Vitamins and Supplements for Macular Degeneration

Age-related macular degeneration (AMD) is a condition involving deterioration of the macula (the middle portion of the retina). There are two forms of AMD, including the wet form and the dry form. Approximately 8 out of 10 people with AMD have the dry form.  Dry AMD occurs because of thinning and breaking down of the macula.

Studies have shown that certain vitamins and supplements may help some people with AMD (age-related macular degeneration). The Age-Related Eye Diseases Study (AREDS), sponsored by the National Institutes of Health (NIH) found that supplementation with specific micronutrients slowed down the progression of dry AMD by 25%, while staving off symptoms of vision loss. What are these specific micronutrients and how do they work to lesson symptoms of AMD?

Types and Stages of AMD

It’s important to understand that there are two forms of AMD, the dry form and the wet form. There are also several stages of this eye disease. The form of AMD you have and the stage of the condition will impact whether vitamins and supplements will be recommended by your healthcare provider.

Dry AMD

Dry AMD involves gradual thinning of the structure of the eye called the macula (the central portion of the retina, responsible for high-resolution central vision). The retina is responsible for transmitting images to the brain for visual recognition. 

Deterioration of the macula causes blurred vision. Later, dry AMD can result in vision loss in the center field of vision.

With dry AMD, small yellow deposits (called drusen) begin to collect under the retina. Drusen do not cause vision loss until they start to get larger and grow in number. Once drusen begin to grow in number and size, it puts a person at risk for early or intermediate stage AMD.

During early AMD, symptoms may be subtle, but once the intermediate stage begins, blurred spots in the central vision may occur. As the condition progresses, the breakdown of the cells of the macula causes advanced AMD, involving symptoms of blurred (gray or black) spots that can obstruct the central vision as the spots get bigger.

Wet AMD

In wet macular degeneration, there is growth of very small, fragile blood vessels that easily burst and leak blood into the macula (under the retina). This can result in rapid progression and damage to the retina and also causes a loss of central vision.

In both dry and wet AMD, this loss of central vision manifests as a gray or black spot in the middle of one’s field of vision, but the treatment (and prevention) modalities differ, depending on the type of AMD that is being treated as well as the stage of the condition.

Stages of AMD

When it comes to taking vitamins and supplements for macular degeneration, it’s important to understand that there are three stages of the disease, these include:

• Early stage: Often there are no symptoms in the early stage of AMD, or symptoms may be very subtle. Upon examination by the ophthalmologist, there are medium-sized drusen deposits, but no pigment changes have occurred and there is no vision loss.
• Intermediate stage: This stage involves large drusen and retinal pigment epithelium (RPE) disturbances, also referred to as pigment changes that can lead to vision loss. In fact, some experts believe that the RPE is where macular degeneration begins. The RPE functions to nourish the retinal cells. Note, there may be mild vision loss at this stage of AMD, but no other noticeable symptoms are usually present.
• Late (or advanced) stage: Dry (or wet) AMD that causes vision loss.

Vitamins in a specific formula (called AREDS2) are often prescribed by the ophthalmologist or other healthcare provider for people with early- to mid-stage AMD.

Vitamins and Supplements for AMD

The National Institutes of Health (NIH) found that vitamin and micronutrient supplements in a specific formula—called AREDS 2 Formula—were effective in reducing the progression of dry AMD to the late or advanced stage (in which vision loss occurs) by 25%.

AREDS 2 Formula List

The AREDS 2 Formula contains several vitamins and micronutrients, in a specific dosage and recommended daily amount, including:

• Lutein 10 milligrams (mg): This is a type of micronutrient, called a carotenoid, that comes from plants. Carotenoids are structurally related to vitamin A. The body does not produce its own lutein; it must obtain lutein from the diet.
• Zeaxanthin 2 mg: Zeaxanthin is also a carotenoid. The body does not produce its own zeaxanthin; it must obtain zeaxanthin from the diet as well.
• Vitamin C 500 mg: Vitamin C is a vitamin that is present throughout all parts of the retina of the eye and is thought to be protective against AMD.
• Vitamin E 400 IU: Vitamin E is an antioxidant, thought to protect the eyes from damage caused by free radicals. Free radicals are unstable molecules that can cause damage to the DNA.
• Zinc oxide 80 mg or 25 mg: Zinc is a trace mineral, thought to play an important role in the function of the retina. Zinc depletion results in difficulty with adapting to night vision and other reduced functions of the retina. 
• Cupric oxide (copper) 2 mg: Copper is another trace mineral. Concentrations of zinc in the body affect the progression of AMD; copper is thought to help balance the level of zinc as well as other metals (such as iron). As a person ages, the level of copper in the body decreases. This could be one contributing factor to age-related AMD.

Retinas from those with AMD have been found to have a higher level of iron than retinas from people (of the same age) without AMD. When copper levels decrease, iron levels rise. Copper and zinc are both thought to help prevent levels of iron from rising too much.  

Differences From AREDS 1 Formula

The AREDS 1 Formula (developed in a previous study) differs from the AREDS 2 Formula in that AREDS 1 contains beta carotene. Beta carotene was linked with lung cancer in smokers and former smokers. Therefore, in the AREDS 2 Formula, the beta carotene has been replaced with lutein and zeaxanthin.

Beta carotene, lutein, and zeaxanthin are micronutrients called carotenoids, which are structurally similar to vitamin A. These nutrients are transported to the retina, where they are thought to protect against damage done by light.

