Nutrition and the Eye: A Recipe for Success

Reportedly, the first medical text was a cookbook. As long ago as 1500 BCE, Egyptian physicians observed a connection between nutrition and eye disease, including prescribing liver, high in vitamin A, to treat night blindness. Chinese doctors in the early 14th century also made the connection between vitamin A and ocular health, prescribing leafy greens, carrots, liver, and egg yolks for patients with eye problems.¹

The association between good vision and eating carrots and fish seems baked into our DNA. While modern medicine has innovated so many useful pharmaceutical treatments, devices, and surgical practices, nutrition remains a central factor in overall health, particularly ocular health.

“As ophthalmologists, even within the constraints of a busy clinic, we have a valuable opportunity to advocate for long-term visual health by promoting simple, science-based lifestyle advice,” Filomena Ribeiro MD, PhD told EuroTimes. “I still remember being told as a child that eating carrots would give me ‘beautiful eyes’—a charming myth, but one rooted in a deeper truth: nutrition does matter.”

Key nutrients—including polyunsaturated omega-3 fatty acids (PUFA) such as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA); lutein; zeaxanthin; and vitamins A, B3, B9, and E—are all known to play a role in visual development and cognitive function. DHA is abundant in the retina and plays a role in phototransduction and neuroprotection.²

This knowledge supports advising patients to include sources of omega-3 PUFA in their diets. Some of the best-known examples include salmon and other fatty fish, nuts, seeds, olive oil, and eggs, which contribute to the increasing popularity of the Mediterranean diet.

“As ophthalmologists, we have an important role in helping patients understand how their daily habits—especially nutrition and lifestyle—can affect their eye health,” noted Başak Bostancı MD. “This applies not only to preventing future problems but also to managing conditions already present.”

The potential benefit of omega-3 in the diet has not been lost on supplement marketers. The size of the eye health supplement market is eye-opening, to say the least. A recent global study valued the eye health supplement market at USD 2.5 billion in 2023, predicting it would grow to USD 4.48 billion by 2032.³

In general, there is little evidence to support the use of nutritional supplements in maintaining general health. However, ophthalmology research has produced some of the few examples where supplements do provide benefits.

The Age-Related Eye Disease Studies (AREDS and AREDS2), conducted by the US National Eye Institute (NEI), followed 4,700 participants aged 55–80 with different degrees of AMD.⁴ Patients received a combination of antioxidants and zinc or placebo over 6 years. While the supplement did not prevent the onset of AMD, it did significantly reduce the risk of progression to advanced disease in patients with intermediate or advanced AMD and the risk of moderate vision loss. No study of dietary supplements in any area of medicine produced such dramatic effects on health.

The follow-up AREDS2 study addressed some of the concerns raised in the first study, including concerns about beta-carotene and cancer risk, the side effects of zinc, and the lack of lutein. The AREDS2 protocol added lutein, zeaxanthin, and/or omega-3 fatty acids but removed zinc and beta-carotene from the formula. In that study, lutein and zeaxanthin were found to be safe and effective, while omega-3 fatty acids did not appear to provide additional benefit in reducing AMD progression.

“While our primary focus is often diagnosis and treatment, patients trust us as experts in vision, and this trust gives us an opportunity to deliver concise, evidence-based guidance,” Dr Bostancı said. “We know from the AREDS and AREDS2 studies that targeted nutritional supplementation can slow the progression of age-related macular degeneration. But our responsibility doesn’t stop with vitamins. Encouraging a healthy diet, regular exercise, smoking cessation, screen-time management, and adequate sleep are all evidence-backed measures that support ocular and systemic health alike.”

Dry eye disease is another area where omega-3 fatty acids play a role. The need is great, with some 5% of the public experiencing symptoms of dry eye. A recent global survey conducted by Bausch + Lomb indicated 58% of adult dry eye sufferers experience frequent or occasional symptoms, but only 1 in 5 have been diagnosed. Population studies suggest a benefit among those practising an eye-healthy diet, with some studies indicating additional potential for omega-3 supplements.^5–7

“Beyond supplements, encouraging patients to adopt a diet rich in leafy greens, oily fish, and colourful vegetables, along with good sleep hygiene and regular physical activity, contributes not just to ocular health, but to overall well-being. Even a brief word from us can carry weight—especially when patients understand that what they eat today may influence how well they see tomorrow,” Professor Ribeiro said.

“And beyond the science, the simple pleasure of selecting fresh ingredients and preparing meals thoughtfully can itself be a powerful act of self-care—a source of balance and well-being in daily life.”

Filomena Ribeiro MD, PhD, FEBO is Head of the Department of Ophthalmology at the Hospital da Luz, Lisbon, Portugal, and president of the ESCRS. filomenajribeiro@gmail.com

Başak Bostancı MD, FEBO is Assistant Professor of the Bahçeşehir University of Istanbul and a cataract and refractive surgeon at World Eye Hospital, Istanbul, Turkey. drbbostanci@gmail.com

1. Niu H, et al. Food & Medicine Homology, 2024 Sept; 1(1).

2. Li J, et al. “Health benefits of docosahexaenoic acid and its bioavailability: A review,” Food Sci Nutr, 2021 Jul 23; 9(9): 5229–5243.

3. “Global Eye Health Supplements Market Size, Share, Growth Analysis,” Skyquestt.com, 2022. https://www.skyquestt.com/report/eye-health-supplements-market.

4. Chew E, et al. “Lutein + Zeaxanthin and Omega-3 Fatty Acids for Age-Related Macular Degeneration,” JAMA, 2013; 309(19): 2005–2015.

5. Wang W-X, et al. “Efficacy of Omega-3 Intake in Managing Dry Eye Disease: A Systematic Review and Meta-Analysis of Randomized Control Trials,” J Clin Med, 2023 Nov 10; 12(22): 7026.

6. Bhargava R, et al. “Omega-3 fatty acid supplements for dry eye—Are they effective or ineffective?” Indian Journal of Ophthalmology, 2023 Apr; 71(4): 1619–1625.

7. Walter K. “What Is Dry Eye Disease?” JAMA, 2022; 328: 84. doi:https://jamanetwork.com/journals/jama/fullarticle/2793824