AREDS Supplements: Who Actually Benefits from Eye Vitamins?

Walk down the vitamin aisle of any pharmacy and you will find shelves of eye supplements, many with labels mentioning AREDS or AREDS2. They promise to protect your vision, support your macula or keep your eyes healthy as you age. Some of these claims rest on one of the most important nutrition trials in eye care. Others stretch that evidence well beyond what it actually showed.

The Age-Related Eye Disease Studies, known as AREDS and AREDS2, were large, long-term clinical trials funded by the US National Eye Institute. They found that a specific high-dose combination of vitamins and minerals can slow the progression of age-related macular degeneration (AMD) in certain people. Crucially, they did not show benefit for everyone. This article explains the formula, the evidence and the practical question that matters most: should you take it?

A quick primer on AMD

Age-related macular degeneration is a leading cause of central vision loss in older adults in high-income countries. It affects the macula, the small central part of the retina used for reading, driving and recognising faces. Eye doctors classify it in stages based on what they see in the retina, especially yellow deposits called drusen and changes in pigment.

• Early AMD: medium-sized drusen, usually with no symptoms.
• Intermediate AMD: large drusen and/or pigment changes; vision may still be good, though some people notice mild blurring or need more light to read.
• Advanced AMD: either geographic atrophy (dry AMD with loss of retinal tissue) or neovascular (wet) AMD, in which abnormal blood vessels leak fluid or blood under the retina.

For more detail on the disease itself, including symptoms and treatment of wet AMD, see our macular degeneration guide.

The original AREDS trial

AREDS enrolled more than 4,700 people aged 55 to 80 and followed them for an average of over six years. Participants were randomly assigned to take antioxidants, zinc, both, or placebo. Published in 2001, the results showed that in people at high risk, meaning those with intermediate AMD or advanced AMD in one eye, the combination of antioxidants plus zinc reduced the risk of developing advanced AMD by about 25 percent over five years. It also reduced the risk of moderate vision loss by about 19 percent.

In people with no AMD or only early AMD, the supplements did not make a meaningful difference, largely because their risk of progressing to advanced disease over the study period was already very low. The supplements also had no significant effect on the development or progression of cataract.

AREDS2: refining the formula

AREDS2, published in 2013, enrolled more than 4,000 people with intermediate AMD or advanced AMD in one eye. It tested whether adding lutein and zeaxanthin or omega-3 fatty acids improved the formula, and whether beta-carotene could be removed and zinc reduced. The main findings were:

• Omega-3 fatty acids added no benefit. See our article on omega-3 and eye health.
• Lutein and zeaxanthin could safely replace beta-carotene, and in secondary analyses appeared somewhat more effective at reducing progression, especially in people with low dietary intake.
• Former smokers taking beta-carotene had a higher rate of lung cancer.
• Lowering zinc from 80 mg to 25 mg made no clear difference to effectiveness.

A ten-year follow-up report published in 2022 confirmed that the lutein-zeaxanthin version was safe and at least as effective as, and possibly better than, the beta-carotene version. Our article on lutein and zeaxanthin covers these pigments in more depth.

What is in the AREDS2 formula?

The daily doses used in the AREDS2 recommended formula are shown below. Many commercial products follow these amounts, but not all do, so labels need careful reading.

Who actually benefits?

Likely to benefit

• People diagnosed by an eye doctor with intermediate AMD in one or both eyes.
• People with advanced AMD (wet or geographic atrophy) in one eye, to help protect the other eye.

Unlikely to benefit

• People with healthy eyes, even if they are older or have a family history of AMD.
• People with early AMD only; the trials did not show a meaningful benefit.
• People with advanced AMD in both eyes; there is no proven benefit for eyes that already have advanced disease.
• People with other eye conditions such as glaucoma, cataract, diabetic retinopathy or dry eye.

This is why diagnosis matters. Only an eye examination with a dilated retinal check or retinal imaging can show which stage, if any, you have. Our page on eye examinations explains what these involve.

Smokers, former smokers and beta-carotene

Two large trials in the 1990s, unrelated to eyes, found that high-dose beta-carotene supplements increased the risk of lung cancer in current smokers and in people exposed to asbestos. AREDS2 then found a higher rate of lung cancer in former smokers who took beta-carotene. For this reason, anyone who smokes or has smoked should avoid formulas containing beta-carotene and choose the lutein-zeaxanthin version.

Smoking is also one of the strongest modifiable risk factors for AMD itself. Stopping smoking does more to protect the macula than any supplement. Our article on smoking and eye disease explains the link.

Why not take them just in case?

It is tempting to think that vitamins are harmless and might as well be taken as insurance. But the AREDS doses are high, and there are reasons for caution:

• No proven preventive benefit: the trials found no reduction in AMD onset in people without intermediate disease.
• Zinc side effects: high-dose zinc can cause stomach upset, and AREDS participants taking zinc had more hospital admissions for genitourinary problems, particularly in men.
• Vitamin E: high doses may increase bleeding tendency and interact with blood thinners; some large studies have raised other concerns at high doses.
• Drug interactions: zinc can interfere with the absorption of certain antibiotics and other medicines.
• Cost: long-term supplements are expensive and offer no value without a clear indication.

Diet and lifestyle still matter

The AREDS doses cannot be reached through food alone, but a healthy diet supports eye health in everyone. Observational studies associate diets rich in leafy greens, fish, nuts and fruit, such as the Mediterranean diet, with lower AMD progression. See our list of foods that support eye health. Other protective steps include not smoking, controlling blood pressure and cholesterol, staying active and wearing UV-protective sunglasses outdoors.

Monitoring your vision

If you have intermediate AMD, the goal is not only to slow progression but also to detect wet AMD early, because modern treatments work best when started promptly. Many eye doctors recommend checking each eye separately at home with an Amsler grid. Our online Amsler grid can help you become familiar with the test, though it is a screening aid only. Attend follow-up visits as your eye doctor advises.

Questions to ask your eye doctor

If you are unsure whether supplements are right for you, bring these questions to your next appointment. The answers depend on what your doctor sees in your retina, your general health and the medicines you already take.

1. Do I have AMD, and if so, which stage is it in each eye?
2. Would the AREDS2 formula be expected to help me, or is my risk of progression too low to justify it?
3. Is there any reason, such as kidney disease, a bleeding disorder or my current medicines, that I should avoid high-dose zinc or vitamin E?
4. How often should I have follow-up examinations or retinal scans?
5. Which symptoms should prompt me to call the clinic straight away rather than wait for my next visit?

Writing the answers down helps you remember them and makes it easier to share the plan with family members or your GP.

When to see a doctor

Book an eye examination before starting any eye supplement, so that your doctor can confirm whether you have AMD and at what stage. Ask about AREDS2 if you have been told you have intermediate AMD, or advanced AMD in one eye. Tell your doctor or pharmacist about all supplements and medications you take.