Skip to main content
SpringerLink
Log in

Antioxidants and vision health: facts and fiction

  • Published:
Molecular and Cellular Biochemistry Aims and scope Submit manuscript

Abstract

A number of nutritional supplements containing antioxidants are advertised for better vision health. Do they benefit the average consumer? The literature was examined for the effectiveness of antioxidants for human eye health, and for the intricacies in collection of such evidence. The following diseases were considered: cataract, glaucoma, age-related macular degeneration (AMD), retinopathy, retinitis pigmentosa, eye infections, and uveitis. The literature indicates that antioxidant supplements plus lutein have a reasonable probability of retarding AMD. For glaucoma, such supplements were ineffectual in some studies but useful in others. In some studies, antioxidant rich fruits and vegetables were also useful for protection against glaucoma. For diabetic retinopathy, antioxidant supplements may have a small benefit, if any, but only as an adjunct to glycemic control. In very high-risk premature retinopathy and retinitis pigmentosa, antioxidant supplements may be beneficial but those with excess Vitamin E should be avoided. For cataract, there is no evidence for an advantage of such nutritional supplements. However, lubricant drops containing N-acetylcarnosine may be helpful in initial stages of the disease. For eye infections and other causes of uveitis, antioxidants have not been found useful. We recommend that a diet high in antioxidant rich foods should be developed as a habit from an early age. However, when initial signs of vision health deterioration are observed, the appropriate nutritional supplement products may be recommended but only to augment the primary medical treatments.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Resnikoff S, Pascolini D, Etya’ale D, Kocur I, Pararajasegaram R, Pokharel GP, Mariotti SP (2004) Global data on visual impairment in the year 2002. Bull World Health Organ 82:844–851

    PubMed Central  PubMed  Google Scholar 

  2. Congdon N, O’Colmain B, Klaver CC, Klein R, Munoz B, Friedman DS, Kempen J, Taylor HR, Mitchell P (2004) Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol 122:477–485

    Article  PubMed  Google Scholar 

  3. Gunasekera V, Ernst E, Ezra DG (2008) Systematic internet-based review of complementary and alternative medicine for glaucoma. Ophthalmology 115:435–439

    Article  PubMed  Google Scholar 

  4. Walia M, Kwan CY, Grover AK (2003) Effects of free radicals on coronary artery. Med Princ Pract 12:1–9

    Article  PubMed  Google Scholar 

  5. Romano AD, Serviddio G, de Matthaeis A, Bellanti F, Vendemiale G (2010) Oxidative stress and aging. J Nephrol 23(Suppl 15):S29–S36

    PubMed  Google Scholar 

  6. Oliveira BF, Nogueira-Machado JA, Chaves MM (2010) The role of oxidative stress in the aging process. Sci World J 10:1121–1128

    Article  CAS  Google Scholar 

  7. Varma SD, Kovtun S, Hegde KR (2011) Role of ultraviolet irradiation and oxidative stress in cataract formation-medical prevention by nutritional antioxidants and metabolic agonists. Eye Contact Lens 37:233–245

    Article  PubMed Central  PubMed  Google Scholar 

  8. Babizhayev MA, Burke L, Micans P, Richer SP (2009) N-Acetylcarnosine sustained drug delivery eye drops to control the signs of ageless vision: glare sensitivity, cataract amelioration and quality of vision currently available treatment for the challenging 50,000-patient population. Clin Interv Aging 4:31–50

    CAS  PubMed Central  PubMed  Google Scholar 

  9. Babizhayev MA, Micans P, Guiotto A, Kasus-Jacobi A (2009) N-acetylcarnosine lubricant eyedrops possess all-in-one universal antioxidant protective effects of L-carnosine in aqueous and lipid membrane environments, aldehyde scavenging, and transglycation activities inherent to cataracts: a clinical study of the new vision-saving drug N-acetylcarnosine eyedrop therapy in a database population of over 50,500 patients. Am J Ther 16:517–533

    Article  PubMed  Google Scholar 

  10. Misner B (2012) What are the effects of topical N-acetylcarnosine [eye drops] on cataract-inhibited vision in an elderly subject?—a case report. Web Med Central http://webmedcentral.com/article_view/3214

