Eye Health Supplements: AREDS2, Lutein, Omega 3 and What Actually Works (UK)

What are eye health supplements?

Eye health supplements are food supplements that combine nutrients found in the retina or linked to vision: usually vitamins C and E, zinc, copper, lutein and zeaxanthin, sometimes with omega 3, vitamin A or bilberry. Most are modelled on the AREDS2 formula from a large US trial in people with macular degeneration, though many shop products use lower doses.

Do eye health supplements work?

Eye health supplements work for one group: people with intermediate age-related macular degeneration, where a high-dose antioxidant and zinc formula modestly slows progression to the late, sight-threatening stage. For people with healthy eyes or early AMD, trials show little or no benefit, and they don’t prevent cataracts. Evidence for lutein alone and for dry eyes is weak or mixed.

The US National Institutes of Health held a royalty-bearing licence with Bausch and Lomb for the AREDS supplement until 2021, and the company supplied tablets for the long-term follow-up. The main trials were publicly funded and placebo-controlled.

What is the AREDS2 formula?

The AREDS2 formula is a daily combination of 500mg vitamin C, 400 IU vitamin E, 80mg zinc, 2mg copper, 10mg lutein and 2mg zeaxanthin. It replaced beta-carotene in the original AREDS formula. It is meant for people with intermediate AMD, or late AMD in one eye, on the advice of an optometrist or ophthalmologist.

In the first AREDS trial, the high-dose formula lowered the risk of progressing to advanced AMD by about a quarter over 5 years in people at higher risk. AREDS2 then found that adding lutein and zeaxanthin, omega 3, or both gave no further benefit in the main analysis. Its 10-year follow-up found beta-carotene nearly doubled the odds of lung cancer, while lutein and zeaxanthin didn’t, and lutein and zeaxanthin were linked with slightly less progression than beta-carotene.

The NHS says there’s some evidence that certain supplements might help stop AMD getting worse, but advises speaking to a GP or your specialist first because they aren’t suitable for everyone. NICE’s AMD guideline (NG82) lists smoking, high blood pressure, obesity and a diet low in omega 3, vitamins, carotenoids and minerals among the risk factors. Its recommendations don’t advise supplements for preventing AMD.

Smokers and beta-carotene

People who smoke, or used to smoke, should avoid eye supplements containing beta-carotene. Two large trials in smokers found more lung cancer with beta-carotene supplements, and in AREDS2 there were more lung cancers in the beta-carotene group, mostly in former smokers. That’s why the AREDS2 formula uses lutein and zeaxanthin instead.

• ATBC trial (1994): 29,133 male smokers in Finland. Beta-carotene was linked with more lung cancer.
• CARET trial (1996): 18,314 smokers, former smokers and asbestos workers. Beta-carotene with vitamin A was stopped early after more lung cancers.
• AREDS2 (2013): 23 lung cancers with beta-carotene vs 11 without, mostly in former smokers.

Check the label for “beta-carotene” or “vitamin A (as beta-carotene)”. Beta-carotene from carrots, sweet potatoes and leafy greens is fine. Stopping smoking is the biggest change you can make for AMD risk: the NHS links smoking with AMD, and your pharmacy or local NHS stop smoking service can help.

Which nutrients support normal vision?

Four nutrients have authorised health claims for vision in Great Britain. Vitamin A, riboflavin and zinc each contribute to the maintenance of normal vision. DHA contributes to the maintenance of normal vision, with the beneficial effect obtained from 250mg of DHA a day. These describe normal eye function, not preventing or treating eye disease.

Lutein, zeaxanthin, bilberry, saffron and astaxanthin have no authorised health claims: every lutein and zeaxanthin claim on the GB register is listed as non-authorised. Most people get enough of the authorised nutrients from food:

• Vitamin A: eggs, cheese, oily fish, and beta-carotene from carrots, spinach and sweet potatoes.
• Riboflavin: milk, eggs, mushrooms and fortified cereals.
• Zinc: meat, shellfish, dairy, bread and cereals. See our zinc guide.
• DHA: oily fish such as salmon, mackerel and sardines, or an algae oil for vegans. See omega 3: foods and how much to take.
• Lutein and zeaxanthin: kale, spinach, peas, sweetcorn and egg yolks.

Read about the research on saffron for eyes, astaxanthin and vitamin E in our separate guides.

Do omega 3 supplements help dry eyes?

Omega 3 supplements probably don’t help most people with dry eyes. In the DREAM trial, 535 people took 3g of fish oil or an olive oil placebo for a year, and symptoms improved equally in both groups. A 2019 Cochrane review found little or no reduction in symptoms, with low certainty evidence. Lubricating drops from a pharmacy are the usual first step.

See our guide to dry eyes for what helps. If your eyes feel tired after screens, the 20-20-20 rule and regular breaks do more than any capsule: see why your eyes feel heavy and tired and do blue light glasses work?

How often should you have an eye test?

The NHS advises a routine eye test usually every 2 years, or more often if your optometrist recommends it. An eye test can pick up AMD, glaucoma and other problems before you notice symptoms. NHS sight tests are free if you’re 60 or over, have diabetes or glaucoma, or are 40 or over with a close relative who has glaucoma.

Free NHS sight tests also cover under-16s, 16 to 18 year olds in full-time education, people registered as sight impaired, and people on some benefits. If you have diabetes and are 12 or over, you’ll also be invited for diabetic eye screening every 1 or 2 years.

Eye supplement safety and medicines

• High-dose zinc: 80mg is more than three times the NHS guide of 25mg a day. Take that dose only on an optometrist’s, ophthalmologist’s or GP’s advice. High zinc reduces copper absorption, which can lead to anaemia.
• Antibiotics: zinc can reduce the absorption of tetracycline and quinolone antibiotics such as ciprofloxacin. Ask a pharmacist how far apart to take them.
• Blood thinners: high-dose vitamin E can add to the effect of warfarin, other anticoagulants and aspirin. Check with your GP, pharmacist or anticoagulant clinic.
• Vitamin A (retinol): the NHS says don’t take supplements containing vitamin A if you’re pregnant, and women past the menopause and older men should have no more than 1.5mg a day from food and supplements combined.
• Smokers and former smokers: avoid beta-carotene (see above).
• Doubling up: a multivitamin plus an eye formula can push zinc and vitamin A over safe levels. See can you overdose on vitamins? and are multivitamins worth taking?
• Diabetes, glaucoma and other eye conditions: no supplement treats these. Keep your screening and eye appointments.