Age-related macular degeneration (AMD) affects the central part of the retina called the macula, which is responsible for sharp, detailed vision. It’s the leading cause of vision loss in people over 50 in developed countries, and with an ageing population, the numbers are climbing. In the UK alone, AMD affects around 600,000 people, with that figure expected to rise significantly over the coming decades.

The question many people ask is straightforward: can nutrition actually make a difference? The honest answer is that diet and supplements won’t reverse existing damage, but there’s reasonable evidence they may slow progression in some cases. This article examines what the research actually shows for the most commonly discussed supplements.

Understanding Macular Degeneration

Before getting into supplements, it helps to understand what we’re dealing with. The macula is a small area at the centre of your retina packed with photoreceptor cells. It’s what allows you to read, recognise faces, and see fine details. When the macula deteriorates, central vision becomes blurry or distorted while peripheral vision usually remains intact.

AMD comes in two forms:

Dry AMD accounts for about 85-90% of cases. It develops slowly as light-sensitive cells in the macula break down. Drusen (tiny yellow deposits) accumulate under the retina. Progression is typically gradual over years.

Wet AMD is less common but more serious. Abnormal blood vessels grow beneath the retina and leak fluid or blood, causing rapid damage. Though only 10-15% of AMD cases are wet, it’s responsible for roughly 80% of severe vision loss from the condition 1.

Risk factors include age (obviously), smoking, family history, high blood pressure, obesity, and prolonged exposure to sunlight. Some of these you can’t change, but lifestyle factors including diet are within your control.

1. Lutein and Zeaxanthin

Of all the supplements discussed for eye health, lutein generates the most interest. Along with its companion zeaxanthin, these are carotenoid pigments that concentrate in the macula, giving it a yellowish colour. They act like internal sunglasses, filtering blue light and neutralising free radicals.

What the Research Shows

The evidence for lutein is more substantial than for most eye supplements. A meta-analysis reviewing 12 studies found that lutein, zeaxanthin, and meso-zeaxanthin all contributed to increased macular pigment optical density (MPOD) in both healthy individuals and those with existing AMD 2. Higher MPOD is associated with better visual function and may offer some protection against AMD progression.

Another analysis of 8 studies involving 1,176 participants found that lutein supplementation improved visual function in AMD patients, including both visual acuity and contrast sensitivity 3. The improvements correlated with increases in macular pigment density.

The landmark AREDS2 study (Age-Related Eye Disease Study 2) tested lutein and zeaxanthin as part of a supplement formula. While the overall formula showed benefits for reducing progression to advanced AMD, isolating the specific contribution of lutein proved difficult since it was tested alongside other nutrients 4.

Practical Considerations

The typical dose used in research is 10mg of lutein and 2mg of zeaxanthin daily. Your body doesn’t produce these compounds, so they must come from diet or supplements.

Food sources include:

Dark leafy greens (kale, spinach, collards)
Egg yolks
Broccoli
Peas
Orange peppers

The average Western diet provides only 1-3mg of lutein daily, well below the amounts used in clinical studies. For those with AMD or at high risk, supplementation may make sense, though dietary improvements are always worth considering first.

For a deeper look at lutein specifically, see our detailed article on lutein benefits and side effects.

2. Zinc

Zinc is the second most abundant trace mineral in the body, and the retina contains notably high concentrations of it. It plays a role in transporting vitamin A from the liver to the retina, where it’s used to produce melanin, a protective pigment.

What the Research Shows

The original AREDS study, a major randomised controlled trial, found that a combination of zinc (80mg as zinc oxide), copper (2mg to prevent zinc-induced copper deficiency), vitamin C (500mg), vitamin E (400 IU), and beta-carotene (15mg) reduced the risk of progressing to advanced AMD by about 25% over five years in people with intermediate AMD or advanced AMD in one eye 5.

However, pulling apart the individual contribution of zinc is tricky. A Cochrane review examining zinc specifically concluded that while the AREDS data supports its use as part of a combination formula, the evidence for zinc alone is less consistent 6.

It’s worth noting that the 80mg zinc dose used in AREDS is quite high compared to the recommended daily allowance of 8-11mg. At this dose, some people experience gastrointestinal upset or copper depletion (hence the added copper in the formula). The AREDS2 study tested a lower 25mg dose, which appeared similarly effective with fewer side effects, though this wasn’t a direct comparison.

Practical Considerations

Good dietary sources of zinc include oysters (extraordinarily high), beef, crab, lobster, pork, chicken, beans, nuts, and whole grains. Vegetarians may need to pay extra attention since plant-based zinc is less readily absorbed.

