Vision Supplements Review (with Lutein and Zeaxanthin)
Find the Best Vision
Supplement. Tests and Reviews of Popular Vision Supplements.
Medically reviewed and
edited by Tod Cooperman, M.D.
Last Updated: 11/29/2021 | Initially Posted:
10/18/2019Latest Update: Caution With Vitamin
Supplements
Table of Contents
Summary
·
What are lutein and zeaxanthin? Lutein and
zeaxanthin are anti-oxidant pigments found in the macula of the eye (in the
retina) and are believed to protect the macula from damage (see What It Is).
·
What are the health benefits of lutein and zeaxanthin? On average, people
don't consume enough lutein and zeaxanthin in their diets and/or
have low levels of lutein in their blood or low macular pigment density; for
them, taking a lutein supplement may slow the progression of
age-related macular degeneration (although it won't improve the condition) as
well as reduce the risk of needing cataract surgery. It may also improve some
aspects of brain function (See What It Does).
·
How much lutein and zeaxanthin should I take? A dose of 10 mg of
lutein appears to be better than a lower dose (6 mg). Higher dose products
(e.g., 20 mg to 40 mg) are common, although it is not known if a higher dose is
better. Nevertheless, 20 mg has been shown to be safe in a 6-month study.
·
Which types of lutein and zeaxanthin are best? It's not clear
whether the "free" or "ester" form, or a natural or
synthetic source, is better and it is not clear if there is added benefit with
zeaxanthin (see Forms of lutein).
·
How much do lutein and zeaxanthin cost? Lutein and
zeaxanthin at a reasonable dose (10 to 20 mg) can be obtained for as little as
about 10 to 15 cents per day (see What CL Found).
·
Other ingredients, particularly zinc and vitamin C, may provide
additional benefit in slowing the progression of age-related macular
degeneration (see AREDS). Formulas with these ingredients were
also reviewed.
·
What did CL's tests of lutein and zeaxanthin show? Our tests showed
that most products contained the lutein and zeaxanthin they claimed to provide,
but one product had only 50% of its listed zeaxanthin.
·
Which lutein and zeaxanthin products are best? We chose
three Top Picks among
lutein and vision supplements based on value and clinical evidence.
·
How to take lutein and zeaxanthin: To enhance
absorption, it is best to take lutein and zeaxanthin supplements with a fatty
meal, but be aware that consumption of certain foods and supplements may
decrease absorption of lutein and zeaxanthin (see Concerns and Cautions). In addition, try to
eat at least one orange per week and have fish at least once a week,
as these are also associated with a reduced risk of AMD.
What It Is:
Lutein
and zeaxanthin are members of the carotenoid family — a group of natural plant
pigments that includes beta-carotene and lycopene. Lutein and
zeaxanthin have identical chemical formulas and are isomers (they have slightly
different molecular structures). They, along with a stereoisomer of zeaxanthin
known as meso-zeaxanthin, are the only carotenoids found in high concentration
in the macula of the eye and surrounding retinal tissue, where they may protect
the eye from damaging light. Lutein and zeaxanthin are available from a wide
variety of foods and it is believed that meso-zeaxanthin is synthesized in the
retina from lutein. However, most adults in the U.S. consume less lutein and
zeaxanthin than the amount believed to lower the risk of macular degeneration.
Consequently, dietary supplements are often used to increase lutein and
zeaxanthin levels.
What It Does:
The macula is an area within the retina of the eye that is
responsible for conveying fine color images to the brain. The macula can
degenerate with age, resulting in loss of vision. Age-related macular
degeneration is the leading cause of blindness in the U.S. More than nine
percent of people in the U.S. over age 40 show some form of macular
degeneration and it affects 27% of adults 65 and older. It is believed that
lutein and zeaxanthin, both of which are anti-oxidants, protect the macula by
scavenging potentially damaging free radicals and absorbing certain high-energy
light. Studies of populations generally show that people who get the most
lutein and zeaxanthin from their diets tend to have lower rates of macular
degeneration. One double blind, placebo controlled
study (Richler Optometry 2004) showed that after one
year of daily supplementation with 10 mg of lutein (or 10 mg of lutein plus a
mixture antioxidants, vitamins and minerals) ocular pigment increased and
vision improved in people with atrophic age-related macular degeneration. A
subsequent study failed to find benefit with lutein, but it used a lower dose
(6 mg daily) and involved fewer people (Bartlett Eur J Clin Nutr 2007).
Additional human studies suggest that among people with age-related macular
degeneration, those with low blood levels of lutein may be more likely to
benefit from taking lutein supplements. Even in people
with healthy eyes, the density of macular pigment does not seem to increase
with lutein/zeaxanthin supplementation unless the density was low to start.
This was seen in a 6-month study in Japan using FloraGLO
or XanMax (1 capsule daily, each containing approx.
10.5 mg lutein and 1 mg zeaxanthin). There was no increase in macular pigment
density in most people in the study, except those with low density at the start
(Obana, PLoS One, 2015). In a study among 120 men and women (average age 56) in
France with a family history of age-related macular degeneration but normal
macular pigment density and no other risk factors or signs of the disease,
supplementation with a capsule containing lutein (5 mg), zeaxanthin (1 mg),
vitamin C (90 mg), vitamin E (15 mg), zinc (7.5 mg), copper (<0.5 mg), and
resveratrol (0.5 mg), as well as 33 mg of fish oil, taken twice daily for six
months, did not increase macular pigment density compared to placebo (Korobelnik, JAMA Opthalmol 2017).
The message: If macular pigment density is not low, lutein and
zeaxanthin may not help.
Some research suggests that pigmentation may continue to
improve over several years of supplementation. One clinical trial compared
three different formulations in men and women with early age-related macular
degeneration over a 3 year period: 20 mg of lutein
plus 0.86 mg zeaxanthin (Ultra Lutein, Natural Organics, Inc.), 10 mg
lutein plus 2 mg zeaxanthin and 10 mg meso-zeaxanthin (Macushield,
Macuvision Europe Limited), and 3 mg lutein plus 2 mg
zeaxanthin and 17 mg meso-zeaxanthin (not commercially available). The study
found that all three formulas significantly increased macular pigmentation over
the first year, with no further gain in the second year. However, during the
third year, there were further increases in pigmentation among those who took
formulas containing meso-zeaxanthin. Over the course of the 3 year study,
vision remained stable (no improvement and no decline in vision) with each
formula, and no progression to advanced macular degeneration occurred (Akuffo, Eye 2015).
