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An upcoming issue of Vision Research is highlighting Age-related Macular Degeneration (AMD) research. There is a growing body of evidence suggesting that increased consumption of certain nutrients, specifically lutein and zeaxanthin, augments levels of these molecules in the macula, subsequently improving visual function and reducing the risk for certain age-related eye diseases.
Macular Pigment Optical Density. The ability to measure lutein and zeaxanthin levels in the macula is of great importance to enhance research, to provide a methodology to assess eye health and offer responsive, appropriate clinical care. Traditional laboratory methods used to measure lutein and zeaxanthin, namely high-performance liquid chromatography (HPLC), cannot be used on living eyes, so a surrogate optical indicator of xanthophyll levels in the eye is often employed: macular pigment optical density (MPOD). MPOD is a measurement of the attenuation of blue light by macular pigment and is linearly related to the amount of lutein and zeaxanthin in the macula.
Clinical Support
Expert Review of the Value of MPOD Measurement
An article in an upcoming issue of Vision Research reviews the findings from a panel of experts with extensive experience in carotenoid physiology and/or macular pigment measurement48. This panel reached a consensus on the value of noninvasive macular pigment measurement as a screening tool for AMD risk based on a review of the literature and their clinical experience. The following conclusions were reached:48
Review additional MPOD consensus panel conclusions in Vision Research.
References
1. Francoise, J.L., E. W. Askew, L.C. Lang, and P. S. Bernstein. "Serum and Macular Responses to Antioxidant Supplementation Versus a Carotenoid-Rich Dietary Intervention in the Elderly." Current topics in nutraceutical research 4, no. 1 (2006): 69-78.
2. Aleman, T. S., J. L. Duncan, M. L. Bieber, E. de Castro, D. A. Marks, L. M. Gardner, J. D. Steinberg, A. V. Cideciyan, M. G. Maguire, and S. G. Jacobson. "Macular Pigment and Lutein Supplementation in Retinitis Pigmentosa and Usher Syndrome." Invest Ophthalmol Vis Sci 42, no. 8 (2001): 1873-81.
3. Berendschot, T. T., R. A. Goldbohm, W. A. Klopping, J. van de Kraats, J. van Norel, and D. van Norren. "Influence of Lutein Supplementation on Macular Pigment, Assessed with Two Objective Techniques." Invest Ophthalmol Vis Sci 41, no. 11 (2000): 3322-6.
4. Bernstein, P. S., D. Y. Zhao, S. W. Wintch, I. V. Ermakov, R. W. McClane, and W. Gellermann. "Resonance Raman Measurement of Macular Carotenoids in Normal Subjects and in Age-Related Macular Degeneration Patients." Ophthalmology 109, no. 10 (2002): 1780-7.
5. Bone, R. A. "Macular Pigment Response to a Supplement Containing Meso-Zeaxanthin, Lutein and Zeaxanthin." Nutrition & Metabolism 4, no. 12 (2007).
6. Bone, R. A., J. T. Landrum, L. H. Guerra, and C. A. Ruiz. "Lutein and Zeaxanthin Dietary Supplements Raise Macular Pigment Density and Serum Concentrations of These Carotenoids in Humans." J Nutr 133, no. 4 (2003): 992-8.
7. Cardinault, N., J. M. Gorrand, V. Tyssandier, P. Grolier, E. Rock, and P. Borel. "Short-Term Supplementation with Lutein Affects Biomarkers of Lutein Status Similarly in Young and Elderly Subjects." Exp Gerontol 38, no. 5 (2003): 573-82.
8. Duncan, J. L., T. S. Aleman, L. M. Gardner, E. De Castro, D. A. Marks, J. M. Emmons, M. L. Bieber, J. D. Steinberg, J. Bennett, E. M. Stone, I. M. MacDonald, A. V. Cideciyan, M. G. Maguire, and S. G. Jacobson. "Macular Pigment and Lutein Supplementation in Choroideremia." Exp Eye Res 74, no. 3 (2002): 371-81.
9. Hammond, B. R., E. J. Johnson, R. M. Russell, N. I. Krinsky, K. J. Yeum, R. B. Edwards, and D. M. Snodderly. "Dietary Modification of Human Macular Pigment Density." Invest Ophthalmol Vis Sci 38, no. 9 (1997): 1795-801.
