What medications and supplements are recommended for better eye health?

Medications and Supplements for Eye Health

For general eye health and prevention of age-related conditions, omega-3 fatty acids show the strongest evidence for benefit, while the AREDS2 formulation (vitamin C, vitamin E, zinc, copper, lutein, and zeaxanthin) is specifically recommended for patients with intermediate or advanced age-related macular degeneration to reduce progression risk by up to 36% over 10 years. 1

Evidence-Based Supplement Recommendations by Condition

Age-Related Macular Degeneration (AMD)

AREDS2 formulation is the only proven intervention to slow AMD progression and should be prescribed to all patients with intermediate AMD or advanced AMD in one eye. 1 The formulation includes:

• Vitamin C
• Vitamin E
• Zinc (25mg, not 80mg to reduce genitourinary side effects)
• Copper (necessary to prevent copper-deficiency anemia from zinc)
• Lutein 10mg
• Zeaxanthin 2mg 1

This supplementation can prevent progression in over 300,000 patients and reduces risk by up to 36% over 10 years. 1 If all at-risk patients received these supplements, more than 300,000 could delay disease progression and associated vision loss. 1

Dry Eye and Computer Vision Syndrome

Omega-3 fatty acid supplementation provides moderate certainty evidence for improved dry eye symptoms after 45 days to 3 months, with a 20% reduction in symptoms considered clinically important. 2 The recommended dosage is long-chain omega-3 fatty acids (EPA + DHA 0.35-1.4 g/day). 3

However, berry extract supplements show no benefit for visual fatigue or dry eye symptoms in computer vision syndrome, with very low certainty evidence across multiple studies. 2

General Eye Health and Prevention

A well-balanced diet rich in fruits and vegetables is recommended based on observational studies, though there is insufficient evidence to support a specific diet. 2

Key dietary components for eye health include:

• Fish (4 portions weekly) for omega-3 content (EPA + DHA 0.35-1.4 g/day) 3
• Green leafy vegetables (spinach, broccoli, zucchini) for lutein/zeaxanthin content (at least ≥42 μg/day) 3
• Citrus fruits (orange, kiwi, grapefruit) for vitamin C and folic acid 3
• Extra virgin olive oil (almost 20 mg/day) for vitamin E and polyphenols 3
• Nuts or oil seeds (20-30 g/day) for zinc content (at least ≥15.8 mg/day) 3

What Does NOT Work

Cataract Prevention

There is currently no level 1 evidence that high-dose antioxidant supplementation slows cataract progression. 2 A 2012 Cochrane Systematic Review found no evidence to support high doses of vitamin E, vitamin C, or beta-carotene in preventing cataract development or progression. 2

Moderate evidence exists that a multivitamin/mineral supplement may decrease cataract risk, but specific high-dose antioxidants are not recommended. 2

Computer Vision Syndrome

Blue light-blocking lenses show no benefit for eye strain compared to no blue light-blocking lenses across three randomized controlled trials. 2

Oral carotenoid supplements (lutein ester, zeaxanthin combinations) show very low certainty evidence with inconsistent results for visual fatigue. 2

Critical Safety Considerations

AREDS2 Formulation Warnings

• Beta-carotene must be avoided in current or former smokers due to 18% increased cumulative incidence of lung cancer (relative risk 1.28). 1
• Zinc at 80mg increases genitourinary hospitalizations; use 25mg dose instead, which shows equivalent efficacy with better safety profile. 1
• Coordinate with primary care physicians before initiating long-term AREDS2 supplementation due to potential adverse effects. 1

Omega-3 Supplementation

Participants dropped out of omega-3 supplement groups due to gastric intolerance in clinical trials. 2 The certainty of evidence for adverse events was judged to be low. 2

Lifestyle Modifications That Matter

Smoking cessation is mandatory as cigarette smoking is the only proven modifiable risk factor for AMD, with current smokers facing 2-3 times higher risk. 4 Smoking shows a dose-response effect for nuclear sclerosis cataracts. 2

Ultraviolet-B blocking sunglasses and brimmed hats are reasonable precautions, as cumulative lifetime UV-B exposure has been associated with lens opacities. 2

Long-term increased physical activity and exercise may decrease the risk of cataract, while prolonged inactivity and sitting may be associated with cataract progression. 2

Common Pitfalls to Avoid

• Do not delay effective treatment (such as cataract surgery or anti-VEGF therapy for wet AMD) in favor of supplements, as supplements have no proven benefit for treating established disease requiring intervention. 1
• Do not recommend peptide-based therapies for AMD management, as they lack FDA approval and evidence, and may delay effective treatment. 1
• Do not use aspirin for cataract prevention, as multiple studies show no benefit. 2
• Avoid recommending supplements to patients with adequate nutrition unless they have specific risk factors (intermediate/advanced AMD, symptomatic dry eye). 2, 1