Modern lifestyles are impacting the eyesight of the U.S. population.

More people need to wear prescription glasses than ever before, and myopia has doubled over three decades to affect 42% of Americans, the Myopia Institute reported. Per the U.S. Centers for Disease Control (CDC), the prevalence of myopia is disproportionately increasing in teens between the ages of 13 and 16.

With the population aging, the number of Americans with impaired vision is expected to double by 2050, according to an estimate by the National Eye Institute.

While there’s still much more to learn about the role nutrition plays in eye health over one’s lifespan, there is already a burgeoning market of nutraceutical products created to improve vision and eye-related complaints like dryness, fatigue, and more.

The global eye health supplements market, dominated by Asia-Pacific (APAC) and North America, is worth $2.39 billion, with $1.39 billion represented by APAC countries, according to Euromonitor International.

It’s estimated that the market will reach $3.25 billion by 2028, with sustained growth projected in both APAC and North America. “The sustained growth within this market can be contributed to various factors, including new advancements around supplement delivery systems in the category, increased consumer interest in preventive eye health solutions to mitigate the effects of prolonged screen time, and rising prevalence of eye diseases,” said Caroline Schroeder, marketing communications manager at Lycored.

Entry Points for Younger Consumers

Between learning, communication, and gaming, a younger population is contending with greater demands placed on their eyes than ever before, due to blue light, eye fatigue, eye strain, and even hand-eye coordination, noted Kratika Gupta, global marketing lead for OmniActive Health Technologies.

OmniActive conducted a survey of parents, which found that most are concerned about their children’s eye health and vision, but aren’t aware of preventive options available to them. For example, 17% of parents admitted their child’s vision had gone unchecked for 3 years or more, and six in 10 parents said that while they expressed regular concerns about their children’s eye health, they were unfamiliar with how to support it.

Only 21% of parents provided their children with supplements to protect vision, while 23% said they made sure to include fruits and vegetables rich in eye health vitamins and minerals in their children’s diets. The survey also found that children, on average, use digital devices for over 4 hours daily.

“Unfortunately, some people aren’t proactively thinking about eye health until an issue arises, however, we are trying to change that at Unibar,” said Sevanti Mehta, president of Unibar Corporation. “Taking care of our eye health should be top of mind for all consumers, mainly because we live longer and rely heavily on digital devices for everyday tasks. Marketing eye health supplements as part of someone’s daily health routine, just like a multivitamin, can bring more awareness to this critical sensory organ.”

“The eyes are a part of the body, so nutrients that support general health will also affect eye health,” Mehta continued. “Vitamins and minerals are designed to work together, as they are when found in food, so a full-spectrum supplement is often the best option for eye health.”

“From a young age, many people are given the advice to eat carrots for better vision, but advice around nutrition and eye health doesn’t typically go beyond that. Eye health isn’t commonly top of mind until a problem presents or changes occur with vision during adulthood,” said Schroeder.

Leslie Gallo, president of Artemis International, noted that research is still elucidating the mechanisms of action behind eye health conditions of the 21st century. “Computer vision syndrome (CVS) and digital eye strain (DES) are both very real conditions that are affecting people well below age 40, which used to be the benchmark of when people would begin to experience vision issues,” she said.

With increased concerns about young people’s eye health, Gupta said to expect gummies and soft chews to rise drastically in sales within this market, after the market catered to older audiences for so long. “Gummies are a great format to increase compliance in the younger demographic. In fact, OmniActive’s latest Lutemax study in children ages 5-12 used a gummy format and compliance was excellent.”

The esports world is also clamoring for gummies, Gupta noted. “OmniActive is being approached more consistently by companies looking to formulate an eye health gummy specifically for the younger generations. We are also seeing an uptick of interest from e-gaming companies looking for a proven eye health solution. The e-gaming demographic, while broad, does cater to a younger generation. These consumers are looking for any edge they can get to stay focused and energized while e-gaming.”

More broadly, collaboration between the nutraceuticals industry and gaming platforms will be one of the most important factors influencing younger people to try eye health supplements, noted Mehta.

Traditional delivery formats still dominate, but Schroeder similarly expects serious growth in gummies and functional foods as eye support solutions become more popular. “With increased time and increased demand, there is an opportunity to explore a wider range of delivery formats that fit into consumers’ lifestyles,” she said, noting that several key eye health ingredients like vitamin A, lycopene, lutein, and vitamin E are compatible with a wide range of applications.

“Overall, the category is growing quickly, and adding eye health support in the food and beverage channels is a tremendous opportunity,” said Gallo.

Mehta noted that optometrists are much more aware of nutrition’s role in eye health, and are recommending eye health supplements in greater numbers to patients of all ages. 