10. Johnson, E. J., H. Y. Chung, S. M. Caldarella, and D. M. Snodderly. "The Influence of Supplemental Lutein and Docosahexaenoic Acid on Serum, Lipoproteins, and Macular Pigmentation." Am J Clin Nutr 87, no. 5 (2008): 1521-9.
11. Johnson, E. J., B. R. Hammond, K. J. Yeum, J. Qin, X. D. Wang, C. Castaneda, D. M. Snodderly, and R. M. Russell. "Relation among Serum and Tissue Concentrations of Lutein and Zeaxanthin and Macular Pigment Density." Am J Clin Nutr 71, no. 6 (2000): 1555-62.
12. Koh, H. H., I. J. Murray, D. Nolan, D. Carden, J. Feather, and S. Beatty. "Plasma and Macular Responses to Lutein Supplement in Subjects with and without Age-Related Maculopathy: A Pilot Study." Exp Eye Res 79, no. 1 (2004): 21-7.
13. Kopsell, D. A., M. G. Lefsrud, D. E. Kopsell, A. J. Wenzel, C. Gerweck, and J. Curran-Celentano. "Spinach Cultigen Variation for Tissue Carotenoid Concentrations Influences Human Serum Carotenoid Levels and Macular Pigment Optical Density Following a 12-Week Dietary Intervention." J Agric Food Chem 54, no. 21 (2006): 7998-8005.
14. Kvansakul, J., M. Rodriguez-Carmona, D. F. Edgar, F. M. Barker, W. Kopcke, W. Schalch, and J. L. Barbur. "Supplementation with the Carotenoids Lutein or Zeaxanthin Improves Human Visual Performance." Ophthalmic Physiol Opt 26, no. 4 (2006): 362-71.
15. Landrum, J. T., R. A. Bone, H. Joa, M. D. Kilburn, L. L. Moore, and K. E. Sprague. "A One Year Study of the Macular Pigment: The Effect of 140 Days of a Lutein Supplement." Exp Eye Res 65, no. 1 (1997): 57-62.
16. Morganti, P., G. Fabrizi, and C. Bruno. "Protective Effects of Oral Antioxidants on Skin and Eye Function." Skinmed 3, no. 6 (2004): 310-6.
17. Richer, S., W. Stiles, L. Statkute, J. Pulido, J. Frankowski, D. Rudy, K. Pei, M. Tsipursky, and J. Nyland. "Double-Masked, Placebo-Controlled, Randomized Trial of Lutein and Antioxidant Supplementation in the Intervention of Atrophic Age-Related Macular Degeneration: The Veterans Last Study (Lutein Antioxidant Supplementation Trial)." Optometry 75, no. 4 (2004): 216-30.
18. Rodriguez-Carmona, M., J. Kvansakul, J. A. Harlow, W. Kopcke, W. Schalch, and J. L. Barbur. "The Effects of Supplementation with Lutein and/or Zeaxanthin on Human Macular Pigment Density and Colour Vision." Ophthalmic Physiol Opt 26, no. 2 (2006): 137-47.
19. Schalch, W., W. Cohn, F. M. Barker, W. Kopcke, J. Mellerio, A. C. Bird, A. G. Robson, F. F. Fitzke, and F. J. van Kuijk. "Xanthophyll Accumulation in the Human Retina During Supplementation with Lutein or Zeaxanthin - the Luxea (Lutein Xanthophyll Eye Accumulation) Study." Archives of biochemistry and biophysics 458, no. 2 (2007): 128-35.
20. Schweitzer, D., G.E. Lang, B. Beuermann, H. Remsch, M. Hammer, E. Thamm, C.W. Spraul, and G.K. Lang. "Objektive Bestimmung Der Optischen Dichte Von Xanthophyll Nach Supplementation Von Lutein." Ophtalmologe 99 (2002): 270-75.
21. Stringham, James M., and B. Hammond. "Macular Pigment and Visual Performance under Glare Conditions." Optometry & Vision Science 85, no. 2 (2008): 82-88.
22. Trieschmann, M., S. Beatty, J. M. Nolan, H. W. Hense, B. Heimes, U. Austermann, M. Fobker, and D. Pauleikhoff. "Changes in Macular Pigment Optical Density and Serum Concentrations of Its Constituent Carotenoids Following Supplemental Lutein and Zeaxanthin: The Luna Study." Experimental eye research 84, no. 4 (2007): 718-28.
