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Oh, Say Can You See?

Vision Health Vision Health

Vision is one of the most preciously held senses—and preserving eye health is an increasingly important goal for adults of all ages.

Of all the five senses, vision is often deemed the one people would rather not lose at all costs. For good reason, so much of what we see informs and inspires us.

The National Eye Institute describes how the eye works to see: As light passes through the cornea (the clear, dome-shaped covering in the front of the eye) it bends, or refracts, in response to and to accommodate the incoming light. The iris regulates the size of the pupil in the center of the iris, which controls the amount of light that enters the eye. The lens is behind the pupil, which acts to further focus light or an image onto the retina—a thin photosensitive tissue that contains photoreceptor cells, which convert light into electrical signal. The signals journey from the retina to the brain via the optic nerve, and the brain identifies and processes what it “sees.”

The following statistics about approximately how many people are affected by eye conditions are from the American Academy of Ophthalmology (which also noted that there are more than 19,000 ophthalmologists in the United States).

• Cataracts affect approximately 25 million Americans age 40 and older. By age 75, approximately half of all American adults have cataracts, a very common condition where the lens becomes cloudy.

• Glaucoma affects more than 2.7 million Americans age 40 and older.

• Nearly 2.1 million Americans age 50 and older have late age-related macular degeneration (AMD), the stage that can lead to severe vision impairment. In 2010, 9.1 million Americans had early AMD. By age 80, one in 10 American adults has late AMD, which is more common in women than in men.

• The prevalence of dry eye syndrome increases with age. An estimated 3.2 million women over age 50 and 1.68 million men age 50 and over are affected by dry eye syndrome. But this is occurring more in younger people in the digital age.

The dietary supplement industry has been actively engaging in research and development of ingredients that have scientific evidence supporting value for vision health, primarily focusing on aging individuals as many cases of vision impairment arise in individuals after age 50 or so. But there have been clear shifts in research and subsequent ingredient development and marketing for end products.

“Supplementation had focused on lowering risk of conditions like AMD or slowing its progression. What has changed over the past several years is the science and conversation about the importance of eye-health ingredients beyond just protection,” said Brian Appell, marketing manager, New Jersey-based OmniActive Health Technologies, Inc.

He added that there is increasing emphasis on research about how nutrients protect the structure and function of the eye, and hence, vision; for example, more published studies are showing how nutrients, like the macular carotenoids, help promote visual acuity.

Lutein and zeaxanthin are, hands down, the top carotenoids for eye health. In the past 10 years, the research on lutein and zeaxanthin has grown substantially. In 2014, the National Eye Institute published the results of the landmark Age-Related Eye Disease Study 2 (AREDS2), a five-year study of more than 4,000 adults with AMD. This study evaluated whether certain nutrients, including FloraGLO lutein and zeaxanthin, could prevent or slow the progression of AMD, according to Diane Alexander, PhD, senior technical services manager Iowa-based Kemin Human Nutrition and Health. The results showed a 26 percent reduction in the risk of progression to advanced AMD among participants who supplemented with the highest intake of lutein and zeaxanthin compared to those with the lowest consumption levels.

Equally, there has been more research substantiating the amount of lutein and zeaxanthin supplementation to increased levels in the eye, as measured by macular pigment optical density (MPOD). “Researchers are now using MPOD as a biomarker for the amounts of lutein and zeaxanthin in the body as well as a long-term indicator of the adequacy of the diet,” Alexander stated. “It can take between two to four months of daily supplementation with 10 mg of FloraGLO Lutein for an individual’s MPOD to increase significantly.”

Additionally, pointed out Appell, “the implications of increased blue light exposure becomes more apparent, researchers are continuing to examine how nutrients like macular carotenoids can help protect the eyes from various sources, including prolonged exposure to digital devices.”

Alexander agreed, explaining that lutein and zeaxanthin have also been shown to have the capability to help improve visual quality in younger people with healthy vision. She reported that a 2008 study found that visual performance was improved in healthy eyes of young adults who consumed FloraGLO Lutein and zeaxanthin, and that a follow-up randomized, double-blind, placebo-controlled study published in 2014 confirmed the results. “Together, these studies showed that supplementation with lutein and zeaxanthin resulted in significantly decreased photo-stress recovery time (i.e., the time it takes to recover from a blinding flash of light) and increased chromatic contrast which was related to the increase in MPOD values following supplementation,” she said. Further, she added, researchers have shown that lutein and zeaxanthin when taken during pregnancy can accumulate in the eyes of the fetus as early as 17 to 22 weeks of gestation.

