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In 2017, I wrote an article for Vitamin Retailer called “Lutein & Zeaxanthin: Protection Against Blue Light Damage to Eyes,” which appeared in the May issue. Since that time, there has been additional research on lutein and zeaxanthin for eye health. Furthermore, there is some great research on astaxanthin for eye health, as well using astaxanthin in combination with lutein and zeaxanthin. That’s what this article is all about.
Background
If you want a comprehensive explanation of blue light, see the aforementioned article in Vitamin Retailer’s digital edition online. Meanwhile, here’s a synopsis: Blue light from digital devices and outdoor light can be harmful to the eyes.1 Nearly one-third of adults spend more than half their waking hours (nine plus) using a digital device.2 Headache, eye fatigue and other indications of eye strain are associated with the daily use of video display terminals on computers and other electronic devices, and are common with three or more hours/day of exposure.3,4 The good news is that lutein and zeaxanthin—as well as astaxanthin—can provide substantial protection against blue light damage.
Lutein and Zeaxanthin
Here’s a brief review of lutein and zeaxanthin, antioxidant carotenoids which protect against oxidative stress and harmful free radicals.5 Lutein and zeaxanthin protect the eyes and help them filter out harmful blue light from computers and other digital devices, as well as and outdoor light.6 Likewise, lutein and zeaxanthin were clinically tested7 to improve glare performance (i.e., excessive brightness, as might be caused by oncoming headlights at night). Specifically, they improve photo stress recovery (i.e., measuring the amount of time required for the macula to return to its normal level of function after being exposed to a bright light source). Furthermore, lutein and zeaxanthin were also shown to help promote contrast sensitivity—the ability to distinguish an object against its background. Not surprisingly, all of this has resulted in lutein and zeaxanthin making it more comfortably to use computers and other digital devices throughout the day.
Astaxanthin Studies
Astaxanthin is another antioxidant carotenoid with research shown its value for a broad range of health and wellness benefits (see my astaxanthin articles in the May 2012 and September 2020 articles of Vitamin Retailer). Among its many benefits is the role it plays in eye health.
A four-week, double-blind, randomized, placebo-controlled study8 examined the supplementation effects of astaxanthin or placebo on subjects suffering from visual display terminal (VDT) induced visual fatigue. Subjects were divided into two groups: 6 mg astaxanthin treated and placebo groups. The groups’ visual accommodation (i.e., the ability of the lens of the eye to change shape, allowing for a change in focus from far to near) was evaluated as well as a subjective questionnaire designed to evaluate visual asthenopia (eye fatigue). Results were that, in the astaxanthin treated group, the change of visual accommodation before and after supplementation improved significantly compared with the placebo group. Also, the subjective questionnaire evaluating visual asthenopia revealed a marked reduction in “heavy headednes” claims (i.e., the feeling of faintness, dizziness, or feeling of floating, wooziness). Other typical improvements of fatigue symptoms included “dimness of sight” and “stiff shoulders and back.” After four weeks safety and adverse events were found to be the same in both groups. In conclusion, 6 mg of astaxanthin per day from was shown to improve eye fatigue and be safe for consumption.
Another four-week, double-blind, placebo-controlled study9 confirmed the efficacy of 6 mg/day of astaxanthin on accommodation and asthenopia and its safety in two groups of subjects who complained of asthenopia. Study results were that visual accommodation was significantly improved in the astaxanthin group compared to the placebo group. Likewise, the subjective degree of asthenopia significantly improved in two parameters compared to placebo: “bleary-eye feeling” and “tendency of irritation.” Also, there were no changes in laboratory tests, nor were there any adverse events. In conclusion, administration of 6 mg/day astaxanthin improved visual accommodation and subjective symptoms of asthenopia and was confirmed to be completely safe.