In addition to lutein and zeaxanthin, other ingredients may improve macular
degeneration. See the section Eye Health Supplements.
A preliminary study suggests that lutein may help
treat retinitis pigmentosa (Bahrami BMC Ophthalmol 2006). Population studies also suggest
a reduced risk of developing severe cataracts (clouding of the
lens of the eye) in people consuming higher amounts of lutein in their diet.
The AREDS 2 study found that supplementation with lutein and zeaxanthin did not
have a benefit except in those with the very lowest dietary intakes of lutein
and zeaxanthin — among this group, the number of people requiring cataract
surgery was reduced by 32%. There is also preliminary research suggesting that
lutein and zeaxanthin may help protect skin from sun damage.
Increased lutein intake has also been associated with a lower risk of colon
and breast cancer.
Lutein and zeaxanthin are also found in very small amounts
in the brain and preliminary evidence suggests they may have a positive effect
on brain functioning. A placebo-controlled clinical study found that when
healthy young people (in Georgia, U.S.) took a daily supplement containing
zeaxanthin (20 mg as Eye Promise Zeaxanthin from ZeaVision, Inc., which funded the study) or zeaxanthin in
combination with lutein (26 mg and 8 mg, respectively, as EyePromise
vizual EDGE), they showed an average 20% increase in
the speed of a type of visual processing required to
discriminate a light source as flickering versus steady. This type of visual
processing is typically slowed by aging, and faster processing tends to be
positively correlated with, for example, improved sports performance and driver
safety, reading speed, and executive cognitive function (Bovier, Arch Biochem Biophys 2015). In
addition, a placebo-controlled study in Ireland among healthy adults with low
central macular pigment density (under 0.55 optical density units at
0.23 degrees of eccentricity, as determined by eye exam) found that taking a
formulation of 10 mg of lutein, 10 mg of meso-zeaxanthin, and 2 mg of
zeaxanthin daily for 12 months lead to improvements in episodic memory (e.g.,
remembering where you parked your car) (Power, J Alzheimers Dis 2018).
Another study in Georgia (funded by Omniactive,
which sells Lutemax lutein) among a small group of
healthy young college students suggested that lutein and zeaxanthin
supplementation may reduce psychological stress. Supplementing with
softgels providing 13 mg or 27 mg of a combination of
lutein/zeaxanthin (83%/17%) modestly reduced psychological stress scores and
levels of cortisol (a stress hormone), while placebo did not. The improvements
were statistically significant for the high dose at 6 months, and for both high
and low doses at 12 months. Blood samples indicated that the students had low
consumption of lutein from their diets and, as expected, the supplements increased
macular densities in students' eyes, which, the researchers speculated, might
indicate increased levels of these compounds and an anti-oxidant effect in
students' brains as well (Stringham, Nutri Neurosci 2017). As part of the same study, the
researchers evaluated the participants' cognitive function during the first six
months of the trial. They found that supplementation with either the 13 mg or
17 mg dose of the lutein/zeaxanthin combination improved overall memory
performance, verbal memory, attention, speed of processing and psychomotor
speed (i.e. reaction time and fine motor coordination)
compared to placebo. In addition, blood levels of a protein that plays an
important role in brain cell growth and cognitive function (brain-derived
neurotrophic factor, or BDNF) increased and certain inflammatory proteins
decreased in those who took lutein and zeaxanthin compared to placebo. However,
findings based on the full 12 months of supplementation were not reported,
which is disconcerting. The researchers indicated (in email correspondence with
ConsumerLab) that this was because of "funding
constraints." (Stringham, Physiol
Behav 2019).
A study by the same researchers which was also
funded by Omniactive suggested that daily
supplementation with 24 mg of a combination of lutein, zeaxanthin and mesozeaxanthin (at a ratio of 83%:10%:7%, respectively)
daily can benefit people who spend prolonged periods of time in front
of computer, phone, or tablet screens. In the study, 35 healthy
college-aged men and women (average age 21) were given the supplement daily for
six months. Over that time, compared to a group which received a placebo, headaches were
reduced by 35%, eye strain was reduced by 20%, and eye
fatigue was reduced by 30%. Participants also reported 20% fewer sleep
complaints (Stringham, Foods 2017).
There is preliminary evidence suggesting astaxanthin, another
carotenoid, might help prevent eye fatigue and protect the lens of the eye
against cataracts, as well as protect the stomach against ulcers, help with
male infertility, and reduce risk of macular degeneration. However, more
research is needed. Astaxanthin is naturally produced by a type of algae and,
through the food chain, provides the pink coloration of salmon, trout, krill,
shrimp and other crustaceans. (For more about astaxanthin see the Astaxanthin Supplements Review).
See ConsumerTips™ for
information about ingredient forms, dosage, and safety issues.
Quality Concerns and
Tests Performed:
No
government agency is responsible for routinely testing lutein and zeaxanthin
supplements for their contents or quality. ConsumerLab.com purchased and
evaluated supplements to determine whether they contained the amounts of these
compounds stated on their labels. Products containing whole herbs and/or more
than 250 mg of minerals per daily serving were tested for potential
contamination with lead, cadmium, and arsenic, and all non-chewable and non-timed release tablets also were tested to be sure that they
would properly disintegrate. (See How Products Were Evaluated for
information on testing methods and passing score.)
What CL Found:
Among the products selected by ConsumerLab.com, all but one were found to provide the amounts of lutein and zeaxanthin
claimed on their labels: Doctor's Best Lutein with OptiLut was
discovered to contain only 50% of its listed zeaxanthin — we found 1 mg per
capsule, rather than 2 mg. It did, however, contain it's claimed 10 mg of
lutein per capsule and its actual ratio of lutein to zeaxanthin is within the
range found in other products.
All applicable tablet products disintegrated properly.
Choosing among the products:
Passing tests of quality is just one hurdle a product should overcome before
you consider using it. Other questions to be answered are: Is the dose
appropriate; how does it compare on price; and, if there are other ingredients,
do they make the product more or less desirable?
As noted in the ConsumerTips™ section,
a useful daily dosage of lutein for someone who does not get enough from their
diet ranges from 6 mg to 10 mg and, possibly, up to 20 mg. If you
already eat more than half a cup a day of green leafy vegetables, you can
probably skip a supplement. If you get some greens but perhaps not enough,
a supplement with at least 6 to 10 mg could help. If you don't eat green leafy
vegetables, 10 mg would seem more appropriate and even 20 mg may be helpful and
still safe.
