· with Fresh Corn Polenta, Warm Kale Salad, & Berry Sauce ·



3/4 cup quality corn meal
1 ear corn
1 bay leaf
1/4 red bell pepper
1/4 orange bell pepper
1 clove garlic
2 links hot sausage
2 cups baby kale
2 tablespoon blackberry jam
1 tablespoon dried cherries
2 tablespoon balsamic vinegar
2 tablespoon good red wine
S&P to taste
Olive oil


  1. Simmer Hot Sausage for 10 minutes in a pot covered with water. Drain and place cooked sausage in the cooler. When cool remove casings, and slice sausage on the bias ¾” set aside.
  2. Remove corn from the cob set aside.  Add corn cob to small pot with bay leaf, cover with 5 cups cold water bring to boil and simmer 15 minutes, strain and reserve corn broth and bay leaf.  Rinse baby kale and dry on a paper towel.  (cooking tip – ALWAYS WASH YOUR VEGETABLES).
  3. Prepare berry sauce: cover dried cherries with red wine and balsamic vinegar set aside 20 minutes to soften the cherries.  Add blackberry jam to a bowl with balsamic vinegar, soaked cherries and wine, whisk well, little bit of crack pepper- set aside.


  1. Bring corn broth to a boil with the bay leaf slowly add cornmeal with the corn kernels, and constantly stir with a whisk, cook over medium heat for 10 minutes, if polenta gets to thick add water as you are cooking to adjust the texture, season S&P to taste.  Turn off the heat cover with lid to keep warm- set aside.
  2. In a non-stick pan put pan on medium heat, add the olive oil and begin browning the sausage and julienne sliced peppers, with crushed garlic.  Keep warm once sausage is caramelized on very low heat- can cover as well.
  3. In a small sauté pan add tablespoon of olive oil, add the kale, S&P to taste and quickly sauté on high heat for 15-20 seconds just to wilt.


Spoon in corn polenta on a plate, add the sausage and peppers with roasted garlic.  Place warm kale on plate and spoon over berry sauce with cherries. Serve immediately.  Garnish with basil or your favorite herb. Enjoy!

This is the perfect dish for spring.  The warm soft polenta is comfort food and rich in lutein.  The spicy sausage contains paprika which has ocular health benefits.  The julienne red and orange peppers are an excellent source of zeaxanthin.  Warm kale salad is an excellent source of lutein.  To summarize the corn, peppers, kale, blackberry jam, and dried cherries are all essential ingredients packed with anti-oxidants to enrich your macular pigment, enhance your vision, and help preserve your vision.

This is a fun easy recipe and so delicious!  The corn broth will give greater flavor to the polenta, the balance of balsamic vinegar and blackberry jam with cherries helps cut the richness of the spicy sausage.  Make it for both yourself and friends and family!

Don’t forget…To maintain good Ocular Health always eat your Fruits and Veggies!

sales aid_enriching macular pigment

Lutein, Zeaxanthin and Meso-Zeaxanthin Across the Lifespan

The idea that a select few dietary nutrients could serve functions as varied as normal brain development, eye protection, skin protection, cardiovascular health, reaction time improvement, cognitive function enhancement, and age-related disease prevention at first seems preposterous. Indeed, any reasonable person approached with such a claim should be highly skeptical, and ask for the evidence. In the following [article], I will provide the evidence for lutein (L), zeaxanthin (Z), and mesozeaxanthin (MZ) as the nutrients described above, and characterize how they play a role in normal development, enhanced function, and health across the lifespan.

L and Z are naturally-occurring carotenoid pigments found primarily in leafy-green vegetables, such as kale.

Lutein and Zeaxanthin are naturally-occurring carotenoid pigments found primarily in leafy-green vegetables, such as spinach and kale (Sommerburg et al. 1998). They are not synthesized by the body, and so must be obtained from dietary sources, or supplements. Those who have diets rich in leafy greens, or supplement with sufficient L and Z, tend to have higher blood and tissue concentrations of these carotenoids (Ciulla et al. 2001; Bone et al. 2003). Although somewhat rare, trace amounts of MZ are present in the diet in various parts of the world – it is found in 21 species of fish, shrimp and sea turtles, as well as eggs (due to supplementation of chicken feed) in California and Mexico (Maoka et al. 1986; Nolan et al. 2013). Importantly, MZ has been shown to be converted from L in the retina; it is found in high densities in the very center of the retina, where it affords protection and performance to the vulnerable neural tissue there. In terms of dietary response, the body appears to recognize MZ, as it has been shown to be readily deposited in the retina when taken in supplement form (Bone et al. 2007; Loughman et al. 2012). L, Z, and MZ serve very important functions in the body. Firstly, they are extremely potent antioxidants. L, Z, and MZ’s antioxidant capability enables them to protect bodily tissues against damaging free-radical oxygen (Krinsky et al. 2003). This is an extremely important function, because if free-radical reactions continue unabated they can lead ultimately to DNA damage, which manifests as tissue degeneration or cancer. We often fail to appreciate the high-energy, somewhat violent nature of the chemistry of our body; for this reason the body builds a defense against oxidation in key areas, such as the retina and brain, where it is most needed. With regard to L, Z, and MZ, this preferential placement in vulnerable tissues starts very early.