Researchers, Appell explained, are looking at endpoints such as contrast sensitivity, photo-stress recovery and glare performance, which characterize how well we see under various conditions and which can be measured with validated methods. “So, it’s not just about reducing risk of age-related conditions like AMD anymore (a condition that may take several decades to develop), but providing a more immediate benefit to consumers—seeing better,” he commented.

Another emerging area of eye-support supplement research is how ingredients support ability to interact with our environments, he added. “Vision is our primary means of navigating and interacting with our environments. And how fast we react within our environments starts with how fast visual information travels from our eyes to our brain—known as “visual processing speed.” Improving visual processing speed through supplementation provides new opportunities in different categories—like sports nutrition—where reaction time is key.”

Currently, the eye health and vision-support dietary supplement market has clearly evolved from just an aging-eye-disease risk-lowering category to include active wellness—providing visual support benefits that are more relevant to consumers of all ages.

Market Opportunities

The directions in which the research is taking opens up new markets beyond aging adults. For example, improving visual processing speed is an attribute not only for athletes, but for first responders and other emergency personnel.

Ceci Snyder, MS, RD, global product manager for Kemin Human Nutrition and Health reported that Kemin continues to see interest in eye health at all ages and segments—children/parents, prenatal, healthy adults and the traditional AMD patient. “As the author of a patent on how lutein blocks blue light, our customers are excited to offer blue light products with FloraGLO Lutein,” she said. “We see opportunities from the very young (because FloraGLO is the only lutein GRAS [generally recognized as safe] for infant formula) to older consumers (because FloraGLO was the source of lutein in the AREDS2 study). For Baby Boomers, the interest in eye supplements will continue as age-related eye health concerns develop. The ability of lutein and zeaxanthin to improve eye performance, even in healthy eyes, by increasing macular pigment density offers new opportunities.”

Appell observed two broad categories: the prevention market and the visual performance market. Prevention targets the 50-plus consumers, who will remain a strong market for eye care formulas as the aging population continues to grow. Their motivations, he said, are to prevent or slow down age-related eye conditions like AMD, glaucoma and cataracts.

The other market—where Appell said he sees a bigger opportunity—is vision performance because we rely almost exclusively on our vision to navigate our environments. By marketing nutrients that augment the eyes’ ability to see in low/bright light conditions, to quickly recover from sudden exposure to bright light(s), and reduce eye fatigue/strain when using digital devices, you open the market to younger generations of consumers interested in “performance” formulas.

Another untapped market is sports nutrition, as it relates to visual processing speed and reaction time. This is one of the fastest growing categories in nutrition and companies are only now starting to cater to the e-gamer market—a multibillion-dollar industry where players rely heavily on eye-hand coordination and reaction time. But vision health/visual performance is important across all sports sectors and catering to these consumers can be a big win for companies moving forward.

Historically, consumers have been driven to multivitamins with added eye-support benefits, but as the target market opportunities flourish as described, the concept of a singular supplement for eye health nourishment becomes more attractive to wellness-oriented consumers across the generation board.

“Based on the results of several randomized trials, daily intakes of 10 mg lutein and 2 mg zeaxanthin are typically recommended to realize eye health benefits, explained Alexander. “However, these levels of lutein and zeaxanthin are rarely found in multivitamin formulations. In order to get these efficacious levels of lutein and zeaxanthin, consumers should look for standalone vision support/eye health supplements that contain 10 mg FloraGLO Lutein and 2 mg zeaxanthin. This dosage ensures they are maximizing their eye protection and improving their visual function and performance.”

Appell agreed that there may be space limitations in multivitamins that don’t allow for higher, efficacious doses, “but that’s a minor issue,” he said. “I think there is a compelling argument that certain ingredients—specifically macular carotenoids—should be provided in standalone formulas because they, like other nutrients such as fish oil, could be considered ‘conditionally essential.’”

Further, he clarified, these nutrients are usually synthesized or present in adequate amounts in the body, but under certain circumstances may require additional supplementation. Because the body cannot synthesize the macular carotenoids, dietary intake is the only way to ensure optimal levels in the retina and protect against daily blue light exposure. “And with the rise of blue light exposure in our daily lives and the fact consumers don’t eat enough fruits and vegetable to get adequate amounts of these nutrients, there is a need for supplementation at higher doses that might not be achievable from just a multivitamin,” he asserted.

Top Eye-support Ingredients

The three eye-health ingredients gaining the most research traction are proprietary compounds of omega-3 EFAS, lutein and zeaxanthin.

