Nutrition for Healthy Eyes: What to Eat — and Avoid — if You Have Dry or Wet AMD
Brightly colored fruits and vegetables plus certain fatty fish can help slow damage from age-related macular degeneration (AMD) and its more advanced form, wet macular degeneration.
Brightly colored fruits and vegetables, oily fish, and dark, leafy greens — most of us are familiar with the health-enhancing powers of certain foods. But few appreciate the potentially significant role that some nutrients can play in eye diseases.
Here, explore the current thinking about the foods and nutrients that affect age-related macular degeneration (AMD), from its onset to its advanced form. Use these tips to fortify your vision.
AMD and Its Sidekick, Oxidation
Today, AMD remains a leading cause of irreversible vision loss among older adults. Most cases occur among those age 55 or older, resulting from decades of the wear and tear of oxidation, the biological equivalent of rusting.
Left to run its course, AMD can irreversibly damage the macula, the critical light-sensing area of the retina responsible for straight-ahead vision. Under oxidation’s relentless assault, the macula can become a collecting point for cellular debris called drusen, the hallmark of early-stage, or dry, AMD.
As AMD worsens and the body dispatches fragile new blood vessels to nourish the injured area, some unstable vessels can leak blood or fluid directly onto the retina. That change marks the progression from dry AMD to the wet form that can threaten central vision.
Treatments to slow or stop the course of wet macular degeneration ensure that many Americans with AMD won’t face permanent central vision loss. Treatment includes medications that inhibit vascular endothelial growth factor (VEGF); these drugs are injected into the eye to stop unstable vessel formation. But strict adherence to a schedule of anti-VEGF injections can be difficult for older adults and patients who may face barriers to simply getting to doctor appointments.
That frustrating reality has sent researchers searching for easier, more accessible ways to arrest AMD’s forward march.
Research has explored how oxidative stress is linked to AMD and the potential of antioxidants to counteract oxidative damage. In a review of studies, published in the journal Antioxidants, the authors note, “in large clinical studies such as AREDS and AREDS2, antioxidants have been proven to be associated with reduced risk of progression to advanced AMD.”
Aging, genetics, sun damage, and diet all contribute to AMD, but researchers recognize that one factor offers the greatest degree of individual control: what people eat. Current preventive care for vision focuses on colorful plant-based foods, according to an article published in the journal Foods, including oily and fatty fish; dark, leafy greens; and other nutrient-rich foods.
Are There Treatments to Slow Progression of Wet AMD?
Calvin W. Roberts, MD, an ophthalmologist and clinical professor at Weill Cornell Medical College, discusses treatments for slowly down progression for wet AMD.
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Types of Foods to Avoid
Metabolic syndrome (MetS), characterized by an enlarged waist circumference, blood lipid imbalances, high blood pressure, and hyperglycemia, affects about 1 in 3 American adults, vastly increasing their risk for diabetes, heart disease, and stroke. And research suggests that it may contribute to the onset and progression of AMD.
Curbing MetS involves changing your diet and reducing your intake of refined carbohydrates like white flour; sugary snacks and drinks; saturated fats found in red meat and full-fat dairy; cured meats, which are high in sodium; and processed foods, which tend to consist of refined carbs, added sugars, salt, and saturated fats.
“What goes into your body has ramifications for all your organs but particularly your heart, your brain, and your eyes,” says Julia A. Haller, MD, the ophthalmologist-in-chief at Wills Eye Hospital in Philadelphia.
Get Started With the Eye-Healthy Mediterranean Diet
The Mediterranean diet and the related anti-inflammatory diet supply the basic micronutrients supporting vision health. Modeled after the traditional cuisines of Greece, Italy, and neighboring countries, the Mediterranean diet emphasizes colorful vegetables and fruits, fish, olive oil, seeds, and spices that offer ocular antioxidants. These nutrients safeguard the retina from threats such as excessive light damage and are also believed to improve systemic immunologic conditions that can affect the entire body. Considered a healthful lifestyle rather than a diet, the Mediterranean diet resembles the Dietary Approaches to Stop Hypertension (DASH) diet.
It’s described as “eating the rainbow.” Colorful fruits and vegetables, along with dark, leafy greens, help defend the eyes from common environmental threats, particularly excessive light. A report published in the Journal of Nutrition and Metabolism referred to these foods as containing a “plethora of not only vitamins and minerals but phytonutrients,” molecules that promote antioxidant and anti-inflammatory activity.
Here are some of the foods and nutritional strategies that may help slow the progression of AMD.