23. Wenzel, A. J., C. Gerweck, D. Barbato, R. J. Nicolosi, G. J. Handelman, and J. Curran-Celentano. "A 12-Wk Egg Intervention Increases Serum Zeaxanthin and Macular Pigment Optical Density in Women." J Nutr 136, no. 10 (2006): 2568-73.
24. Wenzel, A. J., J. P. Sheehan, C. Gerweck, J. M. Stringham, K. Fuld, and J. Curran-Celentano. "Macular Pigment Optical Density at Four Retinal Loci During 120 Days of Lutein Supplementation." Ophthalmic & physiological optics 27, no. 4 (2007): 329-35.
25. Zeimer, M., H. W. Hense, B. Heimes, U. Austermann, M. Fobker, and D. Pauleikhoff. "[the Macular Pigment: Short- and Intermediate-Term Changes of Macular Pigment Optical Density Following Supplementation with Lutein and Zeaxanthin and Co-Antioxidants. The Luna Study]." Ophthalmologe 106, no. 1 (2009): 29-36.
26. Vishwanathan, R., E. F. Goodrow-Kotyla, B. R. Wooten, T. A. Wilson, and R. J. Nicolosi. "Consumption of 2 and 4 Egg Yolks/D for 5 Wk Increases Macular Pigment Concentrations in Older Adults with Low Macular Pigment Taking Cholesterol-Lowering Statins." Am J Clin Nutr (2009).
27. Moeller, S. M., N. Parekh, L. Tinker, C. Ritenbaugh, B. Blodi, R. B. Wallace, and J. A. Mares. "Associations between Intermediate Age-Related Macular Degeneration and Lutein and Zeaxanthin in the Carotenoids in Age-Related Eye Disease Study (Careds): Ancillary Study of the Women's Health Initiative." Arch Ophthalmol 124, no. 8 (2006): 1151-62.
28. The Eye Disease Case-Control Study Group. "Antioxidant Status and Neovascular Age-Related Macular Degeneration." Arch Ophthalmol 111, no. 1 (1993): 104-9.
29. Delcourt, C., I. Carriere, M. Delage, P. Barberger-Gateau, and W. Schalch. "Plasma Lutein and Zeaxanthin and Other Carotenoids as Modifiable Risk Factors for Age-Related Maculopathy and Cataract: The Pola Study." Invest Ophthalmol Vis Sci 47, no. 6 (2006): 2329-35.
30. Gale, C. R., N. F. Hall, D. I. Phillips, and C. N. Martyn. "Lutein and Zeaxanthin Status and Risk of Age-Related Macular Degeneration." Invest Ophthalmol Vis Sci 44, no. 6 (2003): 2461-5.
31. Snellen, E. L., A. L. Verbeek, G. W. Van Den Hoogen, J. R. Cruysberg, and C. B. Hoyng. "Neovascular Age-Related Macular Degeneration and Its Relationship to Antioxidant Intake." Acta Ophthalmol Scand 80, no. 4 (2002): 368-71.
32. Tan, J. S., J. J. Wang, V. Flood, E. Rochtchina, W. Smith, and P. Mitchell. "Dietary Antioxidants and the Long-Term Incidence of Age-Related Macular Degeneration: The Blue Mountains Eye Study." Ophthalmology 115, no. 2 (2008): 334-41.
33. Vu, H. T., L. Robman, C. A. McCarty, H. R. Taylor, and A. Hodge. "Does Dietary Lutein and Zeaxanthin Increase the Risk of Age Related Macular Degeneration? The Melbourne Visual Impairment Project." Br J Ophthalmol 90, no. 3 (2006): 389-90.
34. Haegerstrom-Portnoy, G. "Short-Wavelength-Sensitive-Cone Sensitivity Loss with Aging: A Protective Role for Macular Pigment?" J Opt Soc Am A 5, no. 12 (1988): 2140-4.
35. Hammond, B. R., B. R. Wooten, and D. M. Snodderly. "Preservation of Visual Sensitivity of Older Subjects: Association with Macular Pigment Density." Invest Ophthalmol Vis Sci 39, no. 2 (1998): 397-406.
36. Weiter, J. J., F. Delori, and C. K. Dorey. "Central Sparing in Annular Macular Degeneration." Am J Ophthalmol 106, no. 3 (1988): 286-92.
