In this episode of Evidence-Based Retina, host Rishi Singh, MD, FASRS and guest Priya Vakharia, MD, FASRS discuss the evolving role of nutritional supplementation in age-related macular degeneration (AMD), including emerging evidence supporting B vitamins and the potential impact of PreserVision AREDS3 (Bausch+Lomb).
Dr. Vakharia is a retina specialist at Retina Vitreous Associates of Florida and an assistant professor of ophthalmology at the University of South Florida.
Nutritional supplementation for AMD fast facts
- AMD is a leading cause of vision loss in older adults, with early, intermediate, and advanced disease stages.
- AREDS and AREDS2 supplements are currently the only vitamins clinically proven to reduce progression from intermediate to advanced AMD.1,2
- AREDS2 supplementation is recommended for high-risk AMD patients, but there are currently no proven supplements for early AMD.
- PreserVision AREDS3 is a commercially available formulation that builds on the traditional AREDS2 formula by adding folate, vitamin B6, vitamin B12, and thiamine.
- The PreserVision AREDS3 formulation also contains a lower zinc dose, which may improve tolerability for patients who experience gastrointestinal side effects.
- Emerging evidence supporting the role of B vitamins in AMD comes from a combination of randomized clinical trial data, observational studies, and cardiovascular studies in which AMD outcomes were evaluated secondarily.3
- Key studies supporting the role of B vitamins in AMD include the Women’s Antioxidant and Folic Acid Cardiovascular Study (WAFACS), the Blue Mountains Eye Study, and the Alienor Study.3
- No dedicated clinical trial has yet evaluated whether PreserVision AREDS3 slows AMD progression.
The emerging B vitamin evidence behind PreserVision AREDS3
The growing interest in B vitamins and AMD stems from several large studies originally designed to evaluate cardiovascular outcomes that also tracked AMD incidence and progression. While AMD was not the primary endpoint in these studies, secondary findings consistently suggested a potential protective effect of B vitamin supplementation on macular degeneration risk.
Dr. Vakharia highlighted three studies in particular during the discussion. One of the most notable was the Women’s Antioxidant and Folic Acid Cardiovascular Study (WAFACS). This double-masked, placebo-controlled trial randomized participants to receive folic acid, vitamin B6, and vitamin B12 or placebo.4
After approximately 7 years of follow-up, the B vitamin group developed fewer cases of confirmed AMD, including visually significant AMD, than the placebo group—55 cases versus 82 cases—a statistically significant difference.4
Dr. Vakharia also discussed the Blue Mountains Eye Study, which examined vitamin deficiencies and AMD risk. Patients with vitamin B12 deficiency had a higher risk of both early and late AMD, while folate deficiency was associated with a substantially increased risk of macular degeneration overall.5 The study found that vitamin B12 supplementation was associated with a 47% lower risk of incident AMD.
The Alienor Study further supported this trend, finding that higher dietary intake of vitamins B5 and B6 was associated with a lower risk of developing advanced AMD.6
The rationale behind PreserVision AREDS3
According to Dr. Vakharia, PreserVision AREDS3 builds on the established AREDS2 formula while containing supplementary B vitamins supported by emerging research.
The formulation includes:7
- Folate
- Vitamin B6
- Vitamin B12
- Thiamine
It also contains a lower zinc dose than AREDS2, which may improve tolerability in patients who experience gastrointestinal upset.7 Despite the enthusiasm surrounding the formulation, Dr. Vakharia emphasized that PreserVision AREDS3 has not yet been validated in a dedicated AMD clinical trial. Any potential benefit is currently extrapolated from observational findings and secondary study outcomes rather than direct prospective evidence.
What this means in practice
For retina specialists and eyecare providers, the most immediate impact of AREDS3 may be patient conversations.
Dr. Vakharia noted that patients already taking AREDS2 supplements will likely encounter the new formulation in pharmacies or online and ask whether they should switch. She emphasized that clinicians should be familiar with the evidence supporting the addition of B vitamins, as well as the current limitations of the data.
She also expressed openness to discussing Preservision AREDS3 earlier in the disease process, particularly for patients with early AMD and a strong family history who do not yet meet AREDS2 criteria. She noted that the formulation appears low risk for many patients and may offer potential benefit, although direct evidence demonstrating prevention of AMD progression is not yet available.
She also stressed the importance of establishing realistic expectations when talking with patients. Because the existing evidence primarily comes from studies in which AMD outcomes were secondary, confounding factors remain possible. Until a dedicated clinical trial is completed, AREDS3 should be viewed as a promising—but not yet proven—addition to AMD management.
Conclusion
For now, Dr. Vakharia sees PreserVision AREDS3 less as a universal recommendation and more as an opportunity for evidence-based discussions with patients about risk reduction, supplementation, and early intervention approaches in AMD care.
As additional studies and potential future clinical trials emerge, AREDS3 may help reshape how eyecare providers approach earlier intervention in AMD management.
This article was written by Lindsay Curtis based on the recorded conversation between Drs. Singh and Vakharia.