The Macular Carotenoids in the Womb / Infancy / Childhood

L and Z have been shown to play a major role in the early development of neural tissue in utero.

Until fairly recently, the role of L, Z, and MZ in health was thought to be limited to helping protect against the development of age-related macular degeneration (AMD; e.g. Seddon et al. 1994). Over the last 6-7 years, however, solid evidence from prenatal and neonatal research indicates an important role for these carotenoids in the very beginning of life. For example, it has been shown that L and Z play a major role in the early development of neural tissue in utero: At about 6 weeks of gestation (before the retina starts to develop), L and Z are transferred via the umbilical cord (Rubin et al. 2012) from the mother to the fetus, and start to accumulate in an ocular reservoir called the vitreous humor. At 20 weeks gestation, as the retina begins to be “built,” L and Z are diverted from the vitreous humor into the now-forming retinal tissue, where they serve as antioxidants during the volatile, extremely high metabolic environment of neurogenesis (Panova et al. 2007). Because oxygen is one of the major building blocks of neural tissue, the potential for free-radical oxidative stress and damage is high; based on the conspicuous timing of passage from the vitreous humor to the retina, coupled with the antioxidant capability of L and Z, it is not unreasonable to suggest that they play a crucial, early role in the development of neural tissues. L in particular is also found in high concentrations in the infant brain (Vishwanathan et al. 2011). This is true of no other carotenoid. The development of the brain occurs so rapidly and with such metabolic intensity that it makes sense the body would put L (a potent antioxidant) in an area of such high oxidative stress. Additionally, because much neurodevelopment in the brain and retina occurs after birth, L no doubt maintains this role well into childhood. In fact, an argument could be made that children, despite their relatively small stature, actually need as much or more daily L (and also Z and MZ) as adults. This is for two reasons: 1) Children are still developing, and are thus using more oxygen to build tissues. More oxygen leads to increased potential for oxidative stress, and L, Z, and MZ can help to reduce it. 2) Tissue stores of L, Z, and MZ (such as the retina, brain, and adipose tissue) are relatively empty. By ensuring that a meaningful amount of these carotenoids is included in a child’s diet, accumulation in these critical areas of the body is promoted. This would ultimately lead to enhanced protection into adulthood and beyond.

Lutein, Zeaxanthin, and Mesozeaxanthin in Adulthood / Old Age

Excitingly, new research direction for L, Z, and MZ involves their potential role in preventing the onset, or slowing the progression, of cognitive decline.

In adults, L, Z, and MZ in the retina (where they are collectively referred to as the “macular carotenoids”) have been shown to be positively associated with a number of important functions related to both health and performance. There are several visual performance advantages, including increasing visual processing speed (Hammond & Wooten, 2005), and many parameters of visual performance in bright light environments. On average, subjects with higher concentrations of the macular carotenoids are able to maintain visibility of a flickering light at higher frequencies than those with lower retinal lutein (who see the light as a stable, solid disc of light). In other words, those subjects with higher concentrations of L, Z, and MZ in their retinas have faster visual systems; this manifests as faster reaction time performance. High macular carotenoid concentration has also been shown to substantially improve visual performance in bright light environments (i.e. glare). These effects include reduced visual discomfort in bright light (Stringham et al. 2003; 2004; 2011), increased ability to see through glare (Stringham and Hammond, 2007; 2008), and decreased photostress recovery time (recovering a visual target after exposure to an extremely bright light; Stringham and Hammond, 2007; 2008; Stringham et al. 2011). More recently, the macular carotenoids have been shown to be associated with better cognitive function in people over 50 – subjects with higher macular carotenoid concentrations (which have been shown to be correlated to brain levels of L and Z – Vishwanathan et al. 2013) perform better on cognitive tasks related long-term memory and decision-making (Feeney et al. 2013). Additionally, in a recent study of deceased centenarians (those who had lived to over 100 years of age), Johnson et al. (2013) found that brain concentrations of L were significantly higher than any other carotenoid, especially in areas that serve cognitive function, such as the frontal and temporal lobes. This suggests not only that L appears to be very important to brain function well into old age, but also (based on the areas into which it is deposited) that L is important in preserving high-level cognitive function. L also appears to play a protective role in cardiovascular health, in that it inhibits vascular cell adhesion molecules from accumulating atherosclerotic plaques (Kailora et al. 2006). Over time, this function leads to a greatly reduced risk for developing atherosclerosis, and cardiovascular disease. Interestingly, L and Z (by virtue of their deposition throughout the layers of the skin) also appear to provide protection from UVB-induced erythema (i.e. sunburn; Heinrich et al. 2003). Moreover, L and Z were shown to help manage and limit damage already caused by UVB light. Perhaps the most exciting new research direction for L, Z, and MZ involves their potential role in preventing the onset, or slowing the progression, of cognitive decline. As noted above, in several studies, people over 50 years of age performed significantly better on cognitive tasks as a function of their macular carotenoid concentration. This idea was recently investigated by Nolan et al. (2014) in a study of early-stage Alzheimer’s disease patients versus normal, age-matched controls. The Alzheimer’s patients were shown to have significantly lower macular carotenoid concentrations than the control subjects. This finding suggests that, as in AMD, perhaps the macular carotenoids are preventing cumulative damage over the lifespan that can, if left unchecked, produce neural damage that ultimately lead to cognitive impairment. In a follow-up study (Nolan et al. 2015), Alzheimer’s disease patients were found to respond positively in the retina to macular carotenoid supplementation, which suggests that the body maintains the ability to absorb and use these carotenoids in neural tissue, and that they may offer some potential benefit in increased concentrations. Lastly, as noted earlier, there is a well-established relationship between high concentrations of macular carotenoids and a reduced risk for developing AMD, the leading cause of blindness in people over 60 in the United States (National Eye Institute). Importantly, there is evidence that even after the onset of AMD symptoms (e.g. mild distortions of central vision), macular carotenoid supplementation can slow down, or even perhaps stop the progression of the disease (Richer et al. 2004). It appears therefore that the macular carotenoids have not only long-term protective effects on tissues, but also can have acute beneficial effects as well.