37. Parisi, V., M. Tedeschi, G. Gallinaro, M. Varano, S. Saviano, and S. Piermarocchi. "Carotenoids and Antioxidants in Age-Related Maculopathy Italian Study: Multifocal Electroretinogram Modifications after 1 Year." Ophthalmology 115, no. 2 (2008): 324-33 e2.
38. Richer, S. "Armd--Pilot (Case Series) Environmental Intervention Data." J Am Optom Assoc 70, no. 1 (1999): 24-36.
39. Massacesi, A. L., R. Faletra, F. Gerosa, G. Staurenghi, and N. Orzales. "The Effect of Oral Supplementation of Macular Carotenoids ( Lutein and Zeaxanthin) on the Prevention of Age-Related Macular Degeneration: A 18 Month Follow up Study (Abstract)." IOVS 42, no. 4 (2001): S234.
40. Bahrami, H., M. Melia, and G. Dagnelie. "Lutein Supplementation in Retinitis Pigmentosa: Pc-Based Vision Assessment in a Randomized Double-Masked Placebo-Controlled Clinical Trial [Nct00029289]." BMC Ophthalmol 6, no. 1 (2006): 23.
41. Cangemi, F. E. "Tozal Study: An Open Case Control Study of an Oral Antioxidant and Omega-3 Supplement for Dry Amd." BMC ophthalmology 7 (2007): 3.
42. Olmedilla, B., F. Granado, I. Blanco, and M. Vaquero. "Lutein, but Not Alpha-Tocopherol, Supplementation Improves Visual Function in Patients with Age-Related Cataracts: A 2-Y Double-Blind, Placebo-Controlled Pilot Study." Nutrition 19, no. 1 (2003): 21-4.
43. Wenzel, A. J., K. Fuld, J. M. Stringham, and J. Curran-Celentano. "Macular Pigment Optical Density and Photophobia Light Threshold." Vision Res 46, no. 28 (2006): 4615-22.
44. Bone, R. A., J. T. Landrum, S. T. Mayne, C. M. Gomez, S. E. Tibor, and E. E. Twaroska. "Macular Pigment in Donor Eyes with and without Amd: A Case-Control Study." Invest Ophthalmol Vis Sci 42, no. 1 (2001): 235-40.
45. Beatty, S., I. J. Murray, D. B. Henson, D. Carden, H. Koh, and M. E. Boulton. "Macular Pigment and Risk for Age-Related Macular Degeneration in Subjects from a Northern European Population." Invest Ophthalmol Vis Sci 42, no. 2 (2001): 439-46.
46. Obana, A., T. Hiramitsu, Y. Gohto, A. Ohira, S. Mizuno, T. Hirano, P. S. Bernstein, H. Fujii, K. Iseki, M. Tanito, and Y. Hotta. "Macular Carotenoid Levels of Normal Subjects and Age-Related Maculopathy Patients in a Japanese Population." Ophthalmology 115, no. 1 (2008): 147-57.
47. LaRowe, T. L., J. A. Mares, D. M. Snodderly, M. L. Klein, B. R. Wooten, and R. Chappell. "Macular Pigment Density and Age-Related Maculopathy in the Carotenoids in Age-Related Eye Disease Study. An Ancillary Study of the Women's Health Initiative." Ophthalmology 115, no. 5 (2008): 876-83 e1.
48. Bernstein, P. S., F. C. Delori, S. Richer, F. J. van Kuijk, and A. J. Wenzel. "The Value of Measurement of Macular Carotenoid Pigment Optical Densities and Distributions in Age-Related Macular Degeneration and Other Retinal Disorders." Vision Res (2009).
49. Wooten, B. R., and B. R. Hammond. "Macular Pigment: Influences on Visual Acuity and Visibility." Prog Retin Eye Res 21, no. 2 (2002): 225-40.
---
Diane E. Alexander, Ph.D. is a Technical Service Manger at Kemin Health, LC. She received her Ph.D. in Molecular Microbiology and Microbial Pathogenesis from the Washington University School of Medicine.
Macular Pigment Optical Density. The ability to measure lutein and zeaxanthin levels in the macula is of great importance to enhance research, to provide a methodology to assess eye health and offer responsive, appropriate clinical care. Traditional laboratory methods used to measure lutein and zeaxanthin, namely high-performance liquid chromatography (HPLC), cannot be used on living eyes, so a surrogate optical indicator of xanthophyll levels in the eye is often employed: macular pigment optical density (MPOD). MPOD is a measurement of the attenuation of blue light by macular pigment and is linearly related to the amount of lutein and zeaxanthin in the macula.
