A Closer Look at the Eye Health Market

In 1952, a low-budget film, Bwana Devil, appeared in theaters during the short-lived "Golden Era" of 3-D cinematography. Old photos from 1950s movie theaters reveal cinema fans adorned with boxed-shaped white 3-D eye glasses. Although the novelty of 3-D movies wore off rather quickly, the idea of going to the movies for entertainment has only flourished. The main act of seeing a movie is viewingsight. It requires vision, or good enough vision to view the silver screen. Unfortunately, eye ailments such as age-related macular degeneration (AMD), cataract, glaucoma and diabetic retinopathy make it difficult for many to enjoy simple luxuries such as going to the movies. When faced with the thought of which sense is the most important there is no doubt that consumers would select sight as number one, said Bill Van Dyke, CEO, B&D. Consistent eye exams are critical to maintaining ones eye sight, but there is no doubt consumers are looking toward nutrition as well.

According to the National Retina Institute (NRI), AMD, an abnormality of the blood supply to the light-sensitive portion of the retina, primarily a result of aging, affects 1.5 million Americans and is the leading cause of visual impairment in people older than 65 years. NRI reports dry AMD, caused by the aging and thinning of the blood vessels under the macula, is accountable for 80 percent of all cases of AMD, but only 20 percent of severe vision loss. Wet AMD, a response to the continued development of cellular waste products under the retina, is accountable for the other 20 percent of cases, and causes the majority of severe vision loss. Diabetic retinopathydefined by NRI as the leaking of blood vessels within the retina, commonly found in diabetics that can lead to retinal swelling, scarring and retinal detachmentis treatable with early detection. According to the Natural Marketing Institutes (NMI) 2008 Health and Wellness Trends Database®, 21 percent of consumers (general population U.S. adults) are managing or treating vision/eye-health problems.

The nutraceutical industry has set its sights on eye health and beneficial carotenoids, such as lutein and zeaxanthin, that are not only the main components of macular health, but work preventively to fight the risk of developing ocular ailments. Consumer awareness still has a ways to go, but its on the rise. NMIs 2008 Health and Wellness Trends Database also reported 44 percent of consumers are more likely to use supplements in preventing/treating vision/eye-health problems, while 37 percent prefer foods and 9 percent beverages. The top products/ingredients consumers reported they associate with eye health were lutein, vitamin E, antioxidants and lycopene.

All eye-health ingredients may not be widely understood and recognized, said Hiren Doshi, business development director, OmniActive Health Technologies. Yet consumer awareness about the need to include antioxidant carotenoids and nutrients (such as lutein) in their dietthrough food and supplementshas definitely increased. This shift toward greater eye-health awareness is illustrated by the growth in antioxidant claims for new products, which have reportedly multiplied more than three-fold from 2002 to 2006, according to Datamonitors Product Scan Online service.

Baldur Hjaltason, sales manager for EPAX AS agreed: One could say the U.S. market is still in its infancy, not at least compared to Europe, where the market for eye-health ingredients is estimated to be worth $43 million USD in 2007. According to a Frost & Sullivan report, it is expected to grow to $87 million USD in 2014. He noted until recently there has been little focus on role of ingredients such as lutein, beta-carotene, zeaxanthin and DHA from marine oils on eye health; rather, most of the eye health studies have been done on single ingredients. However, the focus seems to be turning to combinations of one or more of those ingredients, examining eye health in broader way.

Consumers are increasingly concerned with eye health. Based on our own research and discussions with our customers, we know consumers are more concerned about eye health and awareness is improving, said Kevin Meyle, director of product management, nutritional ingredients at Kalsec. Also, the benefits of published studies like Celtic Age-Related Macular Degeneration (CARMA) and, eventually, the The Age-Related Eye Disease Study (AREDS) II will only highlight the beneficial effects of supplementing their diets to improve eye health.

Consumer awareness is vital, as low awareness increases the risk of consumers developing poor eye health, leading to bigger issues. Eye health is something consumers do not think about until there is a problem, and by then, it may be too late, said Phil Gowaski, sales manager, Chrysantis Inc. Awareness of supplements and ingredients benefits eye health by drawing attention to the fact that the eyes require specific nutrients to continue functioning properly, as well as aiding in prevention of eye disease.