In summary, L, Z, and MZ appear to provide meaningful, significant benefits across the lifespan. The more we learn about these carotenoids, the more it becomes apparent that they are crucial to normal development, health, and performance. From their involvement very early in protecting developing neural tissues, to reducing cumulative damage that results in age-related disease, it is clear that L, Z, and MZ are meant to play a significant role in human development, performance, and aging. Although L, Z, and MZ are not considered essential nutrients (i.e., vitamins), based on the available scientific evidence, they may certainly be considered essential for optimal health and performance. Lastly, given our ever-increasing lifespan, any factor that can plausibly extend to us a benefit that can ensure more healthful years of life is always welcome. L, Z, and MZ appear to be such factors.

JAMES STRINGHAMAbout the author: James Stringham, Ph.D.

Dr. Stringham earned his doctoral degree in experimental psychology from the University of New Hampshire in 2003. During postdoctoral appointments at the Schepens Eye Research Institute at Harvard Medical School and the Medical College of Georgia, he conducted research on ocular lutein, age‐related macular degeneration, the effects of intense light on visual performance, and plasticity of the visual system. Dr. Stringham then took a position as a visiting assistant professor at the University of Georgia, where he continued and extended a research program involving lutein and many facets of visual performance. In 2007, he became a senior vision scientist in the Air Force Research Laboratory (AFRL), where he was involved in extensive testing of the effects of lutein and zeaxanthin on human visual performance. Currently he is a research scientist at the University of Georgia, where his research includes studying the effects of lutein, zeaxanthin, and mesozeaxanthin on a variety of human physiological, health, and performance parameters.


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Feeney J, Finucane C, Savva GM, Cronin H, Beatty S, Nolan JM, Kenny RA. (2013). Low macular pigment optical density is associated with lower cognitive performance in a large, population-based sample of older adults. Neurobiol Aging. 34(11):2449-56.
Seddon, J. M., Ajani, U. A., Sperduto, R. D., Hiller, R., Blair, N., Burton, T. C., Farber, M. D., Gragoudas, E. S., Haller, J., Miller, D. T., & et al. (1994). Dietary carotenoids, vitamins A, C, and E, and advanced age-related macular degeneration. Eye Disease Case-Control Study Group. JAMA : the journal of the American Medical Association, 272, 1413-1420.
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The Three Macular Carotenoids: Complementary Functions of Lutein, Zeaxanthin and Meso-Zeaxanthin

Figure 1. Chemical structures of the three macular carotenoids: Lutein, RR-zeaxanthin (“zeaxanthin”), and meso-zeaxanthin. From Nolan et al. (2013).

Lutein and the two zeaxanthin isomers, RR-zeaxanthin (3R,3’R-zeaxanthin) and meso-zeaxanthin (3R,3’S-RS-zeaxanthin) are the only three carotenoids found in the eye, specifically in the macula of the retina (Bone et al. 1997). RR-zeaxanthin and meso-zeaxanthin are both considered zeaxanthin; they differ only in the spatial orientation of the hydroxyl group on the C3’ chiral position (Nolan et al. 2013 – see Figure 1). They are obtained via the diet, and concentrated in the central retina (termed the macula – the region of the retina responsible for highest visual performance). The location of their respective areas of deposition is highly specific: lutein is the dominant carotenoid in the peripheral macula, RR-zeaxanthin in the mid-peripheral macula and meso-zeaxanthin at the center of the macula (Bone et al. 1997).

Table 1. Concentrations and relative distribution in the macula for the three retinal carotenoids. From HKG Opththalmology, 2000; Vol. 1 #4.
Table 1. Concentrations and relative distribution in the macula for the three retinal carotenoids. From HKG Opththalmology, 2000; Vol. 1 #4.

