Lutein supplementation ‐ the rationale

Abstract Purpose Photo‐oxidation is believed to play a role in age‐related macular degeneration (AMD). Macular pigment (MP), consisting of lutein (L), zeaxanthin (Z) and meso‐Z, protects the retina from photo‐oxidative damage. We review this rationale and critically appraise the current evidence‐base germane to the use of supplements containing the macular carotenoids in patients with, or at risk of developing, AMD. Methods The evidence supporting a role for MP in the prevention of AMD is primarily available from observational studies and interventional (supplementation) studies. We present data from the following observational and interventional studies: Age‐Related Eye Disease Study (AREDS, I and II); Lutein Antioxidant Supplementation Trial (LAST); LUtein Nutrition effects measured by Autofluorescence (LUNA); Carotenoids in Age‐Related MAculopathy (CARMA). Results The AREDS I demonstrated that patients with AMD exhibited a 25% risk reduction in progression to advanced AMD when supplemented with zinc plus antioxidants. The LAST reported that visual function improved with L supplementation alone, or with L supplementation in combination with other antioxidants. The LUNA study reported a significant increase in MP optical density with 12 mg L and 1 mg Z, combined with co‐antioxidants (p > 0.05). Conclusion In conclusion, we await the outcomes of several randomized controlled trials before a truly meaningful comment can be made upon the potential beneficial effects of supplemental L, Z and meso‐Z in patients with AMD. However, the benefits of the macular carotenoids, if any, relate to the ability of these compounds to protect against chronic and cumulative retinal damage and, therefore, the putative protective effect of this pigment may need to be exerted in the young and middle age.