  11. Ha JW, Schwahn AB, Downard KM (2010) Ability of N-acetylcarnosine to protect lens crystallins from oxidation and oxidative damage by radical probe mass spectrometry (RP-MS). Rapid Commun Mass Spectrom 24:2900–2908

    Article  CAS  PubMed  Google Scholar 

  12. Gritz DC, Srinivasan M, Smith SD, Kim U, Lietman TM, Wilkins JH, Priyadharshini B, Aravind S, Prajna NV, Smolin G, Thulasiraj RD, Selvaraj S, Whitcher JP (2006) Antioxidants in prevention of cataracts in South India: methodology and baseline data. Ophthalmic Epidemiol 13:97–107

    Article  PubMed  Google Scholar 

  13. Gritz DC, Srinivasan M, Smith SD, Kim U, Lietman TM, Wilkins JH, Priyadharshini B, John RK, Aravind S, Prajna NV, Duraisami TR, Whitcher JP (2006) The Antioxidants in Prevention of Cataracts Study: effects of antioxidant supplements on cataract progression in South India. Br J Ophthalmol 90:847–851

    Article  CAS  PubMed  Google Scholar 

  14. Toh T, Morton J, Coxon J, Elder MJ (2007) Medical treatment of cataract. Clin Experiment Ophthalmol 35:664–671

    Article  PubMed  Google Scholar 

  15. Fernandez MM, Afshari NA (2008) Nutrition and the prevention of cataracts. Curr Opin Ophthalmol 19:66–70

    Article  PubMed  Google Scholar 

  16. Mathew MC, Ervin AM, Tao J, Davis RM (2012) Antioxidant vitamin supplementation for preventing and slowing the progression of age-related cataract. Cochrane Database Syst Rev 6:CD004567

    PubMed  Google Scholar 

  17. Agte V, Tarwadi K (2010) The importance of nutrition in the prevention of ocular disease with special reference to cataract. Ophthalmic Res 44:166–172

    Article  PubMed  Google Scholar 

  18. Casson RJ, Chidlow G, Wood JP, Crowston JG, Goldberg I (2012) Definition of glaucoma: clinical and experimental concepts. Clin Experiment Ophthalmol 40:341–349

    Article  PubMed  Google Scholar 

  19. Grant J, Tran V, Bhattacharya SK, Bianchi L (2013) Ionic currents of human trabecular meshwork cells from control and glaucoma subjects. J Membr Biol 246:167–175

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Shoshani YZ, Harris A, Shoja MM, Rusia D, Siesky B, Arieli Y, Wirostko B (2012) Endothelin and its suspected role in the pathogenesis and possible treatment of glaucoma. Curr Eye Res 37:1–11

    Article  CAS  PubMed  Google Scholar 

  21. Anwar Z, Wellik SR, Galor A (2013) Glaucoma therapy and ocular surface disease: current literature and recommendations. Curr Opin Ophthalmol 24:136–143

    Article  PubMed  Google Scholar 

  22. Zanon-Moreno V, Ciancotti-Olivares L, Asencio J, Sanz P, Ortega-Azorin C, Pinazo-Duran MD, Corella D (2011) Association between a SLC23A2 gene variation, plasma vitamin C levels, and risk of glaucoma in a Mediterranean population. Mol Vis 17:2997–3004

    CAS  PubMed  Google Scholar 

  23. Yuki K, Murat D, Kimura I, Ohtake Y, Tsubota K (2010) Reduced-serum vitamin C and increased uric acid levels in normal-tension glaucoma. Graefes Arch Clin Exp Ophthalmol 248:243–248

    Article  CAS  PubMed  Google Scholar 

  24. Zanon-Moreno V, Garcia-Medina JJ, Gallego-Pinazo R, Vinuesa-Silva I, Moreno-Nadal MA, Pinazo-Duran MD (2009) Antioxidant status modifications by topical administration of dorzolamide in primary open-angle glaucoma. Eur J Ophthalmol 19:565–571