Each of these carotenoids plays an important role in protecting the retina and enhancing visual performance (Bone et al. 2003; Thurnham & Howard, 2013; Stringham et al. 2011). The characterization and functions of lutein and RR-zeaxanthin are well known, and the science behind these two xanthophylls has grown at a steady rate. Meso-zeaxanthin has historically been incorrectly coupled with RR-zeaxanthin as an impurity or its isomer, and the measurement of meso-zeaxanthin in serum and foods had largely been ignored until awareness of its specific role in the eye emerged. One of the primary functions of the macular carotenoids is quenching potentially damaging free radical oxygen species (ROS). Each of the macular carotenoids is a potent antioxidant with specific targets. Meso-zeaxanthin is the most potent of the three, followed by RR-zeaxanthin, which is twice as potent as lutein in quenching reactive oxygen species (Bhosale & Bernstein, 2005). The protective role of lutein is more pronounced within the cellular membrane. Meso-zeaxanthin is located at the very center of the macula, the focal point of visual function. Its central location and stronger antioxidant potential make Meso-zeaxanthin critical in protecting the tissue at most risk – the center of the fovea has the highest packing density of photoreceptors, and maintains the highest metabolic rate, and light exposure – and therefore is under nearly constant assault (see Table 1 for specific locations of deposition for the three macular carotenoids). It is quite advantageous, therefore, that the tissue at most risk is protected by the strongest antioxidant of the three. meso-zeaxanthin also provides the best protection for the lipid membrane (Landrum et al. 1999; Subczynski et al. 2010). In terms of overall retinal protection, a mixture of the three macular carotenoids at a ratio of 1:1:1 has been shown to quench singlet oxygen more effectively than any of the three individually (Li et al. 2010). Meso-zeaxanthin and RR-zeaxanthin are perpendicular to the cell membranes to better protect the lipid membrane from oxidation and absorb similar wavelengths of high energy light (Sujak et al. 1999). Lutein is both parallel and perpendicular to the cell membrane, and also oriented near the surface of the cell membrane; this makes it a better filter of blue light. Because lutein and the zeaxanthin isomers absorb different wavelengths of light, together, the three absorb a broader spectrum of high energy light, which offers greater protection of retinal tissue (see Figure 2 for a pictorial representation of this phenomenon). Structural differences, orientation to cell membranes, macular location and differing absorption spectra therefore help the three macular carotenoids work together to provide superior filtration of blue light as compared to each individually (Billsten et al. 2003; Li et al. 2010; Nolan et al. 2013).


Figure 2. Anatomical location of the macular pigment, and spectral absorption of individual macular carotenoids that serve to make the overall macular pigment absorption spectrum (thick, dark orange line) relatively wide.

In addition, the three macular carotenoids work together for optimal eye health and visual function. Each individually and in combination with each other has been shown to increase macular pigment optical density. But the typical central peak of macular pigment optical density, found in the very center of the fovea, can be realized in subjects with atypical macular pigment spatial profiles at baseline only when supplemented with all three macular carotenoids (Nolan et al. 2012). This suggests that a combination of all three macular carotenoids is required to produce what appears to be a normal density distribution within the retina, and hence most likely normal retinal health and function. In terms of visual performance, increased density of the macular carotenoids is associated with faster visual processing (Hammond and Wooten, 2005), significantly improved visual performance in glare (Stringham et al. 2007; 2008; 2011; 2013) and reduced visual discomfort in bright light (Stringham et al. 2003; 2004; 2011; 2013).

Meso-zeaxanthin is the most recently characterized of the three retinal carotenoids, and is often found in trace amounts within commercially available lutein and RR-zeaxanthin supplements (ranging from 0.02-0.07% if chiral analysis is performed [Nolan et al. 2013]). As such, whether as dietary intake or part of lutein and/or zeaxanthin isomer(s) supplementation, Meso-zeaxanthin has already been part of studies investigating the nutritional impact on visual performance and AMD risk reduction. There are over 70 lutein studies at doses of 6-40mg, over 10 RR-zeaxanthin studies at doses of 1-20mg and several meso-zeaxanthin studies at doses of 8-14.9mg. Science continues to develop around the role of meso-zeaxanthin in eye health, and it is already established as a critical macular carotenoid with a specific function in ocular health. Today the significance of meso-zeaxanthin in the retina is well-established (e.g., Thurnam et al. 2008). Meso-zeaxanthin has proven bioavailability in humans (Thurnham et al. 2008), and has also been shown to be present in human serum pre-supplementation. Additionally, supplementation of meso-zeaxanthin has resulted in both increased serum levels and macular pigment optical density (Connolly et al. 2010), which, given its exceptional antioxidant properties, bodes well for human health.

Traces of meso-zeaxanthin are present in the diet and can be found in 21 species of fish, shrimp and turtles.
Traces of meso-zeaxanthin are present in the diet and can be found in 21 species of fish, shrimp and turtles.

