Your eyes work constantly. Reading screens, driving, watching television, scrolling through phones. And unlike muscles that you can rest, your eyes are processing visual information every waking moment. The question many people ask is whether supplements can help protect their vision as they age.

I’ve gone through the clinical research on the most commonly recommended eye health supplements. The picture is more nuanced than supplement marketing would have you believe, but there is genuine evidence worth discussing.

The basics of eye health

Before diving into supplements, it helps to understand what we’re actually trying to protect.

The retina at the back of your eye contains photoreceptor cells that convert light into electrical signals. The macula, a tiny area only about 5 millimetres across, is responsible for central vision and colour discrimination. It contains the highest concentration of cone cells anywhere in the eye.

As we age, several things can go wrong. The most common concern is age-related macular degeneration (AMD), which affects the central vision people depend on for reading, driving, and recognising faces. Cataracts cloud the lens. Dry eye syndrome makes the eyes uncomfortable and vision less clear. Glaucoma damages the optic nerve.

The NHS estimates that AMD affects over 600,000 people in the UK, with numbers rising as the population ages [1]. It’s the leading cause of severe vision loss in people over 50.

So what can supplements actually do?

1. Lutein and zeaxanthin

Lutein gets the most attention of any eye supplement, and there are reasonable grounds for this.

Lutein and its close relative zeaxanthin are carotenoids, yellow pigments found in plants. Your body cannot make them, so they must come from diet. What makes them relevant to eye health is where they accumulate: the macula contains lutein and zeaxanthin at concentrations roughly 1,000 times higher than anywhere else in the body [2].

These pigments appear to do two things. First, they filter blue light before it reaches the photoreceptors. Blue light, particularly the high-energy wavelengths emitted by screens and LED lights, can damage retinal cells over time. Second, as antioxidants, lutein and zeaxanthin neutralise reactive oxygen species that accumulate during normal visual processing.

What the evidence shows

The most influential study is AREDS2, a large randomised controlled trial sponsored by the US National Eye Institute. In people who already had intermediate AMD, supplementation with 10 mg lutein and 2 mg zeaxanthin reduced the risk of progression to advanced AMD by about 18% over five years [3]. The benefits were most pronounced in people with low dietary intake of these nutrients.

A meta-analysis of 12 randomised trials with 1,764 participants found that lutein supplementation does increase macular pigment optical density, both in healthy people and those with existing AMD [4]. Whether this translates to preserved vision in healthy people remains less certain.

A large prospective study following about 100,000 participants found that people with higher dietary intake of lutein and zeaxanthin had approximately 40% lower risk of developing advanced AMD [5].

My honest take

The evidence for lutein is actually decent, particularly for people already showing signs of macular degeneration. For prevention in healthy eyes, the case is less clear cut but plausible given the biological mechanisms involved.

If you eat plenty of dark leafy greens like spinach, kale, and collard greens, you’re probably getting adequate lutein already. One serving of cooked spinach contains about 12 mg. Egg yolks are another good source, particularly from pasture-raised chickens.

For people who don’t regularly eat these foods, or who have a family history of AMD, a supplement providing 10-20 mg of lutein with 2-4 mg of zeaxanthin matches what has been studied in trials.

Lutein appears quite safe. The only notable side effect in studies has been harmless yellow colouration of the skin at very high doses, called carotenodermia. It reverses when you stop the supplement.

2. Omega-3 fatty acids (fish oil)

Omega-3 fatty acids, particularly DHA and EPA, are structural components of cell membranes throughout the body. DHA is especially concentrated in the retina, where it comprises roughly 50% of the fatty acid content of photoreceptor outer segments [6]. This has led to considerable interest in whether omega-3 supplementation might protect eye health.

Dry eye syndrome

The strongest evidence for omega-3s in eye health relates to dry eye syndrome, a condition affecting an estimated 5-34% of adults depending on how it’s defined [7].

A meta-analysis of seven trials with 790 dry eye patients found that omega-3 supplementation improved tear break-up time (how long the tear film remains stable) and Schirmer test scores (a measure of tear production) [8]. The effects were statistically significant, though symptom scores on questionnaires didn’t always improve as much.

The DREAM study, a large rigorous trial published in 2018, complicated this picture somewhat. Over 12 months, 3,000 mg of omega-3s daily did not outperform olive oil placebo for dry eye symptoms [9]. This surprised many researchers, though some have questioned whether the olive oil placebo was truly inert.

My interpretation: omega-3s probably help some people with dry eyes, but they’re not a guaranteed solution. A trial of 2-3 months seems reasonable if you have persistent symptoms.

The relationship between omega-3s and AMD is more complex. Observational studies consistently show that people who eat more fish have lower rates of AMD. But when researchers test omega-3 supplements in controlled trials, the results are mixed.

