Seeing is Believing

Vision Health

 

 
 

As vision health issues increase, companies have been innovating effective products for the practitioner market.

Out of the five senses, sight is perhaps the most important for human beings—and the majority of the population would likely agree. According to a study by the National Library of Medicine (NLM) National Center for Biotechnology Information, published in JAMA Opthalmology, “[220] participants (88 [percent]) ranked sight as their most valuable sense …” Researchers ultimately concluded that “sight was the most valued sense, followed by hearing. These results suggest that people would, on average, choose 4.6 years of perfect health over 10 years of life with complete sight loss …”

Clearly, a practitioner’s patients are bound to value their sight quite highly, and the market reflects their concerns about it.

Trends/State of the Market

“We have seen a huge growth in needs for occasional dry eye support as well as tired and fatigued eyes,” said Alison Gers, vice president, Vitamin Health Inc. (West Bloomfield, MI), which manufactures the Viteyes brand. “With the usage of digital screens, the need for eye health supplements is growing tremendously. People are concerned with occasional dry eye from screen use, kids being on their screens too much starting at a young age, and natural supplements in general to protect their eye health,” she noted.

“Due to our technology, an epidemic increase worldwide in myopia, computer eye strain and dry eyes, along with increases in cataracts and macular degeneration, are having more people pay attention to their vision,” Marc Grossman, OD, Lac, based in New Paltz, NY, concurred. During the pandemic, “People were spending even more time at home, not going outside enough, and more time on digital devices … which led to an increase in myopia and computer eye strain.” Additionally, “due to the mask wearing, increases in styes and blepharitis were found.”

Dayna Dye, education content writer; Kristin Chapman, MSc, category manager; and Vanessa Pavey, ND, education specialist, Life Extension (Fort Lauderdale, FL), agreed. “Smartphones, tablets and computers have become an integral part of our lives,” they said. “Excessive exposure to blue light can not only affect your vision but influence your mood, sleep habits, attention span and more. And while older consumers may be more focused on supporting healthy vision, the younger consumer may be much more affected by the discomforts associated with long hours looking at a screen such as eye fatigue, effect of light glare and occasional dryness.”

Furthermore, the vision health market as a whole, according to the Life Extension trio, “has had a healthy growth rate since 2018, however, as with many other categories, we are starting to see a leveling out in sales in 2022 and 2023. While most shoppers are still purchasing in the mass market, the direct-to-consumer channel has been steadily growing, as many consumers migrated to online shopping during the pandemic, and many have remained there.”

However, Dr. Jeffrey Anshel, an optometrist based in Kauai, HI, added that “Vision is the number one sense that people fear losing, even more than death in many cases. Thus, with the aging of the population and extended lifespans, eye health will continue to be a growth market.”

Vision Health Concerns and Causes

“A couple of the biggest concerns facing vision health are Age-Related Macular Degeneration (AMD) and complaints of occasional dry eye,” said Gers. “Those at higher risk for AMD include current or previous smokers, individuals with a family history of AMD, obesity or unhealthy weight levels and a poor diet.”

Dye, Chapman and Pavey noted that “The most common vision health issue in the U.S. is refractive errors.1 These include myopia (near-sightedness), hyperopia (far-sightedness), astigmatism (distorted vision at all distances), and presbyopia (decreased ability to focus up close that occurs during aging).” However, these can be corrected by glasses, contact lenses or surgery, they added. “Other common vision health issues, including blindness, are AMD, cataracts, diabetic retinopathy, glaucoma, amblyopia and strabismus.”

AMD includes wet and dry forms of the disease. In wet AMD, they explained, “abnormal blood vessels grow under the macula, which can leak blood and fluid. This, along with scarring, causes central vision loss. In the more common dry form of AMD, the macula thins during aging, causing blurred central vision. A common early sign of dry AMD is minute white or yellow deposits under the retina, which are known as drusen. Large and numerous drusen increase the risk of developing either form of AMD.”1

Like AMD, the main cause of cataracts is also aging. However, according to the trio, “disease, trauma, medications and genetic predisposition are also associated with their formation.2 Chronic exposure to ultraviolet B rays is also involved in cataract formation,”3 which makes wearing sun-protective lenses important.”4

