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Vitamins, nutrients and the eye

In various studies and clinical trials antioxidant vitamins found in certain foods have been linked with eye health. They help to maintain healthy cells and tissues in the eye.

The main focus has been on the anti-oxidant vitamins A, C and E. These vitamins can be found in many different sources of fruit and vegetables such as oranges, kiwis, grapefruit, dried apricots, tomatoes, peppers, raw carrots, green leafy vegetables including kale and spinach, green peas, green beans and brussel sprouts. They can also be found in nuts, seeds, dairy products and eggs. These are only a few of the food types in which antioxidant vitamins can be found. The British Nutrition Foundation can provide you with further information on this. Their contact details are at the end of this leaflet.

Lutein and eye health

More recently it has been suggested that two types of antioxidants, known as ‘carotenoids’, called Lutein (pronounced Loo-teen) and Zeaxanthin (pronounced Zay-a-za-thin) may also help with eye health. Some studies have found that people who have a good diet rich in carotenoids, particularly lutein and zeaxanthin, have a lower risk of developing AMD. Lutein and Zeaxanthin can be found naturally in vegetables and fruit. For example, Lutein can be found in yellow peppers, mango, bilberries, and green leafy vegetables such as kale, spinach, chard and broccoli. Zeaxanthin can be found in orange sweet peppers, broccoli, corn, lettuce (not iceberg), spinach, tangerines, oranges and eggs. Many of these overlap with food types in which vitamins A, E and C are present.

Age-related macular degeneration (AMD)

A large research trial, called the ‘Age-Related Eye Disease Study’ (AREDS), showed that high quantities of the antioxidant vitamins A, C, E, beta-carotene and the minerals zinc as zinc oxide, and copper as cupric oxide, can help to slow down the progression of AMD. It would be very hard to obtain the large quantity of vitamins used in the trial from your diet. Therefore some people who have AMD may consider supplementation with vitamins and anti-oxidants. Such high dosages of vitamins and minerals might have possible side effects on the body.

For this reason it is very important to consult your doctor first before taking a supplement.

Eye health

Following the AREDS research trial there have been over 150 smaller scale studies looking at how vitamins and minerals, both from food and in a vitamin supplement, can help eye health in general, and in particular AMD and cataracts. A number of these studies have looked specifically at the carotenoids Lutein and Zeaxanthin which have been particularly associated with healthy eyes.

Some of these studies have shown how certain vitamin and mineral supplements can have a positive effect on eyes and sight. Others have shown there to be no or little benefit. For this reason various organisations are calling for further, larger scale research.

As a result of these studies there are now a number of different supplements for eye health on the market. There is still divided medical opinion on the use of supplements for both eye health and for preventing, or slowing down, the progression of AMD and cataracts in particular. The general consensus of opinion is that with a good balanced diet that includes sufficient fresh fruits and vegetables there should be no need to use supplements.

However, research has shown that many people in the UK do not get enough vitamins and minerals from their diet. Some people might consider taking a supplement for their general and eye health when :

• • their diet does not include enough fresh fruit and vegetable
  • diet does not include enough vitamins and minerals
  • vitamins and minerals from food are not adequately absorbed by the body .
  • it is hard to obtain or prepare fresh fruit and vegetables
  • they have been told to take a supplement by their doctor or nutritionist.

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Lipid and fatty acid profile of the retina, retinal pigment epithelium/choroid, and the lacrimal gland, and associations with adipose tissue fatty acids in human subjects.

Bretillon L, Thuret G, Grégoire S, Acar N, Joffre C, Bron AM, Gain P, Creuzot-Garcher CP.
Eye and Nutrition Research Group, UMR1129 FLAVIC, INRA, 17 rue Sully, BP 86510, F21065 Dijon cedex, France. Eye Res. 2008 Aug 29.

Accumulation of lipids within Bruch's membrane (BrM) and between BrM and retinal pigment epithelium (RPE) accounts for one of the biological changes associated with normal aging and may contribute to the development of age-related maculopathies. The origin of these lipids is still being actively investigated. The relative contribution of plasma lipids and lipids coming from the neural retina remains a matter of controversy.

Low-density lipoproteins (LDLs) have been reported to significantly participate in the retina's lipid supply, after active remodeling within RPE. Meanwhile, RPE expresses the enzymatic machinery for synthesizing lipoprotein-like particles.

The objective of this study was to establish associations between the fatty acid profile of the ocular structures and adipose tissue as a surrogate for the subjects' past dietary intake. Lipids and fatty acids were analyzed from the neural retina, retinal pigment epithelium (RPE)/choroid, the lacrimal gland, and adipose tissue, collected from 27 human donors (19 women, eight men) aged 59-95 years.

DHA concentrations in the neural retina were positively associated with the concentrations in cholesteryl esters (CEs) from RPE/choroid and negatively associated with DHA concentrations in phospholipids (PLs) from RPE/choroid. DHA in orbital fat was positively associated with DHA in the lacrimal gland. No significant association was observed in the other ocular structures. Linoleic acid in orbital fat was positively associated with linoleic acid in the lacrimal gland, followed by the neural retina and CEs from RPE/choroid; it was slightly correlated with PLs from RPE/choroid.

Other fatty acids that originate exclusively from the diet such as trans fatty acids were detected in orbital fat, the lacrimal gland, PLs, and CEs from RPE/choroid. DHA in the neural retina was poorly associated with its dietary intake, contrary to other fatty acids such as linoleic acid. Within this context, CEs may be important carriers of fatty acids entering the retina. Although epidemiological studies have reported the benefit of DHA in the prevention of age-related macular degeneration, the leading cause of blindness in Western countries, the relevance of supplementing patients with DHA is questioned.

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Use of statins and angiotensin converting enzyme inhibitors (ACE-Is) and the higher risk of age-related macular degeneration: nested case-control study.

Etminan M, Brophy JM, Maberley D. Curr Drug Saf. 2008 Jan;3(1):24-6.
Centre for Clinical Epidemiology and Evaluation, Vancouver General Hospital, 7 Floor - 828 West 10 Ave., Vancouver, British Columbia, Canada. metminan@shaw.ca

BACKGROUND: Age related macular degeneration (AMD) is a progressive degenerative disease affecting central vision. Recent studies have shown that that statins may lower the risk of AMD potentially due to statins' anti-inflammatory and anti-oxidative properties. We sought to further explore this association and also explore the role of angiotensin-converting enzyme inhibitors (ACE-Is) with respect to the development of AMD.

METHODS: We conducted a nested case-control study within a cardiovascular cohort that had undergone revascularization interventions in the Province of Quebec, Canada. Cases were identified as those with an ICD-9 code for AMD. For each case, four controls were randomly chosen from the cohort and matched to the cases by age and calendar time. Conditional logistic regression was used to estimate rate ratios and adjust for potential confounders.

RESULTS: Our nested case-control study consisted of 2,867 cases and 11,468. Current users of ACE-Is or statins were at a slightly higher risk of developing AMD (1.19 [1.07-1.33]) and (1.30 [1.17-1.44]) respectively. The results were similar for those using these drugs in the year prior.

CONCLUSIONS: Based on the results of our study, statin and ACE-I use may be associated with an increase in the risk of AMD. Given that our study is an observational study, further studies are required to confirm or refute these findings.