Improve Night VisionJuly 2017
By Susan Pickens
Night driving becomes increasingly difficult and dangerous with age, primarily related to changes in our vision and eye structures.
Many older people restrict their driving by avoiding high-risk situations, such as night driving.1
Here are three facts about the age-related visual loss:
- Even normal retinal aging limits our vision, especially in the dark.2
- Those with early age-related macular degeneration are 4.3 times as likely to report difficulty with night driving, 5-fold more likely to have trouble with near vision, and 2.7 times as likely to have difficulty with glare, compared with same-age people in normal retinal health.2
- At least 43% of people five years out from cataract surgery experience glare-related difficulties with driving.3
But one doesn’t have to accept the end of independence and mobility as one’s eyes age. Two new studies published in late 2016 offer hope for those of us still driving, especially at night.
Together, these studies provide new support for supplementing with macular carotenoids, natural pigments that we must consume in order to shield our vulnerable retinal cells from degeneration with age.
Those pigments, lutein, zeaxanthin and meso-zeaxanthin, have long been recognized for their importance in overall retinal protection.4-6
The new studies show that supplementation with these pigments provides targeted benefits important to night drivers, namely, how our eyes respond upon exposure to a bright light against a dark background.
This article will examine new studies showing lutein, zeaxanthin, and meso-zeaxanthin improve photostress recovery time and disability glare.
Based on these findings, it is apparent that even those of us with apparently normal vision should optimize their intake of the macular carotenoids like zeaxanthin, to see better.
Eyes Naturally Contain Carotenoids
You might be surprised to know your eyes naturally contain pigments that are found in plants such as spinach, kale, corn, and collard greens.
These macular carotenoids consist of lutein and zeaxanthin, and meso-zeaxanthin pigments.
Macular carotenoids absorb blue light, which is one of the most damaging kinds of visible light.7 These carotenoids are also capable of preventing some of the oxidative stress experienced by the delicate light receptor cells in the retina. The retina is the layer of nerve cells that sends visual information from the eye to the brain.7
Macular carotenoids occur naturally in the retinal pigmented epithelium that lies just underneath the light-sensitive cells of the retina. There, they act much the way blue-light filters in front of computer screens do, to reduce the amount of harmful blue light that our retinas must experience.
But over time the concentration of macular and circulating carotenoids declines, partly with aging and partly as a result of metabolic changes.8-12 These effects leave our eyes vulnerable to glare, and slow to recover from sudden exposure to bright lights (say, the headlights of an oncoming car).
New Findings About Macular Carotenoids
Two recent studies looked at the impact of supplemental carotenoids on the eye’s natural protective layer, and its response under conditions of bright light and glare – precisely what nighttime drivers encounter.
Researchers wanted to determine the effects of macular carotenoids on the following measurable parameters related to night driving:
- Photostress recovery (how quickly retinal cells recover from intense exposure to bright lights)
- Disability glare threshold (the point at which subjects could no longer see a target through a glaring ring of light)13
- Macular pigment optical density (density of the protective pigment layer)
In the first study, scientists recruited 59 healthy volunteers, average age of 22.13 They divided the subjects into three groups, each receiving a daily dose of:
- Lutein (10 mg), plus zeaxanthin (1 mg), plus meso-zeaxanthin (1 mg)
- Lutein (20 mg), plus zeaxanthin (2 mg), plus meso-zeaxanthin (2 mg)
The supplementation continued for one year, with measurements of macular pigment optical density, photostress recovery, and disability glare made at baseline (before supplementation), and at 6 and 12 months.
The study found that macular pigment optical density, the measure of how much protective macular pigment was present, increased significantly in both carotenoid-treated groups, compared with placebo recipients, both at six and at 12 months. Furthermore, both photostress recovery times and disability glare thresholds improved significantly from baseline in the supplemented groups, compared with placebo, at both follow up visits.
The study showed that supplementation with lutein, zeaxanthin, and meso-zeaxanthin, at either a low or a higher dose, substantially improved the protection of the volunteers’ eyes. Their visual performance improved under conditions similar to night driving: the ability to see a target despite bright, glaring lights around it was enhanced by the supplementation.
Interestingly, macular pigment optical density was significantly associated with both the glare and the photostress responses. This study showed that increases in macular pigment optical density enhance visual performance in bright light conditions, which in turn improves night vision.13
Effects in Older Study Subjects
The first study showed greater macular pigment optical density in young adults is associated with better vision under conditions of bright light and glare.
