Higher dietary intake of some vitamins, minerals, carotenoids, and fatty acids are associated with decreased progression to late-stage age-related macular degeneration (AMD) and geographic atrophy (GA), according to study results published in Ophthalmology. Recent data have indicated that closer adherence to a Mediterranean diet and its fish component were linked to decreased progression to late stage AMD. Consequently, study researchers sought to evaluate the relationships between diet and the risk of progression to late stage AMD and its subtypes.1

This study was a post hoc analysis of two controlled clinical trial studies.1 Investigators reviewed data from the 1992-1998 Age-Related Eye Disease Study (AREDS) and 2006-2008 AREDS2 studies. They collected and centrally graded annual fundus photos for late AMD. Additionally, they then calculated nutrient intake based on food frequency questionnaires participants submitted.1 The study had a median of 10.2 years worth of follow-up and found that nine nutrients were significantly associated (P ≤.0005) with decreased risk of late AMD. Diets higher in vitamins A, B6, and C, folate, β-carotene, lutein/zeaxanthin, magnesium, copper, and alcohol were associated with a decreased risk of progression from non-neovascular (dry) AMD to neovascular (wet) AMD.1 The same nutrients have also indicated protective associations against large drusen development. These associations are even stronger with GA than wet AMD.1

Conversely, saturated fatty acid, monounsaturated fatty acid, and oleic acid were all associated with a greater risk of AMD progression, to both wet AMD and GA.1 Additionally, similar studies found lower rates of disease progression with higher intake of omega-3 long-chain polyunsaturated fatty acids (LC-PUFAs), minerals (copper, magnesium, and selenium), B vitamins, and antioxidant carotenoids (e.g., vitamin C, β-carotene, and lutein/zeaxanthin), and lower intake of saturated and monounsaturated fats. This all contributed to mounting evidence that a Mediterranean-like diet pattern, or the intake of certain individual food components, is associated with decreased incidence of late AMD.2,3 In particular, the research pointed to a growing body of evidence connecting the omega-3 LC-PUFAs found in fish to lower risk of AMD.1 

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The investigations also suggest strong genetic interactions exist for some nutrient-genotype combinations, particularly between omega-3 LC-PUFA intake and CFH genotype. This may provide important insights into the underlying biological pathways.1

This research could be clinically significant for ophthalmologists who currently have very few interventions to slow AMD progression.1


1. Agrón E, Mares J, Clemons T, et al. Dietary nutrient intake and progression to late age-related macular degeneration in the Age-Related Eye Disease Studies 1 and 2. Ophthalmol. Published online August 25, 2020. doi: 10.1016/j.ophtha.2020.08.018 

2. Merle BMJ, Colijn JM, Cougnard-Grégoire A, et al. Mediterranean diet and incidence of advanced age-related macular degeneration: The EYE-RISK consortium. Ophthalmol. 2019;126(3):381-390. doi:10.1016/j.ophtha.2018.08.006

3. de Koning-Backus APM, Buitendijk GHS, Kiefte-de Jong JC, et al. Intake of vegetables, fruit, and fish is beneficial for age-related macular degeneration. Am J Ophthalmol. 2019;198:70-79. doi: 10.1016/j.ajo.2018.09.036