For more on zinc supplementation, read our article on zinc effects and side effects.

3. Fish Oil (Omega-3 Fatty Acids)

Omega-3 fatty acids, particularly DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid), are essential fats that the body cannot produce on its own. DHA is found in remarkably high concentrations in the retina, making up about half of all fatty acids in photoreceptor cell membranes.

What the Research Shows

Observational studies have generally found associations between higher fish consumption and lower AMD risk. A large Australian cohort study following 3,654 participants over five years found that those eating more omega-3-rich fish had significantly lower rates of both early and late AMD 7.

However, when researchers tested omega-3 supplementation in randomised trials, results were less impressive. The AREDS2 study added DHA and EPA to the original formula but found no additional benefit for AMD progression 4. A Cochrane review concluded that increasing omega-3 intake through supplements probably does not prevent or slow AMD 8.

This disconnect between observational data and trial results is common in nutrition research. It might mean that:

Omega-3 from whole fish provides benefits that isolated supplements don’t
The people who eat more fish differ from non-fish-eaters in other ways
Protection works better for prevention than treatment of established disease
Trial durations weren’t long enough to detect effects

Practical Considerations

Regardless of the AMD-specific evidence, omega-3 fatty acids have well-established benefits for cardiovascular health, and heart disease and AMD share some risk factors. Eating oily fish (salmon, mackerel, sardines, herring) twice weekly is sensible general health advice.

If you’re interested in supplementation, our article on fish oil benefits and side effects covers the topic in detail. We also have specific information on DHA.

What About the AREDS Formula?

The most robust evidence for nutritional intervention in AMD comes from the AREDS and AREDS2 studies. These large, well-designed trials showed that a specific combination of nutrients could reduce progression to advanced AMD by about 25% in people already at high risk.

The current AREDS2 formula contains:

Vitamin C (500mg)
Vitamin E (400 IU)
Lutein (10mg)
Zeaxanthin (2mg)
Zinc (80mg)
Copper (2mg)

This formula is specifically intended for people with intermediate AMD or advanced AMD in one eye. It has not been shown to prevent AMD from developing in the first place, and the high doses aren’t appropriate for everyone.

Putting It All Together

If you have AMD or are concerned about your risk, here’s what seems reasonable based on current evidence:

Get your eyes checked regularly. Early detection matters, especially for wet AMD where treatments like anti-VEGF injections can be effective if started promptly.

Don’t smoke. This is probably the most modifiable risk factor. Smokers have roughly double the risk of AMD compared to non-smokers.

Eat your vegetables. Dark leafy greens are cheap, widely available, and contain lutein along with numerous other beneficial compounds. Two servings daily is a sensible target.

Consider fish. Even if supplements haven’t proven themselves, whole fish consumption is consistently associated with lower AMD risk in population studies.

Talk to your doctor about supplements if you have intermediate or advanced AMD. The AREDS2 formula has legitimate evidence behind it for slowing progression in this specific group. But it’s not a magic bullet, and it comes with costs and potential side effects.

Be realistic. Supplements won’t restore lost vision or guarantee prevention. They’re one piece of a larger picture that includes regular eye exams, not smoking, controlling blood pressure, and maintaining a healthy weight.

For general information on foods that support eye health, see our article on health foods good for eyesight.

References

NHS. Age-related macular degeneration (AMD). https://www.nhs.uk/conditions/age-related-macular-degeneration-amd/
Ma L, et al. (2016). Effect of lutein and zeaxanthin on macular pigment and visual function in patients with early age-related macular degeneration. Ophthalmology. PubMed
Liu R, et al. (2017). Lutein and zeaxanthin supplementation and association with visual function in age-related macular degeneration. Investigative Ophthalmology & Visual Science. PubMed
Age-Related Eye Disease Study 2 Research Group (2013). Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration: the AREDS2 randomized clinical trial. JAMA. PubMed
Age-Related Eye Disease Study Research Group (2001). A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for AMD. Archives of Ophthalmology. PubMed
Evans JR, Lawrenson JG (2017). Antioxidant vitamin and mineral supplements for slowing the progression of AMD. Cochrane Database of Systematic Reviews. PubMed
Tan JS, et al. (2009). Dietary fatty acids and the 10-year incidence of AMD: the Blue Mountains Eye Study. Archives of Ophthalmology. PubMed
Lawrenson JG, Evans JR (2015). Omega 3 fatty acids for preventing or slowing the progression of AMD. Cochrane Database of Systematic Reviews. PubMed