AREDS2 found no additional benefit from adding DHA and EPA to the lutein/zeaxanthin regimen for AMD progression [3]. However, people in both groups were still taking the baseline AREDS supplement, so omega-3s might have helped if tested in isolation.

A Cochrane review concluded there is no good evidence that omega-3 supplements prevent AMD in healthy people [10]. The observational associations might reflect other factors about people who eat fish regularly.

What I’d say

Omega-3s are more promising for dry eye symptoms than for preventing macular degeneration. If you have dry eyes that don’t respond well to artificial tears, a trial of fish oil supplements providing at least 1,000 mg combined EPA/DHA daily is reasonable.

For general eye health, eating oily fish twice a week is probably more useful than supplements, and comes with broader cardiovascular benefits. Salmon, mackerel, sardines, and herring are all good choices.

See our detailed article on fish oil benefits and side effects for more information.

3. Bilberry

Bilberry is a European cousin of the blueberry, traditionally used for eye complaints. The story goes that Royal Air Force pilots ate bilberry jam during World War II to improve their night vision. There’s actually no good evidence this happened, but the legend persists in marketing materials.

Bilberries are rich in anthocyanins, the dark purple pigments that give the berries their colour. Anthocyanins have antioxidant properties and may support blood vessel health by stabilising collagen fibres and reducing capillary permeability [11].

What the research shows

The clinical evidence for bilberry is honestly quite thin compared to lutein.

One retrospective study followed 332 patients with normal-tension glaucoma (a type where optic nerve damage occurs despite normal eye pressure). Those taking bilberry extract showed better preservation of visual field over 24 months compared to those not taking it [12]. That’s interesting, but retrospective studies can’t prove causation, and the groups may have differed in other ways.

For healthy eyes or AMD prevention, there’s little meaningful clinical trial data. Most studies are small, short-term, and focus on surrogate markers rather than actual visual outcomes.

A 2019 systematic review found insufficient evidence to recommend bilberry for any eye condition [13].

My assessment

Bilberry is probably safe in typical supplement doses, but I wouldn’t expect dramatic benefits for most people. If you enjoy bilberries as food, that’s fine. Paying premium prices for concentrated extracts based on current evidence seems questionable.

If you want antioxidant support for eye health, lutein has far more clinical backing.

Other supplements worth mentioning

Vitamin A

Vitamin A is genuinely essential for vision. It’s a precursor to rhodopsin, the light-sensitive pigment in rod cells. Severe vitamin A deficiency causes night blindness and, eventually, complete blindness.

However, vitamin A deficiency is rare in developed countries. Taking extra vitamin A when you’re not deficient doesn’t improve vision and can be toxic at high doses. Pregnant women in particular should avoid vitamin A supplements due to teratogenic risks.

Beta-carotene, which converts to vitamin A in the body, was part of the original AREDS formula but was removed in AREDS2 because it increased lung cancer risk in smokers. If you smoke, avoid supplements containing beta-carotene.

For more on vitamin A, see our article on vitamin A benefits and contraindications.

Astaxanthin

Astaxanthin is a red carotenoid from algae and the pigment that gives salmon its pink colour. Some small studies suggest it might help with eye strain from screen use. A trial in 49 workers who used computers all day found astaxanthin reduced accommodation amplitude decline (how well the eye adjusts focus) after four weeks [14].

The evidence is preliminary. If you’re interested in trying it, 6-12 mg daily is the range studied. See our astaxanthin article for details.

Zinc

Zinc was included in the original AREDS formula and contributed to slowing AMD progression. However, the doses used (80 mg) were quite high and caused stomach upset in some participants. AREDS2 found that 25 mg worked about as well with fewer side effects.

For people not taking an AREDS-type supplement, a regular multivitamin provides sufficient zinc for most purposes.

What actually helps protect your eyes

Supplements are one small piece of eye health. The evidence-backed strategies that matter most are:

Regular eye examinations. Many eye conditions develop gradually without symptoms. An optometrist can detect problems like glaucoma years before you notice anything wrong. The NHS recommends eye tests every two years for most adults, more frequently if you’re over 70, have diabetes, or have a family history of glaucoma.

Blood sugar control. Diabetic retinopathy is a leading cause of blindness, and the single most important factor is glycaemic control. People with diabetes should see an ophthalmologist annually. For more on managing blood sugar, see our article on diabetes and supplements.

Blood pressure management. Hypertension damages the small blood vessels in the retina. Keeping blood pressure controlled protects your eyes as well as your heart and brain.

Not smoking. Smoking roughly doubles the risk of AMD and increases cataract risk. If you smoke, quitting is probably more beneficial for your eyes than any supplement.

