Mirtogenol: Innovative patented combination for eye health

Dr Franziska Weichmann, Manager of Scientific Communications and Product Development, Horphag Research explains about Mirtogenol^®, a patented combination of Mirtoselect^® bilberry extract and Pycnogenol^® French maritime pine bark extract which is one of the first nutritional approaches developed to address eye health

According to the World Health Organization (WHO) “globally, more than 2.2 billion people are affected by vision impairment, with at least half of them having an eye condition that could have been prevented or is yet to be addressed” (1).

Diabetes significantly contributes to eye-related health risks, potentially leading to complications such as diabetic retinopathy, cataracts and diabetic macular oedema (2). Diabetes type 2 is described as a “modern preventable pandemic” with its global prevalence having tripled in the past 20 years (3). In India, a recent study estimates that 101 million people, which accounts for 11.4 per cent of the country’s population, are currently living with diabetes, and this number shows an increasing trend (4).

Many of these eye conditions, if undetected or not adequately treated, can lead to blindness. Cataract, uncorrected refractive error, and glaucoma are the three most common causes of blindness worldwide (5). While cataract and uncorrected refractive error can be reversed by operation or spectacle correction, damages caused by glaucoma cannot be reversed. Glaucoma comprises a group of eye conditions that damage the optic nerve, the health of which is vital for good vision. This damage is often caused by an abnormally high pressure in the eye (6). Insufficient blood supply due to increased intraocular pressure (IOP) or reduced ocular blood flow (OBF) are considered major treatable risk factors for glaucoma (7). Lowering IOP is the only proven method to avoid irreversible damages. Treatments include prescription eyedrops, oral medications, or surgery, but oral supplementation is increasingly popular among consumers looking at natural alternatives (6).

Mirtogenol^®, a patented combination of Mirtoselect^® bilberry extract and Pycnogenol^® French maritime pine bark extract, is one of the first nutritional approaches developed to address eye health.

In several studies, Pycnogenol^® has been shown to positively affect eye health by strengthening retinal capillaries in diabetic retinopathy (8-10) and by reducing the recurrence of retinal vein thrombosis (11, 12). Additionally, Pycnogenol^® provides potent antioxidant protection for the eyes (13, 14). Maintaining healthy retinal capillaries helps control leakage of fluids and blood into the retina and reducing retinal edema (9).

Mirtoselect^® was shown to have a positive impact on eye health as well, by improving tear secretion and plasmatic antioxidant potential in subjects suffering from Dry Eye Disease (DED) symptoms (15).

In 4 clinical studies on more than 200 patients, the unique combination product Mirtogenol^® showed significant effects on intraocular pressure (IOP) and ocular blood flow (OBF) (16-19).

Intraocular pressure significantly reduced with Mirtogenol^®

A clinical pilot study with 38 asymptomatic subjects with intraocular hypertension showed that after 2 months of supplementation with Mirtogenol^®, the intraocular pressure (measured in mmHg) was strongly lowered (16). For a total of 6 months, the subjects were supplemented with two Mirtogenol^® capsules per day that contained 40 mg of Pycnogenol^® and 80 mg of Mirtoselect^® each.

After 3 months, the intraocular pressure exhibited a significant reduction of 13 per cent compared to baseline, whereas no effect was shown in the control group. At that point, 19 out of 20 patients taking Mirtogenol^® had an IOP in a normal range. The effects on ocular arterial blood flow velocity were similarly improved after 2 months regarding systolic and diastolic components in different ocular arteries. After 3 months, the increase in arterial flow velocity in the retinal and ciliary arteries was statistically significant as compared to both baseline and control group, in which no alteration of flow velocity was found.

The study suggests the use of Mirtogenol^® as a safe preventative solution for lowering the risk of developing symptomatic glaucoma by controlling intraocular pressure and improving ocular blood flow.

Mirtogenol^® improves eye blood flow

Another 6-month study with 79 patients with asymptomatic ocular hypertension investigated the effects of a lower dose of Mirtogenol^® (1 capsule, containing 40 mg of Pycnogenol^® and 80 mg of Mirtoselect^®) per day for controlling intraocular pressure in patients medicated with latanoprost eye drops (17). Latanoprost is a drug used to treat increased pressure inside the eye, including ocular hypertension and open angle glaucoma. It is a prostaglandin analogue and increases the outflow of aqueous fluid from the eyes (20). In addition to latanoprost eye drops, a part of the patients was also supplemented with Mirtogenol^®.

