Harvard Men's Health Watch

Vitamins and vision loss

Have regular eye exams to pick up age-related macular degeneration (AMD). A special vitamin cocktail can slow the condition's progress.

Did you take your "eye vitamins" today? The supplement aisle offers a variety of dietary supplements that claim to support or preserve "eye health." Certain vitamins actually can help—but only if you already have a diagnosis of age-related macular degeneration (AMD), a common cause of vision loss in later life.

AMD damages the part of the eye called the macula, which provides clear central vision. Having regular eye exams can spot the condition in its early stages. Medications and a special cocktail of vitamins can slow AMD's progression.

If you don't have AMD but are at above-average risk because of family history or older age, should you take eye vitamins just in case? Although there's no strong proof that supplements prevent AMD, it can't hurt to hedge your bets with a nutritious diet and heart-healthy lifestyle.

"Some of the same things that keep you from getting cardiac disease also help to prevent macular degeneration: eat a healthy diet with lots of green leafy vegetables, exercise, and don't smoke," says John Miller, an ophthalmologist and AMD expert at Harvard-affiliated Massachusetts Eye and Ear Infirmary.

Early detection is key

AMD damages the light-sensitive layer of cells (the retina) in the back of the eye and the blood vessels that nourish it. About 4% of Caucasian men have the condition by age 75. The proportion rises to 14% by age 80 (but remains around 2% in black and Asian men).

Dilated eye exams can reveal the earliest signs of AMD. During the exam, the doctor puts drops in your eye to expand (dilate) the iris and allow a clear view of the retina. The American Academy of Ophthalmology recommends that people over 65 get dilated eye exams every one to two years.

Dilated exams are essential for people with a close relative, such as a sibling or parent, who already has AMD. "If you have a significant family history of AMD, you should see an eye doctor sooner for a dilated eye exam," Dr. Miller says.

New findings from AREDS2

In 2001, the Age-Related Eye Disease Study (AREDS) showed that a combination of beta carotene, vitamins C and E, zinc, and copper reduced by 25% the chance of intermediate or advanced AMD getting worse. A follow-up study, called AREDS2, tried to improve on the initial findings.

AREDS2 tested various combinations of the original AREDS vitamin cocktail with three other ingredients: omega-3 fatty acids (the nutrient you get from fish) and two different plant-based nutrients, lutein and zeaxanthin.

In some combinations, lutein and zeaxanthin replaced beta carotene, which is associated with greater risk of lung cancer in current or former smokers. AREDS2 also lowered the dose of zinc, which can cause stomach upset and other side effects.

The AREDS2 scientists reported in 2013 that adding omega-3s, lutein, or zeaxanthin neither improved nor reduced the benefit of the AREDS cocktail. Neither did removing beta carotene or lowering the dose of zinc. That means the new cock-tail (see "AREDS2 eye vitamin formula for AMD") still slows down the progression of AMD, without the safety concerns related to beta carotene and zinc.

"All of these vitamins are available over the counter. A prescription is not required," Dr. Miller says. He gives patients a sheet with the list so they can pick the products they need, with a pharmacist's help if necessary. Off-the-shelf AREDS2 mixes are also available.

But even if a product claims it contains the AREDS2 formula, verify it for yourself or ask your pharmacist to help. "I think it is smart for patients to verify the ingredients of any over-the-counter vitamin they are taking," Dr. Miller notes.

Eye health products

Before AREDS2 even concluded, supplement manufacturers started marketing products with the same formula used in the study. The claims they make for "eye health" are a bit vague. And again, there's no hard evidence that these products prevent AMD or improve vision.

It makes more sense to just enrich your diet. A varied, plant-based diet can provide the same amounts of nutrients in the AREDS formula. You will get more comprehensive health benefits, and you won't have to wonder if your supplement truly delivers the nutrients it promises.

AREDS2 vitamin formula for age-related macular degeneration

The Age-Related Eye Disease Study (AREDS2) showed that taking a cocktail of specific vitamins and minerals can help slow the advance of age-related macular degeneration (AMD).

Nutrient

Daily dose

Food sources

Vitamin C

500 mg

Citrus fruits, tomatoes and tomato juice, potatoes, red and green peppers, strawberries, cantaloupe.

Vitamin E

400 IU

Nuts, seeds, vegetable oils, pumpkin, asparagus, peanut butter, swordfish

Zinc

25 mg

Oysters, crab, lobster, beans, nuts, whole grains, milk, fortified breakfast cereals

Copper

2 mg

Shellfish, whole grains, beans, nuts, potatoes, organ meats, dark leafy greens, dried fruits, yeast

Lutein

10 mg

Egg yolks, corn, dark leafy greens, asparagus, broccoli, Brussels sprouts, carrots, lettuce, peas, winter squash

Zeaxanthin

2 mg

mg = milligrams; IU = international units

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