Findings from a recent study published in Translational Vision Science & Technology evaluated the effect of a 6-month lutein ester supplementation on children’s choroidal thickness (CT).
Give me some background.
Previous studies have highlighted the effect of choroidal thickness in myopia development and progression, with choroidal thinning acting as an early sign of myopia progression that may precede and predict changes in axial length (AL) and scleral remodeling.
Lutein is a xanthophyll carotenoid known for its antioxidant properties that cannot be synthesized by the body and must be obtained from fruits, vegetables, or supplements.
- Existing studies have demonstrated its dual protective roles as a blue light filter and antioxidant in the macula; however, its influence on CT remains understudied.
As such: A research team sought to elucidate whether lutein ester supplementation could slow or improve CT in children attending primary school.
Now talk about the study.
In this double-blind, randomized control trial, 180 children aged 8-12 years were recruited from a school in Feicheng, Shandong Province, China, from April to May 2021, with follow-up completed in November 2021.
- The setup: Participants were randomly assigned to the treatment group (n=90, receiving one sachet with 8 mg lutein ester) or the control group (n=90, one placebo sachet).
- Note: Each participant orally consumed one sachet daily for 6 months.
- The main outcome measure: The between-group differences in changes in CT at 6-month follow-up visits.
Findings?
The 6-month mean subfoveal CT decrease was 1.16 µm (-3.32 to 5.63 µm) for the treatment group and -8.92 µm (-13.43 to -4.41 µm) for the control group, with a mean difference of 10.08 µm (95% confidence interval [CI]: 3.68 to 16.47, P=0.002, corrected P=0.018).
A similar trend was observed for the 6-month temporal 1 mm and 1.5 mm choroidal thinning as follows:
- Mean temporal 1 mm CT decrease
- Treatment group: -2.83 µm (-9.63 to 3.96 µm)
- Control group: -16.76 µm (-24.20 to -9.33 µm)
- Mean difference: 13.93 µm (95% CI: 3.79-24.07, P=0.007, corrected P=0.030)
- Mean temporal 1.5 mm CT decrease
- Treatment group: -1.24 µm (-9.64 to 7.15 µm)
- Control group: -15.77 µm (-22.67 to -8.88 µm)
- Mean difference: 14.53 µm (95% CI: 3.59-25.47 µm), P=0.010, corrected P= 0.030)
While 6-month lutein ester supplementation suppressed choroidal thinning, no significant changes in spherical equivalent refraction (SER) or AL were observed compared to the control group.
Expert opinion?
The 10-15 µm increase in CT observed in the intervention group compared to the control group reflects a fundamental shift in choroidal dynamics, the study authors explained.
How: The net ~10 µm difference represents a preservation of choroidal integrity against progressive thinning, rather than a substantial thickening.
And how did lutein compare to other myopia control options?
The magnitude of the protective effect was comparable to that reported after one month of orthokeratology treatment, which demonstrated a mean difference of 10.62 µm compared to placebo, the authors added.
Plus: While more pronounced CT changes have been observed with repeated low-level red-light therapy or high-dose atropine, such interventions carry potential drawbacks—including photophobia, impaired near vision, or risks of corneal infection.
Meanwhile: Lutein ester supplementation potentially offers advantages in safety, accessibility, and cost-effectiveness.
So how does lutein address myopia development and progression?
Lutein may impact myopia pathogenesis in the following ways:
- Quenching singlet oxygen and scavenging free radicals, reducing oxidative stress in the retinal pigment epithelium (RPE) and choroidal tissues to preserve their structural integrity and thickness
- Its anti-inflammatory properties may address chronic low-grade inflammation that contributes to myopia development
- Enhancing blood supply in the choroid, which improves oxygenation and nutrient delivery to the outer retina and RPE
- By supporting retinal health and potentially facilitating dopamine-related pathways, it may indirectly stimulate signals that prevent choroidal thinning
Were there any limitations to the study?
A few to note, including:
- The 6-month duration was likely too short to observe meaningful between-group differences in the slower-progressing parameters of AL and SER; as such, these should be considered preliminary findings
- The single-center design restricted variations in environmental factors
- Non-cycloplegic refraction was used during ocular examinations, which may have introduced measurement biases
- The sample size calculation did not account for potential interaction effects (e.g., age, sex, lifestyle factors) before the analysis, which limited the ability to rigorously test subgroup-specific effects
- Given that the study population included only children between 8 and 12 years old in Eastern China, it is unclear whether these findings are generalizable to other populations
Take home.
These findings suggest that 6-month lutein ester supplementation could effectively mitigate subfoveal and temporal choroidal thinning, which are key biomarkers in myopia development.
Moreover: Considering lutein’s favorable safety, affordability, and global availability, this analysis highlights its untapped potential as a promising, adjunctive nutritional strategy to support clinical efforts in myopia prevention and management.
- Future studies should include longer follow-up, diverse populations, and multimodal biomarkers to determine whether CT preservation translates to reduced myopia incidence or progression.