Lutein and Zeaxanthin

What are lutein and zeaxanthin and what do they do in the eye?

Lutein and zeaxanthin are carotenoids of the xanthophyll class. According to the review by Bernstein and colleagues, the human macula concentrates these two pigments and meso-zeaxanthin with specific carrier proteins; they are yellow pigments that absorb short-wavelength (blue) light and work as local antioxidants in a region at high risk of light-related oxidative stress. ^[8] In the introduction to their meta-analysis, Wilson and colleagues state that these three carotenoids are the only carotenoids found in the human macula and that they may play a role in visual function. ^[7]

This is “role in the body” information. That the pigments are present in the macula does not mean that taking extra amounts orally protects vision or slows disease; these questions are addressed below separately with clinical studies. ^[8]

Which foods contain lutein and zeaxanthin?

According to Bernstein and colleagues, lutein and zeaxanthin must be obtained from dietary sources such as green leafy vegetables and orange and yellow fruits and vegetables; meso-zeaxanthin, by contrast, is rare in foods and is thought to form in the macula through metabolic conversion of ingested carotenoids. ^[8]

Do supplements raise macular pigment?

Yes, but as the dose increases. In the meta-analysis by Wilson and colleagues, 46 studies (3,189 participants; mean age 43; 42% men) in adults with healthy eyes were evaluated. At total lutein/zeaxanthin intakes below 5 mg per day (mostly 3–6-month dietary interventions), there was no significant change in macular pigment optical density (MPOD) (pooled mean difference 0.02; 95% CI −0.01 to 0.05). Between 5 and 20 mg/day the mean increase was 0.04 units (0.02–0.07), and at 20 mg per day and above (3–12 months) 0.11 units (0.06–0.16). ^[7] MPOD is a biomarker; this analysis does not show clinical vision outcomes, and the authors state that more research is needed to determine the minimum dose and duration for a clinically important change in MPOD or visual function. ^[7]

Do lutein and zeaxanthin work for age-related macular degeneration?

Short answer: As a component of the AREDS2 formula, it is used for intermediate AMD; however, the contribution of lutein and zeaxanthin alone was not significant in the first analyses, and a borderline benefit was reported in long-term follow-up.

AREDS2 (2013)

AREDS2 is a multicenter, double-masked, placebo-controlled 2×2 factorial study of 4,203 participants aged 50–85 at risk of progression to advanced AMD (large drusen in both eyes, or large drusen in one eye and advanced AMD in the other). Participants received lutein (10 mg) + zeaxanthin (2 mg), DHA (350 mg) + EPA (650 mg), both, or placebo; all also received the original AREDS formula or one of its four variations. At a median follow-up of 5 years, the year-5 Kaplan-Meier progression probabilities were 31% for placebo, 29% for lutein + zeaxanthin, 31% for DHA + EPA, and 30% for the combination. In the primary comparison with placebo there was no significant reduction: HR 0.90 for lutein + zeaxanthin (98.7% CI 0.76–1.07; P=0.12), 0.97 for DHA + EPA (0.82–1.16), and 0.89 for both together (0.75–1.06). Removing beta-carotene or a lower zinc dose did not affect progression. ^[2]

10-year follow-up (AREDS2 report 28, 2022)

In the epidemiological follow-up study, 3,882 participants (mean age 72.0; 57.7% women) were evaluated for 10 years; during the follow-up period all participants received AREDS2 supplements with lutein/zeaxanthin, so the results are no longer a randomized placebo comparison. For progression to late AMD, comparing groups with and without lutein/zeaxanthin, HR was 0.91 (95% CI 0.84–0.99; P=0.02); limited to those assigned to beta-carotene, HR 0.80 (0.68–0.92); in the direct comparison of lutein/zeaxanthin with beta-carotene, HR 0.85 (0.73–0.98). There was no effect for DHA/EPA (HR 1.01). According to the article’s conflict-of-interest statement, NIH had a royalty-bearing license agreement with a company for the AREDS supplement (ended in 2021) and the company supplied the AREDS2 supplements during the last 5 years of follow-up. ^[3]

Cochrane reviews (2023 and 2017)

The 2023 Cochrane update by Evans and Lawrenson covers 26 studies (11,952 people; age 65–75) examining antioxidant vitamin and mineral supplements in people with AMD. Antioxidant vitamins (AREDS formula) were found to reduce progression to late AMD (OR 0.72; 95% CI 0.58–0.90; 3 studies, 2,445 participants; moderate certainty); it was calculated that there was about 78 less progression (26–126) per 1,000 people with intermediate AMD at high risk of progression. There were 6 studies comparing lutein (with zeaxanthin or alone) with placebo; most of the evidence came from AREDS2 (1 study, 4,176 participants, 6,891 eyes): RR 0.94 (0.87–1.01) for late AMD, 0.92 (0.84–1.02) for neovascular AMD, and 0.92 (0.80–1.05) for geographic atrophy (low certainty); RR 0.98 (0.91–1.05) for loss of 15 letters or more of vision; quality of life was similar. In the exploratory subgroup analysis of substituting lutein/zeaxanthin for beta-carotene within AREDS2, HR was 0.82 (0.69–0.96) for late AMD. The authors state that the effect of lutein/zeaxanthin alone is small with low-certainty evidence, but that the exploratory analyses support lutein/zeaxanthin as a suitable substitute for beta-carotene in the AREDS formula. ^[4]

