NIH findings suggest Mediterranean diet is associated with slower AMD progression

Data from an extensive literature review conducted by the National Institutes of Health (NIH) and the National Eye Institute (NEI) showed that a Mediterranean-based diet is associated with a decreased risk of progression of age-related macular degeneration (AMD).¹ The research is based on data from 2 large NIH-run cohort studies (AREDS/AREDS2).² Researchers recommend discussing nutrition with patients at any stage of AMD to encourage better outcomes.

The findings were published in the American Journal of Ophthalmology. First author Tiarnán Keenan, MD, PhD, a staff clinician in retinal disease in the Division of Epidemiology and Clinical Applications at NEI, led the study.

Nutrition and eye care

AMD is the leading cause of irreversible vision loss among older adults.³ It occurs when there is an accumulation of extracellular deposits, such as fats, proteins, and other cellular waste, in the macula.⁴ This accumulation causes photoreceptor cells in the macula, which is located in the center of the retina, to lose function.⁴ Several lifestyle factors can affect the progression of AMD, and one of the most important is diet and nutrition^1,3 Diet is considered a major risk factor for AMD, with data from previous studies suggesting that a high intake of omega-3 and unsaturated fats was associated with a decreased risk of disease progression.³

“Dietary modification is a noninvasive, scalable intervention that empowers patients to protect their own visual health, typically with broader systemic health and longevity benefits,” the study authors stated.¹

Study design and patient characteristics

Keenan’s research team reviewed data from ARED/AREDS2 patients diagnosed with AMD at various stages of progression. The team used the Alternate Mediterranean Diet (aMED) index to evaluate the impact of diet on AMD progression across various disease stages. This index can be used by all patients and measures their intake of the following: whole fruits, vegetables, whole grains, nuts, legumes, red meat, fish, ratio of monounsaturated to saturated fatty acids, and alcohol.¹ Outcomes were analyzed by tertiles of aMED scores, with tertile 3 most closely following a Mediterranean-based diet.¹

The AREDS study included a subset of 3640 participants with AMD, aged from 55 to 80 years. Participants were enrolled at 11 clinics nationwide from 1992 to 1998 and were followed for 5 years. AREDS2 was launched in 2006 and included 4203 participants aged 50 to 85 years.⁵ AREDS2 included only participants with intermediate AMD in both eyes or intermediate AMD in one eye and advanced AMD in the other eye.²

Researchers also supplemented their literature review with data from major epidemiologic and cohort studies in Europe and North America, such as the Rotterdam/Alienor studies and EYE-RISK consortium. Adjustments to the data included accounting for age, sex, smoking, total calorie intake, body mass index, inter-eye correlation, and genetic risk.¹

The literature review showed that participants with early-stage AMD with upper tertile aMED scores were 21% less likely to develop intermediate AMD. Participants already in the intermediate stage within that upper aMED tertile were 23% less likely to progress to either geographic atrophy (GA) or neovascular AMD. Additionally, fish intake alone had the strongest protective association among patients with intermediate AMD, with a 31% reduction in risk.¹

Their review also found a complementary association between diet and supplement use, meaning that supplements cannot substitute for a proper diet but can enhance a patient’s nutritional intake. Additionally, the team found that supplements more strongly decrease the risk of neovascular AMD. It is recommended that patients adopt both the Mediterranean diet and AREDS supplements to decrease their risk of both neovascular AMD and GA.¹

Implementation in practice

“Optometrists can use an early AMD diagnosis as a teachable moment by giving patients a simple, practical message: Move toward a Mediterranean-style eating pattern with more vegetables, whole fruit, whole grains, legumes, nuts, and fish, and less red and processed meat and highly processed food,” Keenan said in a statement to Optometry Times. “The goal is steady improvement rather than perfection, so even 1 or 2 achievable changes can be worthwhile. For early AMD, the emphasis should be on diet, smoking cessation, and overall healthy lifestyle, since AREDS2 supplements are not recommended solely at this stage.”

The data from their study also support the conclusion that it is never “too early or too late” for patients to adopt a healthy diet, even if their AMD has progressed. “Even moderate changes in diet may lead to meaningful improvement, and the importance of specific components may vary according to disease stage,” the study authors stated.¹ Smoking remains the most important modifiable risk factor for AMD, with physical activity and weight control following.¹

References

1. Keenan TDL, Hébert M, Chew EY, Johnson MW. What should patients with age-related macular degeneration eat? Am J Opthalmol. 2026; 288;12-21. doi:10.1016/j.ajo.2026.04.003

2. AREDS/AREDS2 clinical trials. National Eye Institute. Updated October 22, 2025. Accessed July 30, 2026. https://www.nei.nih.gov/eye-health-information/clinical-trials/age-related-eye-disease-studies-aredsareds2/about-areds-and-areds2

3. Vemulakonda G, Bailey S, Kim S, et al; American Academy of Ophthalmology Preferred Practice Pattern Retina/Vitreous Committee. Age-related macular degeneration preferred practice pattern. Ophthalmology. 2025;132(4):P1-P74. doi:10.1016/j.ophtha.2024.12.018

4. Fleckenstein M, Keenan TDL, Guymer RH, et al. Age-related macular degeneration. Nat Rev Dis Primers. 2021;7(1):31. doi:10.1038/s41572-021-00265-2

5. Sangiovanni JP, Agron E, Meleth AD, et al; Age-Related Eye Disease Study Research Group. {omega}- 3 long-chain polyunsaturated fatty acid intake and 12-y incidence of neovascular age-related macular degeneration and central geographic atrophy: AREDS report 30, a prospective cohort study from the Age-Related Eye Disease Study. Am J Clin Nutr. 2009;90(6):1601-1607. doi:10.3945/ajcn.2009.27594