Following a recent Ophthalmology and Therapy commentary examining the existing literature and emerging evidence and research of B vitamins and their role in age-related macular degeneration (AMD) disease prevention and management, The Ophthalmologist spoke with co-author Julie Poteet to learn more about what the analysis revealed.
What did your recent commentary focus on?
Our commentary explored the emerging role of B vitamins – particularly B6, B9 and B12 – in AMD through mechanisms that extend beyond antioxidant support, including homocysteine regulation, vascular health, mitochondrial function, and cellular metabolism. The evidence suggests these nutrients may influence upstream pathways involved in AMD pathogenesis and could represent an important adjunctive strategy alongside AREDS and AREDS2 nutrients.
How do you see nutritional strategies reshaping the clinical conversation around AMD management?
Nutrition is shifting the conversation from reactive management toward earlier, upstream intervention aimed at preserving retinal resilience before irreversible damage occurs. We are increasingly recognizing AMD as a multifactorial metabolic disease influenced by diet, vascular function, oxidative stress, and mitochondrial health – not simply a condition of aging alone.
Were there any inconsistencies revealed across the studies covered in the commentary?
Yes – there was variability in study design, formulations, patient populations, and endpoints, which makes direct comparison challenging. However, despite these differences, a consistent signal emerged linking homocysteine dysregulation and B-vitamin–dependent pathways to retinal and vascular health.
What B vitamins were shown to be most effective as a nutritional strategy aimed at AMD prevention/slowing progression?
The strongest evidence currently centers on the combination of folate (B9), vitamin B6, and vitamin B12, particularly in relation to homocysteine reduction and vascular support. The Women’s Antioxidant and Folic Acid Cardiovascular Study demonstrated a significant reduction in AMD risk with this combination, although additional studies are needed to further define optimal formulations and patient selection.
How do you think clinicians should approach B vitamin supplementation in patients with early versus intermediate AMD?
For intermediate AMD, AREDS2 remains the clinically proven option. For early AMD, where no established nutritional standard currently exists, B vitamins may be a reasonable adjunct in selected patients – especially those with elevated homocysteine, vascular risk factors, poor dietary intake, or possible nutrient depletion. This may be relevant because B vitamin insufficiency is common in older adults, and these vitamins support mitochondrial and metabolic function, which may play a role in AMD progression.
The anticipated trial for the PreserVision AREDS3 eye vitamin formula is an important next step – what key questions do you hope it will answer?
One of the most important questions is whether targeting upstream metabolic pathways – such as mitochondrial dysfunction, vascular compromise, and impaired one-carbon metabolism – can meaningfully alter the trajectory of patients presenting in earlier stages. A clinical trial on the PreserVision AREDS3 eye vitamin formula would also be helpful to clarify whether personalized nutritional approaches based on AMD phenotype or metabolic risk factors may improve outcomes beyond a one-size-fits-all model.
What is the biggest misconception about nutrition and AMD that you would like to see addressed?
One major misconception is that nutrition plays only a supportive or “wellness” role rather than a clinically meaningful one. The AREDS studies established nutrition as a clinically proven option for those with moderate-to-advanced AMD, and emerging evidence suggests we may only be beginning to understand how metabolic and nutritional interventions influence retinal health.
AMD is an incredibly heterogeneous disease, and that complexity likely requires a broader, more personalized approach to prevention and management. As our understanding of retinal metabolism and mitochondrial biology evolves, nutrition with both B vitamins and the AREDS2 nutrients may become an increasingly important part of comprehensive retinal care – not just for slowing progression, but potentially for preserving long-term retinal function and healthy aging overall.
