by: Julie Poteet, Cecelia Koetting & Priya S. Vakharia
Abstract
No current treatments are curative for age-related macular degeneration (AMD), and preventing disease progression is challenging. Dietary factors play a role in the course of macular degeneration, and management of AMD commonly includes nutraceuticals (e.g., supplementation with a combination of antioxidant vitamins and minerals). This commentary summarizes the existing literature, emerging evidence, and upcoming research on the role of B vitamins in both preventing the development of AMD and slowing its progression.
Key Summary Points
| Age-related macular degeneration (AMD) is a leading cause of vision loss in older adults, and while there is no cure, nutritional interventions can help slow progression. |
| Two studies, the Age-Related Eye Disease Study (AREDS) and AREDS2, demonstrated that specific combinations of antioxidant vitamins and minerals—particularly those including lutein and zeaxanthin—reduce the risk of progression to late-stage AMD. |
| Emerging evidence highlights the potential role of B vitamins (especially B6, B9, and B12) in both reducing the risk of AMD development and slowing its progression. |
| Low levels of B vitamins may be associated with higher AMD risk, possibly due to increased homocysteine levels that damage retinal tissue through oxidative stress and inflammation. |
| The upcoming AREDS3 trial will assess whether adding higher-dose B vitamins to current supplements can provide additional protective benefits, especially for early-stage AMD. |
Introduction
Age-related macular degeneration (AMD) is a leading cause of blindness and visual impairment throughout the world [1, 2]. Intermediate-stage AMD, which may be asymptomatic, can progress to either atrophic (dry) AMD or neovascular (wet or exudative) AMD [1]. Preventing AMD progression is challenging, as the pathogenesis is incompletely understood. Processes implicated in AMD include an interconnected network of increased oxidative stress, mitochondrial dysfunction, and inflammatory activation [3]. There are currently no treatments that are curative for AMD; rather, the focus of available therapies is on the prevention or slowing of disease progression [2].
Intake of specific nutrients and antioxidant supplements has been shown to reduce the risk of progression from intermediate to late/advanced AMD [2]. For example, data from the Age-Related Eye Disease Study (AREDS) randomized, placebo-controlled clinical trial demonstrated that supplementation with a combination of antioxidant vitamins and minerals (vitamin C, vitamin E, β-carotene, zinc, and copper; Table 1) [4] reduced the risk of progressing from intermediate to advanced AMD by 25% over 5 years [5]. In a subsequent randomized, placebo-controlled study, AREDS2, patients who were assigned to treatment with a modified version of the original AREDS supplement (addition of lutein and zeaxanthin; removal of β-carotene) had an 18% lower risk of progression to late AMD and a 22% lower risk of neovascular AMD compared with those who received the original AREDS supplement [6]. The proposed mechanisms for macular protection of carotenoids in AREDS2 includes neutralization of free radicals, thereby reducing oxidative stress and inflammation, and protection from blue light-mediated damage by increasing the macular pigment (Fig. 1) [7].
Read more: https://link.springer.com/article/10.1007/s40123-025-01281-1
Source: 
& Julie Poteet, OD, MS, CNS, FOWNS