Eye Health Supplements
For age-related macular degeneration (AMD) prevention, take the AREDS2 formulation containing vitamin C, vitamin E, zinc, copper, lutein, and zeaxanthin if you have intermediate AMD or advanced AMD in one eye. 1
Who Should Take Eye Supplements
You need supplements only if you have specific risk factors for AMD progression:
- Intermediate AMD (large drusen ≥125 μm) in one or both eyes 1
- Advanced AMD (geographic atrophy or neovascular AMD) in one eye 1
- Age 55 years or older with monocular or binocular intermediate AMD 1
An estimated 8 million Americans meet these criteria and could delay disease progression with supplementation. 1 More than 300,000 could prevent vision loss if appropriately supplemented. 1
The AREDS2 Formulation (What to Take)
The evidence-based supplement regimen contains: 1, 2
- Vitamin C (exact dose from AREDS formulation) 1
- Vitamin E (exact dose from AREDS formulation) 1
- Zinc oxide (exact dose from AREDS formulation) 1
- Cupric oxide (copper) (exact dose from AREDS formulation) 1
- Lutein 10 mg 2
- Zeaxanthin 2 mg 2
Critical modification: Beta-carotene should be replaced with lutein/zeaxanthin, especially for current or former smokers, due to increased lung cancer risk. 2 The AREDS2 trial found 23 lung cancers (2.0%) in the beta-carotene group versus 11 (0.9%) in the no beta-carotene group, predominantly in former smokers. 2
What NOT to Take (Evidence Against)
Omega-3 fatty acids (DHA + EPA) do NOT reduce AMD progression risk when added to the AREDS formulation. 2 The AREDS2 trial with 4,203 participants found no statistically significant reduction in progression to advanced AMD with DHA 350 mg + EPA 650 mg daily (hazard ratio 0.97,98.7% CI 0.82-1.16, P=0.70). 2
For dry eye symptoms specifically, omega-3 supplements show conflicting evidence:
- One small study showed improvement with 2,000 mg essential fatty acids three times daily for tear film and symptoms 1
- However, a large NIH-funded trial found 3,000 mg omega-3 daily for 12 months provided no significant benefit over placebo in moderate to severe dry eye disease 1, 3
The American Academy of Ophthalmology recommends omega-3 supplementation only as modest adjunctive therapy for meibomian gland dysfunction-related dry eye, not as primary treatment. 3
Supplements With Insufficient Evidence
Berry extracts (blackcurrant, maqui berry, goji berry) show no benefit for eye health. 1 Pooled data from 4 studies with 198 participants demonstrated no decrease in dry eye symptoms with oral berry extract supplements versus placebo (P=0.65). 1
Carotenoid combination supplements show mixed results. 1 One study reported reduced visual fatigue with lutein ester, zeaxanthin, and berry extracts after 4 weeks, but evidence quality was very low and outcomes focused on computer vision syndrome rather than morbidity or vision loss. 1
Critical Implementation Points
Commercially available preparations often do NOT contain the correct doses proven effective in clinical trials. 4 Verify your supplement matches AREDS2 formulation specifications exactly. 4
Smoking cessation is mandatory. 1 Cigarette smoking consistently increases AMD progression risk in a dose-dependent manner based on pack-years smoked. 1 Smoking-cessation counseling may influence patients to stop smoking and reduce AMD progression risk. 1
Dietary modification alone can increase lutein and zeaxanthin intake without supplements. 4 Foods rich in these carotenoids include leafy green vegetables. 5 However, older adults often cannot achieve adequate micronutrient intake through diet alone, making supplementation necessary. 5
Common Pitfalls to Avoid
Do not take supplements if you only have early AMD or no AMD. 1 The AREDS2 formulation is proven effective only for intermediate or advanced AMD, not for primary prevention in healthy eyes. 1
Do not use beta-carotene if you are a current or former smoker. 2 Substitute with lutein/zeaxanthin instead. 2
Do not rely on omega-3 supplements as primary therapy for any eye condition. 2 They failed to show benefit in the highest quality randomized trial for AMD. 2
Do not expect supplements to reverse existing vision loss. 1 Early treatment of neovascular AMD with anti-VEGF therapy (not supplements) within 2 years of diagnosis reduces legal blindness and visual impairment. 1 Supplements only slow progression in at-risk patients. 1