Orange, Red, and Yellow Plants
Carotenoids are antioxidants that your body can turn into vitamin A, a known booster of vision health. One of those carotenoids is beta-carotene, which gives some foods their orange, yellow, or red color and has been shown to reduce the risk of macular degeneration.
Carrots and sweet potatoes as well as bell peppers, apricots, cantaloupe, mangoes, oranges, papayas, tomatoes, and watermelon are among the beneficial, anti-oxidative foods. And beta-carotene is the major carotenoid in most pumpkins.
Citrus Fruits
Evidence suggests that vitamin C, in combination with other nutrients, can slow the progression of AMD, notes the American Optometric Association.
Vitamin C is found in berries, broccoli, Brussels sprouts, cantaloupe, grapefruit, guava, kiwi, lemons, limes, oranges, parsley, sweet peppers, tomatoes, and dark, leafy greens. One medium-sized orange provides about 70 milligrams (mg), over three-quarters of the ideal daily intake for adults.
Because water-soluble vitamin C quickly washes from the body, consider taking a supplement. The American Academy of Ophthalmology notes that 500 mg of vitamin C per day, along with vitamin E, zinc, copper, lutein, and zeaxanthin, may decrease the risk of dry AMD and wet AMD.
AREDS and AREDS2 Supplements
Vitamin C, vitamin E, zinc, copper, lutein, and zeaxanthin make up the vitamin and mineral supplement called AREDS or AREDS2, which can help delay the progression of AMD.
Because it’s almost impossible to consume adequate amounts of the right proportions of all the nutrients that affect vision health through food alone — and to do so every day — AREDS vitamin formulations were created to address eye issues. AREDS2 eliminated beta-carotene after it was found to increase lung cancer risk among smokers and former smokers. (This was beta-carotene in high-level, supplement form, not from food sources.)
Combining vitamins and minerals in a way that, the National Eye Institute says, can’t be duplicated otherwise, AREDS2 includes this formula:
500 mg vitamin C
400 international units vitamin E
80 mg zinc
20 mg lutein
2 mg copper
2 mg zeaxanthin
AREDS and AREDS2 supplements can’t prevent AMD, but they’ve been shown to reduce the risk of progression from intermediate to advanced AMD.
Still, AREDS isn’t for everyone. “AREDS and AREDS2 are high-dose supplements meant for people with disease, not for the average person,” says Johanna M. Seddon, MD, an ophthalmology professor and the director of the Macular Degeneration Center of Excellence at the University of Massachusetts Chan Medical School in Worcester.
Leafy Greens
Lutein, a carotenoid that is part of the AREDS mix, is plentiful in dark, leafy greens, including collards, cooked kale, spinach, and cilantro and parsley, as well as lettuce and romaine. Broccoli is also recommended for preventing and supporting the treatment of AMD.
A report published in the European Journal of Nutrition states that the average American consumes only 1 mg to 2 mg of lutein a day. This is far short of the 6 mg to 30 mg daily intake recommendation from the American Macular Degeneration Foundation. For people with early and midstage AMD, doctors say that supplements can help boost the nutrients to recommended levels.
Dark, leafy vegetables also contain abundant amounts of vitamin K. Research suggests that this vitamin plays an important role in eye health. People taking warfarin (Coumadin) or other blood thinners should inform their doctor before altering their vitamin K intake, since the nutrient can interfere with the action of these drugs.
Flavonoid-Rich Berries, Fruits, and Tea
A research review published in Biomedicine & Pharmacotherapy suggests that consuming the plant antioxidants called flavonoids is linked to lower probabilities of having AMD and that a “routine diet rich in flavonoids may contribute to the progression and prevention of AMD.” There’s substantial evidence that flavonoids help reduce oxidative stress and inflammation.
Research recommends having 5 to 10 daily servings of flavonoid-rich fruits and vegetables (at roughly 40 grams per serving). Flavonoids are found in berries, cherries, dark chocolate, onions, red grapes, red wine, and tea (black and green).
Pomegranate and Its Juice
The liquid within the seeds (arils) of this deep red fruit stimulates vasodilation, the expansion of blood vessels. Its distinctive mix of polyphenols, vitamin C, and minerals such as vitamin K means eating pomegranate can reduce high blood pressure and increase blood flow throughout the body, as well as reduce cellular inflammation.
An overview published in the journal Antioxidants underlines pomegranate’s ability to address general inflammation, high blood pressure, high cholesterol, and oxidative stress — all of which can contribute to or worsen AMD.
Fatty, Oily Fish Rich in Omega-3 Acids
An article published in Current Opinion in Pharmacology summarizes the prevailing wisdom among vision professionals: Oily fish have a protective effect on the macula. “Fish should definitely replace meat at least three times a week,” says Dr. Seddon.