Some products contain lutein as an "ester" and some as non-esterified
"free" lutein -- either form is fine, and all products list the
amounts of lutein from these forms, so that lutein amounts can be compared
"apples-to-apples." The same holds true with zeaxanthin, which is
available in a synthetic form that is also acceptable.
As shown in the graph below, all of the products provided at least 6 mg of
lutein per suggested daily serving and some provided much more — up to 40
mg.
To help compare products on price and value, ConsumerLab.com calculated the
cost to obtain 10 mg of lutein from each product. This ranged from 5 cents to
56 cents per 10 mg of lutein in most products, or as high as $1.21 in a formula
containing bilberry extract and other ingredients. Trunature
[Costco] Vision Complex Lutein & Zeaxanthin provided lutein at the
lowest cost, with a 14 cent softgel providing 25 mg
of lutein and 5 mg of zeaxanthin, working out to 5 cents per 10 mg of lutein
(with 2 mg of zeaxanthin).
Top Picks:
Lutein/zeaxanthin-only:
As noted earlier, studies tend to indicate that, if you need to supplement with
lutein, a dose of 10 mg is appropriate. This is the amount in the AREDS
formulas (discussed further below). If you want 10 mg of lutein without the
full AREDS formula, among the products that we reviewed there were two that
will provide this dose: Doctor's Best Lutein with OptiLut and MacuShield Original Formula. Our Top
Pick for a 10 mg dose is Doctor's Best -- taking
one capsule rather than the suggested two capsules. This is despite the fact
that this product was "Not Approved" in testing because it contained
only half the zeaxanthin claimed on its label (1 mg instead of 2 mg per
capsule). However, each capsule, which we verified to provide 10 mg of lutein,
costs only 10 cents, versus 56 cents for MacuShield,
making Doctor's Best much more economical. MacuShield contains more zeaxanthin (2 mg per softgel plus 10 mg of meso-zeaxanthin), but it's not clear
if this is clinically significant. (Note: We typically only
consider "Approved" products as Top Picks but made
an exception in this case in light of the large cost savings.)
If you want a lower dose of 6 mg, you can get this from Douglas
Laboratories Lutein but you'll pay more — 27 cents per softgel. If for some reason you want a very large dose of
lutein, Trunature [Costco] Vision
Complex Lutein & Zeaxanthin provides 25 mg (and 5 mg of
zeaxanthin) per softgel for just 14 cents, making it
the least expensive source of lutein per gram among all the products. Be aware,
however, that although it is called a vision complex, it does not contain the
other ingredients found in products resembling the AREDS formulas.
Vision formulas:
Among vision formulas, it is helpful to judge products against what has been
shown to work (or not) in two major studies focused on slowing the progression
of age-related macular degeneration. These two studies, AREDS and AREDS2 (see
discussion below) showed the following ingredients and doses to be helpful if
taken daily:
·
21.8 mg of zinc, or 69.6 mg but with 1.6 mg of copper to offset
reduced copper absorption caused by the zinc (the lower zinc dose may be just
as effective and preferable to avoid side-effects of excess zinc)
·
452 mg of vitamin C
·
400 IU of vitamin E
·
10 mg of lutein and 2 mg of zeaxanthin, especially if you don't
consume enough green leafy vegetables.
Beta-carotene, often
listed as "vitamin A (as beta-carotene)" on labels, is not needed and
should be avoided by current smokers and people who have been occupationally
exposed to asbestos. You can also skip formulas with omega-3 fatty acids from
fish oil as these provide no added eye health benefit. (Omega-3 fatty acids may
be helpful, however, if you suffer from certain forms of dry eye).
Other ingredients, such as bilberry, were not included as part of the study and
are unlikely to have additional benefit in age-related macular degeneration.
(Preliminary research suggests that bilberry may improve retinal lesions in
people with retinopathy related to diabetes or hypertension and it may provide
a short-term improvement in night vision. More about bilberry supplements,
including our ConsumerLab.com's tests of products,
are found in the Bilberry Supplements Review).
The products that most closely resemble the ideal formula
to slow the progression of age-related macular degeneration are Bausch
& Lomb PreserVision Eye Vitamin & Mineral
Supplement AREDS Lutein and Systane I-Caps. They
are our Top Picks for vision formulas, although
neither, in our opinion, is perfect.
On the positive side, both provide the correct amounts of lutein (10 mg) and
zeaxanthin (2 mg) and sufficient vitamin C (452 mg in Bausch --
which is the exact AREDS amount -- and 500 mg in Systane).
Although Bausch is a more exact match to
one of the AREDS formulas, it contains what has been shown to be an
unnecessarily large amount of zinc (69.6 mg per day), which is over the
established upper tolerable intake level of 40 mg and can increase the risk of
copper deficiency (which can cause anemia, heart problems, difficulty with
balance and other symptoms). Although its 2 mg of copper may help offset the
reduction in copper absorption that can be caused by this much zinc, be aware
that at least one case of copper deficiency with related symptoms has been
reported with regular use of a Bausch's PreserVision AREDS 2 formula providing 80 mg of
zinc per day along with 2 mg of copper.
Systane provides 25 mg of
zinc per day (slightly more than then 21.8 mg in the ideal AREDS formula, but
still below the upper limit) as well as 2 mg of copper. Unlike Bausch,
which is softgels, Systane is a
large chewable which, although it has a nice sweet, berry flavor, leaves a
slight metallic after taste (from zinc), includes mannitol (a sugar alcohol
that can cause some gassiness), and contributes about 20 Calories per day.
Of the two, Bausch is much less expensive: 37 cents per day
for 2 softgels vs. 67 cents per day for 2 chewable
tablets of Systane. Unless you have trouble swallowing softgels and prefer a chewable, Bausch is
a better way to go although, ideally, we'd prefer that it contained less zinc.
Other formulas in this review which could be beneficial regarding age-related
macular degeneration are:
·
LifeExtension MacuGuard
Ocular Support (31 cents per day) is essentially lutein (10 mg) and
zeaxanthin (4 mg) with an antioxidant, cyanadin-3-glucoside (from black currant
extract), which animal research suggests may have some benefit for night vision
(Lee, Current Eye Res 2014).