Due to meso-zeaxanthin’s relatively recent empirical characterization, there have been some concerns with regard to its safety. Studies of meso-zeaxanthin supplementation containing fairly high doses (e.g. Connolly et al. 2010), have produced no reports of adverse events. In addition, meso-zeaxanthin is considered safe for use in food and dietary supplements and it meets the regulatory criteria per an FDA-acknowledged GRAS notification (http://www.fda.gov/ucm/groups/fdagov-public/@fdagov-foods-gen/documents/document/ucm275974.pdf). In addition, a supplement containing meso-zeaxanthin was proven to be unequivocally safe in a GLP toxicological study (Ravikrishnan et al. 2011). Meso-zeaxanthin is not only converted from lutein in the eye (Neuringer et al. 2004) but is also found in the diet. Trace amounts of meso-zeaxanthin are present in the diet in various parts of the world – it is found in 21 species of fish, shrimp and sea turtles, as well as eggs in California and Mexico (Maoka et al. 1986). Additionally, meso-zeaxanthin has been a component of a xanthophyll supplement added to chicken feed in Mexico over the last 10 – 15 years (Nolan et al. 2013). Because of the lack of awareness of meso-zeaxanthin and the previous difficulty in measuring this particular carotenoid, it had typically not been tested. It is possible therefore that its presence in the diet and serum has been potentially underreported and it is most likely available in more foods than we are aware of.

The eye contains three carotenoids – lutein and two zeaxanthin isomers (meso-zeaxanthin and RR-zeaxanthin) – each with a specific location and distinctive role in retinal protection and visual performance. In terms of supplementation, lutein was the first commercially available macular carotenoid. As the state of the science has progressed, the need for higher levels of RR-zeaxanthin was determined. It is now clear that meso-zeaxanthin plays a critical role alongside lutein and RR-zeaxanthin in eye health. Given the specialized locations and functions of each macular carotenoid, it is reasonable to suggest that that the best way to support eye health and visual performance is to consume all three macular carotenoids, via diet or supplementation.


JAMES STRINGHAMArticle by: James Stringham, Ph.D.

About the author: Dr. Stringham earned his doctoral degree in experimental psychology from the University of New Hampshire in 2003. During postdoctoral appointments at the Schepens Eye Research Institute at Harvard Medical School and the Medical College of Georgia, he conducted research on ocular lutein, age‐related macular degeneration, the effects of intense light on visual performance, and plasticity of the visual system. Dr. Stringham then took a position as a visiting assistant professor at the University of Georgia, where he continued and extended a research program involving lutein and many facets of visual performance. In 2007, he became a senior vision scientist in the Air Force Research Laboratory (AFRL), where he was involved in extensive testing of the effects of lutein and zeaxanthin on human visual performance. Currently he is a research scientist at the University of Georgia, where his research includes studying the effects of lutein, zeaxanthin, and mesozeaxanthin on a variety of human physiological, health, and performance parameters.


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Ravikrishnan R, Rusia S, Ilamurugan G, Salunkhe U, Deshpande J, Shankaranarayanan J, Shankaranarayana ML, Soni MG. (2011). Safety assessment of lutein and zeaxanthin (Lutemax 2020): subchronic toxicity and mutagenicity studies. Food Chem Toxicol. 49(11):2841-8.
Johnson EJ. (2002). The role of carotenoids in human health. Nutr Clin Care. 2002 Mar-Apr;5(2):56-65.
Bone RA, Landrum JT, Cao Y, Howard AN, Alvarez-Calderon F. (2007). Macular pigment response to a supplement containing meso-zeaxanthin, lutein and zeaxanthin. Nutr Metab (Lond). 11;4:12.
Maoka T, Arai A, Shimizu M, Matsuno T. (1986). The first isolation of enantiomeric and meso-zeaxanthin in nature. Comp Biochem Physiol B. 83(1):121-4.
Stringham JS, Fuld K, Wenzel AJ. Spatial properties of photophobia. Invest Ophthalmol Vis Sci. 2004;45(10):3848–3858.

Stringham JM, Hammond BR Jr. The glare hypothesis of macular pigment function. Optom Vis Sci. 2007;84(9):859–864.
Hammond BR Jr, Wooten BR. CFF thresholds: relation to macular pigment optical density. Ophthalmic Physiol Opt. 2005;25(4):315–319.
Stringham JM, Hammond BR Jr. Macular pigment and visual performance under glare conditions. Optom Vis Sci. 2008;85(2):82–88.
Stringham JM, Fuld K, Wenzel AJ. Action spectrum for photophobia. J Opt Soc Am A. 2003;20(10):1852–1858.
Stringham JM, Garcia PV, Smith PA, McLin LM, Foutch, BK. Invest Ophthalmol Vis Sci. 2011;52:7406–7415.
Stringham JM, Snodderly DM (2013). Enhancing performance while avoiding damage: a contribution of macular pigment. Invest Ophthalmol Vis Sci. 54:6298–6306.

