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MacuHealth should be recommended to two types of people. The first type includes ordinary people who want to maximize their visual performance in everyday life, especially if they are complaining of glare, difficulty with driving or other activities or difficulty with twilight vision.
The second group of people includes those with early AMD, or those at risk of developing AMD (people with a family history of AMD, or smokers, etc.
To view the MacuHealth Patient Chart for a complete guide to which of your patients need to be on MacuHealth click here.
Clinical trials show as many as 30% of patients do not have the enzymes necessary for the conversion of retinal lutein to retinal meso-zeaxanthin. At this time there is no way of knowing who converts and who doesn’t. When including meso-zeaxanthin in the supplement formulation, this concern is eliminated. In 2012 a ground breaking study in Experimental Eye Research, “Macular carotenoid supplementation in subjects with atypical spatial profiles of macular pigment”, demonstrated that patients with atypical macular pigment profiles (inability to convert) were found to have completely restored macular pigment profiles within 8 weeks of being supplemented with a formulation containing meso-zeaxanthin. Patients that do not have the ability to do this conversion have also been shown to be at greater risk of developing age-related macular degeneration.
A recent head-to-head trial of serum concentrations of macular pigment’s constituent carotenoids of following supplementation with high concentrations of Zeaxanthin versus high concentrations Lutein versus MacuHealth (10-10-2) revealed that the best serum concentrations of macular pigment’s constituent carotenoids was actually achieved with the MacuHealth formulation, thereby maximally facilitating capture by the target tissue (macula).
Also, the 10-10-2 formulation used by MacuHealth is the only formulation that has been proven to maximally augment macular pigment at the very centre (where Meso-Zeaxanthin is the dominant carotenoid) and to enhance visual performance in normal subjects and in subjects with early AMD. In other words, a short answer to your question is that the 10-10-2 formulation is the only formulation on the planet earth with science that backs up its usefulness in the real world. Introducing another formulation to the market will require a repeat of all studies to date, which will take at least 6 years.
The answer to this question is yes. Bernstein (a Salt Lake City-based retinal specialist) has eloquently shown that all three carotenoids are required to exert a maximal antioxidant effect. In order words, there are three parts to the jigsaw; two of those three parts isn’t enough to complete the jigsaw.
Furthermore, and with respect to the quantity aspect of your question, it has been shown that those at greatest risk of AMD (subjects with a central dip in their macular pigment spatial profile) can only have a normal profile of their macular pigment realised when the formulation contains all three of macular pigment’s constituent carotenoids, i.e. the MacuHealth formulation.
Again, this is backed up by evidence in normal subjects where the MacuHealth formulation was the only formulation to improve visual function (in terms of contrast sensitivity), under mesopic and photopic (night time and day time, respectively) conditions, with or without a glare source. This study has also been shown to have a similar and equally beneficial effect in subjects with early AMD (and in each of these trials, the MacuHealth formulation was compared with other formulations that differed from MacuHealth because they lacked Meso-Zeaxanthin, and no such benefit was demonstrable with these alternative formulations).
Yes, we would agree that a formulation should not contain beta-carotene for these reasons. However, this is not true of supplemental LMZ, as it has actually been shown that best serum bioavailability is achieved following supplementation with a formulation that contains all three of macular pigment’s constituent carotenoids (i.e. MacuHealth formulation).
The very center of the retina (that area which serves sharpest vision) is known as the fovea. The fovea does not contain photoreceptors that are sensitive to blue light (and therefore blue light is completely wasted on the central retina).
In addition, blue light is defocused, in a phenomenon known as chromatic aberration, so blue light actually blurs your vision and does not contribute to it at all. Also, a very common cause of visual disturbance is the result of light scatter. Light scatter simply means the wavelengths of light travelling through the atmosphere hit particles (inside or outside the eye) and are bounced in different directions, and this causes blurred vision.
Interestingly, it is only the short wavelength of visible light which are scattered (that is because a short wavelength is more or less the same size as a small particle whereas a long wavelength will not be disturbed when it hits small particle).