Besides visual benefits, it seems that astaxanthin also has sports performance benefits. Another four-week, placebo-controlled study10 examined the effects of 6 mg/day astaxanthin or placebo on visual acuity and muscle fatigue in two respective experiments. Results were that in the first experiment, the deep vision and the critical flicker fusion (i.e., the frequency at which flickering light can be perceived as continuous and it is used to assess the processing of temporal vision) of the astaxanthin group was significantly improved compared to the placebo group. In the second experiment, serum lactic acid concentration at two minutes after activity (1,200 m running) of the treatment group was significantly lower than that of the control one. Based on these findings, it suggested that supplementation of astaxanthin is effective for the improvement of visual acuity and muscle fatigue that may lead to sports performance benefits.
Additional studies11-13 have also shown improvements in visual accommodation and other parameters of health vision in subjects supplemented with 4-12 mg/day astaxanthin.
Furthermore, an open label trial14 was conducted to examine eye symptom improvement in 22 middle-aged and older subjects (aged between 46 and 65 years) with complaints of eye strain, who were supplemented with 6 mg/day astaxanthin. In addition to improvements in accommodation function of the eye, results showed there were also improvements in some subjective symptoms of eye strain related to presbyopia. This included improvements in “eye strain,” “difficulty to see near objects,” “blurred vision,” and “shoulder and low back stiffness.”
A Combination of Lutein, Zeaxanthin and Astaxanthin
Since lutein/zeaxanthin and astaxanthin have individually been shown to provide significant benefits for eye health, two studies were conducted to examine the effects of their combination.
A multicenter, prospective open-label randomized study15 was to determine whether supplementation with a targeted supplement would improve visual acuity and visual function in 145 age-related macular degeneration (AMD) patients randomly assigned to two different treatment groups. Interventions were lutein (10 mg), zeaxanthin (1 mg), astaxanthin (4 mg; AZYR SIFI, Catania, Italy), and antioxidants/vitamins supplementation formula or no dietary supplementation for two years. Primary outcome was mean changes in visual acuity (VA) at 12 and 24 months. Other measures included contrast sensitivity (CS) and National Eye Institute visual function questionnaire scores (NEI VFQ-25; a patient-reported outcome measure of vision-targeted health status and to assess vision-related quality of life) at 12 and 24 months. Results were that patients in the treated group showed stabilization of VA with significantly better VA scores compared to the nontreated group at 24-month follow-up. An improvement in CS (p=0.001) and final mean NEI VFQ-25 composite scores at 12 and 24 months higher in treated group compared to nontreated group were also shown (p<0.001). In conclusion, patients treated with lutein/zeaxanthin and astaxanthin together with other nutrients were more likely to report clinically meaningful stabilization/improvements in VA, CS and visual function through 24 months compared with nontreated subjects.
The impairment of eye-hand coordination and smooth-pursuit eye movement caused by visual display terminal (VDT) operation is thought to impair daily living activities, for which no effective methods are currently known. This randomized, placebo-controlled, parallel-group clinical trial16 aimed to test the hypothesis that the combination of astaxanthin, lutein and zeaxanthin can prevent the impairment of eye-hand coordination and smooth-pursuit eye movement caused by VDT operation. Healthy subjects who regularly worked with VDTs were randomly assigned to the active and placebo groups. All of the subjects received either 6 mg of astaxanthin, 10 mg of lutein and 2 mg of zeaxanthin or placebo once daily for eight weeks. Eye-hand coordination, smooth-pursuit eye movements, and macular pigment optical density (MPOD) were evaluated at 0, two, four, and eight weeks. Results were that the astaxanthin, lutein and zeaxanthin group showed significantly improved eye-hand coordination after VDT operation at eight weeks. However, there was no clear improvement in the effect of the supplementation on smooth-pursuit eye movements. The active group also showed a significant increase in MPOD levels. In conclusion, consumption of a supplement containing astaxanthin, lutein, and zeaxanthin mitigates the decline of eye-hand coordination after VDT operation.
Conclusion
Blue light from digital devices and outdoor light can be harmful to the eyes and are associated with headache, eye fatigue and other indications of eye strain. Clinical research has shown that lutein and zeaxanthin can protect the eyes and help them filter out harmful blue light, and similar research has shown that astaxanthin can also help as well. The combination of lutein, zeaxanthin and astaxanthin has been shown to be particularly effective in improving visual acuity, contrast sensitivity, visual function, and mitigating the decline of eye-hand coordination caused by visual display terminal operation. VR
References:
1 Kuse Y, Ogawa K, Tsruma K, Shimazawa M, Hara H. Damage of photoreceptor-derived cells in culture induced by light emitting diode-derived blue light. Sci Rep. 2014 Jun 9;4:5223.
