Out of Focus

by Lisa Schofield | January 10, 2025

Barring degenerative eye conditions, patients may be complaining of irritations that cause squinting and excessive blinking. Here’s how to help them see the light better.

Ocular discomfort has become a common issue among Americans who have healthy eyes. And they don’t need to visit the ophthalmologist when naturopaths can help them to naturally see their way through vision-deterring annoyances.

Newer Concerns

In the past five years, vision support has become prominent. Jessica Stefanski, NMD, LAc, clinical education manager, Wisconsin-based Standard Process, observed that the vision-support category has increasingly focused on three areas—solutions for eye strain caused by heavy use of digital technology, nutraceuticals to mitigate effects of excessive exposure to UV light and oxidative stress, and solutions for dry eye.

Vanessa Pavey, ND, education scientist, Florida-based Life Extension, said, “The ability to focus on tasks and eye health tend to go hand-in-hand, so there was a large jump in consumer interest in cognitive and eye health supplements with 73 percent saying they were interested in using these products again or for the first time, according to Mintel research. And we may see an uptick in the eye health market for Gen Z in 2025 as approximately half spend more than four hours daily in front of a screen.

There are now more targeted solutions to blue light’s effect on the eyes, such as apps for reducing screen brightness, dietary supplements, and blue light-blocking glasses, and these solutions are sought by consumers who want to reduce the negative effects of prolonged exposure to screens, such as digital eye strain, dry eyes, headaches and even disrupted sleep patterns, pointed out Kylen Ribeiro, CEO, Florida-based Lightbody.

“As people become more informed about digital eye strain and its long-term effects, they are investing in solutions that address these concerns,” she said. “The shift to a more digital lifestyle has driven the vision-support category to innovate and expand, positioning itself as a critical part of modern preventative health and wellness routines, instead of just a place for those who have chronic eye health conditions.”

In Stefanski’s view, more recently, researchers are increasing studies on the impacts of oxidative stress and inflammation on eye health because chronic oxidative stress and inflammation are closely related mechanisms that damage ocular tissue.

Within the past decade, Integrative Neuro-ophthalmologist Rudrani Banik, MD, IFMCP, founder and medical director, EnVision Health, New York, NY, associate professor of ophthalmology, Icahn School of Medicine at Mount Sinai New York, and co-director of Neuro-Ophthalmology Service, has certainly seen more of these cases. She explains that digital eye strain is a syndrome of blurry vision, trouble focusing, glare, light sensitivity, dry eye, headaches and neck/shoulder strain from being on screens for hours each day.

Dry eye, she noted, is often related to reduced blink rates while viewing screens, but also due to inflammation of the eyelids (meibomian gland dysfunction or MGD), ocular rosacea, autoimmune diseases like Sjogren’s, lupus, and RA (rheumatoid arthritis), and Demodex follicularum, a common eyelid mite infestation.

Alexander Zubkov, MD, ophthalmologist for California-based 1MD Nutrition, stated “the growth in the vision-support category has seen significant advancements primarily driven by four factors. One is an increase in awareness as people are more conscious of digital eye strain and its long-term effects due to prolonged screen time. Two is an increase in age-related eye conditions seen in an aging population. Third is advancement in research, such as studies demonstrating the role of specific nutrients in supporting eye health, which have informed product development. And last is personalized nutrition trends as consumers are increasingly seeking tailored supplements to address specific needs such as dry eyes, or blue light protection.”

Eye’m Talking

As Dr. Banik has mentioned, digital eye strain and dry eye are more than simplistic complaints, and likely patients aren’t aware. “Supporting visual acuity and vision preservation is multifaceted, and requires an approach that is as well,” commented Stephanie Nishek, ND, scientific industry advisor to Earth Lab Holdings/Wise Woman Herbals, Oregon.

“With the increase of screen time and aging population in the United States, naturopaths should discuss vision health with their patients,” emphasized Céline Torres-Moon, senior scientist, Protocol For Life Balance, Illinois. “It is now well established that there is a correlation between time spent in front of screen and dry eyes. So asking patients about their screen use is important as we tend to underestimate the time we spend in front of screens when we add up all devices.”

She added that a healthy diet and lifestyle are being consistently demonstrated by epidemiological data and clinical research to support healthy vision and eye health; carotenoids, DHA and antioxidants have a long history of use as effective supplements to protect vision. “However, newer research suggests that the gut microbiota might affect eye health too. However, more research is needed to see how influencing the gut microflora through the diet might benefit visual acuity.”

