Proper Nutrition and Dry Eyes

Proper Nutrition and Dry Eyes

Michael P. Lange OD, CNS, 10/24/2011

Dry eyes can be improved through proper nutrition. The vast majority of dry eye patients will notice a significant improvement in dry eye symptoms once the correct dietary and lifestyle modifications are implemented. Dry eye is a nutritionally responsive condition and this paper will discuss how proper diet and supplementation may improve subjective and objective signs and symptoms of dry eyes.

Most of our patients, whether fat or thin, are nutritionally compromised. Very rarely will you meet a patient that is of ideal body weight, medication free and on a truly healthful diet. As a clinician you will know at the first glance of your patient and after a brief discussion how critical a dramatic adjustment in their diet is going to be to their overall health and their dry eyes. Proper nutrition is one of the most important single factors in maintaining the health of our patients. Most people in today’s society are not getting the required vitamins, minerals and essential fatty acids from the foods they are eating. We have become a society living ‘life on the go’ that is fueled by fast food and junk food. Our typical diet is caloric dense and nutrient deficient. Americans consume a diet that is unbalanced—with too many omega-6 fatty acids and not enough omega-3 fatty acids—leading to increased inflammation and disease in the body. This is associated with increased levels of cytokines, proteins that trigger inflammation. Inflammation is one of the root causes of dry eye syndrome (keratoconjunctivitis sicca) and many other systemic diseases. Our foods are processed, sugar- and salt-laden, filled with trans fats, hydrogenated oils, high fructose corn syrup, synthetic dyes, chemicals and artificial sweeteners. These poor nutritional habits combined with a sedimentary lifestyle are why the health of the American people (our patients) is becoming compromised. America is home to the most obese people in the world. According to the CDC (Center for Disease Control and Prevention) obesity in adults has increased by 60% within the past twenty years. A staggering 70% of American adults are overweight or obese and obesity related deaths have accelerated to more than 300,000 a year, second only to tobacco related deaths.

Dietary modifications and lifestyle changes

Dr. Lange recommends everyone learn the 'dirty dozen' fruits and vegetables
Dr. Lange recommends everyone learn the ‘dirty dozen’ fruits and vegetables

Most nutritional experts recommend 10-13 servings of organically grown fruits and vegetables a day. Americans are falling short of this amount and are becoming more and more nutritionally compromised. 70% of adults are not even consuming five portions of fruits and vegetables a day. The population that consumes the least amount of vegetables and fruits are more predisposed in developing disease and illness. These large and growing groups of people are nutritionally compromised and more prone to develop free radical damage in their bodies and eyes. These are the patients who are more prone to have dry eyes, cataracts and retinal disease. I have seen in clinical practice for close to twenty years the positive effects dietary modifications and lifestyle changes can have directly on ocular health and total body health.

I have finally come to the realization that patients who will follow a combination of the Mediterranean, paleo or hunter gatherer type of diet, eating more like our ancestors, along with regular exercise and proper sleep benefit significantly. This is a diet that consists of organically grown fruits, vegetables, seeds, nuts, whole grains, proteins and mainly water and a few other beverages. I recommend patients avoiding water that is in plastic bottles and drinking water that is filtered or in glass bottles due to the potential for bisphenols leaching into the water from the plastic. Bisphenols cause endocrine disruption which will compound a dry eye problem. Bisphenols are in plastic bottles as well as in canned foods. F, D and C red yellow and blue dye can also cause endocrine disruption and so should be avoided. Dyes are in just about everything we consume these days, so teach your patients to be proactive in their health and read labels. I recommend patients try to consume half their body weight in ounces of good quality water daily. I also advise patients to try to substitute their morning coffee with organic green tea and lemon. The antioxidant and anti inflammatory effects of green tea and lemon have significant health benefits and many of my patients will notice symptomatic relief of their dry eyes from this one simple step. I advise my patients to try to eat 10-13 servings of fruits and vegetables on a daily basis. I recommend “the dirty dozen” fruits and vegetables be only organically grown due to their high amounts of pesticide found inside this specific group. Most of us have an accumulated build up of pesticide exposure in our bodies due to numerous years of exposure. This “chemical burden” leads to a variety of serious health issues that may potentiate a dry eye condition. The protein in this particular type of diet should always be free range organically raised or wild, not farm raised! Try to get your patients to eat fish at least three times per week to improve the omega three to omega 6 ratio in their blood. The fish that is highest in omega three and lowest in potential contaminants are sardines, anchovies, herring, mackerel, wild rainbow trout and wild Alaskan salmon. Some of your patients will follow your directions precisely; however the majority is going to wonder off of these specific recommendations. This is why supplementation with antioxidants and omega-3 fatty acids is so important.

Blood chemistry testing

How do you know the specific nutritional status of your patients without testing them? The only accurate way to test for these deficiencies is through blood testing. We will routinely do three special blood tests to gain valuable insight into the nutritional health of our patients. A SpectraCell intracellular blood test, vitamin D 25 OH and an omega-3 index test will help determine what your patient’s nutritional status is and if they have nutritionally modifiable risk factors for ocular conditions like dry eyes. You will quickly see that almost everyone you test is deficient in antioxidants and omega three. Many of these patients will also have elevated CRP, homocystein, triglycerides, cholesterol and arachidonic acid. The majority of these blood chemistries can be positively impacted through proper nutrition. The poor results on these tests can help motivate your patients to making these crucial dietary and lifestyle modifications that will positively impact their overall health. After reviewing the results of these tests with your patients they will finally understand the benefit of proper supplementation. Realistically, due to these tests not being covered by Medicare or insurance, not everyone will be able to have these tests done because of the cost. Let’s now review the specific protocol that is working extremely well with the dry eye population.

Omega-3 fish oil

The majority of large clinical studies that have documented the positive health benefits of omega-3 fatty acids have utilized fish or fish oil consumption. There is a multitude of positive studies supporting the beneficial health aspects of a higher consumption of omega-3 from fish oil or fish. The medical community has readily embraced these positive health benefits and is prescribing and recommending fish oil supplements to their patients. The increased public awareness regarding omega 3 fish oil has created an omega-3 explosion. Consumers that are in tune with prevention and wellness are becoming proactive in their health and practicing prevention by consuming more fish or purchasing fish oil supplements from the drug store, health food store or through the Internet. However, one must be careful with consuming too much fish because of the potential contaminants that are in particular types of fish. With all of the contamination in the oceans it is becoming more and more difficult to recommend consuming large amounts of fish. The consumer or patient must also be aware that all fish oil is not created equal! The health care professional should be educating their patients on the benefits of proper omega-3 supplementation.