Glaucoma is often, but not always, “caused by increased intraocular pressure,” said Dye, Chapman and Pavey. “As with AMD and cataracts, older age is a risk factor for glaucoma. Other factors that are associated with increased risk of glaucoma are family history of the disease, African heritage and the use of corticosteroid drugs.” In addition, “Failure to schedule regular eye examinations that include intraocular pressure measurement can lead to a lack of early treatment for the glaucoma that can lead to vision loss.”5

Amblyopia is caused by “a change in nerve pathways between the retina of the eye and the brain in which one eye receives fewer visual signals,” the trio explained. “This leads to a reduction in the eyes’ ability to work together and suppression of input from the weaker eye by the brain. An imbalance of muscles that position the eye, significant difference in vision between the eyes, and early cataracts can cause amblyopia. Family history of amblyopia is associated with increased risk.”6

Lastly, strabismus, according to Dye, Chapman and Pavey, “has a number of causes, depending upon its subclassification: pseudostrabismus (apparent squint), heterophoria (latent squint), and heterotopia (manifest squint). Pseudostrabismus can be caused by a prominent epicanthal fold (the fold of skin above the eye) among other potential causes. Heterotophoria has both anatomical causes (for example, weakness of muscles on the exterior of the eye) and physiological causes (such as working with certain microscopes or magnifying glasses). Heterotopia has sensory, motor, neurogenic and myogenic causes, and can also be due to the disease myasthenia gravis.”7

“Aging, exposure to free radicals, a diet high in saturated fat and high blood pressure are some of the contributing factors to the alteration of the retina over time,” said Celine Torres-Moon, science writer, Protocol for Life Balance (Bloomingdale, IL). “As the population [ages], signs of aging of the retina and more specifically of the macula are a common occurrence.”

Dr. Anshel noted that “Considering students who had to do remote learning [during the pandemic], instead of attending a classroom where their vision can be directed in various directions and distances during the day, they were now confined to viewing a display screen for six to eight hours a day.” As a result, “this put an extreme strain on the visual system and likely contributed to psychological stress and reduced test scores that the media has reported. The visual system is not designed to view near targets for extended periods of time.” However, Dr. Anshel noted, “the major source of blue light comes from the sun—not a computer display.”

As far as causes of some of the most common eye issues discussed, Dr. Anshel echoed Dye, Chapman and Pavey, noting that age is the most common. “Even dry eyes happen most often in women over 40 (due to hormonal changes). It has been shown that breast milk contains strong levels of lutein, so babies get a good dose. However, the public doesn’t think much about lutein in the diet until they are over 50 and concerned about eye health. Thus, there is a ‘lutein gap’ that needs to be addressed.”

Natural Approaches/Products for Vision Health

“The No. 1 super nutrient for eye health would be lutein,” said Gers. “Another up-and-coming nutrient for eye health would be astaxanthin.” She explained, “Lutein is often missing or low in our diets because of the lack of vegetables and fruits in the diet. Lutein is found in rich concentrations in the macula of the eye, sifting out damaging short-wavelength UV light that affect the delicate macula. Our bodies do not make lutein, therefore it needs to be sourced from the diet.”

Some of the foods that are rich in lutein, according to Gers, include spinach, eggs, kale and more. However, “if you are not eating a diet high in lutein, have macular health concerns (current or future) or are on your digital screens too much (blue light), you may benefit from a lutein-based supplement,” she noted. “Viteyes offers lutein in AREDS2 formulas, Essentials or our Viteyes Blue Light Defender supplements (kids through adults).” Astaxanthin, which works in the eye muscles to provide relief from tiredness due to overuse, can also be found in the company’s Blue Light Defender supplements, according to Gers. Viteyes supplements are manufactured in the U.S. under strict cGMP (current good manufacturing practice) guidelines, added Gers, and they are available in capsules, soft gels, chews, gummies and powder forms.

“Being proactive is important in preserving eye health with age. The eyes contain delicate structures that are vulnerable to oxidative damage and excess blood sugar,” explained Dye, Chapman and Pavey. “Avoiding smoking, excess alcohol consumption and wearing UV-blocking glasses can help protect from oxidative damage. Controlling blood sugar and getting regular exercise can also benefit long-term eye health. And, most importantly, having routine eye exams to help identify issues in the early stages is critical in preserving vision.”