Clinical Support
- Over two dozen studies have been published demonstrating an increase in macular carotenoids following lutein/zeaxanthin supplementation of 2-30 mg per day or a high carotenoid diet1-26.
- The body of evidence from eight epidemiological studies provides support from an observational perspective that consumption of lutein and zeaxanthin from food is associated with reduced risk for AMD27-33.
- The anatomical location of macular carotenoids is ideal for them to act as an optical filter. Consistent with this, improvements in visual function and comfort parameters have been associated with lutein and zeaxanthin supplementation and subsequent increases in MPOD in close to a dozen published studies34-38,17,39,14,40-43.
- A growing body of evidence suggests a relationship between levels of macular pigment and risk of age-related eye diseases, although a direct link has not been established. Risk factors for AMD including tobacco use, light iris color, age, obesity, and gender are associated with low levels of MPOD. Additionally, five studies have shown that in eyes that have been afflicted with AMD (examined post-mortem) or eyes that have been deemed to have a higher risk for AMD (due to AMD in the fellow eye) tend to have lower MPOD than healthy eyes or eyes that are deemed to be at lower risk to AMD44-47,4.
Expert Review of the Value of MPOD Measurement
An article in an upcoming issue of Vision Research reviews the findings from a panel of experts with extensive experience in carotenoid physiology and/or macular pigment measurement48. This panel reached a consensus on the value of noninvasive macular pigment measurement as a screening tool for AMD risk based on a review of the literature and their clinical experience. The following conclusions were reached:48
- "The current body of knowledge regarding macular lutein and zeaxanthin and their roles in protection against age-related eye diseases support the hypothesis that AMD is in part a manifestation of an ocular deficiency of these molecules and that higher macular levels may protect against AMD."
- "Macular pigment measurement has the potential to become a commonly tested biomarker to measure risk for eye disease and visual function."
- Approximately, 43% of the U.S. population have what the panel considers to be "low MPOD" -- a central MPOD below 0.2 d.u.49
- "More clinical studies are necessary to more accurately define the range of MPOD values and distributions that might correlate with disease risk; however, the body of evidence that supports a link between a lack of macular pigment and AMD risk is growing."
- "Expansion of the scientific data and improvements in methodology and equipment necessary to measure MPOD levels in a diverse population will hopefully bring about a paradigm shift in way we recognize, diagnose, and treat those at risk for AMD and other age-related eye diseases."
Review additional MPOD consensus panel conclusions in Vision Research.
References
1. Francoise, J.L., E. W. Askew, L.C. Lang, and P. S. Bernstein. "Serum and Macular Responses to Antioxidant Supplementation Versus a Carotenoid-Rich Dietary Intervention in the Elderly." Current topics in nutraceutical research 4, no. 1 (2006): 69-78.
2. Aleman, T. S., J. L. Duncan, M. L. Bieber, E. de Castro, D. A. Marks, L. M. Gardner, J. D. Steinberg, A. V. Cideciyan, M. G. Maguire, and S. G. Jacobson. "Macular Pigment and Lutein Supplementation in Retinitis Pigmentosa and Usher Syndrome." Invest Ophthalmol Vis Sci 42, no. 8 (2001): 1873-81.
3. Berendschot, T. T., R. A. Goldbohm, W. A. Klopping, J. van de Kraats, J. van Norel, and D. van Norren. "Influence of Lutein Supplementation on Macular Pigment, Assessed with Two Objective Techniques." Invest Ophthalmol Vis Sci 41, no. 11 (2000): 3322-6.
4. Bernstein, P. S., D. Y. Zhao, S. W. Wintch, I. V. Ermakov, R. W. McClane, and W. Gellermann. "Resonance Raman Measurement of Macular Carotenoids in Normal Subjects and in Age-Related Macular Degeneration Patients." Ophthalmology 109, no. 10 (2002): 1780-7.
5. Bone, R. A. "Macular Pigment Response to a Supplement Containing Meso-Zeaxanthin, Lutein and Zeaxanthin." Nutrition & Metabolism 4, no. 12 (2007).
6. Bone, R. A., J. T. Landrum, L. H. Guerra, and C. A. Ruiz. "Lutein and Zeaxanthin Dietary Supplements Raise Macular Pigment Density and Serum Concentrations of These Carotenoids in Humans." J Nutr 133, no. 4 (2003): 992-8.