Fish Oil Demo with Dr Michael Lange
Ethyl ester based fish oil eats Styrofoam!

Omega-3 fish oil has two readily available forms: ethyl ester fish oil and triglyceride form fish oil. I recommend purchasing the triglyceride form fish oil over the ethyl ester version of omega-3 fish oil for a variety of reasons. The ethyl ester form of fish oil is highly unstable and therefore it can oxidize and become rancid quicker than the triglyceride form of fish oil. Many of the ethyl ester fish oils may become rancid before you purchase them. This is one of the reasons many people get a nasty aftertaste or have problems burping up an unpleasant fish taste from the ethyl ester form of fish oil. Studies also indicate that the triglyceride form omega-3 fish oil absorbs much faster and more efficiently therefore increasing bio availability. Most fish oil that is being sold OTC or as a prescription in the United States is the ethyl ester version because it is significantly less expensive to manufacture. The final phase in the purification of a triglyceride form of fish oil requires the ethyl ester molecule to be cleaved off and replaced with a triglyceride molecule, thus making it a more natural omega-3 fish oil than the ethyl ester version. The triglyceride form of omega-3 fish oils are extremely pure and concentrated making them the ideal choice for your patients. If you do not know if your fish oil is an ethyl ester version or triglyceride version you should call the customer service department on the back of the bottle. You can also squeeze the contents of your fish oil into a Styrofoam cup and watch for the chemical reaction. If the cup begins to dissolve after 10 to 20 minutes, then you have an ethyl ester form. However, some fish oils with very low concentrations of ethyl ester fish oil may not dissolve the cup. When shopping for the best triglyceride form fish oil, look for high levels of EPA and DHA. I recommend finding an omega-3 fish oil supplement that has an EPA between 400-450 per gel cap and a DHA around 250-300 per gel cap. These are the levels I have studied using the latest in omega-3 blood testing and have found that the consumption of two gel caps a day of this concentration can increase your omega index to a desirable level over 8%. This omega-3 index measures the concentration of EPA and DHA as a percent of total essential fatty acids in the red blood cell membranes. Recent research is proving that the desirable level for cardio protection is an omega index over 8%. This research claims that levels greater than 8% correlate with a 90% reduction in the potential for a fatal heart attack. The vast majority of Americans have an omega index closer to 4%.

Best sources of omega-3

Fortifeye Super Omega Fish Oil
Fortifeye Super Omega Fish Oil

My research team and I have tested a variety of omega-3 oils from flax, krill and ethyl ester fish oils and have not found nearly the improvements in the omega index with these other types of omega-3 fatty acids. So all omega-3 supplements are not created equal! Most of the inferior brands of fish oil and krill oil you can purchase OTC have no therapeutic value and won’t move the omega index very much. Many of the OTC fish oils are also filled with higher than the acceptable amounts of contaminants like PCB. Is this something you want to recommend to your patients? After years of study, a lot of trial and error and a one month research trip to Norway, I developed a highly purified triglyceride omega-3 fish oil concentrate with an outstanding 1600mg of omega-3 (EPA 860mg, DHA 580mg) in just two gel caps! The teams at Fortifeye Vitamins and the Omega 3 Test have been actively studying the influence of two daily capsules of this concentrated Super Omega on blood levels of omega-3 and the results have been astounding! After just thirty days, mean blood levels of omega-3 have increased from 4.2% to 9.1% with some patients as high as 11%! The results are a true testament to the benefits of proper levels of omega-3 supplementation. These are the levels that have produced positive results in our dry eye population. Most patients do quite well on two per day dosing of these levels and will start to experience symptomatic relief in 1-3 months. If the patient is over 250 lbs or has a significant dry eye problem I would recommend doubling the dosage. We have positive results using these levels of omega-3 fish oil with our MGD patients, those with recurrent hordeolums, conjunctivitis, chronic low grade uveitis, blepharitis and we are even seeing positive impact on our diabetic maculopathies and macular degeneration patients. Based on the current world wide research available, combined with the ongoing research being done at Fortifeye Vitamins, I feel the primary eye care provider should be making omega-3 recommendations to all of their patients. EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are the two principal EFAs (essential fatty acids) found in fish known as omega-3 fatty acids. The current research suggests the anti-inflammatory effects of fish oil may help with dry eye syndrome. EPA generates the anti-inflammatory eicosanoids prostaglandin E3 and leukotriene B5. If the concentration of EPA is high enough the EPA blocks the delta-5 desaturase enzymatic step that stops the conversion of omega-6 EFAs to the inflammatory cascade of arachidonic acid (AA). This allows more conversion to anti-inflammatory prostaglandin E1 (PGE1). PGE1 then binds to EP2 and EP4 receptors to activate adenylate cyclase and increase cyclic AMP (adenosine monophosphate) which in turn stimulates a healthier tear production. DHA also decreases production of pro-inflammatory eicosanoids and helps to balance the body’s response to inflammation. Both EPA and DHA contribute to reducing inflammation in somewhat different but complementary mechanisms. The increase in omega-3 EFAs has also shown to improve dysfunction in the meibomian gland with a much thinner and clearer meibomian gland secretion, thus helping with meibomian gland dysfunction. The increased consumption of a triple molecularly distilled and concentrated triglyceride form omega-3 fish oil will help to get the balance between omega-6 and omega-3 in better harmony and allows for less inflammation in the body and eyes. Americans have too high a percentage of pro-inflammatory omega-6 in their diet. The addition of some good omega-3 fish oil is the start to a healthier body and visual system.


Fortifeye Focus
Fortifeye Focus – An astaxanthin, lutein and zeaxanthin super carotenoid supplement designed and recommended by Dr. Michael Lange, OD CNS.