·
USANA Visionex ($1.21 per day)
provides somewhat less zinc than the AREDS formula (10 mg per day), but
provides a reasonable amount of vitamin C (500 mg), lutein (10 mg) and
zeaxanthin (2 mg).
Although not tested in
this review, here are descriptions of other marketed vision formula
supplements:
·
Bausch + Lomb Ocuvite Lutein &
Zeaxanthin doesn't follow the AREDS formula, providing just 6 mg of
lutein (but no zeaxanthin), 60 mg of vitamin C, 30 IU of vitamin E, and 15 mg
of zinc, as well as 2 mg of copper.
·
GNC Preventative Nutrition Eye Formula provides 100% of
the DV of the AREDS ingredients, but adds 100% of the DV of vitamin A (50% as
beta-carotene and 50% as retinol from fish liver oil) and 500 mg of vitamin C —
an amount close to that in the AREDS formula, and twice the lutein (20 mg with
4 mg of zeaxanthin).
·
Lipotriad Visionary contains AREDS
ingredients, some in higher amounts, along with a modest amount of omega-3
fatty acids from fish oil — although the fatty acids may have no added benefit
in terms of vision, according to the AREDS2 study.
·
MacuHealth with LMZ3 provides 10 mg of lutein and 2 mg of
zeaxanthin in each softgel, per the AREDS formula,
and includes 10 mg of meso-zeaxanthin. However, it does not include other
ingredients from the AREDS formula: zinc (and copper), vitamin C, and vitamin E
and it is more expensive than most other products at 89 cents per 10 mg of
lutein.
·
Ortho Molecular Products 4Sight provides 30 mg of
lutein and 1.5 mg of zeaxanthin per day as well as zinc (15 mg) but also
several other ingredients, such as Gingko biloba, which do not seem
to have strong evidence of vision benefit.
·
TwinLab OcuGard
Plus (74
cents per day) provides relevant ingredients, including 25 mg of zinc per day
and 20 mg of lutein. However, it provides a much higher amount of vitamin C —
1,500 mg per day than the AREDS formulas. You may not want to take this much
vitamin C, as some research suggests that high-dose vitamin C may increase
the risk of cataracts.
·
Nutrilite Vision Health with
Lutein provides
10 mg of lutein per day, as well as bilberry, spinach
concentrate, and 50 mg of black currant extract. (A preliminary study of black
currant extract suggested possible benefit with 50 mg in visual fatigue due to
computer monitors -- (Nakaishi, Altern Med
Rev, 2000).
Test Results by Product:
Listed
alphabetically below are the test results for 13 supplements containing lutein.
Some also contain zeaxanthin and/or meso-zeaxanthin and some are formulas with
other ingredients of potential relevance to vision. Eight were selected by
ConsumerLab.com and five others (each indicated with a CL flask icon) are
included for having passed the same evaluation through ConsumerLab.com's
voluntary Quality Certification Program.
Products listed as "Approved" contained their listed amounts of
lutein and zeaxanthin and met ConsumerLab.com's
quality standards (See Passing Score).The full list of ingredients in
each product is provided in the last column.
Results of
ConsumerLab.com Testing of LUTEIN, ZEAXANTHIN & VISION SUPPLEMENTS
(Click arrows or swipe left or right to see all columns)
Approval Statusⓘ
Product Name
Claimed Amount of Lutein and Zeaxanthin Per
Daily Servingⓘ
Suggested Daily Serving on Label
Pill Sizeⓘ
Cost for Suggested Daily Serving
[Price per 10 mg Lutein]
Price
Additional "Vision" Ingredients
Other Notable Features
Full List of Ingredients Per Daily Serving
Lutein & Zeaxanthin:
NOT APPROVED
Top Pick
for lutein
(See explanation)
Doctor's Best® Lutein with OptiLut®
Dist. by Doctor's Best, Inc.
2 veggie caps
20 mg lutein from esters (OptiLut®)
✔
4 mg zeaxanthin (OptiLut®)
Found only
2 mg zeaxanthin per serving (50% of listed amount)
Take 2 capsules daily with or without food, or
as recommended by a nutritionally-informed physician.
Large veggie cap
$0.20
[$0.10]
$12.11/120 veggie caps
Vegan. Non-GMO. Gluten Free. Soy Free.
2 veggie caps
Lutein (from OptiLut® Lutein Esters extracted from
marigold flower (Tagetes erecta)) 20 mg,
Zeaxanthin (from OptiLut® marigold flower ext., (Tagetes
erecta)) 4 mg.
Other Ingredients: Microcrystalline cellulose, more...
APPROVED
Douglas Laboratories® Lutein
Mfd. by Douglas Laboratories
1 softgel
6 mg lutein
✔
0.3 mg zeaxanthin
✔
As a dietary supplement, adults take 1 to 2 softgels, or as directed by your healthcare professional.
Medium softgel
For 1 softgel
$0.27
[$0.45]
$24.40/90 softgels
None.
1 softgel
Vitamin E (as d-alpha-tocopherol) 1 IU, Lutein 6 mg, Zeaxanthin 300 mcg.
Other Ingredients: Safflower Oil, gelatin (capsule), glycerin, and water.
APPROVED
Dist. by General Nutrition Corporation
1 softgel
40 mg lutein
✔
1 mg zeaxanthin
✔
As a dietary supplement, take one softgel capsule daily.
Medium/large softgel
$0.58
[$0.15]
$34.99/60 softgels
No Sugar, No Starch, No Artificial Flavors, No
Preservatives, Sodium Free, No Wheat, Gluten Free, No Corn, No Dairy, Yeast
Free.
1 softgel
Calories 5, Total Fat 0.5 g, Lutein 40 mg, Zeaxanthin 1 mg.
Other Ingredients: Soybean Oil, Gelatin, Safflower Oil, Glycerin, Yellow
Beeswax, Soy Lecithin, Carmine (Color), Titanium Dioxide (Mineral Whitener).
APPROVED
Healthy Origins® Natural Luteinⓘ
Dist. by Healthy Origins®
1 veggie softgel
20 mg lutein (Lutemax® 2020)
✔
4 mg zeaxanthin (Lutemax® 2020)
✔
Adults: Take one (1) veggie softgel
daily, or as recommended by a health care professional.
Medium veggie softgel
$0.13
[$0.06]
$22.99/180 veggie softgels
Does not contain Gluten, Milk, Eggs, Fish,
Shellfish, Peanuts, Wheat or Soy, No Preservatives or Artificial Flavors. Soy
Free. Non-GMO.