“Consumers who are in tune with their overall health and wellness will likely lean into ingredients that support many facets of their own health, including for eyes,” Schroeder said. “Lutein is a good solution for these individuals, not only because it supports eye health, but also for its potential in other areas of health and wellness, including cognitive performance and protective skin benefits.”

Protection Across the Lifespan

The eye health supplement category stands on the shoulders of a series of NIH-funded studies called AREDS (Age Related Eye Disease Studies), the most recent of which was published in 2022, finding that a combination of lutein, zeaxanthin, vitamins C and E, copper, and zinc significantly slowed down age-related macular degeneration.¹

Thanks to this research, lutein and zeaxanthin, two pigments shown to filter blue light to prevent it from damaging the retina, are the most popular ingredients within this category by a large margin, noted Schroeder. In 2019, the two represented a 31.2% share of the eye health supplements market, and lutein/zeaxanthin supplements are anticipated to make up 37% of eye health supplement sales by 2024, Schroeder said.

But while earlier studies investigating the relationship between nutrition and eye health mostly looked at older adults, newer studies are validating additional benefits for the AREDS carotenoids, and other essential nutrients in people of all ages.  

A recent unpublished study found that a daily dose of 10 mg of lutein and 2 mg of zeaxanthin isomers from OmniActive’s Lutemax Kids, which is suitable for gummies, was linked to improvements in both cognitive and visual function. In 60 children between ages 5 and 12, who were already exposed to a minimum of 4 hours of digital device use per day at baseline, Lutemax 2020 was shown to be bioavailable in gummy form, and were able to increase macular pigment optical density. The subjects who took Lutemax Kids experienced less eye strain and eye fatigue following blue light exposure by the end of the treatment period.

Another study found that these two carotenoids begin accumulating in the eye between 6 and 14 weeks of gestation, and onward during infancy, making the case for the use of these ingredients in maternal nutrition solutions. The study, led by University of Utah’s Paul Bernstein, MD, found that maternal supplementation of lutein and zeaxanthin led to improved status in both mothers and babies, noted Deshanie Rai, PhD, FACN, vice president of global scientific and regulatory affairs at OmniActive.²

“The amount of lutein and zeaxanthin in our diet impacts the thickness of the macular pigment, which in turn plays a pivotal role in visual health outcomes through life, including contrast sensitivity, glare discomfort, photo-stress recovery, and delayed progression of age-related macular degeneration. Moreover, research has highlighted the role of lutein and zeaxanthin in helping the eye-brain connection to support both visual performance and brain health outcomes throughout life,” Rai continued. 

OmniActive Health Technologies has also completed two recent clinical studies on a formulation of lutein, zeaxanthin, curcuminoids, and vitamin D3 called Nutritears, demonstrating efficacy in reducing dry eye related discomfort in as little as 2 weeks. “Given the growing prevalence of dry eye issues, especially in response to digital device use, the use of nutraceuticals is also gaining popularity,” Rai said. 

DHA intake across the lifespan is also proving to be an important factor in vision health, starting from day one, in some of the first clinical studies investigating this relationship in human subjects.

In September 2023, a study published in The Lancet Regional Health Europe found that a mixture of the omega-6 arachidonic acid (AA) and omega-3 DHA significantly improved visual function by 2.5 years of age, in a population of 178 preterm babies.³

Breakthrough Ingredients 

Recent research has been making breakthroughs in several other eye-related conditions.

“Studies have shown that almost all eye conditions are affected by nutrients and their deficiencies,” Mehta noted. While it’s unlawful to make claims regarding the relationship between nutrient intakes and eye diseases, “we have seen nutrients address eye pressure, dry eyes, eye fatigue, and overall visual stress due to prolonged digital display viewing,” he said.

“The prevalence of digital eye strain, including dry eyes, and mitigating effects of excessive blue light exposure as a result of digital device use, are becoming additional areas of research and development focus,” said Rai. These include new and improved formulations, new technologies to help increase bioavailability of nutrients with eye health benefits, and new models to understand mechanism of action behind their benefits.”

Unibar’s CapsiClear, standardized to at least 50% concentration of a carotenoid called capsanthin, has been shown in human clinical studies to support improved visual performance, optimal intraocular pressure, and improved dry eye and tear regeneration. Its eye health benefits may be attributable to associated antioxidant activity, and inhibition of inflammatory cytokines including TNF-a, IL-2, and IL-3.

Gallo noted that for computer vision syndrome and digital eye strain, certain botanicals hold promise.

“Wearing glasses with blue light lenses, purported to reduce eye strain, and using certain device settings can help. But one of the most important things that anyone affected by CVS and DES can do to help relieve strain and blurriness is to use products that help enhance blood flow to the microcapillaries of the eyes.”

Antioxidant- and anthocyanin-packed berries like bilberry and black currant have appeared helpful in some studies.

A study supported by Artemis International, which is pending publication, found that treatment with its branded black currant extract, CurrantCraft, led to significant improvements in self-reported measures of eye health in 61 women between the ages of 30 and 59 who worked or studied full-time in an online environment.

