Lutein and Zeaxanthin Supplement Use and Macular Pigment Change Over 14 years in the Second Carotenoids and Age‐Related Eye Diseases Study (CAREDS2), an Ancillary Study to the Women's Health Initiative
Authors: Lawler Tom Patrick , Liu Zhe , Blomme Courtney , Hammond Randy , Gangnon Ronald , Johnson Elizabeth , Wallace Robert , Tinker Lesley , Millen Amy , Wooten Bill , Smollon Bill , Mares Julie 
Published: November 2023

PurposeMacular Pigment (MP), a retinal accumulation of lutein and zeaxanthin (L and Z), may modify risk for age‐related macular degeneration (AMD), a leading cause of blindness. Studies of MP change are limited, and may be influenced by L and Z supplement use. We describe changes in MPOD over 14 years in older women, and the relationship to supplemental L and Z. We describe whether other factors, including diet, lifestyle, and metabolic health, are related to MPOD change, or interact with L and Z supplement use.MethodsPreliminary data for 197 women (ages 70 to 98 years) seen for a 14‐year follow‐up visit were included. MPOD was measured using heterochromatic flicker photometry at 0.5° from the foveal center relative to reference levels at 7°, at baseline (2001–2004) and follow‐up (2016). Daily use of L and Z supplements was assessed by questionnaire at follow‐up. At baseline, waist circumference and body mass index were measured, and diet, lifestyle, and medication use were assessed in questionnaires. Serum L and Z was assessed in specimens from WHI study visits (1994–1998). Prevalent AMD and intraocular lens (IOL) were determined at follow‐up. Relationships between L and Z supplement use and MPOD change and potential interactions were determined by linear regression.ResultsWe observed a MPOD increase of 0.15 density units between baseline and CAREDS2 visits (P < .0001). L and Z supplement use at CAREDS2 was more prevalent than baseline (18% vs. 2%). Consuming >1mg daily, vs. less (including those consuming 0mg) was associated with greater mean (SE) MPOD change since baseline (0.23 ± 0.07 vs. 0.13 ± 0.02; p = .05). Adjustment for confounding strengthened this relationship. In supplement users, the increase in MPOD was greatest with baseline MPOD less than the median, lower healthy eating score, and in those without AMD (Pinteraction < .20). Age, physical activity level, and the presence of an IOL interacted positively with supplement use to predict MPOD change. Physical activity and IOL were directly related to greater MPOD change (P < .01) independent of supplements. Baseline MPOD and serum L and Z were inversely related to MPOD change (P =.05).ConclusionThese results suggest an average increase in MPOD with age that is related to the use of L and Z supplements. Other factors, including AMD status, baseline MPOD, physical activity level, and IOL, may modify this association or independently increase MPOD. Given the relatively small sample size, these results require confirmation in the larger study, once complete.Support or Funding InformationNIH/NEI (R01EY025292)This work was supported in part by an unrestricted grant from Research to Prevent Blindness, Inc. to the UW Madison Department of Ophthalmology and Visual Sciences.