7. Cardinault, N., J. M. Gorrand, V. Tyssandier, P. Grolier, E. Rock, and P. Borel. "Short-Term Supplementation with Lutein Affects Biomarkers of Lutein Status Similarly in Young and Elderly Subjects." Exp Gerontol 38, no. 5 (2003): 573-82.
8. Duncan, J. L., T. S. Aleman, L. M. Gardner, E. De Castro, D. A. Marks, J. M. Emmons, M. L. Bieber, J. D. Steinberg, J. Bennett, E. M. Stone, I. M. MacDonald, A. V. Cideciyan, M. G. Maguire, and S. G. Jacobson. "Macular Pigment and Lutein Supplementation in Choroideremia." Exp Eye Res 74, no. 3 (2002): 371-81.
9. Hammond, B. R., E. J. Johnson, R. M. Russell, N. I. Krinsky, K. J. Yeum, R. B. Edwards, and D. M. Snodderly. "Dietary Modification of Human Macular Pigment Density." Invest Ophthalmol Vis Sci 38, no. 9 (1997): 1795-801.
10. Johnson, E. J., H. Y. Chung, S. M. Caldarella, and D. M. Snodderly. "The Influence of Supplemental Lutein and Docosahexaenoic Acid on Serum, Lipoproteins, and Macular Pigmentation." Am J Clin Nutr 87, no. 5 (2008): 1521-9.
11. Johnson, E. J., B. R. Hammond, K. J. Yeum, J. Qin, X. D. Wang, C. Castaneda, D. M. Snodderly, and R. M. Russell. "Relation among Serum and Tissue Concentrations of Lutein and Zeaxanthin and Macular Pigment Density." Am J Clin Nutr 71, no. 6 (2000): 1555-62.
12. Koh, H. H., I. J. Murray, D. Nolan, D. Carden, J. Feather, and S. Beatty. "Plasma and Macular Responses to Lutein Supplement in Subjects with and without Age-Related Maculopathy: A Pilot Study." Exp Eye Res 79, no. 1 (2004): 21-7.
13. Kopsell, D. A., M. G. Lefsrud, D. E. Kopsell, A. J. Wenzel, C. Gerweck, and J. Curran-Celentano. "Spinach Cultigen Variation for Tissue Carotenoid Concentrations Influences Human Serum Carotenoid Levels and Macular Pigment Optical Density Following a 12-Week Dietary Intervention." J Agric Food Chem 54, no. 21 (2006): 7998-8005.
14. Kvansakul, J., M. Rodriguez-Carmona, D. F. Edgar, F. M. Barker, W. Kopcke, W. Schalch, and J. L. Barbur. "Supplementation with the Carotenoids Lutein or Zeaxanthin Improves Human Visual Performance." Ophthalmic Physiol Opt 26, no. 4 (2006): 362-71.
15. Landrum, J. T., R. A. Bone, H. Joa, M. D. Kilburn, L. L. Moore, and K. E. Sprague. "A One Year Study of the Macular Pigment: The Effect of 140 Days of a Lutein Supplement." Exp Eye Res 65, no. 1 (1997): 57-62.
16. Morganti, P., G. Fabrizi, and C. Bruno. "Protective Effects of Oral Antioxidants on Skin and Eye Function." Skinmed 3, no. 6 (2004): 310-6.
17. Richer, S., W. Stiles, L. Statkute, J. Pulido, J. Frankowski, D. Rudy, K. Pei, M. Tsipursky, and J. Nyland. "Double-Masked, Placebo-Controlled, Randomized Trial of Lutein and Antioxidant Supplementation in the Intervention of Atrophic Age-Related Macular Degeneration: The Veterans Last Study (Lutein Antioxidant Supplementation Trial)." Optometry 75, no. 4 (2004): 216-30.
18. Rodriguez-Carmona, M., J. Kvansakul, J. A. Harlow, W. Kopcke, W. Schalch, and J. L. Barbur. "The Effects of Supplementation with Lutein and/or Zeaxanthin on Human Macular Pigment Density and Colour Vision." Ophthalmic Physiol Opt 26, no. 2 (2006): 137-47.