    PubMed  Google Scholar 

  25. Izzotti A, Sacca SC, Di Marco B, Penco S, Bassi AM (2008) Antioxidant activity of timolol on endothelial cells and its relevance for glaucoma course. Eye (Lond) 22:445–453

    Article  CAS  Google Scholar 

  26. Wang SY, Singh K, Lin SC (2013) Glaucoma and vitamins A, C, and E supplement intake and serum levels in a population-based sample of the United States. Eye (Lond) 27:487–494

    Article  CAS  Google Scholar 

  27. Ramdas WD, Wolfs RC, Kiefte-de Jong JC, Hofman A, de Jong PT, Vingerling JR, Jansonius NM (2012) Nutrient intake and risk of open-angle glaucoma: the Rotterdam Study. Eur J Epidemiol 27:385–393

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Giaconi JA, Yu F, Stone KL, Pedula KL, Ensrud KE, Cauley JA, Hochberg MC, Coleman AL (2012) The association of consumption of fruits/vegetables with decreased risk of glaucoma among older African-American women in the study of osteoporotic fractures. Am J Ophthalmol 154:635–644

    Article  PubMed Central  PubMed  Google Scholar 

  29. Kang JH, Pasquale LR, Willett W, Rosner B, Egan KM, Faberowski N, Hankinson SE (2003) Antioxidant intake and primary open-angle glaucoma: a prospective study. Am J Epidemiol 158:337–346

    Article  PubMed  Google Scholar 

  30. Chung HS, Harris A, Kristinsson JK, Ciulla TA, Kagemann C, Ritch R (1999) Ginkgo biloba extract increases ocular blood flow velocity. J Ocul Pharmacol Ther 15:233–240

    Article  CAS  PubMed  Google Scholar 

  31. Shim SH, Kim JM, Choi CY, Kim CY, Park KH (2012) Ginkgo biloba extract and bilberry anthocyanins improve visual function in patients with normal tension glaucoma. J Med Food 15:818–823

    Article  CAS  PubMed  Google Scholar 

  32. Park JW, Kwon HJ, Chung WS, Kim CY, Seong GJ (2011) Short-term effects of Ginkgo biloba extract on peripapillary retinal blood flow in normal tension glaucoma. Korean J Ophthalmol 25:323–328

    Article  PubMed Central  PubMed  Google Scholar 

  33. Quaranta L, Bettelli S, Uva MG, Semeraro F, Turano R, Gandolfo E (2003) Effect of Ginkgo biloba extract on preexisting visual field damage in normal tension glaucoma. Ophthalmology 110:359–362

    Article  PubMed  Google Scholar 

  34. de Jong PT (2006) Age-related macular degeneration. N Engl J Med 355:1474–1485

    Article  PubMed  Google Scholar 

  35. The Age-Related Eye Disease Study 1(AREDS1) Research Group (2001) A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 8. Arch Ophthalmol 119:1417–1436

    Article  Google Scholar 

  36. The Age-Related Eye Disease Study 2(AREDS2) Research Group (2013) Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration: the Age-Related Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA 309:2005–2015

    Article  Google Scholar 

  37. Evans JR, Lawrenson JG (2012) Antioxidant vitamin and mineral supplements for preventing age-related macular degeneration. Cochrane Database Syst Rev 6:CD000253

    PubMed  Google Scholar 

  38. Evans JR, Lawrenson JG (2012) Antioxidant vitamin and mineral supplements for slowing the progression of age-related macular degeneration. Cochrane Database Syst Rev 11:CD000254

    PubMed  Google Scholar 

  39. Chong EW, Wong TY, Kreis AJ, Simpson JA, Guymer RH (2007) Dietary antioxidants and primary prevention of age related macular degeneration: systematic review and meta-analysis. BMJ 335:755

    Article  PubMed  Google Scholar 

  40. Piccardi M, Marangoni D, Minnella AM, Savastano MC, Valentini P, Ambrosio L, Capoluongo E, Maccarone R, Bisti S, Falsini B (2012) A longitudinal follow-up study of saffron supplementation in early age-related macular degeneration: sustained benefits to central retinal function. Evid Based Complement Alternat Med 2012:429124