A relatively new nutrient used in supplements that comes from the micro alga haematococcus pluvialis, astaxanthin is proving to have multiple health benefits. The super carotenoid astaxanthin is the reason lobsters, shrimp, crabs and wild salmon have a reddish color. Astaxanthin is an extremely potent antioxidant and anti-inflammatory. Clinical studies have now proven that 6mg of astaxanthin can improve the blood flow to the eye and actually aid in accommodation (focusing) and in reducing eye fatigue. Astaxanthin reduces inflammatory markers such as C reactive protein (CRP), nitric oxide synthase (NOS), prostaglandin E2 (PGE2) and tumor necrosis factor (TNF). Astaxanthin is documented with high potencies for neutralizing oxygen radicals. For example, it is 550 times more powerful than vitamin E and 40 times more powerful than beta-carotene against singlet oxygen radicals. These remarkable aspects of astaxanthin are why Fortifeye Vitamins and The Lange Eye Institute are involved in some ongoing clinical blood studies to look more carefully at the anti inflammatory properties of astaxanthin. Early data shows that when combined with Fortifeye Super Omega, 6 mg of astaxanthin is lowering arachidonic acid levels more than the fish oil alone. Studies also indicate that astaxanthin may help in muscle recovery and reduce muscle fatigue. Many patients taking supplemental astaxanthin have also noticed the sun block properties this powerful antioxidant exhibits. Astaxanthin has also been linked to healthier skin and less fine lines and wrinkles have been documented after taking astaxanthin for a few months. Astaxanthin is a truly unique nutrient with some incredible health benefits. I have been very impressed with the potential ocular and overall health benefits of astaxanthin. Dry eye and eye fatigue often times go hand in hand especially in computer vision syndrome (CVS). The typical patient that comes in complaining of eyes that feel tired, fatigued, dry, sandy and gritty after working on the computer for prolonged periods of time are the ones that will benefit from adding 6mg of astaxanthin to their supplement regiment. I will usually start these patients on a combination of omega-3 fish oil and 6 mg of astaxanthin and after three months many of these patients’ symptoms have resolved or improved significantly. These patients will also commonly report an improvement in many other areas: less joint pain, healthier skin, improved energy, improved muscle recovery, more endurance, improvement in focusing and many more. I have seen a synergy with triglyceride form fish oil while using astaxanthin in my dry eye population. If patients are not experiencing the relief they are looking for on omega-3 supplementation alone I will add 6 mg of astaxanthin and see the patient back in three months for follow up. I have been amazed at the positive feedback I have received from these patients. Not only are these patients improving subjectively but their objective signs of dry eye are also improving. I think astaxanthin has a place in eye care especially for the patients who are looking for a more natural approach to help with their dry tired eyes. Think about how many patients the combination of omega-3 and astaxanthin may help in your practice. Just about everyone these days is experiencing some form of dry and fatigued eye symptomology throughout the day. Patients are grateful when you help solve their complaints without recommending surgery or medication.

Gamma-linolenic acid

The moderate to marked dry eye patients may need one additional nutrient in conjunction with the omega-3 and astaxanthin to maximize the nutritional approach for dry eyes. Gamma-linolenic acid (GLA) is an essential fatty acid (EFA) in the omega-6 family that is found mainly in plant seed oils. The three most common plant seed oils where GLA are found are borage seed oil, black currant oil and evening primrose oil. GLA is broken down in the body to dihomo-gamma-linolenic acid (DGLA) and arachidonic acid (AA). DGLA competes with AA and prevents the negative inflammatory effects that AA would otherwise cause. Adequate amounts of magnesium, zinc and vitamins C, B3 and B6 help to promote the conversion of GLA to DGLA rather than AA. It is fairly rare that our patients will have deficiencies in these areas if eating the appropriate foods. However, many of our patients are not getting the appropriate nutrition in their diet and must supplement with a good whole body anti-oxidant. Running a SpectraCell nutritional blood panel may help find many surprising nutritional deficiencies your patients have. Researchers in Japan have shown that astaxanthin may suppress the cyclooxygenase enzyme and decrease the amount of pro-inflammatory PGE2 produced. Once the AA pathway is blocked the DGLA is free to convert to anti-inflammatory prostaglandin E1 (PGE1) and stimulation of tear production occurs. Recent studies suggest that oral GLA supplementation improved dry eye both clinically and subjectively in patients with dry eye syndrome. Studies also show that patients who take a combination of linoleic acid (LA) and gamma-linoleic acid (GLA) prior to and after refractive surgery may have better tear production and less dry eye complications. Studies utilizing GLA and omega -3 fish oil have shown an additive anti-inflammatory effect with no elevation in arachidonic acid. Due to the extremely high amounts of omega-6 in most diets I began studying different ratios of omega-3 and GLA and have decided to use a ratio of approximately 10 to 1 omega-3 to omega-6 (GLA) to maximize the anti-inflammatory effects and gain full advantage of both types of essential fatty acids. If the ratio of omega-6 (GLA) to omega-3 is too high in the omega-6 direction then the possibility of more inflammation related to the high omega-6 low omega-3 ratio exists. Currently for my more advanced dry eye cases I have been using 1600 mg of triglyceride form omega-3, 160 mg of GLA from black currant seed oil, 6mg of astaxanthin and a good whole body anti-oxidant with great results. These patients not only experience ocular health benefits but also notice many general health benefits as well. It is time that both optometrists and ophthalmologists start to utilize the power of proper nutrition to help their patients. It is a win-win for everyone involved.

I really think having educational information as well as supplements available at your office is the smart way to go. This enables the doctor to have some control over the quality of supplements the patient is taking. Once the patient walks out of your door they may buy the cheapest thing they can find on the Internet or warehouse club that has no therapeutic value whatsoever! Educating your entire staff on the importance of proper nutrition is very important as well. Everyone from the front desk to the technicians should be educated on the benefits of proper nutrition. It is a team approach.