1 veggie softgel
Lutein (from Lutemax® 2020 marigold flower extract)
20 mg, Zeaxanthin Isomers (from Lutemax® 2020 marigold
flower extract) 4 mg.
Other Ingredients: Vegetarian Softgel, more...
APPROVED
MacuShield® Original Formula
Dist. by Alliance Pharmaceuticals Limited
1 softgel
10 mg lutein
✔
2 mg zeaxanthin
✔
10 mg meso-zeaxanthin
(unable to test for this)
Take one softgel
capsule daily with a meal.
Medium/large softgel
$0.56
[$0.56]
$201.90/4 bottle of 90 softgels (360 softgels total)
None.
1 softgel
Marigold extract [Providing: Meso-zeaxanthin 10 mg, Lutein 10 mg,
Zeaxanthin 2 mg] 157 mg.
Bulking agent: Sunflower seed oil, capsule shell (gelling agent: bovine
gelatin, humectant: glycerol, colour: red iron oxide
E172), more...
APPROVED
Natures Plus Ultra Maximum Strength Lutein®
Dist. by Nature's Plus
1 softgel
20 mg lutein
✔
0.86 mg zeaxanthin
✔
As a dietary supplement, one softgel
daily.
Medium/large softgel
$0.54
[$0.27]
$32.43/60 softgels
Gluten Free. Free from artificial colors and
preservatives.
1 softgel
Lutein (active carotenoid from marigold flower extract) 20 mg, Zeaxanthin
(active carotenoid from marigold flower extract) 860 mcg.
Other Ingredients: Gelatin, soybean oil, glycerin, beeswax, lecithin, purified
water and natural color.
APPROVED
Puritan's Pride® Lutigold™
Lutein 20 mg
Mfd. by Puritan's Pride, Inc.
1 softgel
20 mg lutein (Lutigold™)
✔
0.8 mg zeaxanthin (Lutigold™)
✔
For adults, take one (1) softgel
daily, preferably with a meal.
Medium softgel
$0.29
[$0.15]
$34.99/120 softgels
No Artificial Color, Flavor or Sweetener, No
Preservatives, No Sugar, No Starch, No Milk, No Lactose, No Soy, No Gluten, No
Wheat, No Yeast, No Fish, Sodium Free.
1 softgel
Lutigold™ Lutein (Contains Zeaxanthin, 800 mcg) 20
mg.
Other Ingredients: Safflower Oil, Gelatin, Vegetable Glycerin, Yellow Beeswax.
APPROVED
Dist. by Solgar, Inc.
1 softgel
40 mg lutein (FloraGLO®)
✔
2 mg zeaxanthin (FloraGLO®)
✔
As a dietary supplement for adults, take one (1)
softgel daily, at mealtime, or as directed by a
healthcare practitioner.
Medium/large softgel
$0.66
[$0.17]
$19.87/30 softgels
Free Of: Gluten, Wheat, Dairy, Yeast, Sugar,
Sodium, Artificial Flavor, Sweetener, Preservatives and Color.
1 softgel
Lutein (FloraGLO®) (supplies zeaxanthin, 2 mg) 40 mg.
Other Ingredients: Safflower Oil, Gelatin, Vegetable Glycerin, Yellow Beeswax,
Soy Lecithin.
APPROVED
Trunature® [Costco] Vision Complex
Lutein & Zeaxanthin
Dist. by Costco Wholesale Corporation
1 softgel
25 mg lutein (Lutemax® 2020 Ultra)
✔
5 mg zeaxanthin
✔
Adults - One softgel
daily with food as a dietary supplement.
Medium softgel
$0.14
[$0.05]
Lowest cost for lutein
$18.99/140 softgels
No Gluten. No Lactose. No Artificial Colors Or Flavors.
Precaution: Contains: Soy.
1 softgel
Lutein (Lutemax® 2020 Ultra) 25 mg, Zeaxanthin
Isomers 5 mg.
Other Ingredients: Soybean Oil, Mixed Natural Tocopherols, Gelatin, Glycerin,
Purified Water USP, Sorbitol. Contains 2% or less of annatto oil, mannitol, sorbitan.
Lutein/Zeaxanthin Plus Other Ingredients:
APPROVED
Top Pick
for vision formula
Bausch + Lomb PreserVision®
Dist. by Bausch & Lomb Incorporated
2 softgels
10 mg lutein
✔
Found:
0.9 mg zeaxanthin
Take 2 soft gels daily; 1 in the morning, 1 in
the evening with a full glass of water and during meals.
Medium/large softgel
$0.37
[$0.37]
$21.94/120 softgel
Vitamin C (452 mg)
Vitamin E (400 IU)
Zinc (69.6 mg)>UL
Copper (1.6 mg)
This product is Vitamin A (beta-carotene) free.
2 softgels
Vitamin C (ascorbic acid) 452 mg, Vitamin E (dl-alpha tocopheryl
acetate) 400 IU, Zinc (zinc oxide) 69.6 mg, Copper (Cupric oxide) 1.6 mg,
Lutein 10 mg
Other Ingredients: Gelatin, Glycerin, Soybean Oil, Soy Lecithin, more...
APPROVED
Dist. by Quality Supplements and Vitamins, Inc.
1 softgel
10 mg free lutein (MacuGuard®)
✔
4 mg zeaxanthin (MacuGuard®)
✔
Take one (1) softgel
daily, with food, or as recommended by a healthcare practitioner.
Medium/large softgel
$0.31
[$0.31]
$18.75/60 softgels
Mixed carotenoids (1.24 mg)
Saffron extract (20 mg)
C3G (2.2 mg)
Non-GMO.
1 softgel
MacuGuard® proprietary blend [Phospholipids, marigold
extract (flower) [providing 10 mg free lutein, 4 mg meso-zeaxanthin
& trans-zeaxanthin], mixed carotenoids [providing 1.24 mg
α-carotene]] 173 mg, Saffron extract (stigma) 20 mg, more...
APPROVED
Top Pick
for vision supplement
Systane® I-Caps® Chewable - Berry Flavor
Dist. by Alcon Laboratories, Inc.
2 chewable tablets
10 mg lutein
✔
2 mg zeaxanthin
✔
2 chewable tablets per day with a meal or as
directed by your physician.