The second study looked at older people and demonstrated that blood levels of macular carotenoids are closely related to their density in the eye (macular pigment optical density).14 The researchers added an omega-3 fatty acid (DHA) to the zeaxanthin-lutein supplement.
This study involved 20 older patients (aged 57 to 71) with either wet macular degeneration or chronic central serious chorioretinopathy in one eye, with the other eye still healthy.14
All patients in this study received the same supplement, a combination of lutein and zeaxanthin, plus the omega-3 fatty acid DHA for a 6-month period.
Visual acuity (standard vision test) and contrast sensitivity (how well the subjects could discern differences in contrast) were measured at baseline and again at one, three, and six months into the study, while macular pigment optical density was calculated at each time point using photos of the retinas.14
The results showed that supplementation translated into significantly higher macular pigment optical density at each time period. Furthermore, contrast sensitivity was significantly increased at three months and remained improved at the end of the six-month study.
Together, these studies demonstrate the importance of routine supplementation with lutein, zeaxanthin, and (optionally) meso-zeaxanthin as well as the omega-3 fatty acid DHA for protecting aging eyes and preserving features essential to night vision.
Macular Pigment Protects Against Glaring Light
These human studies demonstrate that supplementation with lutein and zeaxanthin provides significant benefits in fighting glare and helping our eyes recover from sudden bright light exposures.
Some hints that this might be the case come from earlier studies.
It has long been known that higher levels of zeaxanthin and lutein in the retina are protective against degenerative eye disease.15 In addition, higher levels of these carotenoids in the retina are closely associated with improved visual acuity.15
Contrast sensitivity, the ability to see distinctions between varying levels of contrast, has also been associated with improved macular pigment optical density, which can be increased with supplementation using lutein, zeaxanthin, and meso-zeaxanthin.16
In 2011, higher macular pigment optical density was closely associated with faster photostress recovery times and improved glare disability measurements.17
It has long been established that supplementation with lutein and zeaxanthin can be an important contributor to reducing the risk for age-related macular degeneration.18-20
Two large randomized controlled trials called AREDS and AREDS2 evaluated the use of carotenoids (beta carotene in AREDS and lutein/zeaxanthin in AREDS2), and found supplementation with lutein and zeaxanthin provide the same benefits as beta carotene, but with lower risk of complications.21,22
The new 2016 studies now establish that macular carotenoids can improve vision under conditions that apply during night driving, in addition to their known benefits for retinal function.
Nighttime driving can be intimidating for older drivers, largely because of the painful glare encountered in oncoming headlights and other bright light sources against the otherwise dark background. This can lead many to give up driving.
But new science released just last year now shows that lutein, zeaxanthin, and meso-zeaxanthin can significantly reduce the effects of glare and loss of visual sensitivity that occur when driving at night.
These findings extend previous work demonstrating the importance of these supplements for preventing deteriorating vision from age-related macular degeneration.
The new studies provide valuable insight for anyone who wants to continue to enjoy the freedom, independence, and mobility that come with driving, particularly after dark.
Daily supplementation with lutein, zeaxanthin and meso-zeaxanthin makes sense in the context of preserving eyesight for as long as possible.
If you have any questions on the scientific content of this article, please call a Life Extension® Wellness Specialist at 1-866-864-3027.
- Freeman EE, Munoz B, Turano KA, et al. Measures of visual function and their association with driving modification in older adults. Invest Ophthalmol Vis Sci. 2006;47(2):514-20.
- Scilley K, Jackson GR, Cideciyan AV, et al. Early age-related maculopathy and self-reported visual difficulty in daily life. Ophthalmology. 2002;109(7):1235-42.
- Monestam E, Lundqvist B. Long-time results and associations between subjective visual difficulties with car driving and objective visual function 5 years after cataract surgery. J Cataract Refract Surg. 2006;32(1):50-5.
- Huynh TP, Mann SN, Mandal NA. Botanical compounds: effects on major eye diseases. Evid Based Complement Alternat Med. 2013;2013:549174.
- Widomska J, Subczynski WK. Why has Nature Chosen Lutein and Zeaxanthin to Protect the Retina? J Clin Exp Ophthalmol. 2014;5(1):326.
- Piermarocchi S, Saviano S, Parisi V, et al. Carotenoids in Age-related Maculopathy Italian Study (CARMIS): two-year results of a randomized study. Eur J Ophthalmol. 2012;22(2):216-25.
- Lima VC, Rosen RB, Farah M. Macular pigment in retinal health and disease. Int J Retina Vitreous. 2016;2:19.
