Based on: Ophthalmology and Therapy, 2025 – Narrative Review/Commentary
At a Glance
• Population: Older adults at risk for or living with AMD, drawing on AREDS/AREDS2, Blue Mountains, Alienor, NHANES and WAFACS data
• Focus: B6, B9 (folate) and B12 alongside AREDS2 formulations
• Key outcome: Higher B-vitamin intake is linked to lower AMD risk and slower progression; AREDS3 will test adding higher-dose B vitamins
Summary
Evidence from major cohort studies shows that low intake or deficiency of B6, B9 and B12 is associated with increased risk of developing AMD and with faster progression to advanced stages. Higher dietary intake, especially folate and B12, has been tied to reduced incidence of early, late or overall AMD.
The WAFACS randomized trial demonstrated that daily supplementation with B6, B9 and B12 reduced incident AMD by roughly one-third and visually significant AMD by about 40%. Proposed mechanisms include lowering homocysteine, improving mitochondrial function in the RPE, and reducing oxidative and inflammatory stress. AREDS3 will evaluate whether adding higher-dose B vitamins to AREDS2 provides additional benefit, particularly for early-stage disease.
Practice Considerations
• Assess B-vitamin intake in patients with early/intermediate AMD.
• Note that higher-dose B-vitamin combinations are investigational.
• Nutritional strategies complement, not replace, imaging and clinical management.
• Watch for AREDS3 findings to inform future recommendations.