Medium/large circular chewable tablets
$0.67
[$0.67]
$40.19/2 bottle of 60 chewable tablets (120 chewable tablets total)
Vitamin C (500 mg)
Vitamin E (400 IU)
Zinc (25 mg)
Copper (2 mg)
Precaution: Contains: Milk, Fish (cod, pollack, haddock, hake,
cusk, redfish, sole, flounder).
2 chewable tablets
Calories 20, Calories from Fat 5, Total Carbohydrates 4 g, Sugars 2 g, Vitamin
C (as Ascorbic acid and Sodium ascorbate) 500 mg, Vitamin E (d-alpha tocopheryl acetate) 400 IU, Zinc (as Zinc oxide) 25 mg,
Copper (as Copper citrate) 2 mg, Lutein 10 mg, Zeaxanthin 2 mg, more...
APPROVED
Mfd. by USANA Health Sciences, Inc.
2 tablets
10 mg lutein
✔
2 mg zeaxanthin
✔
Also tested for disintegrationⓘ
Adults, take two (2) tablets daily, preferably
with food.
Large tablet
$1.21
[$1.21]
$33.95/56 tablets
Vitamin C (500 mg)
Zinc (10 mg)
Bilberry Extract (50 mg)
Precaution: Contains: Soy.
2 tablets
Vitamin C (as Poly C® Blend: Potassium, Calcium, Magnesium, and Zinc
Ascorbates) 500 mg, Zinc (as Zinc Citrate) 10 mg, Lutein 10 mg, Zeaxanthin 2
mg, Bilberry Extract (Vaccinium myrtillus L., fruit) 50 mg, more...
Unless otherwise noted, information about the
products listed above is based on the samples purchased by ConsumerLab.com (CL)
for this Product Review. Manufacturers may change ingredients and label
information at any time, so be sure to check labels carefully when evaluating
the products you use or buy. If a product's
ingredients differ from what is listed above, it may not necessarily be of the
same quality as what was tested.
The information contained in this report is
based on the compilation and review of information from product labeling and
analytic testing. CL applies what it believes to be the most appropriate
testing methods and standards. The information in this report does not reflect
the opinion or recommendation of CL, its officers or employees. CL cannot
assure the accuracy of information.
Copyright ConsumerLab.com, LLC, 2021 All
rights reserved. Not to be reproduced, excerpted, or cited in any fashion
without the express written permission of ConsumerLab.com LLC
ConsumerTips™:
Getting
lutein and zeaxanthin from food:
There is no government recommended daily intake for lutein or zeaxanthin.
Population studies suggest a reduced risk of both age-related macular
degeneration and cataract formation in people who get about 6 mg per day of
these compounds from foods. It is estimated that the average U.S. adult
consumes a total of only 2 to 4 mg per day of lutein and zeaxanthin from foods.
It is possible to get from food the amount of lutein and zeaxanthin associated
with a decreased risk of macular degeneration and cataract formation. As little
as a half-cup of cooked kale, Swiss chard, spinach, or collard greens will
provide 6 mg or more of lutein and zeaxanthin, as they are among the richest
food sources. Other foods with fairly high amounts of lutein and/or zeaxanthin
are corn, celery, kiwi fruit, endive, grapes, zucchini, and broccoli. Even
iceberg lettuce and green peas will contribute these anti-oxidants to your
diet. Specially produced eggs, from chickens fed marigold petals, may also
provide high levels of lutein.
Most foods contain more lutein than zeaxanthin, but pepper, oranges and orange
juice typically contain more zeaxanthin than lutein. Interestingly,
oranges and orange juice also provide high amounts of flavonols
(a type of flavonoid) and may be particularly useful in preventing age-related
macular degeneration. A 15-year study in Australia found that adults aged
50 years and over who consumed at least one orange (100 grams
of edible fruit) per week had 58% reduced odds of developing
AMD compared to those who did not consume oranges; consuming one orange per
day had about the same effect but only with regard to reducing the
risk of late-stage AMD, and consuming orange juice daily (versus no orange
juice) only significantly reduced the risk of early stage
AMD. There were no significant benefits regarding AMD associated with
consumption of tea, red wine, or beer, which are also high in flavonoids (Gopinath, Am J Clin Nutr 2018).
The bottom line: Try to eat at least one orange per week. Also, try to
have fish at least once a week,
as this is also associated with a reduced risk of AMD.
For an extensive listing of the amounts of lutein and zeaxanthin in foods, see
the USDA National Nutrient Database.
Getting lutein and zeaxanthin from supplements:
Based on population studies, supplements were often designed in the past to
provide 6 mg of lutein. But more recent research specifically using supplements
showed that 10 mg of lutein appears to be an effective dose for improving
vision in people with atrophic age-related macular degeneration — although it
does not seem to prevent disease progression. Consequently, some products now
provide 10 mg of lutein, along with lesser amounts of zeaxanthin.
Some promotional literature on the Internet suggests that a higher (20 mg)
dosage should be taken by people with advanced macular degeneration. There is
no evidence yet to support this recommendation, although it is known that
larger doses do increase levels of these anti-oxidants in the blood. Research
from the National Eye Institute using supplements containing free form lutein
(see "Forms of Lutein: Free vs. Ester" below) show that normal adult
blood serum levels of lutein double with a daily dose of just 2.5 mg, almost
triple with 5 mg, and quadruple with a daily dose of 10 mg. This would suggest,
however, a diminishing return with even higher doses. Nevertheless, a six-week
study using 20 mg of lutein in people suffering from retinitis pigmentosa,
another sight—robbing condition, experienced improvements in their vision (Bahrami 2006).
Be aware that some manufacturers sell supplements providing very small amounts
of lutein — often just a fraction of milligram — sometimes as part of a larger
formula. The multivitamin Centrum Silver, for example, provides just 0.25 mg
(250 mcg) of lutein. While this allows the product to promote lutein as an
ingredient, it is questionable whether such a small dose provides health
benefit.
If you already get a high amount of lutein from your diet, evidence suggests
that you may not get additional benefit from supplements.
Lutein and zeaxanthin are best absorbed when taken with fats
or oils. Consequently, it is generally recommended to take lutein
supplements with meals -- preferably high-fat rather than low-fat meals.
However, be aware that large amounts of minerals can make carotenoids like
lutein and zeaxanthin less bioavailable. This is likely due to a reaction
between the carotenoid and the divalent ions of minerals such as calcium and
magnesium (Corte-Real, Food Chem 2016; Biehler, J Nutr 2011).
