AREDS Eye Formula

The AREDS formula is the high-dose antioxidant-and-zinc supplement sold as "eye vitamins". It is one of the few supplements with solid trial evidence: in people who already have intermediate macular degeneration, it slows progression to the advanced, sight-threatening stage by about a quarter. It has never been tested as prevention in healthy eyes.

Take an AREDS2-type formula only if an eye doctor has diagnosed intermediate macular degeneration, or advanced disease in one eye. Choose the version with lutein and zeaxanthin instead of beta-carotene, and don't seek out high-zinc products.

What it is

Age-related macular degeneration (AMD) damages the macula, the centre of the retina that handles sharp, straight-ahead vision. It moves from early through intermediate to late (advanced) stages, and the late stage is what takes reading and driving vision.

The formula comes from two large US trials, the Age-Related Eye Disease Studies (AREDS and AREDS2). The current version contains vitamins C and E, zinc, copper, 10 mg of lutein and 2 mg of zeaxanthin.

Who it helps: intermediate disease only

The original AREDS trial cut progression to advanced macular degeneration by about a quarter over an average 6.3 years: a 20% five-year chance of progressing on the formula, against 28% on placebo. That benefit was seen only in people who already had intermediate disease or advanced disease in one eye.^[1]

In people with early disease the five-year risk of progressing was just 1.3%, far too few events for any benefit to show, and eyes with no macular degeneration were never enrolled at all.^[2] So the formula has never been tested as prevention. That is the single most important thing to know before buying it.

The 2023 Cochrane review, pooling 26 trials in 11,952 people, agrees that the full antioxidant-plus-zinc formula "probably slows down progression to late AMD" (about 28% lower odds), at moderate certainty, though that estimate rests on only 3 of the trials and 2,445 participants. In absolute terms that is about 78 fewer cases of late disease per 1,000 people with intermediate disease, against about 4 per 1,000 with early disease.^[3]

Why the second version dropped beta-carotene

The original formula used beta-carotene, which was later linked to lung cancer in smokers. AREDS2 replaced it with lutein and zeaxanthin. Adding lutein and zeaxanthin to the formula gave no significant extra benefit in the trial's main analysis, so their value is as a safer swap rather than an upgrade.^[4]

The swap held up over time. Ten years on (five randomised years, then five more in which everyone took the supplement), the lutein-and-zeaxanthin groups had about 15% less progression to late disease than the beta-carotene groups, and about 9% less than groups given no lutein or zeaxanthin.^[5] Cochrane found that lutein or zeaxanthin added on top of the formula "may have little or no effect" on progression; almost everyone in the trial behind that comparison was already taking the formula, so it is not a test of lutein against nothing.^[6] More on the pigment itself is on Lutein.

Zinc: the lower dose works as well

AREDS2 also randomised 25 mg of zinc against the original 80 mg. The two performed the same at five years and again at ten, with no difference in side effects between them, so there is no reason to seek out the higher dose some products still use.^[7]^[8]

What it doesn't do

Adding lutein and zeaxanthin or omega-3 to it didn't protect thinking. The AREDS2 cognition study, in more than 3,000 older adults, found no effect on cognition; everyone in it, placebo group included, was also taking the background formula, so the formula itself was not tested.^[9]
It isn't a healthy-eye preventive. For people without diagnosed intermediate disease, leafy greens, eggs, not smoking and UV-blocking sunglasses are the sensible habits; see Vision.

What to do

Get a dilated eye exam to find out whether you have macular degeneration and which stage. The formula's evidence depends entirely on the stage.
If you have intermediate disease or advanced disease in one eye, take an AREDS2-type formula under your eye doctor's guidance.
Avoid the old beta-carotene version, especially if you smoke or used to, and don't pay extra for 80 mg of zinc.
If your eyes are healthy or the disease is early, skip it.