2 The Vision Council. Hindsight is 20/20/20: Protect your eyes from digital devices. 2015 Digital Eye Strain Report. Thevisioncouncil.org.
3 Kowalska M, Zejda JE, Bugajska J, Braczkowska B, Brozek G, Malińska M. [Eye symptoms in office employees working at computer stations]. [Article in Polish] Med Pr. 2011;62(1):1-8.
4 Akinbinu TR, Mashalla YJ. Impact of computer technology on health: Computer Vision Syndrome (CVS). Medical Practice and Review. 2014;5(3):20-30.
5 Lutein/Zeaxanthin Isomers Supplementation Impact on Vision Health. Unpublished. 2016:8 pgs.
6 Stringham J. Effects of three levels of lutein supplementation on macular pigment optical density, psychological stress levels, and overall health. Nutritional Neuroscience Laboratory, University of Georgia. Unpublished. 2016:17 pgs.
7 Lutein/Zeaxanthin Isomers Supplementation Impact on Vision Health. Unpublished. 2016:8 pgs.
8 Yasunori N, Miharu M, Hiroki T, Shigeaki O. The supplementation effect of Astaxanthin on Accommodation and Asthenopia. Journal of Clinical Therapeutics & Medicines. 2006; 22(1):41-54.
9 Kenji S, Kazuhiro O, Takuya N, et al. Effect of Astaxanthin on Accommodation and Asthenopia-Efficacy-Identification Study in Healthy Volunteers. Journal of Clinical Therapeutics & Medicines. 2005;21(6):637-650.
10 Keisuke S, Hiroshi Y, Kazuhiro A, et al. Sports Performance Benefits from Taking Natural Astaxanthin Characterized by Visual Acuity and Muscle Fatigue Improvement in Humans. Journal of Clinical Therapeutics & Medicines. 2002;18(9):1085-1100.
11 Nagaki Y, Hayasaka S, Yamada T, et al. Effects of astaxanthin on accommodation, critical flicker fusion, and pattern visual evoked potential in visual display terminal workers. Journal of Traditional Medicines. 2002;19(5):170-173.
12 Kaira N, Ryoko I, Yasuhiro O, Yasuko A, Daisuke N, Chika H, Shizuka S, Yoshiaki S, Masayuki H. Changes in visual function following peroral astaxanthin. Japanese Journal of Clinical Ophthalmology. 2004;58(6):1051-1054.
13 Nanako T, Masayoshi K. Effects of Astaxanthin on Accommodative Recovery. Journal of Clinical Therapeutics & Medicines. 2005;21(4):431-436.
14 Kajita M, Tsukahara H, Kato M. The Effects of a Dietary Supplement Containing Astaxanthin on the Accommodation Function of the Eye in Middle-aged and Older People. Medical Consultation & New Remedies. 2009 March;46(3):89-93.
15 Piermarocchi S, Saviano S, Parisi V, Tedeschi M, Panozzo G, Scarpa G, Boschi G, Lo Giudice G; Carmis Study Group. Carotenoids in Age-related Maculopathy Italian Study (CARMIS): two-year results of a randomized study. Eur J Ophthalmol. 2012 Mar-Apr;22(2):216-25.
16 Yoshida K, Sakai O, Honda T, Kikuya T, Takeda R, Sawabe A, Inaba M, Koike C. Effects of Astaxanthin, Lutein, and Zeaxanthin on Eye-Hand Coordination and Smooth-Pursuit Eye Movement after Visual Display Terminal Operation in Healthy Subjects: A Randomized, Double-Blind Placebo-Controlled Intergroup Trial. Nutrients. 2023 Mar 17;15(6):1459.