For this reason, it is the blue part of visible light which is scattered, and which causes scattered light on the retina in a phenomenon known as “veiling luminance”. This is best described in the following scenario: you are at a barbecue at 3:30 on a July afternoon in Florida and you look at the embers of the barbecue, and they all look grey. Four hours later, at seven thirty, and the embers are of the same brightness, but you can see them clearly. The reason for this is in the bright daylight the visible blue light is scattered over your retina, and this adversely affects the visibility of certain objects.
Therefore and by definition, blue light
- Does not contribute to visual performance (because there are no blue cones photoreceptors at the centre of the fovea)
- Produces chromatic aberration
- Affects the visibility of objects because blue light is the only visible wavelength to be scattered therefore, and by consequence, filtration of blue light before the blue light hits the retina will
- Not damage your visual performance (because there are no blue sensitive photoreceptors),
- Will reduce chromatic aberration (and therefore enhance contrast sensitivity) and
- Will reduce veiling luminance (the impact of scattered blue light), and therefore enhance visibility of objects. This is no longer a theory. This is scientific fact.
With respect to the second part of your question, why is the MacuHealth formulation the best, because the head-to-head trial recently published by Loughman et al. shows that only the MacuHealth formulation results in improved visual performance and experience, under night time and day time conditions, whereas this was simply not the case with the Lutein product which did not contain MZ
Age-related macular degeneration is the result of oxidative stress (oxidative stress simply refers to tissue damage by unstable molecules), and the retina is the ideal tissue for production of oxidative stress and damage by oxidative stress because the retina has the highest oxygen metabolism of any tissue in the mammalian world. Oxidative stress causes inflammation, and if the patient has genes which do not control inflammation (such as the AMD susceptibility genes), the subject will develop AMD.
Accordingly, if the subject can be stopped from generating the unstable molecules that cause oxidative stress in the first place, the patient will not get AMD (because they will not get any inflammation regardless of the genetic background). Oxidative stress is not only caused by oxygen metabolism, but it is also increased in the presence of radiation with light, but only the short wavelength (high energy) blue visible light.
In summary, therefore, oxidative stress is the trigger for AMD, which is produced by oxygen metabolism and by irradiation with visible light (Interestingly, the same is true for the skin, the only other tissue exposed to light, as exposure to such visible blue light also causes wrinkling and aging of the skin; hence, antioxidant creams are used to prevent skin aging;).
Therefore, and by definition, macular pigment reduces the risk of developing AMD and slows down the progression of AMD because
- it filters out blue light before the blue light hits the photoreceptors (and therefore before the blue light does not have the opportunity to irradiate the retina and increase oxidative stress) and
- because macular pigment is made up of three carotenoids (L, Z, and MZ), all of which are antioxidants (an antioxidant is simply a molecule which, like vitamin C, can neutralize the molecules that cause oxidative stress [these are known as free radicals]).
With respect to the second part of your question, how can this be easily explained to the patient? Simply say that the skin and the eyes are the only two organs in the body which are exposed to light. We are told to protect our skin from light from a very young age, with sun cream and protective stuff when out in the sunlight. The exact same is true for your eye, and therefore macular pigment should be seen as a sun screen for the central retina (i.e. the macula).
There is no direct relationship between Drusen and MPOD. However lack of MPOD is associated with increased risk of AMD (which includes Drusen).
It is not necessarily desirable for Drusen to disappear, because when they do, they almost always leave an atrophic patch and vision loss. Drusen are simply a manifestation of an underlying disease (and not the cause of the disease).
One needs to go further back in to the disease process and understand how macular pigment protects against AMD. In brief, it is an antioxidant and protects against blue light, and therefore high levels of macular pigment will prevent or delay the onset of AMD and Drusen formation (but they will not affect existing Drusen).
Astaxanthin is not relevant to the retina.
