CRN Eye Health Support
Protocol development in integrative medicine is not typically a simple process. Individuals require individualized care, and what works for one patient may not work for another.
To establish these protocols, we first developed a Rating Scale that could be used to discern the rigor of evidence supporting a specific nutrient’s therapeutic effect.
The following protocols were developed using only A through D-quality evidence.
Introduction
Age-related macular degeneration (AMD) is a progressive retinal disease that leads to deterioration of the macula—the central part of the retina responsible for sharp, detailed vision. AMD is the leading cause of vision loss and significantly impacts quality of life through its interference with daily activities and independence. (Hassell 2006) According to the Centers for Disease Control and Prevention (CDC), nearly 1.8 million Americans aged 40 and older are living with AMD, and over seven million have large drusen, placing them at high risk for developing the disease. (CDC 2024)
Macular pigment optical density (MPOD) measures the concentration of carotenoid pigments in the macula, primarily lutein and zeaxanthin, which help protect photoreceptors from blue light–induced damage. Maintaining higher levels of these pigments is associated with improved visual function. (Yuan 2025) Building on this understanding, this protocol draws on evidence from the Council for Responsible Nutrition’s (CRN’s) Supplements to Savings Report and other clinical research to provide healthcare providers with practical guidance on supporting macular health through targeted, evidence-based nutritional interventions.
Ingredients
Lutein/Zeaxanthin
Dosing: 10 mg lutein/2 mg zeaxanthin, total per day, minimum six months (Evans 2023)
Supporting evidence:
- Lutein and zeaxanthin are xanthophyll carotenoids that accumulate in the macula, where they filter high-energy blue light and act as antioxidants to scavenge reactive oxygen species (ROS) and mitigate oxidative stress, a key driver of AMD pathophysiology. (Mrowicka 2022)
- A large prospective cohort study (n=102,046) found that individuals in the highest quintile of predicted plasma lutein/zeaxanthin had a 40% lower risk of developing advanced AMD compared to those in the lowest quintile. (Wu 2015)
- The Age-Related Eye Disease Study 2 (AREDS2®) enrolled 4,203 participants aged 50–85 years with bilateral intermediate AMD or advanced AMD in one eye. Replacing beta-carotene with lutein/zeaxanthin in the original AREDS® intervention (supplemental vitamin C, vitamin E, zinc, copper, and beta-carotene) was associated with a modest reduction in AMD progression and, importantly, a lower risk of lung cancer in current/former smokers. (AREDS2 Research Group 2013)
- Multiple meta-analyses of RCTs show that lutein and zeaxanthin supplementation helped increase MPOD, improve visual acuity, and enhance contrast sensitivity in AMD patients. Higher doses and longer duration yield greater and faster increases in MPOD, which correlates with improved visual function. (Liu 2014)(Feng 2019)(Csader 2022)
Disclaimer
The Fullscript Integrative Medical Advisory team has developed or collected these protocols from practitioners and supplier partners to help health care practitioners make decisions when building treatment plans. By adding this protocol to your Fullscript template library, you understand and accept that the recommendations in the protocol are for initial guidance and may not be appropriate for every patient.
- About Common Eye Disorders and Diseases. (2024, May 15). Centers for Disease Control and Prevention. https://www.cdc.gov/vision-health/about-eye-disorders/index.html
- Csader, S., Korhonen, S., Kaarniranta, K., et al. (2022). The Effect of Dietary Supplementations on Delaying the Progression of Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis. Nutrients, 14(20), 4273. https://doi.org/10.3390/nu14204273
- Evans, J. R., & Lawrenson, J. G. (2023). Antioxidant vitamin and mineral supplements for slowing the progression of age-related macular degeneration. The Cochrane Database of Systematic Reviews, 2023(9), CD000254. https://doi.org/10.1002/14651858.CD000254.pub5
- Feng, L., Nie, K., Jiang, H., et al. (2019). Effects of lutein supplementation in age-related macular degeneration. PLoS ONE, 14(12), e0227048. https://doi.org/10.1371/journal.pone.0227048
- Hassell, J. B., Lamoureux, E. L., & Keeffe, J. E. (2006). Impact of age related macular degeneration on quality of life. British Journal of Ophthalmology, 90(5), 593–596. https://doi.org/10.1136/bjo.2005.086595
- Liu, R., Wang, T., Zhang, B., et al. (2014). Lutein and Zeaxanthin Supplementation and Association With Visual Function in Age-Related Macular Degeneration. Investigative Ophthalmology & Visual Science, 56(1), 252–258. https://doi.org/10.1167/iovs.14-15553
- Mrowicka, M., Mrowicki, J., Kucharska, E., et al. (2022). Lutein and Zeaxanthin and Their Roles in Age-Related Macular Degeneration—Neurodegenerative Disease. Nutrients, 14(4), 827. https://doi.org/10.3390/nu14040827
- The Age-Related Eye Disease Study 2 (AREDS2) Research Group. (2013). Lutein + Zeaxanthin and Omega-3 Fatty Acids for Age-Related Macular Degeneration. JAMA, 309(19), 2005–2015. https://doi.org/10.1001/jama.2013.4997
- Wu, J., Cho, E., Willett, W. C., et al. (2015). Intakes of Lutein, Zeaxanthin, and Other Carotenoids and Age-Related Macular Degeneration During 2 Decades of Prospective Follow-up. JAMA Ophthalmology, 133(12), 1415–1424. https://doi.org/10.1001/jamaophthalmol.2015.3590
- Yuan, Y.-X., Wu, H.-Y., Yuan, W.-J., et al. (2025). Macular pigment optical density and measurement technology based on artificial intelligence: a narrative review. International Journal of Ophthalmology, 18(6), 1152–1162. https://doi.org/10.18240/ijo.2025.06.23