Gene Bruno, MS, MHS, the provost for Huntington University of Health Sciences, is a nutritionist, herbalist, writer and educator. For more than 40 years he has educated and trained natural product retailers and health care professionals, has researched and formulated natural products for dozens of dietary supplement companies, and has written articles on nutrition, herbal medicine, nutraceuticals and integrative health issues for trade, consumer magazines and peer-reviewed publications. He can be reached at gene.bruno@hchs.edu.
In 2017, I wrote an article for Vitamin Retailer called “Lutein & Zeaxanthin: Protection Against Blue Light Damage to Eyes,” which appeared in the May issue. Since that time, there has been additional research on lutein and zeaxanthin for eye health. Furthermore, there is some great research on astaxanthin for eye health, as well using astaxanthin in combination with lutein and zeaxanthin. That’s what this article is all about.
Background
If you want a comprehensive explanation of blue light, see the aforementioned article in Vitamin Retailer’s digital edition online. Meanwhile, here’s a synopsis: Blue light from digital devices and outdoor light can be harmful to the eyes.1 Nearly one-third of adults spend more than half their waking hours (nine plus) using a digital device.2 Headache, eye fatigue and other indications of eye strain are associated with the daily use of video display terminals on computers and other electronic devices, and are common with three or more hours/day of exposure.3,4 The good news is that lutein and zeaxanthin—as well as astaxanthin—can provide substantial protection against blue light damage.
Lutein and Zeaxanthin
Here’s a brief review of lutein and zeaxanthin, antioxidant carotenoids which protect against oxidative stress and harmful free radicals.5 Lutein and zeaxanthin protect the eyes and help them filter out harmful blue light from computers and other digital devices, as well as and outdoor light.6 Likewise, lutein and zeaxanthin were clinically tested7 to improve glare performance (i.e., excessive brightness, as might be caused by oncoming headlights at night). Specifically, they improve photo stress recovery (i.e., measuring the amount of time required for the macula to return to its normal level of function after being exposed to a bright light source). Furthermore, lutein and zeaxanthin were also shown to help promote contrast sensitivity—the ability to distinguish an object against its background. Not surprisingly, all of this has resulted in lutein and zeaxanthin making it more comfortably to use computers and other digital devices throughout the day.
Astaxanthin Studies
Astaxanthin is another antioxidant carotenoid with research shown its value for a broad range of health and wellness benefits (see my astaxanthin articles in the May 2012 and September 2020 articles of Vitamin Retailer). Among its many benefits is the role it plays in eye health.
A four-week, double-blind, randomized, placebo-controlled study8 examined the supplementation effects of astaxanthin or placebo on subjects suffering from visual display terminal (VDT) induced visual fatigue. Subjects were divided into two groups: 6 mg astaxanthin treated and placebo groups. The groups’ visual accommodation (i.e., the ability of the lens of the eye to change shape, allowing for a change in focus from far to near) was evaluated as well as a subjective questionnaire designed to evaluate visual asthenopia (eye fatigue). Results were that, in the astaxanthin treated group, the change of visual accommodation before and after supplementation improved significantly compared with the placebo group. Also, the subjective questionnaire evaluating visual asthenopia revealed a marked reduction in “heavy headednes” claims (i.e., the feeling of faintness, dizziness, or feeling of floating, wooziness). Other typical improvements of fatigue symptoms included “dimness of sight” and “stiff shoulders and back.” After four weeks safety and adverse events were found to be the same in both groups. In conclusion, 6 mg of astaxanthin per day from was shown to improve eye fatigue and be safe for consumption.
Another four-week, double-blind, placebo-controlled study9 confirmed the efficacy of 6 mg/day of astaxanthin on accommodation and asthenopia and its safety in two groups of subjects who complained of asthenopia. Study results were that visual accommodation was significantly improved in the astaxanthin group compared to the placebo group. Likewise, the subjective degree of asthenopia significantly improved in two parameters compared to placebo: “bleary-eye feeling” and “tendency of irritation.” Also, there were no changes in laboratory tests, nor were there any adverse events. In conclusion, administration of 6 mg/day astaxanthin improved visual accommodation and subjective symptoms of asthenopia and was confirmed to be completely safe.