Experts Highlight the Benefits of Carotenoids on Ocular Health and Beyond

MacuHealthwebDr. Michael Tolentino is an Orlando, Florida retina specialist and early inventor of anti-VEGF injectable medications. In the September 2015 Primary Eyecare Optometry News article, he reported that several patients with wet AMD in his practice given Macuhealth twice daily to delay or defer injections resulted in improved acuity and resolution of subretinal/intraretinal fluid on OCT. He stated in the article, “While the results are presented as a case series, the response of these patients was equivalent to the typical response obtained after a course of anti-VEGF injections. Furthermore, Macuhealth worked synergistically with injections in patients previously unresponsive to injections.” He further states in the article, “I speculate that the potent antioxidative properties of these three carotenoids diminished the stimulus for VEGF upregulation. This supplement shows promise as a method for diminishing initiation and frequency of injections in patients with exudative AMD.”

Disclosures: Dr. Tolentino has no financial involvement in MacuHealth, Dr. David Nelson is a consultant for MacuHealth and authored the article in PCON covering the Carotenoid Conference. Click here to read the full article.

A Recipe for Eye Health: BBQ Grilled Wild Salmon with Braised Kale

Summer is coming to an end, but there’s still ample time left to do some barbequing! You already know that when it comes to eye health, proper nutrition is imperative. Maintaining a balanced diet and consuming sufficient carotenoids (namely lutein, zeaxanthin and meso-zeaxanthin) can help to ensure that eye sight stays sharp and can even aid in warding off age-related macular degeneration. Said carotenoids are found primarily in leafy green vegetables and certain seafood. So, without further adieu, let’s get down to the details of how to prepare this eye-friendly grill out winner!!

(Ingredients and measurements to the side in blue)

SERVINGBraised Kale
• Rinse and gently pat dry kale fronds, garlic scape and Orange pepper
• Shred Kale fronds roughly ( I like the stalk too)
• With a sharp knife finely dice garlic scape and orange pepper
• Heat 2 tbs of California olive oil in a sauté pan on med-low and toss in finely diced aromatics (garlic scape and orange pepper)
• Sauté for 3 or 4 minutes before adding roughly shredded kale
• Sauté for 5-7 more minutes adding a small splash of purified water if moisture is needed.
• Toss with 1 tsp of pink crystal sea salt and fresh cracked pepper to taste!

Grilled Salmon
• Take one large 16-20oz raw wild salmon filet (with the skin still on!) and rub it with 2 tbs of California olive oil, 1 tsp of pink crystal sea salt and fresh cracked pepper to taste.
• Grab one of your delicious Meyer lemons and slice it thinly into rounds. Place rounds on top of salmon filet.
• Let the salmon marinate on a covered plate for 15 minutes
• During this time, prepare grill. Also begin preparing braised kale
• Slice the other two lemons into halves
• Once grill is ready (coals are mostly white, or if fancy gas grill is up to temp)…
• Place salmon directly on grill skin side down
• Place halved Meyer lemons face down on grill
• Cover for 8-10 minutes
…Once salmon is grilled to a perfect medium rare, remove from grill with a metal spatula (and an assistant). Serve along side of your perfectly braised kale and grilled Meyer lemons! Enjoy.

About the author: Kirsten Stone hails from Portland, Oregon and grew up growing her own food on a farm. She has a lasting passion for nutrition as well as personal and global eye health.

Round-up from the Macular Carotenoids Conference 2015

Above: Downing College in Cambridge, UK (src: wikipedia.org)

Lloyd Snider, O.D. shares lecture topics and key takeaways from the Macular Carotenoids Conference held in Cambridge, UK July 8th-10, 2015.

Above: Downing College in Cambridge, UK (src: wikipedia.org)
Above: Downing College in Cambridge, UK (src: wikipedia.org)

I’m just back and over my jet lag from the Macular Carotenoids Conference 2015, held at Downing College, University of Cambridge, UK. It was an amazing three-day event where the world’s best researchers gathered for a spirited discussion on macular carotenoids. There were 24 lectures, each followed by questions from the attendees. Additionally, there were thirty-four posters presented which also had question and answer sessions. Poster Abstracts and Speaker Abstracts were published in the European Journal of Ophthalmology Supplement. (You can find the abstracts, here.)

Head of a child with puzzle brain. IsolatedSome of the topics covered:

  • Modifying sweet corn to increase carotenoid content
  • Childhood vegetable intake predicting adult MPOD
  • Macular pigment and cognitive function
  • A case of spontaneous MacTel 2 macular hole closure with carotenoid supplementation
  • L, Z, and MZ content in eggs from supplemented chickens
  • The impact of carotenoids and B vitamin supplements in Alzheimer patients
  • Serum response in humans to MZ enriched chicken eggs
  • Macular carotenoids in pre-and post-natal development
  • Macular carotenoids in breast milk
  • Clinical experience with macular carotenoids replacing injections in exudative AMD
  • Structural and functional response in glaucoma to carotenoid supplementation
  • Oxidative stress, carotenoids and dementia
  • Macular carotenoids, psychological stress, and general health status in young adults

Some of the things I learned:

  • There are differing xanthophyll contents in regions of the elderly brain
  • Macular pigment is important in cognition
  • Drusen have a high concentration of zinc.
  • Avocado helps with lutein uptake
  • Ganglion cell loss in glaucoma causes glare and dark adaptation problems
  • Glaucoma patients have lower macular pigment
  • With foveal involvement, more damage means slower photo stress recovery
  • There is a possible link between glaucoma and cognitive decline

After the lectures, expert guides gave us an historical tour of Cambridge and many of its colleges. Sampling some of the many pub offerings was delightful. We also had a great banquet with best poster awards for PhD candidates, as well as surprise entertainment from an opera-singing chef and maitre’d. They had the entire group singing and dancing around the hall.