The 2017 Cochrane prevention review (5 RCTs, 76,756 people; vitamin E, vitamin C, beta-carotene, and multivitamin) concluded that these supplements did not prevent the onset of AMD and reported that there is no evidence on other antioxidant supplements such as lutein and zeaxanthin. ^[5]

NEI’s statement

The National Eye Institute (NEI) states that AREDS 2 supplements may slow progression in intermediate AMD, cannot prevent the transition from early AMD to the intermediate stage, may slow progression in the other eye in people with late AMD in one eye, and will most likely not help people with late AMD in both eyes. In the NEI table, the AREDS 2 contents are listed as vitamin C 500 mg, vitamin E 400 IU, copper 2 mg (cupric oxide), zinc 80 mg, lutein 10 mg, and zeaxanthin 2 mg; there is no beta-carotene. NEI states that because these supplements contain very high amounts of vitamins and minerals, they may alter the digestion of foods and the effect of other drugs in the body, and that beta-carotene in the old AREDS formula may increase the risk of lung cancer in smokers and former smokers. ^[1]

Are lutein and zeaxanthin protective against cataracts?

No benefit shown. In the AREDS2 cataract analysis (3,159 participants with at least one phakic eye; cataract surgery in 1,389 of 6,027 eyes; median 4.7 years), the 5-year probability of progression to surgery was 24% in the group not receiving lutein/zeaxanthin, and with lutein/zeaxanthin HR was 0.96 (95% CI 0.84–1.10; P=0.54); HR for loss of 3 or more lines of vision was 1.03. HR 0.68 (0.48–0.96; P=0.03) in participants in the lowest quintile of dietary lutein/zeaxanthin is a subgroup finding. ^[6] In the observational meta-analysis by Liu and colleagues (1 cohort, 7 cross-sectional studies), the risk of nuclear cataract was lower in those with the highest blood lutein and zeaxanthin levels (RR 0.63 for zeaxanthin; 95% CI 0.49–0.77; 0.73 for lutein; 0.59–0.87); associations for cortical and subcapsular cataract were not significant (borderline for lutein with subcapsular cataract). Because these studies measured blood levels, they do not show the effect of supplements. ^[9]

Are lutein and zeaxanthin safe?

In AREDS2 there was more lung cancer in the beta-carotene group (23 [2.0%] vs 11 [0.9%]; nominal P=0.04), mostly in former smokers; the authors stated that lutein + zeaxanthin may be a suitable carotenoid substitute in the AREDS formula. ^[2] At 10 years of follow-up, the lung cancer OR was 1.82 (95% CI 1.06–3.12; P=0.02) for beta-carotene and 1.15 (0.79–1.66; P=0.46) for lutein/zeaxanthin; the lung cancer outcome is based on self-report. ^[3] In Cochrane 2023, HR for mortality with lutein/zeaxanthin was 1.06 (0.87–1.31; very low certainty). ^[4]

As a food additive, EFSA 2010 set an acceptable daily intake (ADI) of 1 mg/kg body weight/day for lutein obtained from marigold (Tagetes erecta; at least 80% carotenoids, of which 79% is lutein and 5% zeaxanthin); in the 90-day rat study, 200 mg/kg/day was taken as the NOAEL, and it was noted that tier 3 intake estimates at the upper end of the range were above the ADI. JECFA had previously set a group ADI of 0–2 mg/kg body weight for lutein and zeaxanthin. ^[10] The ADI is an assessment of use as a food additive; it is not a supplement dose or evidence of benefit.

How are lutein and zeaxanthin regulated in Türkiye?

In Türkiye, dietary supplements are regulated by the Ministry of Agriculture and Forestry, and Ministry approval is mandatory for every dietary supplement to be placed on the market. ^[13] In the Restricted Substances List (last updated September 21, 2026), the relevant rows are as follows: ^[11]

• Lutein (source: marigold, Tagetes erecta L.): 10 mg/day for ages 4–10 and 15 mg/day for ages 11 and over; published January 22, 2016, ages 4–10 column September 13, 2018. ^[11]
• Zeaxanthin, “of synthetic origin” (must comply with Annex-1 of the Turkish Food Codex Novel Foods Regulation [TGK Yeni Gıdalar Yönetmeliği]): 2 mg/day in both age columns; July 3, 2026. ^[11]
• Zeaxanthin, “other sources” (marigold extract): 2 mg/day for ages 4–10 and 10 mg/day for ages 11 and over; there is a note that “if use in dietary supplements before December 31, 2025 is proven, it will not be evaluated under novel foods”; labels of products aimed at the ages 4–10 group are required to carry the warning “Uzun süreli kullanımda kan trigliserid ve kolesterol düzeylerinin kontrolü önerilir.” (“Monitoring of blood triglyceride and cholesterol levels is recommended with long-term use.”). ^[11]
• Meso-zeaxanthin (from isomerization of lutein): 10 mg/day (ages 11 and over); published April 5, 2018. ^[11]

In the Plant List (updated July 16, 2026), Tagetes erecta (marigold) flower is listed as positive (P). ^[12] In AREDS2, 10 mg lutein + 2 mg zeaxanthin per day was used; the list has upper limits of 15 mg/day for lutein for ages 11 and over and of 2 or 10 mg/day for zeaxanthin depending on the source. The values in the list are upper limits, not evidence of benefit.

Evidence table: claim, population, and limits