Bill Harris, PhD, founder of South Dakota and Australia-based OmegaQuant, and inventor of the Omega-3 Index Test, noted that several studies have sought to determine if eye disorders are linked with an omega-3 deficiency using a dried blood spot-based test called the Omega-3 Index. This test measures the EPA and DHA levels found in red blood cell membranes. A low Omega-3 Index has been linked to increased risk for dry eye, macular degeneration, diabetic retinopathy and glaucoma. Randomized trials in dry eye patients giving placebo or omega-3 supplements have shown significant improvement in symptoms.

The physiological importance of lutein and zeaxanthin in the eye was first identified in the late 18th century, but in 1985 these dietary carotenoids were first discovered to accumulate as macular pigment, according to Alexander. The first clinical research revealing the vision-support/eye-health benefits of this carotenoid combo was published in 1994 (Seddon, et al). The researchers, said Alexander, investigated the associations of dietary carotenoid intake with AMD. They observed that consuming lutein and zeaxanthin from dark-green leafy vegetables was strongly associated with a decreased risk of AMD.

This data inspired the research and development team at Kemin to begin investigating the potential for lutein as a dietary supplement ingredient. There was also evidence that there existed a gap between typical consumption of lutein in the American diet (low) to what was clinically shown to be viable amounts to promote eye health, leading to the launch of FloraGLO Lutein.

According to Alexander, lutein and zeaxanthin have two important functions that enable them to positively impact eye health. The first is their ability to filter blue wavelengths of visible light (which are more energetic than other wavelengths of visible light) and seem to be more efficient at generating reactive oxygen species—and lutein and zeaxanthin are versatile antioxidants that neutralize reactive oxygen species.

FloraGLO Lutein has been used in more than 80 separate published human clinical studies, including the prestigious National Institutes of Health/National Eye Institute’s AREDS2 study, Alexander pointed out.

Lutemax2020 from OmniActive, Appell described, is a “premium lutein with enhanced levels of zeaxanthin isomers in a balanced 5:1 ratio—as found in natural dietary sources—and contains significantly higher levels of zeaxanthin isomers than other lutein ingredients.”

Over the past several years, he added, OmniActive has focused on science on the macular carotenoids to expand the benefits and market opportunities for formulators and consumers. Key studies he points to for vision support include:

LAMA I & II (Lutein, Vision and Mental Acuity) demonstrated Lutemax 2020 to have high bioavailability as well as to help support visual performance, healthy stress levels and brain function in young adults, Appell reported. Then the B.L.U.E. (Blue Light User Exposure) Study, showed Lutemax 2020 supplementation exerted beneficial effects on ocular health and performance, and eye strain and fatigue in those individuals with long-term exposure to digital screens and other sources of high-energy blue light.

These studies, Appell attested, have shown the following four benefits:

  1. Rapid increase of macular pigment optical density (MPOD) the protective layer of carotenoids that help filter blue light
  2. Improved markers of visual performance including contrast sensitivity, phot-stress recovery, glare performance and visual processing speed
  3. Reduction in the effects of prolonged exposure to blue light from digital devices—eye fatigue, eye strain and headache frequency
  4. Improved sleep quality due to the blue light filtering effect of macular carotenoids (blue light plays a role in our sleep/wake cycles)

A mechanism of action study on Lutemax 2020, he said, reveals how macular carotenoids reduce both oxidative- and endoplasmic reticulum stress – major factors that contribute to photoreceptor degeneration. According to the Appell, “the Lutemax 2020 supplemented group, the number of TUNEL-positive cells was significantly reduced compared to that of the vehicle group. Western blotting results revealed that reduction in oxidative stress was due to significant downregulation of phosphorylated c-Jun N-terminal kinase (p-JNK) and significant upregulation of nuclear factor erythroid 2-related factor 2 (Nrf2). In addition, reduction in endoplasmic reticulum stress was due to the significant downregulation of glucose-regulated protein (GRP78), phosphorylated protein kinase RNA-like endoplasmic reticulum kinase (p-PERK), activating transcription factor 4 (ATF4) and activating transcription factor (ATF6).”

Vision preservation is now considered to be a priority for Americans across ethnicities and age groups, according to a published study in the October 2016 issue of JAMA Opthalmology, “Public Attitudes About Eye and Vision Health” (Scott, et al). The researchers’ survey of 2,044 adults in the U.S. conclude that “vision health was a priority with high support for ongoing research for vision and eye health” across all ethnic groups. NIE

For More Information:

Kemin Human Nutrition and Health, www.kemin.com
OmegaQuant, www.omegaquant.com
OmniActives Health Technologies Inc., www.omniactives.com

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