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Madsen-Bouterse SA, Kowluru RA (2008) Oxidative stress and diabetic retinopathy: pathophysiological mechanisms and treatment perspectives. Rev Endocr Metab Disord 9:315–327

    CAS  PubMed  Google Scholar 

  42. Williams M, Hogg RE, Chakravarthy U (2013) Antioxidants and diabetic retinopathy. Curr Diab Rep 13:481–487

    Article  CAS  PubMed  Google Scholar 

  43. Saugstad OD (2006) Oxygen and retinopathy of prematurity. J Perinatol 26(Suppl 1):S46–S50

    Article  CAS  PubMed  Google Scholar 

  44. Garcia-Medina JJ, Pinazo-Duran MD, Garcia-Medina M, Zanon-Moreno V, Pons-Vazquez S (2011) A 5-year follow-up of antioxidant supplementation in type 2 diabetic retinopathy. Eur J Ophthalmol 21:637–643

    Article  PubMed  Google Scholar 

  45. Millen AE, Klein R, Folsom AR, Stevens J, Palta M, Mares JA (2004) Relation between intake of vitamins C and E and risk of diabetic retinopathy in the Atherosclerosis Risk in Communities Study. Am J Clin Nutr 79:865–873

    CAS  PubMed  Google Scholar 

  46. Raju TN, Langenberg P, Bhutani V, Quinn GE (1997) Vitamin E prophylaxis to reduce retinopathy of prematurity: a reappraisal of published trials. J Pediatr 131:844–850

    Article  CAS  PubMed  Google Scholar 

  47. Brion LP, Bell EF, Raghuveer TS (2003) Vitamin E supplementation for prevention of morbidity and mortality in preterm infants. Cochrane Database Syst Rev 4:CD003665

    PubMed  Google Scholar 

  48. Johnson L, Schaffer D, Quinn G, Goldstein D, Mathis MJ, Otis C, Boggs TR Jr (1982) Vitamin E supplementation and the retinopathy of prematurity. Ann N Y Acad Sci 393:473–495

    Article  CAS  PubMed  Google Scholar 

  49. Dani C, Lori I, Favelli F, Frosini S, Messner H, Wanker P, De Marini S, Oretti C, Boldrini A, Massimiliano C, Bragetti P, Germini C (2012) Lutein and zeaxanthin supplementation in preterm infants to prevent retinopathy of prematurity: a randomized controlled study. J Matern Fetal Neonatal Med 25:523–527

    Article  CAS  PubMed  Google Scholar 

  50. Parad RB, Allred EN, Rosenfeld WN, Davis JM (2012) Reduction of retinopathy of prematurity in extremely low gestational age newborns treated with recombinant human Cu/Zn superoxide dismutase. Neonatology 102:139–144

    Article  CAS  PubMed  Google Scholar 

  51. Baumgartner WA (2000) Etiology, pathogenesis, and experimental treatment of retinitis pigmentosa. Med Hypotheses 54:814–824

    Article  CAS  PubMed  Google Scholar 

  52. Hartong DT, Berson EL, Dryja TP (2006) Retinitis pigmentosa. Lancet 368:1795–1809

    Article  CAS  PubMed  Google Scholar 

  53. Berson EL, Rosner B, Sandberg MA, Weigel-DiFranco C, Moser A, Brockhurst RJ, Hayes KC, Johnson CA, Anderson EJ, Gaudio AR, Willett WC, Schaefer EJ (2004) Further evaluation of docosahexaenoic acid in patients with retinitis pigmentosa receiving vitamin A treatment: subgroup analyses. Arch Ophthalmol 122:1306–1314

    Article  CAS  PubMed  Google Scholar 

  54. Pasantes-Morales H, Quiroz H, Quesada O (2002) Treatment with taurine, diltiazem, and vitamin E retards the progressive visual field reduction in retinitis pigmentosa: a 3-year follow-up study. Metab Brain Dis 17:183–197

    Article  CAS  PubMed  Google Scholar 

  55. Berson EL, Rosner B, Sandberg MA, Weigel-DiFranco C, Willett WC (2012) Omega-3 intake and visual acuity in patients with retinitis pigmentosa receiving vitamin A. Arch Ophthalmol 130:707–711