Ribeiro also sees the “gut-eye connection” as an emerging area of research and potential product development. She commented, “Newer research on the microbiome suggests a potential link between gut health and vision, with implications for conditions like age-related macular degeneration (AMD). Naturopaths may find this connection valuable for a holistic approach to care.”

Additionally, she noted, naturopaths should discuss how artificial lighting and prolonged screen use may disrupt circadian rhythms and contribute to oxidative stress on the eyes, which gives rise to the need for proactive care such as supplementation. “Studies are increasingly exploring how cumulative exposure to blue light from screens may contribute to long-term retinal damage, spurring innovation in blue light-blocking supplements and eyewear.”

Regarding supplements, carotenoids lutein and zeaxanthin are known to help reduce oxidative stress and help filter blue light. DHA is also a heavy hitter in the vision-support supplement category as it is known to protect retinal function and may also be effective in reducing dry eye.

“New and intriguing research in eye health supplements is looking at melatonin,” observed Dr. Pavey. “We now know melatonin is synthesized in the retina, uvea, lens, cornea and the ciliary body of the eye, and influences the physiology of the retina and can even modulate intraocular pressure. And as a potent antioxidant, melatonin can help protect eyes from damage incurred by inflammation and oxidative stress.

“Melatonin levels are known to decrease with age, so these findings may be of interest to naturopaths who have clients with circadian dysregulation or sleep problems and are also worried about macular and retinal health,” she added.

Supplements to Recommend

While advising digital screen gazers to follow the 20-20-20 rule (every 20 minutes, look away 20 feet for 20 seconds), and to try to obtain carotenoids, and omega-3 EFAs (essential fatty acids) from a healthy diet, there’s a cache of supplements that can provide protection for vision acuity and reduce irritating symptoms of dry eye and computer vision syndrome.

Life Extension’s MacuGuard Ocular Support with Saffron & Astaxanthin provides marigold derived lutein (10 mg), zeaxanthin with meso-zeaxanthin (4 mg) and alpha-carotene (1.24 mg) per soft gel. “Lutein and zeaxanthin are the main components of macular pigment, which help protect the eyes from excess blue light,” explained Dr. Pavey. The product is formulated with phospholipids to help promote the absorption of these macular pigments. In addition, saffron extract (20 mg) has been shown in multiple clinical studies to help support visual acuity and astaxanthin (6 mg) daily helps promote visual sharpness and eye health.

In a six-month randomized, double-blind, placebo-controlled clinical study 48 healthy college-aged young adults with at least six hours of daily screen time received 24 mg of a patented marigold extract or placebo. Those in the marigold group experienced significant improvements in blue light-absorbing macular pigment ocular density, overall sleep quality, headache frequency, eye strain and eye fatigue compared to placebo.

In another study, 29 subjects with early age-related macular degeneration receiving 20 mg of saffron daily experienced improvement in visual acuity by reading two smaller lines on the Snellen chart compared to baseline at three months.

Life Extension’s Tear Support with MaquiBright features an extract of maqui berry (Aristotelia chilensis) standardized to delphinidins (60 mg), the phytonutrient that supports the eyes natural defenses and encourages the mechanisms that promote production of natural tears. In a clinical study, healthy participants with moderately dry eyes taking 60 mg of a proprietary maqui berry extract daily experienced a 45 percent increase in tear production after 60 days.

Eye Pressure Support with Mirtogenol combines European bilberry and Pycnogenol French maritime pine bark extracts (120 mg) to help promote ocular health by helping to maintain already-healthy eye pressure. Dr. Pavey noted that these extracts are known to promote healthy circulation, and when combined can help encourage healthy ocular blood flow. In one study, participants with asymptomatic ocular hypertension who supplemented with 120 mg of the combination of standardized bilberry extract and French maritime pine bark extract experienced a 24 percent reduction in eye pressure after 16 weeks.

Protocol for Life Balance offers Astaxanthin, 10 and 12 mg, Taurine 1,000 mg, DHA 500 mg and 1,000 mg, as well as Clinical Strength Ocu Support. Torres-Moon explained that the brand’s astaxanthin is a naturally occurring carotenoid derived from non-GMO (genetically modified organism) Haematococcus pluvialis microalgae. “Due to its unique structure, astaxanthin plays an important role in cellular free radical protection and healthy immune system responses. In the eye, astaxanthin helps to neutralize free radicals and helps to manage eyestrain due to computer usage,” she explained.

Taurine is recommended to support ocular health because its free radical scavenging ability protects retinal function and is essential for the function and survival of retinal photoreceptors, RGC and RPE cells. Taurine needs to be obtained through the diet or supplementation as the amount of taurine synthesized by the body may not be sufficient to meet the health needs of the body, such as promoting ocular health.