UV protection. Wearing sunglasses that block UV rays reduces cataract risk. Choose glasses marked with UV400 or CE UV filter category 3 or 4.

Screen habits. The 20-20-20 rule helps with digital eye strain: every 20 minutes, look at something 20 feet away for 20 seconds. This won’t prevent serious eye disease, but it reduces fatigue and discomfort.

Safety considerations

Lutein and zeaxanthin have excellent safety profiles at typical supplement doses (10-20 mg lutein, 2-4 mg zeaxanthin).

Fish oil can increase bleeding risk at high doses and may interact with blood-thinning medications like warfarin or aspirin. If you’re on anticoagulants, discuss fish oil with your doctor first.

Bilberry might also have mild antiplatelet effects. The clinical significance is uncertain, but caution is reasonable before surgery.

High-dose vitamin A is potentially toxic and should be avoided. Beta-carotene increases lung cancer risk in smokers.

The bottom line

Of the supplements commonly marketed for eye health, lutein has the strongest evidence. For people with intermediate AMD or risk factors, the AREDS2 formula (lutein, zeaxanthin, vitamin C, vitamin E, zinc, copper) has genuine support from large trials. For healthy people without AMD, the evidence is less compelling, but lutein appears safe and the biological rationale is sound.

Omega-3s may help with dry eye symptoms but show little evidence for preventing macular degeneration. Bilberry lacks sufficient clinical evidence to recommend.

The foundations of eye health remain non-negotiable: regular examinations, blood sugar control, blood pressure management, not smoking, and UV protection. Supplements might contribute around the edges, but they cannot substitute for these fundamentals.

References

NHS. Age-related macular degeneration. https://www.nhs.uk/conditions/age-related-macular-degeneration-amd/
Bernstein PS, et al. Lutein, zeaxanthin, and meso-zeaxanthin: The basic and clinical science underlying carotenoid-based nutritional interventions against ocular disease. Prog Retin Eye Res. 2016;50:34-66. https://pubmed.ncbi.nlm.nih.gov/26541886/
Age-Related Eye Disease Study 2 Research Group. Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration: the Age-Related Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA. 2013;309(19):2005-2015. https://pubmed.ncbi.nlm.nih.gov/23644932/
Liu R, et al. Lutein and zeaxanthin supplementation and association with visual function in age-related macular degeneration. Invest Ophthalmol Vis Sci. 2015;56(1):252-258. https://pubmed.ncbi.nlm.nih.gov/25515572/
Wu J, et al. Intakes of lutein, zeaxanthin, and other carotenoids and age-related macular degeneration during 2 decades of prospective follow-up. JAMA Ophthalmol. 2015;133(12):1415-1424. https://pubmed.ncbi.nlm.nih.gov/26447482/
SanGiovanni JP, Chew EY. The role of omega-3 long-chain polyunsaturated fatty acids in health and disease of the retina. Prog Retin Eye Res. 2005;24(1):87-138. https://pubmed.ncbi.nlm.nih.gov/15555528/
Stapleton F, et al. TFOS DEWS II Epidemiology Report. Ocul Surf. 2017;15(3):334-365. https://pubmed.ncbi.nlm.nih.gov/28736337/
Liu A, Ji J. Omega-3 essential fatty acids therapy for dry eye syndrome: a meta-analysis of randomized controlled studies. Med Sci Monit. 2014;20:1583-1589. https://pubmed.ncbi.nlm.nih.gov/25193932/
Dry Eye Assessment and Management Study Research Group. n-3 Fatty Acid Supplementation for the Treatment of Dry Eye Disease. N Engl J Med. 2018;378(18):1681-1690. https://pubmed.ncbi.nlm.nih.gov/29652551/
Lawrenson JG, Evans JR. Omega 3 fatty acids for preventing or slowing the progression of age-related macular degeneration. Cochrane Database Syst Rev. 2015;2015(4):CD010015. https://pubmed.ncbi.nlm.nih.gov/25856365/
Chu W, et al. Bilberry (Vaccinium myrtillus L.). Herbal Medicine: Biomolecular and Clinical Aspects. 2nd edition. https://www.ncbi.nlm.nih.gov/books/NBK92770/
Shim SH, et al. Ginkgo biloba extract and bilberry anthocyanins improve visual function in patients with normal tension glaucoma. J Med Food. 2012;15(9):818-823. https://pubmed.ncbi.nlm.nih.gov/22870951/
Nomi Y, et al. Health benefits of anthocyanins in berries. Berry fruit consumption and human health: A systematic review. J Berry Res. 2019. https://pubmed.ncbi.nlm.nih.gov/31268854/
Nagaki Y, et al. Effects of astaxanthin on accommodation, critical flicker fusion, and pattern visual evoked potential in visual display terminal workers. J Tradit Med. 2002;19(5):170-173.