Besides visual benefits, it seems that astaxanthin also has sports performance benefits. Another four-week, placebo-controlled study10 examined the effects of 6 mg/day astaxanthin or placebo on visual acuity and muscle fatigue in two respective experiments. Results were that in the first experiment, the deep vision and the critical flicker fusion (i.e., the frequency at which flickering light can be perceived as continuous and it is used to assess the processing of temporal vision) of the astaxanthin group was significantly improved compared to the placebo group. In the second experiment, serum lactic acid concentration at two minutes after activity (1,200 m running) of the treatment group was significantly lower than that of the control one. Based on these findings, it suggested that supplementation of astaxanthin is effective for the improvement of visual acuity and muscle fatigue that may lead to sports performance benefits.
Additional studies11-13 have also shown improvements in visual accommodation and other parameters of health vision in subjects supplemented with 4-12 mg/day astaxanthin.
Furthermore, an open label trial14 was conducted to examine eye symptom improvement in 22 middle-aged and older subjects (aged between 46 and 65 years) with complaints of eye strain, who were supplemented with 6 mg/day astaxanthin. In addition to improvements in accommodation function of the eye, results showed there were also improvements in some subjective symptoms of eye strain related to presbyopia. This included improvements in “eye strain,” “difficulty to see near objects,” “blurred vision,” and “shoulder and low back stiffness.”
A Combination of Lutein, Zeaxanthin and Astaxanthin
Since lutein/zeaxanthin and astaxanthin have individually been shown to provide significant benefits for eye health, two studies were conducted to examine the effects of their combination.
A multicenter, prospective open-label randomized study15 was to determine whether supplementation with a targeted supplement would improve visual acuity and visual function in 145 age-related macular degeneration (AMD) patients randomly assigned to two different treatment groups. Interventions were lutein (10 mg), zeaxanthin (1 mg), astaxanthin (4 mg; AZYR SIFI, Catania, Italy), and antioxidants/vitamins supplementation formula or no dietary supplementation for two years. Primary outcome was mean changes in visual acuity (VA) at 12 and 24 months. Other measures included contrast sensitivity (CS) and National Eye Institute visual function questionnaire scores (NEI VFQ-25; a patient-reported outcome measure of vision-targeted health status and to assess vision-related quality of life) at 12 and 24 months. Results were that patients in the treated group showed stabilization of VA with significantly better VA scores compared to the nontreated group at 24-month follow-up. An improvement in CS (p=0.001) and final mean NEI VFQ-25 composite scores at 12 and 24 months higher in treated group compared to nontreated group were also shown (p<0.001). In conclusion, patients treated with lutein/zeaxanthin and astaxanthin together with other nutrients were more likely to report clinically meaningful stabilization/improvements in VA, CS and visual function through 24 months compared with nontreated subjects.
The impairment of eye-hand coordination and smooth-pursuit eye movement caused by visual display terminal (VDT) operation is thought to impair daily living activities, for which no effective methods are currently known. This randomized, placebo-controlled, parallel-group clinical trial16 aimed to test the hypothesis that the combination of astaxanthin, lutein and zeaxanthin can prevent the impairment of eye-hand coordination and smooth-pursuit eye movement caused by VDT operation. Healthy subjects who regularly worked with VDTs were randomly assigned to the active and placebo groups. All of the subjects received either 6 mg of astaxanthin, 10 mg of lutein and 2 mg of zeaxanthin or placebo once daily for eight weeks. Eye-hand coordination, smooth-pursuit eye movements, and macular pigment optical density (MPOD) were evaluated at 0, two, four, and eight weeks. Results were that the astaxanthin, lutein and zeaxanthin group showed significantly improved eye-hand coordination after VDT operation at eight weeks. However, there was no clear improvement in the effect of the supplementation on smooth-pursuit eye movements. The active group also showed a significant increase in MPOD levels. In conclusion, consumption of a supplement containing astaxanthin, lutein, and zeaxanthin mitigates the decline of eye-hand coordination after VDT operation.