Delayed Progression, Not Prevention

If taking AREDS 2 Formula vitamins can prevent AMD from progressing, it would make sense that AREDS 2 Formula might be a good preventative supplement to begin taking at a young age; but this is not the case.

Studies have shown that these supplements are safe to take, but there have not been any lifelong studies to show that long-term use of AREDS 2 (longer than 10 years) is safe or effective. Therefore, AREDS 2 vitamins are only recommended for people upon recommendation of the ophthalmologist for those with a specific number of drusen and/or those who have lost vision in one eye.

It’s important to note that nutritional vitamins and supplements do not prevent AMD, however, studies have shown that AREDS 2 supplements may delay progress from the intermediate to the advanced stage of AMD. The overall goal of vitamin supplementation (with the AREDS 2 Formula) is to enable people with AMD to keep their vision longer.

Recommendations for AREDS 2 Formula

The AREDS 2 vitamins are recommended for those with over a certain number of drusen noted by the ophthalmologist. The ophthalmologist checks for drusen when performing a dilated eye exam.

Those with very few drusen (or no drusen) should not take AREDS 2 vitamins; the vitamins are only recommended for those at high risk for AMD (such as those with numerous drusen as determined by the healthcare provider). AREDS 2 vitamins may also be recommended for those who have lost vision in at least one eye from AMD.

What to Look For

One study, conducted by the National Institutes of Health, discovered that some manufacturers, claiming that their vitamins promoted eye health, were selling vitamins that were lacking in the nutrients that were advertised on the product label.

Because the vitamin and natural supplement industry is not tightly regulated by the U.S. Food and Drug Administration (FDA), the burden of ensuring that supplements are pure and effective is on the consumer.

For this reason, it’s important to double check to ensure that you are purchasing a product that has “AREDS 2 Formula” on the label. You may want to take an extra step to be sure you are getting the right nutrient level, by comparing the label’s ingredients to those on the AREDS 2 Formula list.

Sometimes the label says a product has half of the dosage (for example, it contains only 250 mg of Vitamin C). This is because the recommended daily dosage is 2 soft gel capsules (bringing the total dosage for the day to 500 mg, which is in line with the recommended formula).

Food Sources

Studies involving AREDS 2 vitamins have shown that they are safe to take for at least 10 years, but there is not enough clinical research evidence to attest to the safety of taking AREDS 2 vitamins (including zeaxanthin or lutein) for longer time spans.

Therefore, experts encourage those who are at high risk of AMD who wish to take the nutrients that are recommended in the AREDS 2 Formula to try to get their micronutrients from food sources, rather than supplements.

Foods, that are recommended for eye-health include foods that are rich in beta carotene, lutein, and zeaxanthin, such as:

• Egg yolk (in moderate quantities to avoid too much cholesterol)
• Yellow corn
• Orange or yellow peppers
• Kale
• Broccoli
• Spinach
• Kiwi
• Grapes
• Zucchini
• Squash

These foods are recommended by some experts for those who want to take nutrients that may protect against AMD.

Side Effects

In the AREDS2 study, participants were observed after taking a general multivitamin. The multivitamins had no impact on the risk of AMD progression, but the multivitamins were not shown to be harmful, either.

In fact, the study found that AREDS 2 Formula vitamins and micronutrients, in combination with multivitamins, or when taken alone had no adverse effects, other than a slight increase in the risk of urinary-linked hospitalizations in men. In those with AMD, the study also found that zinc supplementation was associated with an increased lifespan.

Other Questions

Is the AREDS 2 Formula given for wet AMD?

The primary indications for AREDS 2 Formula vitamins are when drusen have grown in number and size and/or when a person has lost vision in one eye due to macular degeneration. When taken daily, these supplements may help people with AMD to lower the risk of getting late-stage or wet AMD.

Are there any foods that should be avoided for people with AMD?

An older study published in the Archives of Ophthalmology found that eating “junk food” may be bad for a person’s eyesight. The study discovered that a diet high in certain types of fats (such as vegetable fats with linoleic acid) create the biggest risks of eye diseases, and store-bought junk food put people at a higher risk for eye disease. The junk foods with undesirable fats, identified in the study included:

• Margarine
• Some chocolate
• Commercially prepared pies, cakes, and cookies
• Peanut butter
• Potato chips
• French fries
• Nuts

Can I take a multi-vitamin while taking AREDS 2?

Yes, the AREDS 2 Formulas are not made to be a substitute for a daily multi-vitamin. In fact, in the AREDS study, nearly 9 out of 10 study participants took multivitamins along with AREDS Formula.

Are there other supplements that are recommended for eye health?

Yes, the American Macular Degeneration Foundation (AMDF) recommends taking omega-3 fatty acid supplements (fish oil) 1000 mg if you are not eating wild-caught, cold water fish regularly.

A Word From Verywell

Staving off severe vision loss from macular degeneration is a multi-faceted endeavor. It's important to have regular eye examinations (with your ophthalmologist), take any vitamins or other supplements (recommended by your eye doctor), and eat a healthy, balanced diet, rich in micronutrients. Staying away from certain junk foods is also important.

This will not cure AMD, and it's not guaranteed to prevent progression of the disease, but preventative measures will afford a person with AMD the highest chance of maintaining their vision for as long as possible.