Lutein and Zeaxanthin

Lutein and Zeaxanthin are "carotenoids" or pigments produced by some fruits and vegetables. They are powerful antioxidants which are important in neutralizing free radicals which are the waste products of cell metabolism. These waste products are produced by the normal activity of cells in the body or can be introduced from outside sources like pollution, cigarette smoke, radiation and some medications. Build-up of free radicals can cause damage to the cells. Retinal cells, especially those in the macula, are highly metabolic and produce a lot of waste products that need to be cleaned up. Lutein and Zeathanthin naturally clean up this toxic waste and also can filter blue light and prevent damage from sunlight. They work even better when combined.

Foods that are rich in lutein and zeaxanthin include dark-green vegetables like kale, spinach and broccoli. Egg yolk, peppers and grapes are also good sources.

If you are not getting enough through natural sources, you could supplement with 10 mg Lutein and 2 mg of Zeaxanthin daily. This is especially helpful in protecting against worsening age-related macular degeneration.

  1. Li L, Lee J, Leun H, et al. Lutein Supplementation for Eye Diseases. Nutrients. 2020 Jun; 12(6): 1721.
  2. Mares, J. Lutein and Zeaxanthin Isomers in Eye Health and Disease. Annu Rev Nutr. 2016 July 17; 36: 571-602.


Bilberry or Vaccinium myrtillus is a plant that produces blueberry-like berries. Bilberry is rich in polyphenols called anthocyanins. These are water-soluble pigments that give the berries their violet-blue colour. The berries and leaves of this plant have been used as a treatment for various conditions since the Middle Ages. Bilberry extract has been shown to slow down the progression of high myopia (near-sightedness) in children and alleviate dry and tired eye symptoms.


  1. Kamiya, K, Kobashi, H, Fujiwara, K, et al. Effect of fermented bilberry extracts on visual outcomes in eyes with myopia: a prospective, randomized, placebo-controlled study. J Ocul Pharmacol Ther. 2013 Apr;29(3):356-9.
  2. Omar, I. A. N.Effect of bilberry extract on slowing high-myopia progression in children: 2-year follow-up study. Clin Ophthalmol. 2018, 12: 2575-2579.
  1. Yu W, Chan L, Chung A, et al. Bilberry-containing supplements on severe dry eye disease in young and middle-aged adults: A 3-month pilot analysis. Front Nutr. 2023 Jan 19:10:1061818. Bilberry-containing supplements on severe dry eye disease in young and middle-aged adults: A 3-month pilot analysis.
  2. Riva A, Togni S, Franceschi F, et al. The effect of a natural, standardized bilberry extract (Mirtoselect®) in dry eye: a randomized, double blinded, placebo-controlled trial. Eur Rev Med Pharmacol Sci. 2017 May;21(10):2518-2525.
  3. Kawabata, F. Tsuji, T. Effects of dietary supplementation with a combination of fish oil, bilberry extract, and lutein on subjective symptoms of asthenopia in humans. Biomedical Research 2011, 32 (6) 387-393.
  4. Muth, E. R. Laurent, J. M. Jasper, P. The effect of bilberry nutritional supplementation on night visual acuity and contrast sensitivity. Altern Med Rev. 2000 Apr;5(2):164-73.

Gingko biloba

This herbal supplement has a positive effect on neurological function, especially in peripheral vascular disease, cerebral insufficiency, mental disorders and memory enhancement. Gingko biloba extract is protective of optic nerve and retinal tissues, especially in the case of neuro-degenerative eye diseases like glaucoma. Although it is well-tolerated, it should be taken with caution since it is also a strong blood thinner and will increase the risk of bleeding.

  1. Cybulska, A. K. Mozaffarieh, M. Flammer, J. Ginkgo biloba: An adjuvant therapy for progressive normal and high tension glaucoma. Mol Vis. 2012; 18:390-402.
  2. Shim, S., Kim, J, Choi, C, et al. Ginkgo biloba extract and bilberry anthocyanins improve visual function in patients with normal tension glaucoma. J Med Food. 2012 Sep; 15(9): 818-823.
  3. Labkovich, M, Jacobs, E. B, Bhargava, S. Ginkgo Biloba Extract in Ophthalmic and Systemic Disease, With a Focus on Normal-Tension Glaucoma. Asia Pac J Ophthalmol (Phila).2020 May-Jun;9(3):215-225.


Beta-carotene is an antioxidant which converts to vitamin A (retinol) in the body. Vitamin A is important in many biological functions including vision. Lack of vitamin A can lead to difficulty seeing at night, or "night blindness". Vitamin A deficiency can also cause dry eyes, eye infections, skin problems, and delayed growth. There are many foods rich in vitamin A including meat, fish, eggs, vegetables like carrots, collard greens and fruits like mangoes, watermelons and apricots.

Beta-carotene is no longer advisable as a supplement for macular degeneration since it can increase the risk of lung cancer in people who smoke or have been exposed to asbestos. It has been removed from the AREDS (Age-Related Eye Disease Study) formulated vitamin supplements. Your health care professional should determine if you need supplementation.

  1. Johra, F. T, Bepari, A. K, Bristy, A. T, et al. A Mechanistic Review of beta-Carotene, Lutein, and Zeaxanthin in Eye Health and Disease. Antioxidants (Basel). 2020Oct 26;9(11):1046.
  2. Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group. The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med. 1994 Apr 14;330(15):1029-35.


Niacinamide, also known as nicotinamide is a water-soluble form of vitamin B3. It is not niacin, which is a different form of Vitamin B3 and can be toxic to the retina. Niacinamide is present in foods such as meat, fish, milk, eggs, vegetables and cereals. It is essential for metabolizing fats and sugars in the body, and is crucial in maintaining cell health.

In high doses, it has been shown to support faster recovery of injured optic nerve and retinal cells. It is useful as a neuroprotective therapy for glaucoma and in some patients can help improve their vision to a noticeable extent. However, it can have significant side effects at high doses and is rarely toxic to the liver. It should be taken under the supervision of your ophthalmologist with frequent blood monitoring to ensure that there are no toxic effects to your body.



Quercetin is a flavonol found in many fruits and vegetables. It is a strong antioxidant, anti-inflammatory, anti-fibrotic and immunomodulator. It is also has some protection against cancer, vessel and nerve damage. It has some promising benefits in various diseases, including various eye conditions but research is limited.

  1. Zhao, L, Wang, H, Du, X. The therapeutic use of quercetin in ophthalmology: recent applications. Biomed Pharmacother. 2021 May:137:111371.
  2. Ortega, J. T, Jastrzebska, B. Neuroinflammation as a Therapeutic Target in Retinitis Pigmentosa and Quercetin as Its Potential Modulator. Pharmaceutics. 2021 Nov 16;13(11):1935.

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