The investigators found that Mirtogenol^® further enhances the beneficial effects of latanoprost regarding IOP by 15 per cent. Moreover, Mirtogenol^® along with Latanoprost further improved diastolic ocular blood flow velocity by 40 per cent and systolic ocular blood flow velocity by 9 per cent to normal levels in comparison with latanoprost only.

This research suggests that Mirtogenol^® in combination with latanoprost potentiates the effects of latanoprost for eye health already after 6 weeks and even better results after 6 months supplementation.

Vascular circle around optic nerve better perfused with Mirtogenol^®

A study with 88 asymptomatic patients with intraocular hypertension investigated the effects of 3 months Mirtogenol^® supplementation (2 capsules/day) in association with traditional antihypertensive drugs (dorzolamide-timolol or latanoprost eye drops) on retinal microcirculatory parameters and oxidative stress (18). After 6 weeks, the study showed a positive clinical effect on intraocular pressure and the ocular blood flow when supplementing with Mirtogenol^® in addition to latanoprost. Another 6 weeks later at the end of the study, 58.1 per cent of the subjects treated with Mirtogenol^® and latanoprost had normal IOP levels, compared to 41.4 per cent in the only-latanoprost patient group. The oxidative stress levels (measured as plasma free radicals) were decreased significantly by 17 per cent compared to baseline, when supplementing with Mirtogenol^®. The diastolic and systolic ocular blood flow velocity could be strongly improved by 63 per cent and 24 per cent respectively, when compared to non-supplemented patients. Moreover, after 12 weeks, blood perfusion around the optic nerve (circle of Zinn-Haller) was significantly improved with Mirtogenol^® and latanoprost.

The authors conclude that supplementing with Mirtogenol^® in addition to the standard ophthalmic treatments, improves ocular microcirculatory parameters with faster and greater effects compared to non-supplemented single managements and may contribute to lowering intraocular pressure to normal levels.

Retinal nerve fiber layer thickness maintained and visual field improved with Mirtogenol^®

A prospective, randomised double-blind, placebo-controlled study published in 2017 investigated the effects of Mirtogenol^® supplementation on the changes in retinal nerve fiber layer (RNFL) thickness and visual field (19). 41 patients with primary open angle glaucoma with controlled intraocular pressure levels were supplemented with Mirtogenol^® for 2 months in addition to their glaucoma medications. At the end of the study, Mirtogenol^® maintained RNFL thickness, with an insignificant decrease of 0.8 per cent, whereas in the placebo group, a significant thinning of the RNFL by 1.8 per cent was observed. According to the authors, a decrease of the RNFL thickness by 10-12 per cent is related to a glaucomatous change by 1.5-fold. The mean deviation of visual fields in the Mirtogenol^® group was increased by 29.6 per cent after the two months, whereas in the placebo group, it decreased by 6.9 per cent. A decrease of the mean deviation of the visual field of 1.4 per cent per month indicates glaucoma progression. This study showed further beneficial effects of Mirtogenol^® for eye health as part of addressing risks factors associated with glaucoma.

Mirtogenol^® is a patented combination of Mirtoselect^® bilberry extract and Pycnogenol^® French maritime pine bark extract. It is a safe, natural, and evidence-based solution to help with eye health. For further information, please visit www.mirtogenol.com.

