MEDITERRANEAN DIET AND AGE-RELATED MACULAR DEGENERATION: EVIDENCE FOR A PLANT-FORWARD NUTRITIONAL STRATEGY IN PREVENTION AND DISEASE PROGRESSION

Background: Age-related macular degeneration (AMD) is one of the leading causes of irreversible visual impairment among older adults and represents an increasing public health challenge in aging populations. Although genetic predisposition and advancing age are well-established risk factors, growing evidence suggests that modifiable lifestyle factors, particularly dietary habits, may influence disease development and progression. The Mediterranean diet, characterized by a high intake of fruits, vegetables, legumes, whole grains, nuts, olive oil, and fish, has attracted considerable attention because of its potential protective effects against chronic age-related diseases, including retinal disorders. Objectives and Methods: The objective of this review was to evaluate current evidence regarding the relationship between Mediterranean dietary adherence and AMD prevention and progression, with particular emphasis on its role as a plant-forward nutritional strategy. Relevant epidemiological studies, prospective cohort studies, secondary analyses of the Age-Related Eye Disease Study (AREDS), population-based investigations, and recent systematic reviews were examined. Key findings: The available evidence consistently indicates that greater adherence to Mediterranean dietary patterns is associated with a lower risk of AMD progression and, in some populations, reduced disease prevalence. Several biological mechanisms may contribute to these observations, including attenuation of oxidative stress, modulation of inflammatory pathways, improvement of lipid metabolism, and preservation of vascular function. Key nutrients such as lutein, zeaxanthin, omega-3 fatty acids, polyphenols, and antioxidant vitamins appear to play complementary roles within the broader dietary pattern. Conclusions: Overall, current evidence supports the Mediterranean diet as a promising and practical nutritional approach for promoting retinal health and potentially reducing the burden of AMD. Further prospective intervention studies are needed to clarify causality and optimize dietary recommendations for at-risk populations.