19. Schalch, W., W. Cohn, F. M. Barker, W. Kopcke, J. Mellerio, A. C. Bird, A. G. Robson, F. F. Fitzke, and F. J. van Kuijk. "Xanthophyll Accumulation in the Human Retina During Supplementation with Lutein or Zeaxanthin - the Luxea (Lutein Xanthophyll Eye Accumulation) Study." Archives of biochemistry and biophysics 458, no. 2 (2007): 128-35.
20. Schweitzer, D., G.E. Lang, B. Beuermann, H. Remsch, M. Hammer, E. Thamm, C.W. Spraul, and G.K. Lang. "Objektive Bestimmung Der Optischen Dichte Von Xanthophyll Nach Supplementation Von Lutein." Ophtalmologe 99 (2002): 270-75.
21. Stringham, James M., and B. Hammond. "Macular Pigment and Visual Performance under Glare Conditions." Optometry & Vision Science 85, no. 2 (2008): 82-88.
22. Trieschmann, M., S. Beatty, J. M. Nolan, H. W. Hense, B. Heimes, U. Austermann, M. Fobker, and D. Pauleikhoff. "Changes in Macular Pigment Optical Density and Serum Concentrations of Its Constituent Carotenoids Following Supplemental Lutein and Zeaxanthin: The Luna Study." Experimental eye research 84, no. 4 (2007): 718-28.
23. Wenzel, A. J., C. Gerweck, D. Barbato, R. J. Nicolosi, G. J. Handelman, and J. Curran-Celentano. "A 12-Wk Egg Intervention Increases Serum Zeaxanthin and Macular Pigment Optical Density in Women." J Nutr 136, no. 10 (2006): 2568-73.
24. Wenzel, A. J., J. P. Sheehan, C. Gerweck, J. M. Stringham, K. Fuld, and J. Curran-Celentano. "Macular Pigment Optical Density at Four Retinal Loci During 120 Days of Lutein Supplementation." Ophthalmic & physiological optics 27, no. 4 (2007): 329-35.
25. Zeimer, M., H. W. Hense, B. Heimes, U. Austermann, M. Fobker, and D. Pauleikhoff. "[the Macular Pigment: Short- and Intermediate-Term Changes of Macular Pigment Optical Density Following Supplementation with Lutein and Zeaxanthin and Co-Antioxidants. The Luna Study]." Ophthalmologe 106, no. 1 (2009): 29-36.
26. Vishwanathan, R., E. F. Goodrow-Kotyla, B. R. Wooten, T. A. Wilson, and R. J. Nicolosi. "Consumption of 2 and 4 Egg Yolks/D for 5 Wk Increases Macular Pigment Concentrations in Older Adults with Low Macular Pigment Taking Cholesterol-Lowering Statins." Am J Clin Nutr (2009).
27. Moeller, S. M., N. Parekh, L. Tinker, C. Ritenbaugh, B. Blodi, R. B. Wallace, and J. A. Mares. "Associations between Intermediate Age-Related Macular Degeneration and Lutein and Zeaxanthin in the Carotenoids in Age-Related Eye Disease Study (Careds): Ancillary Study of the Women's Health Initiative." Arch Ophthalmol 124, no. 8 (2006): 1151-62.
28. The Eye Disease Case-Control Study Group. "Antioxidant Status and Neovascular Age-Related Macular Degeneration." Arch Ophthalmol 111, no. 1 (1993): 104-9.
29. Delcourt, C., I. Carriere, M. Delage, P. Barberger-Gateau, and W. Schalch. "Plasma Lutein and Zeaxanthin and Other Carotenoids as Modifiable Risk Factors for Age-Related Maculopathy and Cataract: The Pola Study." Invest Ophthalmol Vis Sci 47, no. 6 (2006): 2329-35.
30. Gale, C. R., N. F. Hall, D. I. Phillips, and C. N. Martyn. "Lutein and Zeaxanthin Status and Risk of Age-Related Macular Degeneration." Invest Ophthalmol Vis Sci 44, no. 6 (2003): 2461-5.
31. Snellen, E. L., A. L. Verbeek, G. W. Van Den Hoogen, J. R. Cruysberg, and C. B. Hoyng. "Neovascular Age-Related Macular Degeneration and Its Relationship to Antioxidant Intake." Acta Ophthalmol Scand 80, no. 4 (2002): 368-71.
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Diane E. Alexander, Ph.D. is a Technical Service Manger at Kemin Health, LC. She received her Ph.D. in Molecular Microbiology and Microbial Pathogenesis from the Washington University School of Medicine.