Dr. Michael P. Lange, O.D., C.N.S.
Dr. Michael P. Lange
Board Certified Optometric Physician and Board Certified Nutritional Specialist

Dr. Michael P. Lange, OD CNS
Board Certified Optometric Physician
Certified Nutrition Specialist
Syndicated Daily Talk Show Host (Ask the Doctor)
CEO and founder of Lange Eye Care and Associates
CEO and founder of the Lange Eye Institute
CEO of Lange Sun and Nutrition Centers
October 24, 2011


Lange Eye Care Locations

Gainesville Office
Lange Eye Care and Associates
3968 SW Archer Road W101
Gainesville, Florida 32608
Phone: 352-376-6622

Ocala Office
Lange Eye Care and Associates
3101 SW College Road
Ocala, Florida 34474
Phone: 352-237-3768

Triple Crown Plaza Office
Lange Eye Care and Associates
11100 SW 93rd Court Road
Suite 15
Ocala, Florida 34481
Phone: 352-291-2000

Summerfield Office
Lange Eye Care Vision Outlet Center
Unit #604 Highway 441S
Summerfield, Florida
Phone: 352-307-3273

Inverness Office
Lange Eye Care and Associates
3808 E. Gulf to Lake Highway
Inverness, FL 34453
Phone: 352-344-5110

Clearwater Offices
Lange Eye Care Optical Gallery & LASIK Center
23666 U. S. Highway 19 North
Clearwater, FL 33765
Phone: 727-791-1214

Lange Sun and Nutrition Center
2551 Drew Street
Suite 302
Clearwater, FL 33765
Phone: 727-216-6275

Williston Office
Lange Eye Care And Associates
129 S. W. 7th Street
Williston, FL 32696
Phone: 352-528-0433

The Villages Office
Lange Eye Institute
466 and CR101
The Villages, Florida
Phone: 352-753-4014





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More information: Dr. Michael P. Lange is a Board Certified Optometric Physician and a Certified Nutrition Specialist who started Lange Eye Care and Associates in Ocala, Florida, in March 1993. Lange Eye Care has grown to nine locations throughout the state of Florida with three Lasik centers. The Lange Eye Institute at The Villages in central Florida is home base for many of the nutritional studies that Fortifeye is involved in. Dr. Lange is one of the first doctors in the industry to utilize intracellular blood tests and blood absorption studies to improve the Fortifeye vitamin line. Dr. Lange travels the world for nutritional research gathering valuable information to continuously improve Fortifeye vitamin formulations. Dr. Lange is still involved in the clinical practice of eyecare. He is a guest lecturer, contributing author to many eyecare magazines, and a daily syndicated talk show host of ‘Ask The Doctor’ which broadcasts every weekday at 9am and Saturdays at 2pm from Tampa Bay on radio stations throughout the country and video streaming all over the world via the Internet.




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Fortifeye™ and the ABCs of Ocular Nutrition

Improve your retinal health by taking Fortifeye vitamins and utilizing acetyl L carnitine, alpha lipoic acid, gogi berry, and green tea. Learn about ORAC value, antioxidant power, endothelial growth factor, cardiovascular disease, avoiding beta carotene. Reduce the risk of cardiovascular disease by taking omega-3 essential fatty acid from omega three fish oil. Lutein increases macular pigment density and reduces wet macular degeneration.

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Vitamin A: back to top

A fat-soluble, antioxidant vitamin important for vision and bone growth, belonging to the family of chemical compounds known as retinoids. Night blindness – the inability to see well in dim light – is associated with a deficiency of vitamin A. This vitamin is needed for the formation of rhodopsin, a retinal pigment. Vitamin A is also needed for the development of a healthy cornea. Third world countries have a high percentage of Vitamin A deficiencies and need supplementation for the pregnant mothers and children. However most developed countries where the population is consuming animal proteins, fruits and vegetables are not deficient in Vitamin A and do not need to supplement. Vitamin A can build up in toxic levels in the body and cause liver problems, birth defects, osteoporosis, neurological problems and many other potential problems. Too much vitamin A may be linked to increased risk of macular degeneration. Since vitamin A deficiency is rare in the populations that are taking Fortifeye vitamins and the potential for vitamin A toxicity exists, Fortifeye has decided to take all vitamin A and beta carotene out of their supplements.

Vitamin B complex: back to top

Eight water-soluble vitamins that play important roles in cell metabolism.

Vitamin C: back to top

Right Ingredients. Right Science. Right for You.(L-ascorbic acid) The most widely taken dietary supplement, Vitamin C is an essential water soluble nutrient required in small amounts to allow a range of essential metabolic reactions. Vitamin C is required for the synthesis of collagen and to maintain healthy skin, tendons, ligaments, blood vessels, cartilage and teeth. Vitamin C is an antioxidant that protects the body against oxidative stress, and is needed as a coenzyme in many reactions. Recent studies suggest that higher vitamin C intake may be associated with reduction in heart disease, strokes, cancers, cataracts and rheumatoid arthritis and excessive amounts of vitamin C may be associated with increase in oxalates that may increase risk of kidney stones. New research indicates that supplementing with vitamin C reduces C-reactive protein (CRP), an inflammatory marker linked with an increased risk of cardiovascular disease, stroke, peripheral artery disease, diabetes and possibly macular degeneration. It may lower CRP as much as statin drugs without the potential side effects. Vitamin C was one of the nutrients in the AREDS study that was beneficial for macular degeneration. High dosages of vitamin C may be beneficial at lowering intraocular pressure in patients with glaucoma.

Vitamin D: back to top

Is a group of fat-soluble pro hormones in two main forms; D2 (meritocracies) and D3 (collectable). Vitamin D is naturally produced by the human body when exposed to sunlight. Vitamin D regulates calcium and phosphorus levels in the blood by promoting their absorption from food in the intestines, and by promoting re-absorption of calcium in the kidneys. It also promotes bone formation and internalization. Vitamin D affects the immune system by promoting interspersion, phagocytes, and anti-tumor activity. After Vitamin D is produced in the skin from sun exposure or consumed in food it is converted in the liver and kidneys to the active form called clairol and then is released into circulation to specific organs. Vitamin D deficiencies are now being linked to several diseases including hypertension, diabetes, tuberculosis, cancer, periodontal disease, multiple sclerosis, collagen vascular diseases, seasonal affective disorder, depression, Parkinson’s and macular degeneration. New science (NHANES III) indicates that patients with higher serum levels of vitamin D may reduce the risk of macular degeneration. Vitamin D has anti inflammatory properties associated with it that may prove beneficial to many health and eye related diseases including macular degeneration. More studies on the use of vitamin D3 and eye disease will be necessary to prove these beneficail aspects. Twenty minutes of sun exposure in fair skinned people (3 to 6 times longer in dark skinned) between 12 and 2 p.m. will produce approximately 10,000 IU’s of vitamin D3. Physicians are now recommending more sun exposure or additional Vitamin D thru foods or vitamins for the high risk populations: elderly, darkly pigmented people, patients on medications that may block the absorption of fat soluble vitamins and people that are not in the sun very often. It is a good idea to have blood calcidiol (25-hydroxy-vitamin D) levels measured especially if you are in a high risk group. This is a current classification level that can give you some guide lines:

