What vitamins help with vision?

Vitamins That Help Vision

For patients with intermediate or advanced age-related macular degeneration (AMD), the AREDS2 formulation containing vitamin C, vitamin E, zinc, copper, lutein (10mg), and zeaxanthin (2mg) is the only proven vitamin therapy that reduces disease progression and vision loss. 1

Evidence-Based Vitamin Recommendations by Condition

Age-Related Macular Degeneration (AMD)

For patients with intermediate AMD or advanced AMD in one eye, prescribe AREDS2 supplements immediately to reduce progression risk by up to 36% over 10 years. 2 This formulation includes:

• Vitamin C (500 mg) 2
• Vitamin E (400 IU) 2
• Zinc (25-80 mg, with 25mg shown equivalent to 80mg) 2
• Copper (2 mg, necessary to prevent copper-deficiency anemia from zinc) 2
• Lutein (10 mg) 2
• Zeaxanthin (2 mg) 2

The combination of antioxidants and zinc reduced progression to advanced AMD with an odds ratio of 0.73 (99% CI, 0.54-0.99) in patients with intermediate AMD or advanced AMD in one eye. 1

Critical caveat: Lutein and zeaxanthin replaced beta-carotene in the AREDS2 formulation because beta-carotene was associated with increased lung cancer risk in former smokers (2.0% vs 0.9%; P = 0.04). 1 Never recommend beta-carotene to current or former smokers. 2

For General Vision Health and Cataract Prevention

There is no level 1 evidence supporting high-dose antioxidant supplementation (vitamin E, vitamin C, or beta-carotene) for preventing cataracts or AMD in healthy individuals. 1, 3 A 2012 Cochrane review of 9 randomized controlled trials found no benefit of vitamin E or beta-carotene supplements in preventing AMD development (pooled RR 0.98,95% CI 0.89-1.08). 3

However, moderate evidence suggests a standard multivitamin/mineral supplement may decrease cataract risk in the general population. 1

Specific Vitamin Functions in Eye Health

Lutein and Zeaxanthin

• These are the only dietary carotenoids that accumulate in the retina and macula, forming the macular pigment. 4
• They filter damaging blue light and ultraviolet light, improving contrast sensitivity and reducing screen glare. 5
• They provide antioxidant and anti-inflammatory effects protecting against oxidative stress. 5, 4
• Recommended daily intake: 10 mg lutein and 2 mg zeaxanthin for high-risk AMD patients. 2
• Dietary sources: Kale, spinach, broccoli, corn, and egg yolks. 4

Zinc

Zinc alone showed decreased risk of progression to late AMD (OR 0.83,95% CI 0.70-0.98) but was less effective than the combination with antioxidants. 1

Important warning: Zinc at 80mg was associated with increased hospitalization due to genitourinary causes. 1 The 25mg dose is now preferred and shown to be equally effective. 2

Vitamins C and E

When combined with zinc, antioxidant multivitamins (vitamins C and E) reduced progression to late AMD (OR 0.72,95% CI 0.58-0.90) and visual acuity loss of more than 3 lines (OR 0.77,95% CI 0.62-0.96). 1

What Does NOT Work

The following have shown no clear effects on AMD progression or visual acuity:

• Vitamin E alone 1, 3
• Beta-carotene alone (and carries lung cancer risk in smokers) 1, 3
• Various other antioxidant multivitamin combinations not matching AREDS2 formulation 1

Clinical Algorithm for Vitamin Recommendations

1. Patient has intermediate or advanced AMD in at least one eye → Prescribe AREDS2 formulation immediately 2

2. Patient is a current or former smoker with AMD → Use AREDS2 formulation WITHOUT beta-carotene (use lutein/zeaxanthin instead) 1, 2

3. Patient has early AMD or no AMD → No proven benefit from high-dose vitamin supplementation; recommend well-balanced diet rich in fruits and vegetables 1

4. Patient concerned about general eye health/cataract prevention → Consider standard multivitamin/mineral supplement (moderate evidence for benefit) 1

Common Pitfalls to Avoid

• Do not recommend AREDS2 supplements to patients without intermediate or advanced AMD – there is no evidence of benefit for prevention. 3
• Do not prescribe beta-carotene to smokers or former smokers – increased lung cancer risk. 1, 2
• Monitor patients on high-dose zinc (80mg) for genitourinary complications; prefer 25mg dose. 1, 2
• Counsel patients that vitamins alone do not treat wet AMD – anti-VEGF therapy is required for neovascular disease. 2

Additional Considerations

If supplementation were provided to all at-risk patients, more than 300,000 could delay AMD progression and associated vision loss. 2 Smoking cessation remains the single most important modifiable risk factor and must be addressed alongside any vitamin supplementation. 2