Therefore, it is best to take lycopene or any carotenoid supplement at
a different time of day than a supplement or meal containing large amounts
(hundreds of milligrams) of a mineral.
When using supplements, lutein levels in the blood rise over time, peaking at 3
months. Once stopped, blood levels fall over a period of months and return to
normal in about six months.
Lutein in supplements comes as either lutein
"esters" (such as the trademarked XANGOLD lutein) or the
non-esterified "free" form of lutein (such as the trademarked FloraGLO lutein). The LutiGold
brand contains lutein (form not listed; however
ConsumerLab.com was informed by maker, NBTY, that it is non-esterified), along
with a small amount of zeaxanthin (800 mcg per 20 mg of lutein). Lutein and
zeaxanthin found in green vegetables, fruits and egg yolk exist in the free
form. Much of the lutein in supplements is extracted from marigold petals,
which naturally contain lutein in the esterified form, although this can be
converted to the free form through a process called saponification. Both forms
are equally well absorbed by the body. The capsule size of various brands of
lutein may differ, even when they provide the same amount of lutein, depending
on the amounts of other ingredients they contain, including inactive
ingredients such as oils. Products often combine lutein and zeaxanthin with
omega-3 fatty acids, vitamin E, Zinc and other ingredients that have been used
the AGE-Related Eye Disease study (see "Vision Formulas Used in AREDS Studies,"
below), resulting in a larger pill or capsule.
Lutein may have an odor --- described by some as similar to vase water in which
flowers have remained too long. This is a result of the extraction and
concentration of lutein esters from marigold flowers which, themselves, can
have a rough odor. This odor is normal and may be particularly strong in
products containing higher amounts of lutein, such as 20 mg. The odor tends to
be greater with esterified lutein than with free form lutein. The odor may be
reduced by formulating the lutein within materials such as microencapsulated beadlets.
A bioavailability study comparing equivalent amounts of free lutein given as FloraGLO (a starch-based beadlet
formula) or Lyc-O-Lutein (an alginate-based beadlet
formula) found a much greater increase in lutein levels in the body with FloraGLO (Evans, Eur J Nutr 2012).
At 14 hours after administration, plasma lutein levels increased by 126% with FloraGLO compared to 7% with Lyc-O-Lutein. (FloraGLO is found in the Solgar product
in this Review.)
Synthetic zeaxanthin:
Most zeaxanthin is derived from plants, but, a synthetic form has become
available in supplements in recent years. An analysis of the safety of this
form was recently performed by the European Food Safety Authority. It concluded
that synthetic form is safe and that a daily dose up to 53 mg does not raise
safety concerns (EFSA Journal 2012).
Saffron
Saffron, derived from the stigma of the crocus flower
(Crocus sativus), contains antioxidant carotenoids, such as crocin and
crocetin, and other compounds, such as safranal,
which are thought to be responsible for some its beneficial effects.
Saffron is sometimes added as an ingredient in vision supplements — although it
was not part of the AREDS formulas discussed below and is not
an ingredient in any products in this Review. Several small studies by a group
of researchers in Italy suggest 20 mg of saffron taken daily for 3 months to
one year can modestly improve retinal sensitivity to light and visual acuity in
men and women with early age-related macular degeneration, although only one of
these studies had a placebo control (Falsini, Invest Ophthalmol Vis Sci 2010; Piccardi, Evid Based
Complement Alternat Med 2012; Marangoni, J Transl Med 2013). A study among 100 men and women (average age 74) in
Australia with mild to moderate age-related macular degeneration (most of whom
were already taking AREDS-based supplements, and half of whom were taking
lutein and/or zeaxanthin) found that a capsule containing 20 mg of saffron
taken once daily with a meal for three months modestly improved visual acuity
compared to placebo. (AREDS supplements were defined as those containing zinc,
copper, Vitamin C, Vitamin E, but not beta-carotene or lutein-zeaxanthin) (Broadhead, Graefes Arch Clin
Exp Ophthalmol 2019).
Standardized saffron extracts such as Satiereal (standardized
to 0.3% safranal) have been studied and promoted for
other uses, such as appetite control (Gout, Nutr
Res 2010).
SPECIAL SECTION: Vision Formulas Used in AREDS Studies:
AREDS: A large study known as AREDS (Age-Related Eye Disease Study)
evaluated the effects of a combination of supplements on eye health. This study
did not evaluate lutein or zeaxanthin. It evaluated the effect of taking zinc
by itself or taking a combination of vitamin C, vitamin E, beta-carotene, and
zinc. The study found that zinc alone or the combination of zinc with vitamin
C, E and beta-carotene can slow the progression of age-related macular
degeneration when taken on a daily basis. The supplements reduced the risk of
progressing to advanced age-related macular degeneration by
25% over a period of 5 years compared to a placebo.
The tablets used in AREDS were manufactured to contain the following minimum
contents throughout their shelf-life: 7,160 IU of vitamin A (from beta
carotene), 113 mg of vitamin C (ascorbic acid), 100 IU of vitamin E (dl-alpha tocopheryl acetate), 17.4 mg of zinc (zinc oxide), and 0.4
mg of copper (cupric oxide). It's important to note that the reason for copper
in this formula is not to promote eye health, but to prevent copper deficiency
due to the high amount of zinc in the formula -- zinc can reduce copper
absorption (see Concerns and Cautions below).
Four tablets were taken daily, providing a total of 28,640 IU of vitamin A
(from beta-carotene), 452 mg of vitamin C, 400 IU of vitamin E, 69.6 mg of
zinc, and 1.6 mg of copper. [NOTE: Some articles about the AREDS report suggest
that the supplement used contained slightly higher amounts of ingredients, such
as 80 mg of zinc per day, but the actual specifications for the product are
those described above. The higher numbers include the non-active salt portion
of each ingredient, which is not typically included in product labeling. For
example, 80 mg of "zinc oxide" actually provides 69.6 mg of active
zinc.]
AREDS 2: In May 2013, results from the AREDS2 (Age-Related Eye Disease Study 2) study were
published. This study was similar to the first AREDS trial, but sought to test
variations of the original supplement formula. Researchers evaluated the
original AREDS formula and added either 10 mg lutein and 2 mg zeaxanthin, 350
mg DHA and 650 mg EPA, or the combination of lutein+zeaxanthin
and DHA+EPA.