• 0-14.9 ng/mL = Severely deficient
• 15.0-31.9 ng/mL = Mildly deficient
• 32.0-100.0 ng/mL = Optimal
• >100.0 ng/mL = Toxicity possible

Vitamin E: back to top

A fat-soluble vitamin in eight forms that is an important antioxidant. Naturally occurring vitamin E exists in eight chemical forms (alpha-, beta-, gamma-, and delta-tocopherol and alpha-, beta-, gamma-, and delta-tocotrienol).The natural forms are usually labeled with the letter “d” (for example, d-gamma-tocopherol), whereas synthetic forms are labeled “dl” (for example, dl-alpha-tocopherol). Of the eight forms, alpha-tocopherol is traditionally recognized as the most active form of vitamin E but new studies suggest that gamma tocopherol exhibits the anti-inflammatory effects. Vitamin E may help prevent or delay coronary heart disease by limiting the oxidation of LDL-cholesterol. Vitamin E may help prevent the formation of blood clots which could lead to a heart attack. It is one of the five nutrients in the AREDS study used to slow down the progression of macular degeneration. Some studies have linked vitamin E as having protective effects on the human lens and macula. New studies indicate that tocotrienols may be effective at inhibiting angiogenesis and having numerous other health benefits. This may prove in the future to be beneficial in diabetic retinopathy and wet macular degeneration. Vitamin E may also help decrease C-Reactive protein which is a risk factor for cardiovascular disease, stroke, peripheral artery disease, diabetes and macular degeneration.

Acai Fruit Extract:  back to top

Acai is a fruit that grows on a particular palm tree in the Amazon rainforest. It is classified as one of the “super fruits” due to its very high ORAC value. Acai has a very high concentration of anthocyanins, antioxidants, fiber, omega essential fatty acids, plant sterols, vitamins and minerals. This nutrient dense fruit has been associated with tremendous health benefits. Fresh acai berries have an ORAC value of about 16,700 per 100 grams, while freeze dried varieties of acai berry can have ORAC as high as 100,000 per 100 grams.

Acetyl-L-carnitine (ALCAR):  back to top

Acetyl-L-carnitine is the acetylated ester of the amino acid L-carnitine. This form much more readily crosses the blood brain barrier than the L-carnitine form and aids in the conversion of fat to energy. ALCAR has been shown in clinical studies to support and improve mitochondrial functioning especially when combined with alpha lipoic acid. Some studies suggest that ALCAR may improve mental clarity, cognition, memory and energy. ALCAR may prove useful in Parkinson’s, Alzheimer’s, depression, diabetic neuropathy and blood sugar control, heart disease, lung disease and macular degeneration. Early studies may prove the combination of ALCAR, COQ-10 and omega three essential fatty acids may have protective effects on macular degeneration.

Alpha-lipoic acid: back to top

An antioxidant postulated to be effective in preventing vitamin C and vitamin E deficiency. It is able to scavenge reactive oxygen species and reduce other metabolites, such as glutathione, maintaining a healthy cellular redox state. Lipoic acid has been shown in cell culture experiments to increase cellular uptake of glucose, suggesting its use in diabetes. Recent studies now suggest that alpha-lipoic acid combined with acetyl-L-carnitine may improve memory and support mitochondrial health. These new studies hypothesize that alpha lipoic acid could benefit dementia and Parkinson’s. Some studies indicate it may be useful in glaucoma patients.

Biotin (B7): back to top

Used in cell growth, the production of fatty acids, metabolism of fats, and amino acids. It plays a role in the Krebs cycle, the process in which energy is released from food. Biotin not only assists in various metabolic chemical conversions, but also helps with the transfer of carbon dioxide. Biotin is also helpful in maintaining a steady blood sugar level.

Bilberry: back to top

Bilberry (European blueberry) is a deep blue fruit with high levels of anthocyanin pigments that have been linked to multiple health benefits. In several studies, bilberry was shown to improve visual acuity at night as well as shortening the time to adapt to dark conditions and recover from glare – important for light-sensitive individuals during night time driving. New science suggests bilberry, like blueberries, may prove to be a potent inhibitor of VEGF and may be helpful in diabetic retinopathy, macular degeneration, heart disease and cancer. Bilberry has an ORAC value of approximately 9,000 per 100 grams.*

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Research has shown increasing intake of antioxidants such as dark green leafy vegetables and dark berries may reduce the risk of macular degeneration and cataracts. Kale and spinach are very high in lutein, a carotenoid that increases macular pigment density in the retina that may have some protection against macular degeneration. Lutein also acts as an internal sunscreen to the retina by absorbing the harmful HIV (blue light) rays from the sun. Lutein may be beneficial at slowing down cataract formation. Blueberries have many health benefits. Studies are proving that blueberries decrease risk of cancers, reduce LDL cholesterol, guard against neurological diseases, relieve arthritis, strengthen immune system, promote urinary tract health and optimize ocular health. New research using blueberries has revealed inhibition of VEGF which may help in the protection of certain cancers, proliferative diabetic retinopathy and the wet stage of macular degeneration. The ORAC value of blueberry is about 6,552 per 100 grams, ORAC of kale is about 1,770 and the ORAC value of spinach is about 1515.

Boron: back to top

A naturally occuring element, boron has been shown to decrease excretion of calcium and activate estrogen and vitamin D. This may retard bone loss as you age and decrease the risk of osteoporosis.

Bromelain:  back to top

Found in abundance in pineapples, bromelain is not a single substance, but rather a collection of enzymes and other compounds. It is a mixture of protein-digesting enzymes called proteolytic enzymes or proteases. Bromelain is an anti-inflammatory agent. In addition to aiding in blood clot formation, it has also been proposed in the use of arthritis treatment. It aids in the absorption of quercetin (flavonoid). Super high dosages of bromelain may cause rapid heart beat.

Fortifeye™ Vitamins are the newest, most advanced nutraceuticals for your eyes and body. Compare Fortifeye to your current vitamins.

Calcium: back to top

A naturally occurring element, calcium is responsible for bone growth and maintenance. Calcium uptake by the body is known to decrease with age, weakening bones (osteoporosis), but calcium supplementation seems to slow that process.