The lectures should be available in the near future on video. We will let you know as soon as they are ready. The next Macular Carotenoids Conference meeting in Cambridge is slated for 2018. I hope to see you there. It is truly a unique experience and a worthwhile, intriguing meeting. Please plan ahead!

lloyd Lloyd Snider, O.D.
Optometric Director

Sponsor Macuhealth

Could Your Eye Vitamins be Making Macular Degeneration Worse?

image source: templeton.org

supplementation for eye disease

‘Could your eye vitamins be making macular degeneration worse?’ The alarming (yet intriguing) notion was recently discussed by Canadian optometrist, Richard Maharaj via his blog, Eyes on Eyes. In the article, Dr. Maharaj reviews some of the recent findings surrounding the important role of genetics in prescribing nutritional eye supplements.

Maharaj refers to the recent scientific research of Dr. Carl Awh et al. which has shown that up to 65% of AMD patients using an AREDS formulation may be on the wrong path due to their individual genetics. Dr. Awh, a vitreoretinal surgeon and leading author/researcher on genetically guided therapy for AMD claims that a subgroup of patients might actually be increasing the progression of AMD by supplementing with an AREDS formula.

It is no secret that the latest AREDS formula has, in some respects, become a standard treatment for dry AMD in recent years – and millions of patients have been prescribed the lutein, zeaxanthin, C, E, zinc and copper formula since AREDS2 was published. However, over the last few years, Awh et al. have discovered that patients experience geno-type dependent responses to AREDS’ antioxidant combination. In particular, Awh found that certain patients had unfavorable reactions to either zinc, anti-oxidants (C, E), or a combination of the two.

image source: templeton.org
image source: templeton.org

Maharaj describes Awh’s findings as ‘compelling enough’ for him to mark a change in the direction of care he delivers. He also voices his concern regarding AREDS’ inclusion of zinc, since zinc has been found to exacerbate certain retinal conditions. Plus, the upper daily limit of zinc by nutrition standards is a meager 40 mg, yet the AREDS formula somehow recommends a whopping 80 mg, causing Dr. Maharaj to further ponder the notion of blanketing all patients with the formula.

Though more research is necessary and some remain beholden to the AREDS formula, Dr. Maharaj notes that he is now, more so than ever, consciously considering the complexity of genetics when prescribing treatment for AMD. Indeed, the notion of personalized medicine is becoming more prominent — and an ‘AREDS for all’ approach is simply no longer appropriate.

If you’re interested in learning more about the role genetics may play in nutritional supplementation for eye disease, click here to view a presentation by Dr. Jerome Sherman on the subject. 


Calcium Supplementation Linked to Higher Risk of Macular Degeneration in Older Population

CalciumA recent National Health and Nutrition Examination Survey has established a link between over consumption of calcium and a significantly increased risk of developing macular degeneration in the older population.

Researchers from the University of California evaluated 3,191 people aged 40 and over who participated in a national health survey. The group consisted of 248 people who were previously diagnosed with macular degeneration. Participants answered multiple questions regarding their use of dietary supplements and antacids, specifically. The survey also accounted for factors including age, sex, ethnicity, obesity smoking, alcohol consumption, cataract surgery, osteoporosis history, glaucoma and heart disease.

The results, published in the April 2015 issue of JAMA Ophthalmology, reported that individuals (aged 68 and older) supplementing with 800 mg of calcium per day were 85% more likely to be diagnosed with macular degeneration than those who do not supplement with calcium. The association between calcium supplementation and AMD was found to be more prominent in older individuals, likely due to the longer duration of calcium supplementation.

Indeed, some calcium is necessary for good health. However, studies like this one show that an over consumption of the mineral mixed with a lack of awareness may be serious concerns; especially considering that calcium supplementation is tremendously common among the older population, often due to concerns about osteoporosis and bone health. In fact, about 43% of the U.S. population (including approximately 70% of older women) say they take calcium supplements.

Researchers acknowledge the study’s limitations noting the possibility that some of the participant’s did not accurately report their use of calcium as well as the lack of research into the role that calcium from food and drink may play. Although the researchers have declined to make any new recommendations regarding calcium supplementation until further studies are conducted, individuals worried about developing AMD should continue to avoid smoking, wear protective eyewear when exposed to UV or blue light, eat a diet rich in leafy green vegetables and limit simple carbohydrates.

As usual, talk to your doctor before starting or discontinuing use of any supplement.