The treatment group saw a 29.9% reduction in reported blurry vision by the end of the 70-day treatment period, and, compared to placebo, experienced an insignificant improvement in self-reported dry eye and eye strain.

“The weary eyes that result from excessive screen use can also cause significant issues for kids, teens, and young adults,” said Melanie Bush, vice president of science and research at Artemis International. “This finding is incredibly relevant for today’s vision support needs,” and “solidifies CurrantCraft black currant extract as a worthy ingredient for vision formulas.” 

A recent 12-week randomized, double-blind, placebo-controlled, parallel group trial measured if a standardized bilberry extract could positively impact ciliary muscle’s tonic accommodation, which is a relaxation of the muscle that focuses the eye; this can be caused by spending too long at a visual display terminal.⁴ In 109 men and women between the ages of 20 and 60, there was a significant improvement in ocular fatigue tests in the treatment group when tested after taking part in tasks involving a visual display terminal.

Meanwhile, another study on a supplement containing a combination of 600 mg of bilberry extract and 240 mg of DHA from fish oil, taken once daily for 3 months, resulted in a significant reduction in severe dry eye compared to placebo in 24 subjects. These results were measured using a number of eye health tests including Ocular Surface Disease Index, non-invasive tear break-up time, phenol red threat test, and percentage of meibomian gland openings.⁵

With the esports industry booming, and the supplements industry looking to captivate gamer audiences, expect there to be more studies specifically analyzing populations of people playing video games, said Bush. “Opportunities exist for standalone vision products as well as blends with other product categories important to esports athletes, like brain support and energy. Ingredients with clinically-studied benefits in specific areas like blurry vision and eye strain would be of particular importance to the esports community.”

The potential to reduce intraocular eye pressure to healthy levels has been a subject of intrigue among many nutrition researchers, especially given its role as a risk factor in glaucoma.

A Phase 2 randomized clinical trial published in JAMA Ophthalmology found that a combination supplement of nicotinamide and pyruvate was able to improve retinal cell survival in 197 open-angle glaucoma patients. Notably, this form of glaucoma can often continue to progress even after intraocular pressure (IOP) decreases. Over a median treatment period of around 2.2 months, this led to significant improvements in visual function, warranting long-term studies to establish the usefulness in slowing glaucoma progression, according to researchers.⁶

Meanwhile, a study of NHANES data published in 2021 found that in 5,768 subjects above the age of 40, broken down into four quartiles of niacin consumption, the odds of having glaucoma diagnosis (either self-reported or through retinal imaging) were significantly lower for those in the third and fourth quartiles. Respectively, these quartiles had an average intake of 21.01-28.22 and greater than 28.22 mg of niacin daily.⁷  

References

1. Chew, E. et al (2022). Long-term Outcomes of Adding Lutein/Zeaxanthin and ω-3 Fatty Acids to the AREDS Supplements on Age-Related Macular Degeneration Progression. JAMA Opthalmology. 140(7):692-698. doi:10.1001/jamaophthalmol.2022.1640

2. Addo, E. et al (2021). The Lutein and Zeaxanthin in Pregnancy (L-ZIP) study-carotenoid supplementation during pregnancy: ocular and systemic effects-study protocol for a randomized controlled trial. Trials. 22(1):300.doi: 10.1186/s13063-021-05244-2

3. Lundgren, P. et al (2023). Visual outcome at 2.5 years of age in ω-3 and ω-6 long-chain polyunsaturated fatty acid supplemented preterm infants: a follow-up of a randomized controlled trial. The Lancet Regional Health – Europe. 32(9):100696. Doi: https://doi.org/10.1016/j.lanepe.2023.100696

4. Kosehira, M. et al (2020). A 12-Week-Long Intake of Bilberry Extract (Vaccinium myrtilus L.) Improved Objective Findings of Ciliary Muscle Contraction of the Eye: A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Comparison Trial. Nutrients. 12(3): 600. Doi: 10.3390/nu12030600

5. Yu, W. et al (2023). Bilberry-containing supplements on severe dry eye disease in young and middle-aged adults: A 3-month pilot analysis. Frontiers in Nutrition. 10 (1). Doi: https://doi.org/10.3389/fnut.2023.1061818

6. De Moraes, C. et al (2022). Nicotinamide and Pyruvate for Neuroenhancement in Open-Angle Glaucoma: A Phase 2 Randomized Clinical Trial. JAMA Opthalmology. 140(1):11-18. doi: 10.1001/jamaophthalmol.2021.4576

7. Lee, S. et al (2023). Associations Between Niacin Intake and Glaucoma in the National Health and Nutrition Examination Survey. Journal of Glaucoma. 32(6):443-450. doi: 10.1097/IJG.0000000000002216