Mediterranean diet can slow progression of age-related macular degeneration

Age-related macular degeneration is a leading cause of central vision loss for older adults.

It affects the macula, which controls sharp, straight-ahead vision, making it hard to see faces, drive or read.

Nearly 20 million United States adults are living with some form of AMD and there are few available treatments.

In a new paper, researchers from University of Michigan and National Eye Institute have summarized data showing that the Mediterranean diet, which focuses on eating fish, fruits, vegetables and whole grains, while avoiding red meat, is beneficial for all stages of AMD.

Mark Johnson, M.D., Professor of Ophthalmology and Visual Sciences, who co-authored the study, explains the risk factors associated with AMD, why the diet is beneficial and the role of nutritional supplements.

What are the different stages of AMD?

Johnson: Early AMD is characterized by the presence in the macula of small deposits of fats and proteins known as drusen.

For patients with early AMD, the risk of vision loss over the next 5-10 years is not much different from those without AMD.

The disease is classified as intermediate AMD when many medium drusen and/or any large drusen are seen in the macula. Most patients with large drusen still have mild or no visual symptoms.

Advanced AMD, the stage where patients begin to experience vision loss, is characterized by the development of either wet AMD, due to leakage or bleeding from abnormal blood vessels, or advanced dry AMD, where expanding patches of atrophy cause slowly enlarging blind spots.

Wet AMD can be treated with a series of anti-VEGF injections that stabilize the abnormal blood vessels, but there are currently no pharmacologic treatments that are safe and effective for halting the progression of dry AMD.

What are the risk factors for AMD?

Johnson: AMD is caused by a combination of genetics, aging and environmental factors.

While isn’t one single gene mutation that routinely causes AMD, many different mutations have been identified that confer added risk of developing the disease later in life.

The risk can be modified by such factors as diet, high blood pressure, smoking, and cardiovascular disease.

How does the Mediterranean diet help manage AMD?

Johnson: Two major clinical trials in the U.S.—the Age-Related Eye Disease Study, or AREDS, and AREDS2—focused on the influence of diet and micronutrient supplements in slowing AMD progression.

Our recent paper summarized the data from these studies and other major epidemiological studies, in order provide clearer guidance for physicians and their patients.

We found that for every stage of macular degeneration, starting with the mildest, there was substantial benefit from aligning one's diet very closely to the Mediterranean diet.

The closer people adhered to the principles of the diet, the more they were protected from advancing to the next stage.

Specific dietary components that turned out to be especially important were fish (around three servings per week), vegetables and avoiding red meat.

It was especially notable that data demonstrated that the Mediterranean diet combined with micronutrient supplements appeared to slow the progression of atrophy toward the center of the macula by as much as 65%.

I now feel that by counseling patients on their diet, I can provide them potentially with the best treatment we currently have. It is relatively inexpensive, carries no appreciable risk, and is beneficial to their health as a whole.

Why does the diet slow AMD progression?

Johnson: For several decades, researchers have shown that leafy green vegetables and foods rich in carotenoids are protective for the macula.

Fish are rich in healthy fats and other beneficial nutrients.

Another important component of the Mediterranean is fiber, which is known to be beneficial for the gut microbiome. And there is increasing evidence that the micro-organisms that live in our digestive tract play important roles in our overall health and likely our eye health.

Conversely, red meat may be harmful to the gut microbiome and may in turn have deleterious effects on the retina and other organ systems.

A healthy diet is all about getting the nutrients that promote health and avoiding those that might be harmful.

How do nutritional supplements help patients with AMD?

Johnson: Supplements alone did not show benefit in patients with early AMD.

In the AREDS studies, patients with early AMD that took antioxidant supplements for six to eight years had no difference in disease progression compared to patients who didn’t take the supplements.

However, for patients with intermediate and advanced AMD, the micronutrient supplements, now referred to as AREDS2 supplements, slowed disease progression significantly.

Importantly, these benefits were found to be additive to those obtained from the Mediterranean diet.

We now strongly encourage our patients to align their diet as closely as possible to the Mediterranean pattern and use AREDS2 supplements as well.

Paper cited: “What Should Patients With Age-Related Macular Degeneration Eat?” American Journal of Ophthalmology. DOI: 0.1016/j.ajo.2026.04.003

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