All Eyes on Supplements

Carotenoids are heating up the market with researched-backed claims on their vision benefits. Zeaxanthin and lutein differ from other carotenoids in that they are not converted in the body into vitamin A, as many other carotenoids are. Although they have yellow pigments, they are mainly found in leafy green vegetables such as kale, spinach, collard greens, broccoli, zucchini, peas and Brussels sprouts. A study in Nutrition Journal recommended patients at risk for AMD increase their intake of green leafy vegetables and wear ultraviolet (UV) protection lenses and hats when outdoors.¹ In 2009, Applied Ergonomics published a study in which 13 participants were randomly assigned to either a lutein, zeaxanthin and black currant extract supplement or a placebo.² The combination formula exerted a possible reduction in visual-fatigue symptoms. Researchers also found higher dietary intake of lutein/zeaxanthin was independently associated with a decreased likelihood of having neovascular and long-term incident AMD, geographic atrophy, and large or extensive intermediate drusen.^3,4

A study conducted by the Macular Pigment Research Group in Waterford, Ireland, showed several variables related to risk for age-related maculopathy (ARM) are associated with a relative dietary lack of key nutrients. Researchers said, Age, the most important and universal risk factor for ARM, is associated with a relative lack of dietary zeaxanthin.⁵ In June 2009, researchers from The CARMA Study Group revealed the results of its five-year study on nutritional supplementation with carotenoids in patients with early AMD. The results showed the intake of the CARMA supplement preserved the quality of macular pigments. According to the outcomes of the study, the macular pigment of participants who were assigned to the placebo declined steadily, whereas a modest increase in the macular pigment of the intervention group was observed. And, beneficial effects on visual function were observed with increasing levels of serum lutein in CARMA study participants.

Meyle said: A little over two years ago, I would run into people at trade shows who didn't know how to pronounce zeaxanthin, much less know about its existence. Now, zeaxanthin continues to gain acceptance as it is viewed as a necessary carotenoid for eye health. There are many advocates of supplementation who are spreading the word using personal and professional blogs, Facebook, Twitter and other electronic media. There is a great amount of discussion going on in these forums every day promoting healthy diets and supplementation of these important ingredients.

Aparna Parikh, marketing manager, DSM Nutritional Products, agreed with Meyle, noting zeaxanthin may still be in its infancy, but science backs both zeaxanthin and lutein and their role in eye health. Trends show a steady increase in the awareness of lutein from 3 percent in 1999 to 30 percent in 2008, she said, citing results of a custom study DSM co-sponsored. Sixty-five percent of those aware of lutein are able to specify eye health as a benefit of lutein. This awareness in part has grown as a result of Wyeth Consumer Healths introduction of Centrum with lutein around 1995. 

NMIs 2008 Health and Wellness Trends Database also stated 16 percent of consumers (general population) agree completely/somewhat that it is important for their stores to have foods/beverages enriched with lutein.

Omega-3s have been lauded for their benefits on brain health, but they are also gaining momentum for their beneficial effects on the eye. Omega-3 remains to be best known for brain health, but is gaining recognition in the eye-health category, Doshi said. Awareness of fish oils/omega-3 is extremely highnine in 10 adults are aware of fish oils/omega-3. Consumers are less aware of the role of omega-3 polyunsaturated fatty acids (PUFAs) and AMD since the science is still emerging, Parikh said.

The research is still surfacing, but plenty of studies currently show favorable results in omega-3s role in eye health. French researchers reported, in spite of the different susceptibility of the retina and the lacrimal gland to dietary PUFAs, the concomitant use of dietary omega-3 and omega-6 PUFAs may be useful in modulating inflammation in both tissues.⁶ In May 2009, a separate French study demonstrated six-month supplementation with a combination of omega-3 and omega-6 PUFAs is more effective than single supplementation, since the eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA) + gamma-linolenic acid (GLA) dietary combination prevented retinal cell structure and decreased glial cell activation induced by the elevation of intraocular pressure in rats.⁷ An Australian study also confirmed omega-3s role in healthy eyes, stating, A diet low in trans-unsaturated fat and rich in omega-3 fatty acids and olive oil may reduce the risk of AMD.⁸ And, a 2009 study provided evidence of protection against early AMD from regularly eating fish, greater consumption of omega-3 polyunsaturated fatty acids and low intakes of foods rich in linoleic acid.⁹

Gowaski also agreed on the recent popularity of omega-3s and noted more attention will be paid to omega-3s, as well as other supplements, when the result from the Age-Related Eye Disease Study(AREDS) II study are released.