8 Ways to Prevent or Halt Macular Degeneration

“An ounce of prevention is worth a pound of cure.” The classic proverb was coined by Benjamin Franklin, who was obviously referencing the concept that it is easier to stop something from happening in the first place than to repair the damage after it has already been done. The notion rings true for many instances, particularly where eye disease is concerned. From smoking to light exposure to diet, there are a variety of known modifiable (and non-modifiable) risk factors that contribute to the onset of macular degeneration. However, with some knowledge and preventative measures, mitigating your AMD risk level is possible. The following are excellent ways to help protect your eye sight:

Extended Group Portrait Of Family Enjoying Day In ParkTalk to Your Family: Having a genetic predisposition to AMD is one of the biggest risk factors for the disease. Ask your immediate relatives about their eye health and make note of it. Be sure to also inquire as to whether they are aware if a grandparent, aunt or sibling developed any eye related diseases or issues in their lifetime. Being armed with your family medical history is a key component in protecting your vision from eye disease. The earlier you are aware and inform your doctor that AMD may be hereditary for you, the more likely treatment can be implemented and vision can be salvaged.

Supplement with Macular Carotenoids: Since the human body does not naturally manufacture ocular carotenoids, it is vital to supplement with all three of them. Lutein, Zeaxanthin and Meso-Zeaxanthin need to work in a synergistic manner to help improve the macular protective pigment at the back of the eye. When this pigment density is increased, the macula (which is responsible for central vision) is more protected from free radicals and harmful blue light spectrums. A supplement like MacuHealth contains all three of the macular carotenoids in the appropriate amounts to help build upon macular pigment, improve visual function and stave off AMD. Check with your doctor whether a nutraceutical like MacuHealth is right for you

Educate Yourself (and Consider Meso-Zeaxanthin!): One of the keys to controlling risk factors for any disease is efficient patient education. If you are at risk for AMD, make it a priority to learn as much as you can about the condition, its symptoms and treatment methods by conducting your own research and asking your doctor important questions. For example, research has concluded that lesser-known carotenoid Meso-Zeaxanthin is the most potent antioxidant of the three macular carotenoids. Since Meso-Zeaxanthin is not found in large amounts in a typical Western diet (it is found in small doses in rainbow trout, shrimp etc.), it is important to ensure that your daily vitamin and/or supplement contains this pigment.

Watch out for Blue Light: With the increasing prevalence of smart phones, tablets and other handy electronics, eyes are exposed to harmful light spectrums now more than ever. In fact, harmful blue light is emitted from fluorescent, CFL and LED bulbs. Exposure to blue light causes a gradual oxidation and deterioration of the macular pigment and macula, leaving eyes more susceptible to glare issues, decreased contrast sensitivity and macular degeneration. Look into purchasing some quality, protective eyewear to lessen your exposure.

Quit Smoking-No SmokingQuit Smoking: While today it is common knowledge that smoking causes respiratory illnesses like emphysema and lung cancer; it seems society is somewhat under informed about the clear link between smoking and macular degeneration. Studies have shown that smoking (and even being exposed to secondhand smoke) can enhance free radical generation and reduce macular pigment density. If you’re a smoker, it’s time to quit the single most controllable risk factor for AMD once and for all!

Eat More Greens: Proper nutrition is critical to eye health. As previously mentioned, it is very difficult to obtain an adequate dose of Meso-Zeaxanthin in the Western diet. However, Lutein and Zeaxanthin are readily found in leafy green and brightly coloured vegetables like kale, bell peppers and spinach, for example.

Exercise Regularly and Stay a Healthy Weight: What’s good for the heart is generally good for the eyes. Aim to reach your target heart rate range at least three times per week. Recumbent bike, yoga, brisk walks and light weight lifting are all low vision or beginner friendly ways to exercise.

Cake RefusalReduce Simple Carbohydrates: Limiting refined sugar in your diet can potentially slow the progression of AMD or even help to protect against the development of the blinding disease. A study from Tufts University showed a correlation between eating food high in glycemic index (such as white pasta, bread, cake or muffins) and an increased risk or worsening of AMD. (Ditch the breakfast bagel and opt for eggs!)

The International Macular Carotenoids Conference

john nolan

The 3rd International Macular Carotenoids Conference will take place at Downing College in Cambridge, UK from July 8th to 10th, 2015. The annual meeting is primarily attended by macular carotenoid researchers who are exploring up-to-date, evidence based hypotheses and the supporting research data into the role of carotenoids in AMD, vision and cognitive function.

Amongst the over 20 experts, scientists and doctors speaking at the conference are Professors John Nolan and Stephen Beatty. Nolan and Beatty are colleagues within the Macular Pigment Research Group at the Waterford Institute of Technology. The pair and their team have dedicated most of their professional lives to researching macular pigment in relation to carotenoids and have published over 30 peer-reviewed papers on the subject. More recently, Nolan and Beatty have been focusing their research on the fascinating correlation between carotenoid levels, visual function and cognitive performance, in particular.

Nolan describes the Macular Carotenoids Conference, to which he is head chairman, as a unique opportunity for young scientists in particular to share their new ideas with more seasoned researchers. Click on the video below to view Professor Nolan’s official address regarding this year’s conference:

Interested in attending the 2015 Macular Carotenoids Conference in Cambridge, UK? For more information and to register, click here.