The trio added, “targeted nutrients like lutein, zeaxanthin, meso-zeaxanthin, black currant fruit standardized to cyanidin-3-glucoside and maqui berry extracts standardized to delphinidins can help support several aspects of eye health.” However, concurring with Gers, they added, “The best-known ingredients that support eye health are lutein and zeaxanthin. Lutein and zeaxanthin are carotenoid antioxidants that help protect not only the macula, but also the retina and lenses.8,9 Lutein and zeaxanthin can even help mitigate the risk factors associated with glaucoma, making carotenoid intake a vital dietary component for overall eye health.”10

Additionally, they added, “there are many other nutrients that can benefit eye health as well as targeted ingredients to support specific aspects of vision. The structures of the eye are delicate and vulnerable to oxidative damage. Additional antioxidants that have been studied in eye health include N-acetylcysteine (NAC), vitamin C, vitamin E (alpha and gamma tocopherols), lipoic acid and resveratrol.”11-15

Dye, Chapman and Pavey listed several different ingredients that can “protect the lenses from becoming clouded by glycation damage, including carnitine and carnosine.”16,17 They explained, “Glycation is a process in which sugar attaches to and damages the protein structures of the body, including the crystallin proteins of the eye lenses. The carnosine derivative, N-acetyl-carnosine, in an eye drop application helps deliver the carnosine directly to the eye.18 Oral supplements that can support natural tear production and tear quality include maqui berry standardized to delphinidins and lactoferrin.19,20 Promoting natural tear production can assist in lubricating the eyes all day without being reliant on the temporary relief from artificial tear drops. Promoting healthy pressure within the eye with select nutrients include french maritime pine bark extract, European bilberry and palmitoylethanolamide (PEA).”21,22

Life Extension, according to Dye, Chapman and Pavey, developed five targeted formulas to support several aspects of eye health. The company’s “MacuGuard Ocular Support with Saffron & Astaxanthin is a multi-ingredient formula to support overall eye health. This formula provides lutein, trans-zeaxanthin, meso-zeaxanthin and alpha-carotene, the carotenoids associated with protection of the macula and retina. We also included phospholipids to help promote the absorption of lutein and zeaxanthin. To support night vision, we added cyanidin-3-glucoside from European black currant fruit, and to support visual acuity, we added 20 mg of saffron extract. And of course, we couldn’t forget astaxanthin, which helps to fight eye fatigue.”

Next, Life Extension’s Gummy Science Digital Eye Support (Berry) is “a no sugar added, berry-flavored gummy formulated with clinically studied Lutemax 2020, a patented marigold extract that provides three macular carotenoids, including lutein and both zeaxanthin isomers, at the same 5:1 ratio found in nature. This formula helps maintain healthy macular pigment density to defend against blue light from digital screens while also improving glare and visual stress caused by excessive light,” according to Dye, Chapman and Pavey.

“Eye Pressure Support with Mirtogenol contains European bilberry and French maritime pine bark known to support healthy circulation, even in the eyes,” they explained. “Over time, fluid pressure inside the ocular chamber of the eye can increase. This combination of nutrients can inhibit this slow increase in fluid pressure by supporting healthy ocular circulation.”

Tear Support with MaquiBright “provides maqui berry (Aristotelia chilensis) extract standardized to delphinidins. Delphinidins support the eye defenses and help promote natural tear production.” And, lastly, the Life Extension trio offered, “Brite Eyes III is a glycerin-based lubricating eye drop that contains N-acetyl-carnosine, an antioxidant the helps protect the eyes from oxidative and glycation stresses that can accumulate with age.”

Life Extension’s “extensive quality,” said Dye, Chapman and Pavey, “begins with raw material testing for every individual ingredient to ensure they are clean, pure and potent. We use advanced analytical chemistry … to ensure the raw materials are exactly what they are. And we test finished products to ensure that what’s on the label is what’s in the product.” The company also offers a certificate of analysis for final testing upon request, and all of its manufacturers are GMP compliant and audited by NSF.