Conclusion
Blue light from digital devices and outdoor light can be harmful to the eyes and are associated with headache, eye fatigue and other indications of eye strain. Clinical research has shown that lutein and zeaxanthin can protect the eyes and help them filter out harmful blue light, and similar research has shown that astaxanthin can also help as well. The combination of lutein, zeaxanthin and astaxanthin has been shown to be particularly effective in improving visual acuity, contrast sensitivity, visual function, and mitigating the decline of eye-hand coordination caused by visual display terminal operation. VR
References:
1 Kuse Y, Ogawa K, Tsruma K, Shimazawa M, Hara H. Damage of photoreceptor-derived cells in culture induced by light emitting diode-derived blue light. Sci Rep. 2014 Jun 9;4:5223.
2 The Vision Council. Hindsight is 20/20/20: Protect your eyes from digital devices. 2015 Digital Eye Strain Report. Thevisioncouncil.org.
3 Kowalska M, Zejda JE, Bugajska J, Braczkowska B, Brozek G, Malińska M. [Eye symptoms in office employees working at computer stations]. [Article in Polish] Med Pr. 2011;62(1):1-8.
4 Akinbinu TR, Mashalla YJ. Impact of computer technology on health: Computer Vision Syndrome (CVS). Medical Practice and Review. 2014;5(3):20-30.
5 Lutein/Zeaxanthin Isomers Supplementation Impact on Vision Health. Unpublished. 2016:8 pgs.
6 Stringham J. Effects of three levels of lutein supplementation on macular pigment optical density, psychological stress levels, and overall health. Nutritional Neuroscience Laboratory, University of Georgia. Unpublished. 2016:17 pgs.
7 Lutein/Zeaxanthin Isomers Supplementation Impact on Vision Health. Unpublished. 2016:8 pgs.
8 Yasunori N, Miharu M, Hiroki T, Shigeaki O. The supplementation effect of Astaxanthin on Accommodation and Asthenopia. Journal of Clinical Therapeutics & Medicines. 2006; 22(1):41-54.
9 Kenji S, Kazuhiro O, Takuya N, et al. Effect of Astaxanthin on Accommodation and Asthenopia-Efficacy-Identification Study in Healthy Volunteers. Journal of Clinical Therapeutics & Medicines. 2005;21(6):637-650.
10 Keisuke S, Hiroshi Y, Kazuhiro A, et al. Sports Performance Benefits from Taking Natural Astaxanthin Characterized by Visual Acuity and Muscle Fatigue Improvement in Humans. Journal of Clinical Therapeutics & Medicines. 2002;18(9):1085-1100.
11 Nagaki Y, Hayasaka S, Yamada T, et al. Effects of astaxanthin on accommodation, critical flicker fusion, and pattern visual evoked potential in visual display terminal workers. Journal of Traditional Medicines. 2002;19(5):170-173.
12 Kaira N, Ryoko I, Yasuhiro O, Yasuko A, Daisuke N, Chika H, Shizuka S, Yoshiaki S, Masayuki H. Changes in visual function following peroral astaxanthin. Japanese Journal of Clinical Ophthalmology. 2004;58(6):1051-1054.
13 Nanako T, Masayoshi K. Effects of Astaxanthin on Accommodative Recovery. Journal of Clinical Therapeutics & Medicines. 2005;21(4):431-436.
14 Kajita M, Tsukahara H, Kato M. The Effects of a Dietary Supplement Containing Astaxanthin on the Accommodation Function of the Eye in Middle-aged and Older People. Medical Consultation & New Remedies. 2009 March;46(3):89-93.
15 Piermarocchi S, Saviano S, Parisi V, Tedeschi M, Panozzo G, Scarpa G, Boschi G, Lo Giudice G; Carmis Study Group. Carotenoids in Age-related Maculopathy Italian Study (CARMIS): two-year results of a randomized study. Eur J Ophthalmol. 2012 Mar-Apr;22(2):216-25.
16 Yoshida K, Sakai O, Honda T, Kikuya T, Takeda R, Sawabe A, Inaba M, Koike C. Effects of Astaxanthin, Lutein, and Zeaxanthin on Eye-Hand Coordination and Smooth-Pursuit Eye Movement after Visual Display Terminal Operation in Healthy Subjects: A Randomized, Double-Blind Placebo-Controlled Intergroup Trial. Nutrients. 2023 Mar 17;15(6):1459.