Carotenoids: back to top

Substances that enable the body to synthesize retinoids. Carotenoids are organic pigments that are naturally occurring in plants and certain animals. New studies are now proving that beta-carotene may block the absorption of lutein. Lutein is a beneficial carotenoid that may improve the health of the macula. Beta-carotene may also increase the risk of lung cancer in smokers. New science suggests beta-carotene may increase risk of aggressive prostate cancer. Due to all the negative science regarding supplemental beta-carotene, Fortifeye Vitamins decided to remove all beta-carotene from their formulas.

Chromium:  back to top

An elemental metal which is thought to even out blood sugar metabolism, potentially helpful for diabetic patients. It is also a powerful antioxidant in one form.

Cinnamon Bark Extract:  back to top

Cinnamon has been used for thousands of years as a spice and for medicinal purposes. Cinnamon has been used as an aid in the common cold, help digestive problems and often used as an antimicrobial. More recently cinnamon has been useful in helping to control glucose, cholesterol and triglycerides in type 2 diabetics. Cinnamon has an ORAC score of 267,536 per 100 grams making it one of the most powerful antioxidants in the world. The numerous health benefits related to diabetes combined with the high antioxidant power makes cinnamon bark extract very appealing for total body as well as ocular health.

Cocoa Extract: back to top

Cocoa is the dried and fermented bean from the cacao tree where chocolate comes from. Cocoa is high in two specific flavanoids – epicatechins and polyphenols. The flavanoids from cocoa have been associated with many health benefits. Cocoa may improve circulation to the brain and heart and thus improve cardiovascular health and improve cognitive abilities. Cocoa may also be beneficial at lowering blood pressure and lowering LDL (bad cholesterol) and raising HDL (good cholesterol). The antioxidant power (ORAC Value) of cocoa is one of the highest of any food on the planet. The high amounts of antioxidant in cocoa may help to retard free radical damage in the body and slow down the age related degenerative diseases in the body and eyes. ORAC value of dry powdered cocoa is about 80,000 per 100 grams and dark chocolate has an ORAC value of approximately 13,000 per 100 grams.

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Naturally occurring, copper is used by the body along with zinc to maximize iron uptake. Copper is an essential nutrient to all humans. It is found primarily in the bloodstream, as a cofactor in various enzymes. Copper is one of five nutrients in the AREDS study used to help slow the progression of macular degeneration.

CoQ10 (Ubiquinone):  back to top

Coenzyme Q10 is an oil soluble vitamin-like antioxidant found in every cell in the body. The highest concentration is found in the mitochondria. The primary function is generating energy. CoQ10 levels decrease with age, certain medications and certain diseases. CoQ10 has been associated with health benefits in numerous diseases like: heart disease, diabetes, gum disease, Parkinson’s, cancer, macular degeneration and glaucoma. CoQ10 deficiencies have been linked to certain medications like statins, beta blockers and tricyclic antidepressants. New studies indicate that CoQ10 combined with omega three fish oil and acetyl-L-carnitine may have protective effects for macular degeneration. Good dietary sources of CoQ10 are salmon, sardines, herring, tuna and mackerel. CoQ10 is best taken with a meal to aid in absorption.

Cyanocobalamin (B12):  back to top

B12 is the most chemically complex of all vitamins. It is involved in the metabolism of every cell in the body and is crucial in DNA and fatty acid synthesis. Elevated homocysteine can be linked to B12 deficiency along with pernicious anemia. New
studies indicate that low B12 status may increase risk of cognitive impairment. B12 deficiency becomes more of a problem as we age and in true vegetarians. Since it is difficult for the elderly population to absorb B12, larger amounts of B12 are now being used in vitamin supplements to help decrease the chances of patients developing B12 deficiencies.

Docosahexaenoic acid (DHA):  back to top

An omega-3 essential fatty acid, DHA is most often found in fish oil. DHA is a major fatty acid in sperm and brain phospholipids, and especially in the retina. Dietary DHA can reduce the level of blood triglycerides in humans, which may reduce the risk of heart disease. Low levels of DHA cause reduction of brain serotonin levels and have been associated with ADHD, Alzheimer’s disease, and depression, among other diseases, and there is mounting evidence that DHA supplementation may be effective in combating such diseases. May be beneficial for macular degeneration and dry eyes. The DHA used in Fortifeye vitamins comes from the highest quality ultra purified triglyceride based fish oils. This natural form of fish oil maximizes absorption, has no after taste and is toxin free. New science is now proving that omega three may decrease the shortening of the end cap of a chromosome know as a telomere. Telomere shortening is seen as an indicator of biological aging, so omega three fish oil should be incorporated into any healthy anti-aging diet.

Eicosapentaenoic acid (EPA):
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An omega-3 essential fatty acid, found most notably in oily fish. EPA is a polyunsaturated fatty acid that acts as a precursor for prostaglandin-3, which inhibits platelet aggregation. EPA is thought to be effective in lowering inflammation. May be beneficial for macular degeneration and dry eyes. Recent studies have suggested that EPA may affect depression and suicidal behavior. EPA may prove to be beneficial for breast cancer, as well as aid in treatment of multiple myeoloma. The EPA used in Fortifeye Vitamins comes from the highest quality (triple molecular distillation) triglyceride based fish oils. This natural form of fish oil maximizes absorption, has no after taste and is toxin free. New science is now proving that omega three may decrease the shortening of the end cap of a chromosome know as a telomere. Telomere shortening is seen as an indicator of biological aging, so omega three fish oil should be incorporated into any healthy anti-aging diet.

Folic acid (B9): back to top

Folic acid or B9 is extremely important during periods of rapid cell division and growth. This B vitamin is needed to produce healthy red blood cells and prevent anemia. Folic acid is essential for healthy homocysteine levels and in the prevention of neural tube defects in infants. Folic acid when combined with B12 and B6 will bring homocysteine levels down. New studies also indicate the combination of B12, folic acid and B6 will decrease the development of macular degeneration. Folic acid is extremely important and you don’t want to have a deficiency, however
there is a fine line between too little and too much. Too much folic acid is associated with cognitive decline and increased risk of certain types of cancer. General consensus as of 2010 is not to take more than 1000mcgs from natural and synthetic sources. Fortifeye Vitamins has cut back the amount of folic acid in their products to make sure the public doesn’t get too much from supplementing.