It is not known that there is an enzyme in the body that converts Lutein to Meso-Zeaxanthin; we simply know that Lutein is bio-converted to Meso-Zeaxanthin (mechanism unknown). No there is not a test to see if someone can convert Lutein to Meso-Zeaxanthin; however, if someone has a central dip in their macular pigment spatial profile, it is likely that they cannot convert Lutein to Meso-Zeaxanthin.
If you have AMD, it is unsurprising that using aspirin (which is a blood thinner) will increase the risk of leakage from any abnormal blood vessels associated with the age-related macular degeneration. However, the decision to discontinue the use of aspirin is not one that can be made by an eye care professional, because the patient will have been prescribed aspirin by his or her own general physician or family physician, and it is only that physician who can make that decision.
In fact, MacuHealth is the only formulation that has been tested in trials, the results of which have been published. There are only two randomized control trials looking at macular pigment supplement versus placebo in terms of visual function, and in one of these trials a small improvement in visual function was noted with Lutein versus placebo (Yao et al.).
In the other trial, MacuHealth was compared with a formulation that did not contain Meso-Zeaxanthin and compared with placebo, and in this trial it was found that MacuHealth resulted in greatly improved visual performance in terms of contrast sensitivity and glare disability (under mesopic and photopic conditions).
There are some further ongoing trials, but these will not be ready for some time. It is also worth noting that the AREDS 2 trial is fundamentally flawed, as macular pigment is not being measured in AREDS 2 and because the supplement being used does not include Meso-Zeaxanthin.
I would present improved visual performance benefits of MacuHealth as follows. A formulation containing macular pigment’s constituent carotenoids, (L, Z, and MZ; MacuHealth;) is required to maximally increase macular pigment and improve visual performance in a way that its competitors do not do (and this has been demonstrated in a randomized, placebo-controlled trial).
It is likely, from an evolutionary perspective, that macular pigment is there to maximize visual performance and result in visual excellence, and this intuitive reason for accumulation of these unique compounds in the central retina is borne out in the recent randomized controlled trial, which showed that supplementation with MacuHealth did indeed result in improved visual performance by maximizing vision under conditions of glare (under twilight and daytime conditions) and by maximizing contrast sensitivity (the ability to discriminate the foreground from the background). In fact, a recent publication has shown this is also true in patients with early AMD.
In other words, it is likely that macular pigment is there, from a Darwinian perspective, in order to achieve maximal visual performance and confer an advantage on a person with higher levels of macular pigment. Serendipitously, macular pigment’s two principal properties (antioxidant and blue light filtration) also protect against aging of the central retina (AMD) by preventing against cumulative oxidative stress both through the antioxidant effect of macular pigment’s constituent carotenoids and also by limiting the amount of oxidative stress produced by absorbing blue light before the blue light irradiates the retina and causesoxidative stress).
In other words, a formulation containing all three of macular pigment’s constituent carotenoids (i.e. MacuHealth) does, with certainty, maximize visual performance in normal subjects, and it is also best placed to protect against age-related macular degeneration (because it is the only formulation that realizes a normal peaked spatial profile of macular pigment in subjects who have a central dip in their profile, the latter being known risk factor for AMD).
MacuHealth represents the only formulation that has demonstrated the aforementioned benefits, which include the optimization of visual performance in normal subjects and in subjects with early AMD, and the maxima increase macular pigment across its spatial profile. A competing product will need to produce the same evidence (quantity and quality), which will take a minimum of six years to achieve.
The 10-10-2 formulation in MacuHealth is correct for the following reasons.
- A dietary consumption of Lutein is typically 3mg per day, and this is clearly not enough because if you supplement 100 people, most of them will actually exhibit an increase in their macular pigment, which means they are walking around with suboptimal levels of macular pigment.
- The 10-10-2 formulation is the only formulation that has shown, consistently, to result in a) augmentation of macular pigment b) realisation of the central dip of macular pigment c) improvement of macular function in normal people (even when compared with compounds that contain Lutein and Zeaxanthin [but no Meso-Zeaxanthin]) and d) improvement in macular function in patients with early age-related macular degeneration.
In summary, therefore, there is no doubt as to the correctness the formulation in MacuHealth.