Whether the effect derives from the entire fish or its stores of health-conferring omega-3 fatty acids alone isn’t clear. Regardless, these seafood varieties seem to target the damage wrought by neovascularization, the proliferation of fragile blood vessels in the eye: anchovies, mackerel, salmon, sardines, swordfish, tuna, shellfish, and shrimp. High-quality fish oil supplements are also an option.
Unfortunately, some of these choices harbor potentially harmful levels of mercury and should be consumed in moderation or avoided altogether. King mackerel, swordfish, and bigeye tuna have some of the highest levels. Albacore and canned white albacore tuna, yellowfin tuna, and Spanish mackerel are classified as good choices by the U.S. Environmental Protection Agency, while salmon, anchovies, canned light tuna, and Atlantic mackerel are among the best.
Walnuts, Seeds, and Olive Oil
Like seafood, most nuts offer a healthy serving of inflammation-fighting omega-3 acids. Walnuts, in particular, have antioxidant and anti-inflammatory effects.
Seeds — particularly chia, flax, and hemp — are bursting with beneficial fats. A whole protein, chia incorporates all nine of the essential amino acids our bodies require.
Olive oil may also help. Research found that older participants who regularly consumed olive oil measurably decreased the risk of advancing to vision-threatening late AMD. The researchers highlighted oleocanthal, which mimics the effects of the nonsteroidal anti-inflammatory ibuprofen, for the positive effect.
Probiotics
The gut microbiome is acknowledged as having outsize effects throughout the body, including the eyes. An article published in Nutrients suggested that the low-grade inflammation triggered by gut microbiome imbalances may contribute to AMD development. Scientists are exploring what they call the gut-eye or gut-retina axis, with some theorizing that microbiome imbalance (or dysbiosis) triggers “inflammaging,” a generalized age-related oxidation. Pro-inflammatory, highly processed prepared or packaged food products and excess alcohol consumption can trigger dysbiosis.
Probiotics — found in foods like yogurt, kimchi, raw sauerkraut, tempeh, miso, and kombucha — may be able to restore balance to the gut and offer a protective effect against AMD. Animal studies have shown some promise, however, the evidence isn’t there yet for humans when it comes to probiotics and a therapeutic effect on AMD. A controlled trial involving 57 participants with AMD showed that an intake of a probiotic mixture over eight weeks offered beneficial antioxidant effects but didn’t affect clinical signs of AMD.
Healthy Vision Guidance
Until each nutrient is fully understood in the context of AMD, Seddon suggests that people with this condition subscribe to three rules for eye health: “Try to increase the frequency of eating vegetables and fruits, including dark, leafy greens. Substitute fish for meat three times a week. And lay off cakes and pies.”
He earned his medical degree from Dartmouth. He completed an ophthalmology residency at the NYU Grossman School of Medicine, where he was chief resident, followed by a fellowship in uveitis and ocular inflammatory disease at the Francis I. Proctor Foundation for Research in Ophthalmology at the University of California in San Francisco.
Dr. Tsui is committed to advancing the field of ophthalmology. His research focuses on utilizing state-of-the-art ophthalmic imaging technology to improve the diagnosis and monitoring of uveitis. He is a co-investigator in several multicenter clinical trials investigating therapeutics for uveitis. He is the author of over 80 peer-reviewed publications and has given talks at national and international conferences.
Along with his clinical and research responsibilities, Tsui teaches medical students and residents. He is on the Association for Research in Vision and Ophthalmology's professional development and education committee, as well as the advocacy and outreach committee, which seeks to increase funding and awareness of vision research. He also serves on the editorial board of Ophthalmology and the executive committee of the American Uveitis Society.
Susan (Sue) Treiman is an award-winning newspaper reporter, television producer, website executive, and corporate communications expert. She is passionate about writing on health, medicine, and wellness. She has been published in every New York City newspaper, produced television programs for ABC News, CBS News, and Paramount Pictures, headed up the editorial work on ABC's original flagship website, ABC.com, and launched the network's first children's website.
More recently, Treiman has served as the in-house journalist for several international management consulting firms. At Everyday Health, she has written about women's health, stress, sleep medicine, and psychology, and has written for various other publications, including Linkwell Health and In the Groove.
Treiman is based in New York, and is an abstract artist who enjoys painting in her free time.
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
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AREDS 2 Supplements for Age-Related Macular Degeneration (AMD). National Eye Institute. June 22, 2021.
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What You Need to Know About Flavonoids. Cleveland Clinic. April 30, 2023.
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