Gamma-linolenic acid (GLA):
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An omega-6 essential fatty acid found primarily in vegetable oils such as evening primrose (oenothera biennis) oil, blackcurrant seed oil, or borage oil. From GLA, the body forms dihomo-gamma-linolenic acid (DGLA). This is one of the body’s three sources of eicosanoids (along with AA and EPA.) DGLA is the precursor of the prostaglandin PGH1, which in turn forms PGE1 and the thromboxane TXA1. PGE1 has a role in regulation of immune system function. GLA is unique among the omega-6 polyunsaturated fatty acids (linoleic acid, GLA, and arachidonic acid) in its potential to suppress tumor growth and metastasis. GLA may also improve tear production and aid dry eyes. GLA by stimulating PGE1 acts as an anti-inflammatory
as well.

Gogi berry: back to top

Gogi berry, or llycium berry, has been used for thousands of years in traditional Chinese medicine. Gogi berry has been named the “anti-aging berry” because of its nutrient dense profile and extremely high antioxidant power. Gogi berry is considered one of the “super fruits” since it has one of the highest ORAC scores of any edible fruit. The ORAC value of 100 grams of gogi is approximately 25,300. Gogi berry may be the richest source of zeaxanthin in the plant family. Studies reveal that intake of a modest daily amount of gogi berries markedly increases fasting plasma zeaxanthin levels. This aids in improving macular pigment density which may prove to be beneficial for macular degeneration. Early studies indicate that gogi berry may have some neuro protective qualities in protecting retinal ganglion cells in glaucoma. The gogi berry may also aid in dark adaptation. The gogi berry is a good source of essential and trace minerals, amino acids, vitamins, polysachrides and essential fatty acids. The nutritional value of the gogi berry is proving to be beneficial for ocular and overall health.

Grape seed extract:  back to top

Used extensively in Europe, grape seed extract is rich in polyphenols, compounds that have antioxidant properties some consider even greater than vitamin C and vitamin E. Beyond its antioxidant powers, it is thought to improve blood circulation and help strengthen blood vessels. It may reduce the risk of cardiovascular disease and cancer. Resveratrol is one of the polyphenols found in grape seeds that has enormous health benefits.

“Since the body does not produce all of the required elements for optimal health, supplements are critical for your best health.”

Green tea extract:  back to top

EGCG, a key antioxidant found in green tea, is thought to support retinal health and works particularly well when in presence of Vitamin E. According to researchers at the University of Kansas, EGCG is 100x more powerful as an antioxidant that Vitamin C and 25x more powerful than Vitamin E. EGCG may also inhibit the formation of new blood vessels (anti-VEGF); this may prove to be useful in supporting retinal health. Green tea has been linked to lower cancer risk, lower cholesterol, faster weight loss, neuro protection, improved cognitive abilities, healthier immune system, better diabetic control and may benefit arthritis. 100 grams of brewed green tea has an ORAC value of approximately 1253. There is some evidence that green tea may help slow down cataracts. New science is proving that green tea may slow down the degeneration of the end cap of the chromosome called a telomere. This makes green tea an anti-aging nutrition.

Hesperidin: back to top

A flavonoid glycoside that has been shown to reduce cholesterol and blood pressure experimentally. In some studies large doses of the glucoside hesperidin were shown to decrease bone density loss. Hesperidin has also been shown to have anti-inflammatory effects.

Iodine: back to top

A chemical element that is required in trace amounts by most living organisms, iodine is necessary for proper production of thyroid hormone.

Lutein:  back to top

A carotenoid found naturally in dark green leafy vegetables (spinach and kale) and other natural sources, this potent antioxidant is sorely lacking in the typical American diet. Lutein and zeaxanthin are the only carotenoids found in the retina of the eye. Lutein supplementation has been shown in landmark clinical studies to increase macular pigment density which may promote macular health. Scientists believe lutein helps filter out dangerous ‘blue’ light, helping to maintain the photoreceptor and retinal health. Lutein is now believed to have a protective effect on the retina and may help to slow down age related macular degeneration. Lutein may have some protective effects against cataract formation. Lutein is more readily available when greens are gently cooked or juiced versus the raw state.

“Clinical studies have shown that increasing supplemental intake of lutein increases macular pigment density in the retina. Low levels of macular pigment is common in patients with macular degeneration.”

Lycopene: back to top

A bright red carotenoid pigment, lycopene is a phytochemical found in tomatoes and other red fruits. Lycopene is the most common carotenoid in the human body and is one of the most potent carotenoid antioxidants. Studies indicate it may reduce the risk of cardiovascular disease, cancer, diabetes, osteoporosis, male infertility and even macular degeneration.

Magnesium: back to top

The chemical element required in trace amounts by the body for the basic nucleic acid catalysis. Magnesium is necessary to maintain the health of almost every organ in the body especially the heart, muscles, kidneys, bones and teeth. Found most notably in spinach, pumpkin seeds and halibut. Magnesium has shown promise in treating symptoms of autism and ADHD, when combined with vitamin B6. There is an association between low magnesium intake and diabetes. Studies indicate that consumption of magnesium may lower C-reactive protein and other signs of chronic inflammation. Inflammation is one of the root causes of many eye diseases.

Manganese: back to top

Elementally found in nature, manganese and in its various ionic states (II) function as cofactors for a number of enzymes.

Mangosteen fruit extract:  back to top

Mangosteen is grown in Southeast Asia and is considered one of the super fruits. Mangosteen is known as the “queen of tropical fruits” and is very high in polyphenols, xanthones and tannins. Mangosteen is known for its health promoting properties and has a high ORAC score. Research indicates that xanthones may support the immune system, maintain intestinal health, help stop free radical damage, and support cartilage, joint and respiratory health.

Molybdenum: back to top

A transition metal important in plant nutrition, and is necessary in animal and human nutrition. It is found at the active site of certain enzymes, including xanthine oxidase, important within the eye.

N-Acetylcysteine: back to top

A co-factor which aids glutathione to increase uptake and efficacy of free radicals as antioxidants. N-Acetylcysteine may be beneficial in certain types of cancer, COPD, bipolar disorders, schizophrenia, boosting the immune system, aiding in detoxification of the body, reducing duration of influenza and may help with chronic blepharitis and symptoms associated with dry eyes.

