Controversies in the Use of Nutritional Supplements in Ophthalmology

Nutritional supplements are widely taken by the general population and several of these products are marketed specifically to improve eye health. The aim of this review is to summarise the evidence for the benefit of supplementation with antioxidant vitamins and other micronutrients for three of the most common eye diseases of the elderly: age-related macular degeneration (AMD), cataract and dry eye syndrome (DES). Although the potential importance of diet and nutrition in these conditions is strongly supported by data from observational studies, evidence from randomised controlled trials (RCTs) on the benefit of nutritional supplementation is generally lacking. However, there is high quality evidence to support the use of an Age-Related Eye-Disease Study (AREDS) supplement containing antioxidants (β-carotene, vitamin C and vitamin E) and zinc to slow progression in those at moderate to high risk of developing advanced AMD. Recent data from the AREDS2 trial provided data to suggest that β-carotene could be replaced with lutein and zeaxanthin on the basis of improved safety without compromising efficacy. Although there is currently insufficient evidence to recommend the routine use of any of the commercially available supplements in cataract and DES, given the public health importance of these conditions further research into the benefit of dietary modification or nutritional supplementation should be a priority.