“Enriching the diet with carotenoids and other nutrients that have a special affinity for the retina is one way of addressing vision health issues,” said Torres-Moon, concurring with Gers, Dye, Chapman and Pavey. Additionally, DHA “is an omega-3 fatty acid known to support eye health, especially during eye development in utero. Furthermore, free radical scavengers found in berries such as maqui help to support eye moisture, which is an important part of the maintenance of eye health.”* Torres-Moon added, “The eye, and more specifically the retina, is especially sensitive to oxidative damage. Macular xanthophylls (lutein, zeaxanthin and meso-zeaxanthin) quench free radicals and, therefore, limit lipid peroxidation in the retina.* Carotenoids also protect against oxidative damage by recycling alpha-tocopherol and acting synergistically with vitamin C.”*

Torres-Moon elaborated, “Lutein and zeaxanthin are also present in human lens, where they scavenge free radicals and modulate the activity of glutathione and some enzymes involved in oxidative stress regulation.* Astaxanthin is another carotenoid that has been widely studied to support eye health.* In preclinical and clinical studies, it has been associated with improvement in retinal blood flow, enhanced vision acuity and improvement in eye accommodation times.”* Furthermore, “Polyphenolic compounds from berries like blueberries, bilberries and maqui berries have also been studied for their positive effect on eye health.* Dietary supplements,” she added, “are a great complement to eye drops, as they support eye health from within.* Many of these dietary supplements have been clinically evaluated to specifically support health and they are very effective for these indications.”

Protocol for Life Balance offers two products for eye health, according to Torres-Moon. “Clinical Strength Ocu Support is a comprehensive multivitamin, multinutrient product that features beta-carotene, zinc in the form of L-OptiZinc (Zinc-L-Methionine), antioxidant vitamins C and E, and many ingredients involved in the reduction of oxidative stress such as selenium, citrus bioflavonoid, rutin, alpha-lipoic acid, CoQ10, glutathione, NAC, as well as plant extracts like green tea, bilberry, grape seed, ginkgo and marigold for lutein and zeaxanthin. Together, these ingredients help nourish your eyes, and with 10 mg of bioavailable lutein per serving, contribute to protecting them against the damaging effects of free radicals produced by sunlight and supporting macular health.”*

The company’s newest product is Astaxanthin 12 mg, “a step up from our existing 10 mg product. This higher strength product has shown in clinical studies to help support healthy blood flow in choroidal tissue.”* The company follows GMPs, its manufacturing facilities are third-party certified and it uses ingredients that have been clinically evaluated.

“The most common surgery performed in the U.S. is cataract surgery,” noted Dr. Anshel. “While there have been tremendous advances in the procedure and the outcomes, it is still a surgical procedure and there are potential risks and side effects.” He stressed the importance of prevention rather than waiting until a serious vision issue occurs. “First and foremost is to stop smoking! Studies confirm that smoking is a causative factor in the development of AMD. Second-hand smoke also contributes,” he warned. “Regular eye exams are also critical to finding these problems, at least at the early stages. Eye problems, in general, are painless and slow to develop, so routine visits to the eyecare professional is critical, especially as we age.”

Dr. Anshel continued, “Of course, paying attention to our diet matters all the time. It is important to realize that our metabolism changes as we age, so foods that we used to eat without worry might not be appropriate for older individuals. And, of course, ‘keep moving’ is one of my mantras.” The first thing Dr. Anshel reminds his patients of is that “eyes are ‘a part of the body,’ so overall health relates to eye health. Nutrients that are important to general health also apply to the eyes and visual system.” The products he would recommend depend upon the condition about which a patient is most concerned. “Most often, it’s a combination of nutrients that support the various parts of the eyes and/or brain (since the eyes are directly connected to the brain).”

Like Dr. Anshel, Dr. Grossman’s approach “is not to just treat the eyes, but to treat the person behind the eyes.” His recommendations “are to serve only as adjunctive therapies to your already prescribed medical treatments. I can also help [patients] to understand the diagnosis and treatment that has been recommended from [their] eye doctor.” He offers a protocol for patients using an integrative medical approach using “nutrition, diet, herbal medicine, Chinese medicine, targeted nutritional supplements and lifestyle changes.”