In addition, some people in the study received the original AREDS formulation,
but with some slight modifications. One group received a version with a lower
dose of zinc - 21.8 mg of zinc (25 mg zinc oxide) instead of the original 69.6
mg (80 mg zinc oxide). Another group received a version without beta-carotene.
And a third group received AREDS with the lower zinc dose and no beta-carotene.
The findings of AREDS2 show that:
·
Adding lutein and zeaxanthin to the original AREDS formulation
provided no additional benefit overall; however, in people with very low
dietary intake of lutein and zeaxanthin the addition of these ingredients
reduced the risk of disease progression by about 36% compared to the original
AREDS formulation.
·
The addition of omega-3 fatty acids (from fish oil) provided no
additional benefit. (And a separate, large, five-year placebo trial also
found no benefit with the combination of fish oil and vitamin D supplementation
(Christen, JAMA Ophthalmol
2020). (See the Fish Oil Supplements Review for
details).
·
Adding the combination of lutein and zeaxanthin plus omega-3
fatty acids provided no additional benefit.
·
Substituting lutein plus zeaxanthin for beta-carotene in the original
AREDS formulation might offer additional benefits. An exploratory analysis of
study data suggests that using lutein plus zeaxanthin instead of beta-carotene
reduced the risk of disease progression by about 18%.
·
Using the lower dose of zinc (21.8 mg) in the AREDS2 formulation
was just as effective as the higher dose of zinc (69.6 mg) used in the original
AREDS formulation.
·
Removing beta-carotene from the original AREDS formulation also
did not impact the risk of disease progression. This is good news for smokers
and former smokers since beta-carotene can increase the risk of lung cancer,
strokes and death from heart disease in these groups.
Genetic testing to
determine use of the AREDS formula?
As part of the AREDS study, DNA samples were obtained which were later analyzed
for specific polymorphisms (i.e., genetic variations) associated with a higher
risk of developing AMD. It was found that people with the "risk"
version of polymorphism CFH Y402H did not benefit
from the AREDS formula; only those with the "nonrisk"
version benefitted. In contrast, those with the "risk" version
of ARMS2 A69S benefitted from the supplement (Seddon, Br J Opthalmol 2016).
However, these associations do not prove that these genetic
tests will result in a better outcome with regard to the use of the AREDS
formula or other nutritional supplements. AMD is a genetically complex disorder
and, according to recommendations of the American Academy of Ophthalmology,
until it can be proven that genetic tests benefit people with AMD, it is
premature to order routine genetic testing for AMD (AAO Task Force on Genetic Testing,
2014).
Concerns and Cautions:
As discussed above, some vision formulas contain
higher doses of zinc than necessary -- amounts that exceed the established
upper tolerable intake level (UL) of 40 mg per day and can inhibit the
absorption of copper. The combination of excess zinc and copper depletion can
cause changes in blood cell counts, dangerously suppress the immune system and
also cause anemia, heart problems, difficulty with balance and walking, and
changes in mood and cognition. Although some vision formulas include small
doses of copper to help prevent this, it may not be sufficient to prevent
copper deficiency in some people. For example, an 81-year-old woman who had
taken a macular degeneration formula containing 80 mg of zinc and 2 mg of
copper per recommended daily serving (PreserVision
AREDS 2) for several years or more was found to have copper deficiency and
high blood levels of zinc, resulting in anemia and low white blood cell and
platelet counts that resolved two weeks after she stopped taking the vision
supplement and was given 8 mg of copper daily (Wahab, J Community Hosp Intern Med Perspect 2021). (For more information about
excess zinc and copper deficiency, see the "Concerns and Cautions"
section of the Zinc Supplements and Lozenges Review).
Lutein supplementation appears to be safe at a dose of 10 mg. A six-month study
using 20 mg of lutein also showed no safety problems (Bahrami 2006).
However, a study based on subject's memory of the previous 10 years suggests
that long term use of supplementation with lutein as well as vitamin A (from
beta-carotene or retinol) was associated with an increased risk of lung cancer
(Satia 2009).
Long-term use should not be recommended for lung cancer prevention,
particularly among smokers.
Simultaneous consumption of the fat substitute olestra, found in fat-free
chips, may decrease the absorption of lutein and zeaxanthin. Beta-carotene from
food and supplements may also decrease the absorption of lutein, zeaxanthin,
and astaxanthin.
To further assist consumers, ConsumerLab.com licenses its flask-shaped CL Seal
of Approved Quality (see The CL Seal) to manufacturers for use on
labels of products that have passed its testing. ConsumerLab.com will
periodically re-evaluate these products to ensure their compliance with ConsumerLab.com's standards.
+ 27 sources
Information on this site
is provided for informational purposes only. It is not an endorsement of any
product nor is it meant to substitute for the advice provided by physicians or
other healthcare professionals. The information contained herein should not be
used for diagnosing or treating a health problem or disease. Consumers should
inform their healthcare providers of the dietary supplements they take.
Latest Clinical Research Updates for Vision Supplements with
Lutein and Zeaxanthin
Caution With Vitamin Supplements
11/30/2021
A woman who, for years,
had taken a popular vision supplement developed anemia and low white blood cell
and platelet counts. What was the connection? Find out in the Concerns and Cautions section of our
Vision Supplements Review. Also see our Top Picks among vision supplements.
10/05/2019
Lutein is often taken as
a supplement to slow the progression of age-related macular degeneration.
However, a study in college students suggests that supplementation with lutein
may also improve aspects of memory and cognitive functioning. For details, see
the What It Does section
of our Vision Supplements Review.
4/30/2019
Saffron, which contains
carotenoids, may improve visual acuity in people with age-related macular
degeneration (AMD) according to a recent study. For details, see the ConsumerTips section
of the Vision Supplements Review. Also see which vision supplements most
closely resemble the ideal formula to
slow the progression of AMD.
7/13/2018
Can consuming certain
foods or beverages reduce the risk of developing age-related macular
degeneration (AMD) — a common eye disease? Yes, according to a recent study.
Get the details in the food section of the
Vision Supplements Review. (Also see our Top Rated vision supplements.)
Lutein and Zeaxanthin Improve Memory
1/16/2018
Lutein and zeaxanthin may
help to slow the progression of age-related macular degeneration in people with
low blood levels of lutein. A new study suggests these compounds may have
another benefit -- improving memory in some people. Get the details in the
"What It Does" section of the Vision Supplements Review >> (Also
see our top choices among
products.)