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Putative protective role of lutein and zeaxanthin in diabetic retinopathy
  1. Kumari Neelam1,2,
  2. Catherina J Goenadi3,
  3. Katherine Lun3,
  4. Chee Chew Yip1,
  5. Kah-Guan Au Eong1,4,5
  1. 1Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore, Singapore
  2. 2Singapore Eye Research Institute, Singapore, Singapore
  3. 3Department of Ophthalmology, National University Hospital, Singapore, Singapore
  4. 4Singapore International Eye Cataract Retina Centre, Mount Elizabeth Medical Centre, Singapore, Singapore
  5. 5International Eye Cataract Retina Centre, Farrer Park Medical Centre, Singapore, Singapore
  1. Correspondence to Dr Kumari Neelam, Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, 90 Yishun Central, Yishun, Singapore 768828, Singapore; kumari.neelam{at}


Diabetic retinopathy (DR) is one of the most important microvascular complications of diabetes and remains the leading cause of blindness in the working-age individuals. The exact aetiopathogenesis of DR remains elusive despite major advances in basic science and clinical research. Oxidative damage as one of the underlying causes for DR is increasingly being recognised. In humans, three hydroxycarotenoids, lutein (L), zeaxanthin (Z) and meso-zeaxanthin (MZ), accumulate at the central retina (to the exclusion of all other dietary carotenoids), where they are collectively known as macular pigment. These hydroxycarotenoids by nature of their biochemical structure and function help neutralise reactive oxygen species, and thereby, prevent oxidative damage to the retina (biological antioxidants). Apart from their key antioxidant function, evidence is emerging that these carotenoids may also exhibit neuroprotective and anti-inflammatory function in the retina. Since the preliminary identification of hydroxycarotenoid in the human macula by Wald in the 1940s, there has been astounding progress in our knowledge of the role of these carotenoids in promoting ocular health. While the Age-Related Eye Disease Study 2 has established a clinical benefit for L and Z supplements in patients with age-related macular degeneration, the role of these carotenoids in other retinal diseases potentially linked to oxidative damage remains unclear. In this article, we comprehensively review the literature germane to the putative protective role of two hydroxycarotenoids, L and Z, in the pathogenesis of DR.

  • Treatment Medical
  • Retina

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  • Contributors KN and K-GAE conceived the topic of the manuscript. K-GAE is the guarantor. KN, CJG, KL and CCY all contributed equally to the analysis of the literature, drafting and revision of the paper. KN and K-GAE made the critical revision of the manuscript and gave the final approval of the version to be published.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.