References:

1. World Health Organization. World Report on Vision 2019 [Available from: https://www.who.int/publications/i/item/world-report-on-vision.
2. Gale MJ, Scruggs BA, Flaxel CJ. Diabetic eye disease: A review of screening and management recommendations. Clin Exp Ophthalmol. 2021;49(2):128-45.
3. Singer ME, Dorrance KA, Oxenreiter MM, Yan KR, Close KL. The type 2 diabetes ‘modern preventable pandemic’ and replicable lessons from the COVID-19 crisis. Prev Med Rep. 2022;25:101636.
4. Anjana RM, Unnikrishnan R, Deepa M, Pradeepa R, Tandon N, Das AK, et al. Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17). The Lancet Diabetes & Endocrinology. 2023;11(7):474-89.
5. Flaxman SR, Bourne RRA, Resnikoff S, Ackland P, Braithwaite T, Cicinelli MV, et al. Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis. The Lancet Global Health. 2017;5(12):e1221-e34.
6. Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: a review. Jama. 2014;311(18):1901-11.
7. Flammer J, Orgül S, Costa VP, Orzalesi N, Krieglstein GK, Serra LM, et al. The impact of ocular blood flow in glaucoma. Prog Retin Eye Res. 2002;21(4):359-93.
8. Spadea L, Balestrazzi E. Treatment of vascular retinopathies with Pycnogenol. Phytother Res. 2001;15(3):219-23.
9. Schönlau F RP. Pycnogenol for diabetic retinopathy: A review. Intl Ophthalmol. 2002;24:161-71.
10. Steigerwalt R, Belcaro G, Cesarone MR, Di Renzo A, Grossi MG, Ricci A, et al. Pycnogenol improves microcirculation, retinal edema, and visual acuity in early diabetic retinopathy. J Ocul Pharmacol Ther. 2009;25(6):537-40.
11. Rodriguez P BG, Dugall M, Hu S, Luzzi R, Ledda A, Ippolito E, Corsi M, Ricci A, Feragalli B, Cornelli U, Gizzi C, Hosoi M Recurrence of retinal vein thrombosis with Pycnogenol® or Aspirin® supplementation: a registry study. Panminerva Med. 2015;57:121-5.
12. Belcaro G, Dugall M, Bradford HD, Cesarone MR, Feragalli B, Gizzi C, et al. Recurrent retinal vein thrombosis: prevention with Aspirin, Pycnogenol(R), ticlopidine, or sulodexide. Minerva Cardioangiol. 2019;67(2):109-14.
13. Chida M SK, Nakanishi-Ueda T, Ueda T, Yasuhara H, Koide R, Armstrong D. In vitro testing of antioxidants and biochemical end-points in bovine retinal tissue. Ophtalmic Research. 1999;31:407-15.
14. Nakanishi-Ueda T, Kamegawa, M., Ishigaki, S., Tsukahara, M., Yano, S., Wada, K. and Yasuhara, H. Inhibitory effect of Lutein and Pycnogenol on lipid peroxidation in porcine retinal homogenate. J Clin Biochem Nutr. 2006;38:204-10.
15. Riva A, Togni S, Franceschi F, Kawada S, Inaba Y, Eggenhoffner R, et al. The effect of a natural, standardized bilberry extract (Mirtoselect®) in dry eye: a randomized, double blinded, placebo-controlled trial. Eur Rev Med Pharmacol Sci. 2017;21(10):2518-25.
16. Steigerwalt RD, Gianni B, Paolo M, Bombardelli E, Burki C, Schönlau F. Effects of Mirtogenol on ocular blood flow and intraocular hypertension in asymptomatic subjects. Mol Vis. 2008;14:1288-92.
17. Steigerwalt RD, Jr., Belcaro G, Morazzoni P, Bombardelli E, Burki C, Schönlau F. Mirtogenol potentiates latanoprost in lowering intraocular pressure and improves ocular blood flow in asymptomatic subjects. Clin Ophthalmol. 2010;4:471-6.
18. Gizzi C, Torino-Rodriguez P, Belcaro G, Hu S, Hosoi M, Feragalli B. Mirtogenol® supplementation in association with dorzolamide-timolol or latanoprost improves the retinal microcirculation in asymptomatic patients with increased ocular pressure. Eur Rev Med Pharmacol Sci. 2017;21(20):4720-5.
19. Widyakusuma A, Artini W, Oktariana V, Prihartono J. The effect of mirtogenol towards the changes in retinal nerve fiber layer thickness and visual field in primary open angle glaucoma. Ophthalmol Ina. 2017;43(1):28-33.
20. Patel SS, Spencer CM. Latanoprost. Drugs & Aging. 1996;9(5):363-78.