How diet and supplements can help living with AMD

If you have age-related macular degeneration (AMD) you may have wondered whether changing your diet, or taking supplements could help protect your sight.

It’s one of the most common topics we get asked and information on the topic can be confusing.

So, what does the evidence tell us? In this article, we look at the role of diet and supplements in AMD and answer some of your most common questions.

I have AMD, should I be taking supplements?

Some clinical trials have shown the benefits of taking supplements for AMD.
The supplements recommended for eye health follow a particular formula, referred to as AREDS.

AREDS2 supplements take their name from two large clinical trials, AREDS (Age-Related Eye Disease Study) and AREDS2, carried out by the NIH National Eye Institute between 1992 and 2012.

The studies found that taking an AREDS supplement could reduce the risk of AMD progressing from intermediate to late AMD by about 25 per cent.

Ruth Hogg, Professor of Ophthalmic Epidemiology and Public Health at Queen’s University Belfast, told the Macular Society that the studies both played a “very significant role” in our understanding of supplements and AMD.

She said: “Both of these studies found that the combination of vitamin C and E, beta-carotene, zinc, and copper reduced the risk of advanced AMD.”

Do AREDS2 supplements work for everyone?

During the studies, the benefit of taking a regular supplement for eye health was not seen in everyone. The studies suggest that you may benefit if:

•    Your eye care professional has told you that you have many medium-sized drusen or one or more large drusen in one or both eyes (you may have large drusen and still have good vision).
•    You have wet AMD in one eye but good vision and dry AMD in the other.
•    You have a diet low in fresh green leafy vegetables and fruit.

There is no clinical evidence that a supplement will be beneficial if:

•    You have been told you have early signs of AMD in one or both eyes (your eye care professional may say that you have several small drusen or a few medium-sized drusen in one or both eyes).
•    You have advanced AMD in both eyes.
•    You have active wet macular degeneration.

What is the AREDS formula and how do I know if my supplements follow it?

The first large AREDS trial began in the 1990s. It found that a particular

 combination of nutrients reduced the chance of progression to advanced AMD in people at higher risk.

A second study, AREDS2, investigated whether the formula could be improved.

The nutrients associated with the AREDS2 formulation are:
Vitamin C 500mg
Vitamin E 400 IU
Copper 2mg
Lutein 10mg
Zeaxanthin 2mg
Zinc 25mg

Some supplements contain the nutrients studied in AREDS2, while others contain quite different doses or add ingredients such as omega-3, vitamin D, meso-zeaxanthin or other antioxidants.

Professor Hogg explained why, as a general rule, people should take supplements which follow the AREDS2 formula.

She said: “There are lots of additional ingredients that there may be a good scientific rationale for why they may be helpful in AMD. But getting sufficient evidence that would satisfy a clinician to recommend them, or for the NHS to prescribe them, is a very costly exercise.

“We always keep coming back to the AREDS2 formulations because those are the supplements which have the high-quality evidence available.”

Who is most likely to benefit from AREDS2 supplements?

The clearest evidence is for people with intermediate AMD. The National Eye Institute says that people with intermediate AMD in one or both eyes may benefit from AREDS2 supplements because they can reduce the risk of progression to late AMD.

What if I have late dry AMD, known as geographic atrophy?

In earlier studies AREDS2 supplements were not thought to offer much benefit once someone had late AMD in both eyes.

However, recent research has shown that when geographic atrophy (GA) had developed away from the very centre of the macula supplements appeared to slow its progression by approximately 55 per cent over an average of three years.

Dr Tiarnan Keenan of the US National Eye Institute, who led the research, told the Macular Society: “Even individuals with advanced dry AMD, as long as the central macula isn’t yet affected, can benefit from these supplements.”

He added: “There’s very little to lose, and we even have some indications that they may help preserve visual acuity for longer.”

Professor Pearse Keane, consultant ophthalmologist at Moorfields Eye Hospital and a co-author of the research, added: “Although AREDS2 supplements are used widely in the UK, we don’t typically recommend them to patients who already have late AMD in both eyes. I think this paper will lead us to recommend their use more widely in people with late AMD. This is exciting because it is a cheap, safe, and well tolerated treatment.”

What if I have wet AMD?

Wet AMD is caused by abnormal blood vessels growing under the macula and leaking fluid or blood. Treatments such as anti-VEGF injections can stop this from happening and reduce the build-up of fluid and are the only approved treatment for wet AMD.
 
Supplements are not a treatment for AMD.

What about injections to slow down theprogresion of GA?

There are drugs available outside of the UK which aim to slow the speed of deterioration caused by GA, but while there is no licence for these eye injections here in the UK, Professor Keenan said oral supplements could have their advantages.

He said: “By contrast, these supplements are very simple, by oral administration and very low cost. Sadly, that cost is often born by the individual themselves. It’s a really good safety profile from the trials themselves, and then from the fact they have been used in the ophthalmology community for 20 years now we know these supplements are safe.”

Will supplements improve my eyesight?

No, AREDS2 supplements are not expected to restore sight that has already been lost.

Are supplements a cure for AMD?

No, there is currently no cure for AMD so you should be wary of any product claiming to cure, reverse or restore vision lost through AMD.

Not all supplements have sound clinical research to support their claims.

What else can I do to help my eyesight?

Eating a healthy diet including at least five portions of fruit and vegetables a day is considered important for all aspects of health.

Ruth Hogg highlighted that there is strong evidence to support the preventative impact of a healthy diet and a lifestyle on the development and progression of advanced AMD.

She said: “If you are considering supplements, remember to talk to your ophthalmologist or GP to decide which are the right choice for you. I'd also encourage you to make small changes in your diet and lifestyle, to adopt more practices suggested, and that this will not just benefit your eyes, but benefit your whole body."