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  56. Jacobson SG, Cideciyan AV (2010) Treatment possibilities for retinitis pigmentosa. N Engl J Med 363:1669–1671

    Article  CAS  PubMed  Google Scholar 

  57. Berson EL, Rosner B, Sandberg MA, Hayes KC, Nicholson BW, Weigel-DiFranco C, Willett W (1993) A randomized trial of vitamin A and vitamin E supplementation for retinitis pigmentosa. Arch Ophthalmol 111:761–772

    Article  CAS  PubMed  Google Scholar 

  58. Amza A, Goldschmidt P, Einterz E, Huguet P, Olmiere C, Bensaid P, Bella-Assumpta L (2010) Elimination of active trachoma after two topical mass treatments with azithromycin 1.5 % eye drops. PLoS Negl Trop Dis 4:e895

    Article  PubMed Central  PubMed  Google Scholar 

  59. Katabarwa MN, Eyamba A, Nwane P, Enyong P, Kamgno J, Kuete T, Yaya S, Aboutou R, Mukenge L, Kafando C, Siaka C, Mkpouwoueiko S, Ngangue D, Biholong BD, Andze GO (2013) Fifteen years of annual mass treatment of onchocerciasis with ivermectin have not interrupted transmission in the west region of cameroon. J Parasitol Res 2013:420928

    Article  PubMed Central  PubMed  Google Scholar 

  60. van Rooij J, Schwartzenberg SG, Mulder PG, Baarsma SG (1999) Oral vitamins C and E as additional treatment in patients with acute anterior uveitis: a randomised double masked study in 145 patients. Br J Ophthalmol 83:1277–1282

    Article  PubMed  Google Scholar 

  61. Read RW (2006) Uveitis: advances in understanding of pathogenesis and treatment. Curr Rheumatol Rep 8:260–266

    Article  PubMed  Google Scholar 

  62. Nussenblatt RB, Kim J, Thompson DJ, Davis MD, Chew E, Ferris FL, Buggage R (2006) Vitamin E in the treatment of uveitis-associated macular edema. Am J Ophthalmol 141:193–194

    Article  CAS  PubMed  Google Scholar 

  63. Bartlett H, Eperjesi F (2003) Age-related macular degeneration and nutritional supplementation: a review of randomised controlled trials. Ophthalmic Physiol Opt 23:383–399

    Article  PubMed  Google Scholar 

  64. Rathore M (2009) Nutrient content of important fruit trees from arid zone of Rajasthan. J Hortic For 1:103–108

    Google Scholar 

  65. Weller P, Breithaupt DE (2003) Identification and quantification of zeaxanthin esters in plants using liquid chromatography-mass spectrometry. J Agric Food Chem 51:7044–7049

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Drs. Kalpna Varshney and M.D. Coughlin for pre-reviewing the manuscript. The following websites are thankfully acknowledged for the images showing the effects of different eye diseases on vision: http://www.nei.nih.gov/health/cataract/cataract_facts.asp, http://www.edinaeyeclinic.com/wp-content/uploads/glaucoma_simulation.jpg, http://oshawaoptometrist.pinkclassic.com/wp-content/uploads/2012/04/amd-vision-loss-5.jpg, http://upload.wikimedia.org/wikipedia/commons/thumb/9/9c/Eye_disease_simulation,_diabetic_retinopathy.jpg/220px-Eye_disease_simulation,_diabetic_retinopathy.jpg.

Author information

Authors and Affiliations

  1. Department of Medicine, McMaster University, Hamilton, ON, L8N3Z5, Canada

    Ashok K. Grover & Sue E. Samson

  2. Department of Biology, McMaster University, Hamilton, ON, Canada

    Ashok K. Grover

Authors
  1. Ashok K. Grover
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sue E. Samson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ashok K. Grover.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Grover, A.K., Samson, S.E. Antioxidants and vision health: facts and fiction. Mol Cell Biochem 388, 173–183 (2014). https://doi.org/10.1007/s11010-013-1908-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11010-013-1908-z

Keywords

Search

Navigation