Niacin (B3):   back to top

A water-soluble vitamin which plays an essential role in energy metabolism in the living cell and DNA repair. It also plays a role in removing toxic and harmful chemicals from the body. Niacin, when taken in large doses, increases the level of high density lipoprotein (HDL) or good cholesterol in blood. New studies are using niacin as a vasodilator to improve circulation in patients that have experienced a vein occlusion in the eye.

Pantothenic Acid (B5):  back to top

A water-soluble vitamin required to sustain life and is critical in the metabolism and synthesis of carbohydrates, proteins, and fats.

Phosphorous:  back to top

An element (always found as a compound in nature) that is a component of DNA and RNA and essential for all living cells where it forms part of the structural framework of these molecules (ADP, ATP).

Pomegranate fruit extract:  back to top

Pomegranate known as the “royal fruit” is a rich source of antioxidants and polyphenols. Pomegranate has a moderate ORAC value of about 2,860 per 100 grams. Some of the health benefits claims of pomegranate are improved circulation to the heart, reduction of arterial plaque, reduction in blood pressure and LDL (bad cholesterol), protective effects for breast and prostate cancer, improvement in erectile dysfunction and may act as an anti-inflammatory. The antioxidant power, improvement in circulation and anti-inflammatory aspects of pomegranate may prove to be beneficial for good ocular health.

Pyridoxine (B6):  back to top

B6 is required for the synthesis of neurotransmitters and red blood cells. It is also necessary for healthy homocysteine levels. Supplementation with pyridoxine, folic acid and B12 reduces the concentration of homocysteine in the bloodstream. Elevated homocysteine is a risk factor for heart disease, stroke, macular degeneration and occlusive artery disease in the eye. Super high dosages of B6 may cause nerve damage in the legs and arms.

Quercetin dehydrate:  back to top

A flavinoid found in such food as citrus and apples, quercetin may have positive effects in combating or helping to prevent cancer, heart disease, cataracts, allergies, inflammations, and certain respiratory conditions. Patients should make their doctors aware if taking high dosages of quercetin prior to antibiotic therapy.

Resveratrol:  back to top

Found in the skin of red grapes, resveratrol is perhaps one of the most potent antioxidants known. Research shows that resveratrol has anti-vascular endothelial growth factor (anti-VEGF) which they believe offers the greatest degree of protection to human blood-vessel cells, particularly within the retina. New studies indicate it may increase life span. Resveratrol may be useful as a chemo-protectant, cardio-protectant, anti-inflammatory, neuro-protectant and may prove useful for diabetes. Fortifeye was one of the first in the industry to utilize resveratrol in their formulas.

“Current studies show that certain nutrients can actually slow or stop the development of unwanted blood vessels (called vascular endothelial growth factor, or “VEGF”). Therefore, nutrients with anti-VEGF properties such as green tea, resveratol, turmeric, and soy isoflavones are tremendously important for overall ocular health, particularly for diabetics or patients with macular degeneration.”

Riboflavin (B2):
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Required for a wide variety of cellular processes; like the other B vitamins, it plays a key role in energy metabolism. Riboflavin is required for the metabolism of fats, carbohydrates, and proteins. Deficiencies can cause corneal and lenticular opacities.

Rutin: back to top

A citrus flavonoid glycoside and antioxidant. It has been suggested that rutin might play an important role in inhibiting some cancers, as well as strengthening the capillaries, including those in the choroid. Rutin is also an inhibitor of VEGF which may prove useful in diabetic retinopathy and wet macular degeneration.

Selenium: back to top

A trace element not naturally produced by the body, selenium is found in high concentration in nuts. Selenium functions as cofactor for reduction of antioxidant enzymes such as glutathione peroxidases and thioredoxin reductase.

Sesame lignans: back to top

Powerful antioxidants that have been shown to work within the essential fatty acid derivatives (GLA) to create positive enzymatic reaction as compared to negative prostaglandin reactions. Sesame lignans help to block the inflammatory cascade of arrachidonic acid inherent to omega six oils.

Taurine: back to top

Compound that in recent laboratory studies have shown that taurine can influence (and possibly reverse) nerve blood flow, motor nerve conduction velocity, and nerve sensory threshold defects. In certain animal cases, the absence of taurine causes central retinal degeneration.

Thiamine (B1): back to top

Plays an important role in helping the body convert carbohydrates and fat into energy. It is essential for normal growth and development and helps to maintain proper functioning of the heart and the nervous and digestive systems. Thiamine is water-soluble and cannot be stored in the body. However, once absorbed, the vitamin is concentrated in muscle tissue.

Turmeric (Curcumin): back to top

Naturally occurring in turmeric, curcumin is in curry spice. Curcumin is known for its anti-inflammatory, chemoprotective, antioxidant, anti-amyloid and anti-VEGF (anti-vascular endothelial growth factor) properties. Studies indicate this compound may be beneficial in inflammatory diseases in the eye and may prove to be effective in slowing down certain types of cataracts. New studies indicate it may decrease chances of developing dementia.

“Thousands of patients are currently using Fortifeye Complete Plus combined with proper diet and exercise to dramatically improve their quality of life.”


Vanadium: back to top

A trace metal most popularly added to drinking water in Asia. It has been suggested that vanadium improves blood sugar control, and increases muscular strength, as well as osteoporosis treatment.

Zeaxanthin:  back to top

Zeaxanthin is one of the two carotenoids contained within the retina of the eye. Zeaxanthin and lutein have an almost identical chemical structure and have similar properties. Zeaxanthin, like lutein, increases macular pigment density and also helps to filter out the harmful blue light from the sun. Gogi berries have one of the highest sources of zeaxanthin and orange bell peppers are relatively high in zeaxanthin and more readily available. Zeaxanthin may also have some protective effects on cataract formation. Zeaxanthin may inhibit VEGF and prove useful for diabetic retinopathy and wet macular degeneration.

Zinc: back to top

A trace metal, zinc is an activator of certain enzymes, such as carbonic anhydrase, important in the transport of carbon dioxide in blood. Clinical studies have found that zinc, combined with antioxidants and certain vitamins (A, C, and E) may delay progression of age-related macular degeneration. Also, significant dietary intake of zinc has also recently been shown to impede the onset of flu. Fortifeye Vitamins uses Opti Zinc to gain superior absorption and bio availability over other forms of zinc.


IMPORTANT NOTE: These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent disease.

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