Lutein, zeaxanthin and AREDS-type eye vitamins for macular degeneration

Lutein and zeaxanthin are yellow carotenoid pigments found in dark leafy greens, peppers, corn and egg yolk. They concentrate in the macula, the central part of the retina used for reading and recognising faces, where they absorb blue light and act as antioxidants. That biology led researchers to test whether higher intake could protect the macula.

The Age-Related Eye Disease Studies were large trials sponsored by the US National Eye Institute. The original AREDS formula contained vitamin C 500mg, vitamin E 400 IU, beta-carotene 15mg, copper 2mg and zinc 80mg. AREDS2 later replaced beta-carotene with lutein 10mg and zeaxanthin 2mg, keeping the other ingredients.

The institute summarises the outcome as a reduction of about 25 percent in the risk of progressing from intermediate to advanced AMD. The AREDS2 formula with lutein and zeaxanthin gave additional benefits compared with the original, and it avoids beta-carotene.

• Vitamin C: 500mg

• Vitamin E: 400 IU

• Copper: 2mg (included to balance zinc)

• Zinc: 80mg

• AREDS2 only: lutein 10mg and zeaxanthin 2mg

The benefit was seen in people with intermediate AMD, and in those with late AMD in one eye, in the fellow eye. It does not apply to someone with healthy eyes, early changes only (such as a few small drusen), or those with cataract. The institute says that the formulas do not prevent AMD onset and have no effect on cataract.

The Macular Society describes AREDS2 supplements as typically recommended for intermediate or advanced dry AMD. Whether a particular person should take them is a decision for the optometrist or ophthalmologist who knows the stage of disease. Wet AMD is treated with eye injections and supplements do not replace that treatment.

Beta-carotene in the original formula increased lung cancer risk in current and former smokers, which is why AREDS2 is preferred for them. NCCIH separately notes that high-dose supplemental vitamin A and beta-carotene can increase lung cancer risk in smokers. Smoking also carries a major risk of AMD itself: the Macular Society says smokers face up to four times the risk, so stopping is the most valuable single step.

The 80mg zinc level has raised discussion about side effects such as stomach upset and effects on copper balance, which is why copper is included. Anyone on blood thinners should note that vitamin E may affect bleeding, and people with other health conditions should ask a pharmacist before starting.

Many over-the-counter products are labelled as eye vitamins, but their strengths vary and many contain lower doses than those tested in the trials. If your eye specialist recommends the AREDS2 approach, ask which product matches the tested formula, because the benefit was shown at the trial doses, and check the label for beta-carotene if you smoke or have smoked.

The Macular Society says a diet low in fruit and vegetables may increase AMD risk and recommends leafy greens, omega-3 and antioxidant-rich foods, while alcohol, obesity and diets high in sugars and saturated fat are linked with higher risk. The NHS lists ageing, smoking, high blood pressure, being overweight and family history as risk factors.

Regular eye tests, home monitoring of central vision, for example with an Amsler grid, and quick reporting of new distortion are essential, as wet AMD needs urgent treatment.