditions in people over the age of 55. The study includes a scientific assessment that provides a critical review and ranking of the relevant scientific literature for specific supplements to determine if there is an association between supplement intake and risk reduction of disease, as well as an economic analysis that determines potential net health care savings from the use of the reviewed dietary supplements due to avoided disease-related medical costs.

The study identifies age-related macular degeneration (AMD) and cataracts, both considered age-related eye disease (ARED), as primary causes for vision impairment and blindness, conditions that threaten a large percentage of the elderly population in the United States. The report cited that in the U.S. population of adults aged 55 and older, there is an expected event rate of AMD of 2.8 percent and of cataract of 33 percent.

Based on its review of the research literature on lutein and zeaxanthin, Frost & Sullivan determined that multiple research studies support the use of lutein and zeaxanthin as having a preventative effect on AMD. The preventative health care cost savings from lutein and zeaxanthin supplementation found in the study do not capture the significant physical and emotional distress, and the overall decline in quality of life that can result from ARED.

The study estimated $7.4 billion in net savings over the next seven years from a reduction in the number of ARED incidents through the use of lutein with zeaxanthin. In those seven years, AMD incidents could be reduced by 23 percent, equating to 115,000 fewer incidents, and cataract incidents could be reduced by 15.3 percent, amounting to 7,659,000 fewer incidents, all through the use of dietary supplements containing lutein and zeaxanthin at preventive intake levels. While the study acknowledges that there is no government-recognized daily intake level for lutein and zeaxanthin, it references the American Optometric Association recommendation of 10 mg lutein and 2 mg zeaxanthin, daily, to achieve eye health benefits based on recent scientific studies, and considers these as preventative intake levels in its analysis.

Lutein and zeaxanthin can be obtained through the diet by eating green, leafy vegetables such as spinach and kale, and foods such as corn, eggs and peppers. However, research shows most Americans only get 10 percent of the lutein and zeaxanthin needed each day from dietary sources—just a fraction of the amount needed to protect their eyes as they age.

For more information, visit www.frost.com/sublib/display-marketinsight. do?id=285115104.

Extra! Extra!

A study about how vegetable oil may help battle blindness is available at www.niemagazine.com.

FOR MORE INFORMATION:

■ AstaReal, Inc., (609) 386-3030

■ Cactus Botanics Limited, (562) 219-2167

■ DSM Nutritional Products, LLC, (800) 526-0189

■ Kemin Industries, (800) 777-8307

■ OmniActive Health Technologies, Inc., (866) LUTEMAX (588-3629)