Dr. Grossman offers 10 tips to take better care of vision:

1. “Looking up: Both children and adults need to look up and away from near tasks to distant objects regularly.

2. Lighting: The illumination on what you are doing should be three times brighter than the rest of the room. Don’t read under a single lamp in a dark room. Eliminating glare is especially important for close-up work

3. Sitting straight: Have chest up, shoulders back and weight over the seat so both eyes are at the eye task level and at an equal distance from what is being seen.

4. Best distance: Reading, writing or close-up work is best done at an eye-to-activity distance equal to the length between middle knuckle and elbow (14 to 16 inches for adults).

5. Posture: Sit upright while reading or watching television in bed. Avoid lying on your back or stomach.

6. Writing: Hold your pencil or pen an inch or so from the tip so you can see and guide it without tilting your head or body to the side.

7. Television: Watch TV from a distance equal to seven times the width of the screen (about eight to 10 feet) and sit upright. Have indirect lamps on in the room but placed to eliminate glare on the screen. Watching television involves and develops very few visual skills and should be limited to a few hours or less daily, especially for children.

8. Participating: Perform outdoor activities that require seeing at a distance. Become aware of what and where things are on all sides. When walking, keep your head up, eyes wide open and look toward objects, but avoid staring at them.

9. Nutrition: A good diet high in fruits and vegetables along with supplementation of lutein, zeaxanthin, bilberry and vitamin A are beneficial for keeping the eyes healthy. Additional nutrients may be required for specific eye conditions.

10. Exercise: Aerobic exercise not only benefits your heart. It’s good for your eyes too. Exercise is extremely important in the prevention of the eyes’ worsening. Exercise raises oxygen levels in the cells and increases lymph and blood circulation. This increased circulation is a prerequisite for good vision.”

Clearly, there are plenty of natural ways in which practitioners can help their patients to keep their eyes healthy, whether through lifestyle changes, diet changes, supplementation or all of the above.

How to Best Help Patients With Vision Health Concerns

“Practitioners can incorporate vision health supplements into their practices by selling at the office or even offering a one-sheeter that gives suggestions to their patients on best supplements for long-term health,” advised Gers. “There are so many supplements out there and patients can be overwhelmed by the number on shelf at pharmacies or online.” The best thing a practitioner can do, however, “is help to educate patients as early as possible,” Gers concluded.

Dye, Chapman and Pavey added that “Practitioners can remind their patients to have routine eye exams, since many eye problems may not have symptoms until the condition becomes advanced. Addressing lifestyle factors like encouraging smoking cessation, controlling blood sugar and blood pressure, and getting regular exercise can help promote eye health.” They added, “Practitioners can also correct dietary deficiencies such as inadequate intake of fish oil fatty acids, vitamins and minerals, along with targeted nutrients for specific eye health concerns.”

According to Torres-Moon, “The eye might not be the first organ practitioners think about when seeing a patient for another condition. However, maintaining eye health is very important for the maintenance of independence as patients age, and some long-term, asymptomatic damage to the retina might be irreversible.” Furthermore, “Practitioners need to be systematic about it, even when patients have no symptoms or vision complaints … It is easy during a consultation for an unrelated issue to forget about eye health. However, the benefits of dietary supplements for eye health have been well established, and these supplements have to be taken regularly to maintain their benefits. It might be difficult,” however, she warned, “for a practitioner to convince a patient that the supplements they are taking now will pay off years later.”

Dr. Grossman believes that “the integrative medical approach that many practitioners can help implement to their patients is an untapped need that needs to be addressed to help people keep their precious gift of sight.” He advises practitioners to “get more education on vision health. My book, Natural Eye Care, is over 800 pages with 2,000 peer review studies on ways to improve vision health [and] is a good start as a reference guide … then, develop cross referrals with eye doctors in your area to help a patient put together their vision health team approach.” All in all, said Dr. Grossman, “As an integrative medical optometrist and acupuncturist for over 43 years, I believe that prevention is the best medicine, as Benjamin Franklin had stated. My hope is that more natural practitioners will get educated on vision health to help people see to their maximum abilities.”

