What Should Patients with Age-Related Macular Degeneration Eat?

PURPOSE: To summarize relevant data on what individuals with age-related macular degeneration (AMD) should eat and to propose simple, evidence-based, dietary and micronutrient supplement guidelines that can be shared with patients and physicians. DESIGN: Focused literature review with interpretation and clinical perspective METHODS: We selectively reviewed literature on the associations between diet, oral micronutrient supplementation, and AMD progression, synthesizing evidence by disease stage. Sources included the Age-Related Eye Disease Studies (AREDS/AREDS2) in the United States, and major epidemiologic and cohort studies in Europe and North America. RESULTS: Across disease stages, closer adherence to a Mediterranean diet is consistently associated with substantially slower AMD progression. In AREDS, individuals with early AMD who adhered more closely to a Mediterranean diet were significantly less likely to develop intermediate AMD. In AREDS/AREDS2 participants with intermediate AMD, higher Mediterranean diet adherence was strongly associated with decreased risk of progression to late AMD, especially for geographic atrophy (GA). Specific dietary components were particularly influential: higher fish intake was most protective, followed by higher vegetable and lower red meat intake. For individuals with geographic atrophy (GA), a Mediterranean diet was associated with markedly slower GA enlargement, including slower expansion towards the fovea. Higher intake of fruit and vegetables, lower intake of red meat, and avoidance of heavy alcohol consumption were most important in the modulation of GA expansion. Oral micronutrient supplementation with the AREDS2 formulation decreased progression to late AMD for individuals with intermediate AMD (or advanced disease in one eye) and slowed expansion of extrafoveal GA towards the fovea. Notably, the benefits of healthy diet and AREDS2 supplementation were found to be complementary and non-redundant. CONCLUSION: Individuals with AMD should adopt a Mediterranean diet (or similar pattern), which appears beneficial at all disease stages. Dietary emphasis may vary by stage. A predominantly plant-based diet appears preferable to an animal-based diet, particularly for late AMD with GA. The AREDS2 formulation is recommended for individuals with intermediate or advanced AMD, and may be especially helpful for those with extrafoveal GA. A Mediterranean diet and micronutrient supplementation have complementary actions, so should be used together for maximal benefit.