A literature review found that adopting the Mediterranean diet (or similar) appears beneficial for patients with age-related macular degeneration (AMD) at all disease stages.

Led by the US National Eye Institute’s Dr Tiarnán Keenan, the review draws primarily on data from the landmark Age-Related Eye Disease Studies (AREDS/AREDS2) and major epidemiologic and cohort studies in Europe and North America. Dr Keenan and colleagues argue that the evidence is now robust enough to warrant direct, stage-specific dietary guidance being shared with patients during clinical consultations.

Across disease stages, the researchers found a closer adherence to a Mediterranean-style diet was consistently associated with substantially slower AMD progression. In AREDS, individuals with early AMD who adhered more closely to a Mediterranean diet were significantly less likely to develop intermediate AMD, they said, while in AREDS/AREDS2 participants with intermediate AMD, higher Mediterranean diet adherence was strongly associated with decreased risk of progression to late AMD, especially for geographic atrophy (GA).

Higher fish intake was found most protective against progression to late AMD in patients with intermediate AMD, followed by higher vegetable and lower red meat intake, authors noted. For individuals with GA, a Mediterranean diet was associated with markedly slower GA progression, including slower expansion towards the fovea. Higher intake of fruit and vegetables, lower intake of red meat and avoidance of heavy alcohol consumption were found to be most important in slowing GA enlargement.

Furthermore, oral micronutrient supplementation with the AREDS2 formulation decreased progression to late AMD for individuals with intermediate AMD (or advanced disease in one eye) and slowed expansion of extrafoveal GA towards the fovea, they said. Notably, the benefits of a healthy diet and AREDS2 supplementation were found to be complementary, so authors recommended they be used together for maximal benefit.

While clinicians may have limited time to address diet effectively within a consultation, behavioural science has demonstrated that patients become more open to change at certain pivotal moments, including when receiving a new diagnosis, the authors noted. These “teachable moments” offer powerful opportunities for clinicians to introduce dietary guidance in a way that feels crucial, timely, personally relevant and actionable, they argued.

“The evidence summarised in this perspective suggests that adopting a Mediterranean diet is helpful at nearly every stage of AMD. Therefore, it may never be too early or too late to adopt a healthy diet. Even moderate changes in diet may lead to meaningful improvement and the importance of specific components may vary according to the disease stage,” they concluded.