by Dr. Laurie Capogna and Dr. Barbara Pelletier
The first step to effectively integrate nutrition into your practice is to educate yourself, your team and your patients. Information in the area of ocular nutrition is abundant and is constantly evolving. Fortunately, nutrition is currently a hot topic and it’s easy to find articles, lectures and webinars in this area. Our goal with this column is to provide you with the knowledge you need to effectively inspire and educate your patients and team about nutrition.
Let’s start with a crash course of the macular pigments: Lutein, zeaxanthin and mesozeaxanthin.
Of the 600 carotenoids in nature, three carotenoids, lutein, zeaxananthin and meso-zeaxanthin are abundant in the macula. Zeaxanthin and meso-zeaxanthin are more concentrated in the central macula, and lutein is more concentrated in the peripheral macula.
They are important to ocular health because they absorb high-energy short wavelength blue light and protect the photoreceptors from its damaging effects. They also act as anti-oxidants, protecting the cells in the eye from free radicals. In addition to showing a lower risk for AMD, people who have the most macular pigments in their retina have increased visual performance in terms of sharpness, contrast sensitivity and glare reduction. 1-7
Food Sources of Macular Pigments
Lutein must be obtained from our diet as it is not made by our bodies. In fact, the average North American only receives 1-3mg lutein per day, well below the recommended 6-10mg/day for optimal ocular health and function.
Lutein is found in the highest concentration in leafy green vegetables, such as kale, spinach, romaine lettuce, collard greens. Another great source of lutein is egg yolks. Although the amount of lutein in egg yolks is less than in dark leafy greens, it is absorbed much more efficiently in the body.
Lutein needs fat to be absorbed and transported in the body. Add a small amount of olive oil to your steamed leafy greens or to your stir-fry pan to reap the benefits of this powerful nutrient.
Kale is the king of green leafy vegetables and is the highest food source of lutein. One medium leaf of kale contains 10 mg of lutein!
Orange peppers are a zeaxanthin powerhouse. In fact half of an orange pepper contains 3mg of zeaxanthin. Other food sources of zeaxanthin include goji berries and saffron.
Mesozeanthin is not commonly found in food. In the retina, lutein is converted to meso-zeaxanthin when there are low levels of zeaxanthin.
In Your Practice
Educate everyone about food sources of lutein and zeaxanthin with these quick tips and tweets!
Leafy Greens: A Handful a day keeps AMD away.
Orange Peppers: 2 Peppers per week, 2 Ways, raw and cooked.
Eggs: Eat 4 Eggs per week: 2 Eggs for breakfast one day, 2 eggs for lunch another.
High-risk patients such as patients with a family history of AMD or risk factors for AMD will benefit from education regarding nutrition and may also benefit from supplements. Patients interested in performance vision and those with low contrast sensitivity or glare disability will benefit from nutrition education and may also benefit from supplements that contain macular pigments. Take it up a notch and measure macular pigment optical density (MPOD) to identify high- risk patients and track their effectiveness of the nutritional therapy, including both supplements and diet.
Every patient will benefit from education regarding the importance of macular pigments. As far as education goes, the sooner the better. You have the power to motivate your patients to make better health decisions that will lead them to a lifetime of healthier eyes. In the long-term your patients will be healthier and feel better cared for. This will lead to more loyal patients, more word-of-mouth referrals and ultimately practice growth.
Photo: Copyright: serezniy / 123RF Stock Photo
Drs. Capogna and Pelletier are the authors of the books Eyefoods: A Food Plan for Healthy Eyes and Eyefoods for Kids: A Tasty Guide to Nutrition and Eye Health. Both books provide a clear plan for patients and are designed to help the eye care professional incorporate nutrition into their practice. To learn more about Eyefoods please visit www.eyefoods .com.
1. Seddon JM, Ajani UA, Sperduto RD, et al. Dietary carotenoids, vitamins A, C, and E, and advanced age-related macular degeneration. Eye Disease Case-Control Study Group. JAMA. 1994;272(18):1413-20.
2. Moeller SM, Parekh N, Tinker L, et al.CAREDS Research Study Group. Associations between intermediate age-related macular degeneration and lutein and zeaxanthin in the Carotenoids in Age-related Eye Disease Study (CAREDS): ancillary study of the Women’s Health Initiative. Arch Ophthalmol. 2006;124(8):1151-62.
3. Beatty S, Murray IJ, Henson DB, et al. Macular pigment and risk for age-related macular degeneration in subjects from a Northern European population. Invest Ophthalmol Vis Sci. 2001;42(2): 439-46.
4. Mares-Perlman JA, Fisher AI, Klein R, et al. Lutein and zeaxanthin in the diet and serum and their relation to age-related maculopathy in the third national health and nutrition examination survey. Am J Epidemiol. 2001;153(5):424-32.
5. Snellen EL, Verbeek AL, Van den Hoogen GW, et al. Neovascular age-related macular degeneration and its relationship to antioxidant intake. Acta Ophthalmol. Scand 2002;80(4):368-71.
6. Age-Related Eye Disease Study Research Group. The relationship of dietary carotenoid and vitamin A, E, and C intake with age-realted macular degeneration in a case-control study. AREDS Report No 22. Arch Ophthalmol. 2007;125:1225-32.
7. Bone RA, Landrum JT, Mayne ST, et al. Macular pigment in donor eyes with and without AMD: a case-control study. Invest Ophthalmol Vis Sci. 2001;42(1):235-40.