Dr. Anshel stresses “the importance of knowing the biochemistry of nutrition to make the best recommendations to patients. I can’t tell a practitioner what ‘brand’ of nutrient might be best because they need to know their patient’s lifestyle and history,” he explained. “One size doesn’t fit all! Most every product comes with a caveat to ‘discuss this with your doctor,’ but if the doctor just recommends the same ‘one-a-day’ pill for everyone, he or she is not doing the patient any favors … You can’t throw a few pills down, after a consistently bad diet, and expect miracles,” he said.

“There is a marked difference between the lifespan and the ‘health-span,’ where we tend to live seven years longer but with significant health problems,” concluded Dr. Anshel. “If one loses their vision, their will to live can be impacted.”

*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

References:

1 Common Eye Disorders and Diseases. Basics of Vision and Eye Health [web] 2022 2022 Dec 19 [cited 2023 2023 May 3]; web page]. Available from: www.cdc.gov/visionhealth/basics/ced/index.html.

2 Thompson, J. and N. Lakhani, Cataracts. Prim Care, 2015. 42(3): p. 409-23.

3 Dillon, J., UV-B as a pro-aging and pro-cataract factor. Doc Ophthalmol, 1994. 88(3-4): p. 339-44.

4 Roberts, J.E., Ultraviolet radiation as a risk factor for cataract and macular degeneration. Eye Contact Lens, 2011. 37(4): p. 246-9.

5 Weinreb, R.N., T. Aung, and F.A. Medeiros, The pathophysiology and treatment of glaucoma: a review. JAMA, 2014. 311(18): p. 1901-11.

6 Staff, M.C. Lazy eye (amyblyopia). Diseases & Conditions [web] 2021 [cited 2023 2023 May 3].

7 Kanukollu, V.M. and G. Sood, Strabismus, in StatPearls. 2023, StatPearls Publishing Copyright 2023, StatPearls Publishing LLC.: Treasure Island (FL).

8 Kijlstra A, et al. Prog Retin Eye Res. 2012;31(4):303-315.

9 Arnal E, et al. Graefe’s Archives in Clinical and Experimental Ophthalmology. 2009;247(1):115-120.

10 Lem DW, et al. Nutrients. Jun 6 2021;13(6):1949.

11 Wang P, et al. Molecular Vision. 2009;15:2945-2952.

12 Weikel KA, et al. Nutr Rev. 2014; 72(1):30-47.

13 Lyle BJ, et al. Am J Clin Nutr. 1999;69(2):272-277.

14 Kojima M, et al. Jpn J Ophthalmol. 2007;51(1):10-13.

15 Hua J, et al. Invest Ophthalmol Vis Sci. 2011 Apr 25;52(5):2809-16.

16 Elanchezhian R, et al. Current Eye Research. 2007;32(11):961-71.

17 Babizhayev MA. Recent Patents on Drug Delivery & Formulation. 2012;6(2):107-148.

18 Babizhayev MA, et al. Am J Ophthalmol. 2009;16(6):517-533.

19 Hitoe S, et al. Panminerva medica. 2014;56(3 Suppl 1):1-6.

20 Devendra J, Singh S. J Clin Diagn Res. 2015;9(10):Nc06-9.

21 Steigerwalt RD, et al. Clin Ophthalmol. 2010;14:471-6.

22 Gagliano C, et al. Invest Ophthalmol Vis Sci. 2011;52(9):6096-100.

Healthy Take Aways

• According to a study by the National Library of Medicine (NLM) National Center for Biotechnology Information, published in JAMA Opthalmology, 220 participants (88 percent) ranked sight as their most valuable sense.
• People would, on average, choose 4.6 years of perfect health over 10 years of life with complete sight loss, according to NLM data.
• Those at higher risk for AMD include current or previous smokers, individuals with a family history of AMD, obesity or unhealthy weight levels and a poor diet.
• Targeted nutrients like lutein, zeaxanthin, meso-zeaxanthin, black currant fruit standardized to cyanidin-3-glucoside and maqui berry extracts standardized to delphinidins can help support several aspects of eye health.

For More Information:

Life Extension, www.lifeextension.com
Protocol for Life Balance, www.protocolforlife.com
Vitamin Health, Inc. (Viteyes), www.vitaminhealth.com, www.viteyes.com