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While lutein and zeaxanthin supplements have been shown to improve ocular health, existing research often overlooks the efficacy of lower dosages and shorter durations of supplementation. This study investigated the effects of combined supplementation with lutein, zeaxanthin, and elderberries in 110 voluntary participants through a randomized controlled trial. Methods: Participants took 6 mg of lutein and 1 mg of zeaxanthin, along with 100 mg elderberry extract once daily for a duration of 20 days. Ocular health was assessed using the Ocular Surface Disease Index (OSDI), while immune status was evaluated with the Immune Status Questionnaire (ISQ). Results: Results showed that combined supplementation significantly (p &lt; 0.05) reduced the OSDI scores in the intervention group from 38.15 \u00b1 11.14 to 18.26 \u00b1 5.57, reflecting a 52.2% reduction. A similar trend was observed with the Visual Analog Scale (VAS), indicating significant (p &lt; 0.05) improvement from 5.31 \u00b1 1.62 to 6.73 \u00b1 1.74, equivalent to a 26.7% improvement. Although the intervention group showed a 15.9% improvement in ISQ scores by the study\u2019s end, this was not significantly different from the placebo group, suggesting that higher dosages or longer durations may be needed to observe a meaningful effect. Additionally, findings from the Food Frequency Questionnaire revealed that the average dietary intake of lutein and zeaxanthin among participants was only 663.49 \u00b5g, equating to just 5.5% of the suggested optimal daily intake. This low consumption is concerning, as it is inversely correlated with the risk of ocular diseases. Conclusions: Collectively, these findings support the use of combined supplementation as an adjuvant approach to improving ocular health.<\/jats:p>","DOI":"10.3390\/nu16244366","type":"journal-article","created":{"date-parts":[[2024,12,18]],"date-time":"2024-12-18T09:43:03Z","timestamp":1734514983000},"page":"4366","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effect of Dietary Supplementation with Lutein, Zeaxanthin, and Elderberries on Dry Eye Disease (DED) and Immunity: A Randomized Controlled Trial"],"prefix":"10.3390","volume":"16","author":[{"given":"Kok Ming","family":"Goh","sequence":"first","affiliation":[{"name":"New Product Development Department, Ecolite Biotech Manufacturing, Yong Peng 83400, Malaysia"},{"name":"Product Development Department, Xmegami Manufacturing, Puchong 47170, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5711-4808","authenticated-orcid":false,"given":"Eugenie Sin Sing","family":"Tan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences, UCSI University, Kuala Lumpur 56000, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Crystale Siew Ying","family":"Lim","sequence":"additional","affiliation":[{"name":"Faculty of Applied Sciences, UCSI University, Kuala Lumpur 56000, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pui Yee","family":"Tan","sequence":"additional","affiliation":[{"name":"Faculty of Environment, University of Leeds, Leeds LS2 9JT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6011-0365","authenticated-orcid":false,"given":"Sayantan","family":"Biswas","sequence":"additional","affiliation":[{"name":"School of Optometry, College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li Ann","family":"Lew","sequence":"additional","affiliation":[{"name":"Product Development Department, Xmegami Manufacturing, Puchong 47170, Malaysia"},{"name":"Faculty of Food Science and Technology, Universiti Putra Malaysia, Serdang 43400, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3956-2217","authenticated-orcid":false,"given":"Chung Keat","family":"Tan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences, UCSI University, Kuala Lumpur 56000, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1007\/s40123-020-00308-z","article-title":"Dry eye disease: Early recognition with guidance on management and treatment for primary care family physicians","volume":"9","author":"Verjee","year":"2020","journal-title":"Ophthalmol. 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