Hjaltason added: The first AREDS was done by the National Eye Institute (NEI) and published in October 2001. It showed beneficial effects on intermediate AMD by consuming vitamins A, C and E as supplements along with the minerals zinc and copper. Now, another AREDS study is in progress where lutein, zeaxanthin and DHA have been included. The results will be out in 2012 and, if successful, will have a great impact when this kind of product combination will be on the market for eye health in the near future.

Carotenoids and omega-3s, along with other supplements, play a major role in eye health and not only do consumers need to be aware of their benefits, manufacturers need to be aware of the quality of these ingredients. We also see supplement manufacturers with the new cGMPs are beginning to have an awareness and understand the differences between dietary zeaxanthin and chemically synthesized non-dietary meso-zeaxanthin, Meyle said. It's important to recognize from the nutritional standpoint that not all zeaxanthin forms have the same bioavailability and the source of zeaxanthin for supplements is seen as very important.

The Marketplace and Future of Eye Health

Its undeniable that the market for eye-health products is on the rise. Lutein and zeaxanthin for middle-aged consumers and omega-3s for infants are both fast-growing segments within eye-health area, Parikh said. What is also gaining interest and momentum is the eye-health area for younger adults as would see in Visual Performance Glaceaus VitaminWater is a good example of this. Its focus SKU containing lutein is one of the top movers for the company, based on pointo- sale scanned data as provided by IRI, and rightfully so. The visual performance platform essentially opens the marketplace to all adultsanyone who drives, anyone who plays sports, anyone who participates in outdoor recreationessentially all adults from what was historically a platform positioned around older adults. While eye health in general is still a developing segment, we at DSM believe the next three to five years will change the way we look at eye health and the market potential it represents.

Van Dyke agreed there is great potential ahead. I believe we will see more elective surgeries to improve eye sight and more companies will promote eye-health nutrients in mainstream products, he said. Delivery systems for eye health will evolve and more money will be spent to understand the role of supplements.

Gowaski concluded: The future looks bright. There is a groundswell of information on proper nutrition for the eyes and awareness of protective nutrients for eye health is also increasing in the general population. The practitioner channel is also growing with optometrists and ophthalmologists recommending proper nutrition and dietary supplements as a means of maintaining and improving eye health.

The future looks bright indeed. With more research being published on the direct correlation between diet/supplementation and sight, eye healths foundation can only strengthen, making consumers sight clearer.

References for "Ocular Health Market"

1.       Maneli Mozaffarieh , Stefan Sacu, Andreas Wedrich The role of the carotenoids, lutein and zeaxanthin, in protecting against age-related macular degeneration: A review based on controversial evidence Nutr J. 2003;2:20

2.       Yagi A et al. The effect of lutein supplementation on visual fatigue: A psychophysiological analysis Appl Ergon. 2009 Jun 19. [Epub ahead of print]

3.       Age-Related Eye Disease Study Research Group et al. The relationship of dietary carotenoid and vitamin A, E, and C intake with age-related macular degeneration in a case-control study: AREDS Report No. 22 Arch Ophthalmol. 2007 Sep;125(9):1225-32

4.       Tan, JS et al. Dietary antioxidants and the long-term incidence of age-related macular degeneration: the Blue Mountains Eye Study Ophthalmology. 2008 Feb;115(2):334-41

5.       Eamonn D O'Connell et al. Diet and risk factors for age-related maculopathy Am J Clin Nutr. 2008;87(3):712-722

6.       Schnebelen C et al. Nutrition for the eye: different susceptibility of the retina and the lacrimal gland to dietary omega-6 and omega-3 polyunsaturated fatty acid incorporation Ophthalmic Res. 2009;41(4):216-24

7.       Schnebelen C et al. A dietary combination of omega-3 and omega-6 polyunsaturated fatty acids is more efficient than single supplementations in the prevention of retinal damage induced by elevation of intraocular pressure in rats Graefes Arch Clin Exp Ophthalmol. 2009 May 13. [Epub ahead of print]

8.       Chong EW et al. Fat consumption and its association with age-related macular degeneration Arch Ophthalmol. 2009 May;127(5):674-80

9.       Tan JS et al. Dietary fatty acids and the 10-year incidence of age-related macular degeneration: the Blue Mountains Eye Study Arch Ophthalmol. 2009;127(5):656-65