- Obana A, Hiramitsu T, Gohto Y, et al. Macular carotenoid levels of normal subjects and age-related maculopathy patients in a Japanese population. Ophthalmology. 2008;115(1):147-57.
- Ward MS, Zhao DY, Bernstein PS. Macular and serum carotenoid concentrations in patients with malabsorption syndromes. J Ocul Biol Dis Infor. 2008;1(1):12-8.
- Sharifzadeh M, Bernstein PS, Gellermann W. Nonmydriatic fluorescence-based quantitative imaging of human macular pigment distributions. J Opt Soc Am A Opt Image Sci Vis. 2006;23(10): 2373-87.
- Carpentier S, Knaus M, Suh M. Associations between lutein, zeaxanthin, and age-related macular degeneration: an overview. Crit Rev Food Sci Nutr. 2009;49(4):313-26.
- Koo E, Neuringer M, SanGiovanni JP. Macular xanthophylls, lipoprotein-related genes, and age-related macular degeneration. Am J Clin Nutr. 2014;100 Suppl 1:336S-46S.
- Stringham JM, O’Brien KJ, Stringham NT. Macular carotenoid supplementation improves disability glare performance and dynamics of photostress recovery. Eye Vis (Lond). 2016;3:30.
- Fujimura S, Ueda K, Nomura Y, et al. Preliminary analysis of the relationship between serum lutein and zeaxanthin levels and macular pigment optical density. Clin Ophthalmol. 2016;10: 2149-55.
- Hammond BR, Jr., Fletcher LM, Elliott JG. Glare disability, photostress recovery, and chromatic contrast: relation to macular pigment and serum lutein and zeaxanthin. Invest Ophthalmol Vis Sci. 2013;54(1):476-81.
- Nolan JM, Power R, Stringham J, et al. Enrichment of Macular Pigment Enhances Contrast Sensitivity in Subjects Free of Retinal Disease: Central Retinal Enrichment Supplementation Trials - Report 1. Invest Ophthalmol Vis Sci. 2016;57(7):3429-39.
- Stringham JM, Garcia PV, Smith PA, et al. Macular pigment and visual performance in glare: benefits for photostress recovery, disability glare, and visual discomfort. Invest Ophthalmol Vis Sci. 2011;52(10):7406-15.
- Berrow EJ, Bartlett HE, Eperjesi F, et al. The effects of a lutein-based supplement on objective and subjective measures of retinal and visual function in eyes with age-related maculopathy -- a randomised controlled trial. Br J Nutr. 2013;109(11):2008-14.
- Richer S, Devenport J, Lang JC. LAST II: Differential temporal responses of macular pigment optical density in patients with atrophic age-related macular degeneration to dietary supplementation with xanthophylls. Optometry. 2007;78(5):213-9.
- Richer S, Stiles W, Statkute L, et al. 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. 2004;75(4):216-30.
- Age-Related Eye Disease Study 2 Research Group. Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration: the Age-Related Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA. 2013;309(19):2005-15.
- Age-Related Eye Disease Study 2 Research Group, Chew EY, Clemons TE, et al. Secondary analyses of the effects of lutein/zeaxanthin on age-related macular degeneration progression: AREDS2 report No. 3. JAMA Ophthalmol. 2014;132(2):142-9.
- Jackson GR, Owsley C, McGwin G, Jr. Aging and dark adaptation. Vision Res. 1999;39(23):3975-82.
- Available at: http://www.ncbi.nlm.nih.gov/books/NBK10850/. Accessed April 6, 2017.
- Lee SH, Jeong E, Paik SS, et al. Cyanidin-3-glucoside extracted from mulberry fruit can reduce N-methyl-N-nitrosourea-induced retinal degeneration in rats. Curr Eye Res. 2014;39(1):79-87.
- Tremblay F, Waterhouse J, Nason J, et al. Prophylactic neuroprotection by blueberry-enriched diet in a rat model of light-induced retinopathy. J Nutr Biochem. 2013;24(4):647-55.
- Tirupula KC, Balem F, Yanamala N, et al. pH-dependent interaction of rhodopsin with cyanidin-3-glucoside. 2. Functional aspects. Photochem Photobiol. 2009;85(2):463-70.
- Yanamala N, Tirupula KC, Balem F, et al. pH-dependent interaction of rhodopsin with cyanidin-3-glucoside. 1. Structural aspects. Photochem Photobiol. 2009;85(2):454-62.
- Matsumoto H, Nakamura Y, Tachibanaki S, et al. Stimulatory effect of cyanidin 3-glycosides on the regeneration of rhodopsin. J Agric Food Chem. 2003;51(12):3560-3.