DHA is an important component of the retina; it is the dominant fatty acid of retinal phospholipids and plays a significant role in maintaining retinal integrity.

Protocol for Life Balance’s Clinical Strength Ocu Support is described by Torres-Moon as a multi-nutrient dietary supplement targeting eye health. In addition to 3 mg beta-carotene, taurine, lutein and zeaxanthin, it is rich in antioxidant vitamins C and E, B vitamins and minerals including zinc, selenium and chromium. It abounds in free radical scavengers, citrus bioflavonoid, rutin, green tea extract, bilberry extract, alpha-lipoic acid, grape seed extract, Ginkgo biloba extract, CoQ10, NAC and glutathione. “This formula was created to keep oxidative stress in the eye at bay,” she noted.

Lightbody Total Eye Health+ is a plant-based supplement formulated to support comprehensive eye health, enhance visual clarity and combat the effects of daily light exposure, including blue light from digital screens. “This product is designed to meet the needs of modern lifestyles, where screen use and artificial light dominate our waking hours,” said Riberio.

The supplement supports vision in three ways—blue light defense, promoting eye moisture and generate more tears, and scavenges free radicals. It includes lutein/zeaxanthin to build a protective macular pigment layer in the back of the eye that filters harmful high-energy blue light, shielding the retina and supporting visual function; MaquiBright, a standardized maqui berry extract that helps restore tear production and alleviates symptoms like dryness, redness and ocular fatigue; and lycopene and rosemary extract to reduce oxidative stress.

Several singular herbs may also be incorporated into a vision-support protocol, recommended Dr. Nishek. Wise Woman Herbals has several single herb extracts to consider when formulating an individualized vision-focused combination tincture. She suggested recommending: gingko to support blood flow and reduce oxidation and free radical damage; curcumin for its general anti-inflammatory properties as well as a demonstrated photooxidative protective effect; lemon balm whose high polyphenol content has potent antioxidative effects; and parsley or mint, which have high carotenoid concentrations that may be beneficial in reducing ultra-violet and light stress damage.

1MD Nutrition’s VisionMD is an advanced vision-support supplement formulated with clinically studied ingredients: lutein and zeaxanthin, astaxanthin, omega-3 EFAs, vitamin E and zinc.

According to Dr. Zubkov, Vision MD from 1MD combines targeted antioxidants and nutrients to protect against oxidative stress, enhance retinal health and maintain overall vision. It is backed by clinical studies demonstrating improved contrast sensitivity, reduced symptoms of digital eye strain, and slower progression of age-related macular degeneration.

New York-based MediNutritionals Research LLC ‘s Patient One MediNutritionals Fat Soluble Vitamins Complete supplies a diverse antioxidant complex of vitamins A, D, E and K1 and K2, mixed carotenoids, and mixed tocopherols and tocotrienols. “Our highly absorbable formula promotes powerful antioxidant activity, helps to stabilize and optimize cell membranes, including the energy producing mitochondria, and modulates inflammatory response,” described Kathy McIntee, vice president.

Standard Process’s Eyeplex has been used by health care practitioners to support ocular health since 1957, according to Dr. Stefanski. “Based on Standard Process’ whole-food philosophy, this formula features a unique blend of plant, organ and gland extracts, providing synergistic support to the added nutrients required for normal eye function,” she explained.

The company’s Bilberry Forte combines MediHerb with the full spectrum, whole-herb extract of bilberry, she added. An observational six-month study of patients with retinopathy compared two bilberry extracts, each providing 57.6 mg/day anthocyanins. Significantly better results were observed from the whole herb extract than from the purified anthocyanin rich extract, indicating contributing activity from the non-anthocyanin components.

While ophthalmologists may be the first point of consultation about eye health status (such as macular degeneration, glaucoma, cataracts), and vision irregularities (e.g., astigmatism, presbyopia), necessitating prescription corrections, the growing commonality of computer vision syndrome (eye fatigue and dry eye) can fall squarely in the naturopathic arena with lifestyle adjustments and supplementation.

Healthy Take Aways

■ Approximately half of Gen Zers spend more than four hours daily in front of a screen.
■ Dry eye is often related to reduced blink rates while viewing screens, but also due to inflammation of the eyelids.
■ Newer research suggests that the gut microbiota might affect eye health too.
■ Studies are increasingly exploring how cumulative exposure to blue light from screens may contribute to long-term retinal damage.
■ In a study, 29 subjects with early age-related macular degeneration (AMD) receiving 20 mg of saffron daily experienced improvement in visual acuity.