News|Articles|October 12, 2026

AAO 2026: What the evidence really shows about nutrition and the eye

Key Takeaways

The evidence for nutrition in eye care is strong for some conditions and thin or absent for others.
The clearest success of nutrition in eye disease is in dry eye disease through the Age-Related Eye Disease Studies (AREDS and AREDS2).
In age-related macular degeneration (AMD), certain dietary patterns reduce the risk of AMD progression by 20% to 56%.
In glaucoma, caffeine is linked to a higher risk of high-tension glaucoma in patients with a family history; higher alcohol use is linked to conversion to glaucoma in glaucoma suspects; nitrates and flavonoids increase IOP-lowering nitric oxide; and diets high in ultra-processed foods were associated with higher risk, and the MIND diet with lower risk.

The evidence for nutrition in eye care is strong for some conditions and thin or absent for others.

The evidence for nutrition in eye care is strong for some conditions and thin or absent for others. A course at the American Academy of Ophthalmology 2026 annual meeting in New Orleans took a close look at what is and what is not known for clinicians to implement in practice.

Why the topic matters

Rudrani Banik, MD, described a mismatch between training and patient behavior. Although the National Research Council recommended 25 to 30 hours of nutrition instruction in medical school in 1985, 71% of schools fell short in 2015, and ophthalmology residencies give the subject little formal attention. She is Founder and Medical Director, EnVision Health NYC, and Associate Professor of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York.

However, patient use of supplements is common, with 60.2% of US adults take a supplement. Among adults aged 60 and older, the figure is 75.9%, and 38.7% take two or more products.

Banik enumerated the jobs of the ophthalmologist: understand the evidence for diet, lifestyle, and supplements; match recommendations to the diagnosis and patient; and counsel patients on benefits, limitations, and safety.

The course discussants covered the ocular surface and dry eye disease (DED), age-related macular degeneration (AMD), glaucoma, and non-glaucomatous optic neuropathies.

DED: clear therapeutic success

The clearest success of nutrition in eye disease, according to Penny Asbell, MD, is in DED through the Age-Related Eye Disease Studies (AREDS and AREDS2). In DED, the established link is xerophthalmia from vitamin A deficiency that affects about 0.3% of the US population Vitamin A increases tears and mucin and reduces keratinization. However, it can promote inflammation and meibomian gland dysfunction (MGD), and oral vitamin A can be toxic. She is the Barrett G. Haik Endowed Chair for Ophthalmology and Director of the Hamilton Eye Institute at the University of Tennessee Health Science Center, Memphis.

The Dry Eye Assessment and Management study¹ evaluated the effects of eicosapentaenoic acid plus docosahexaenoic acid and olive oil placebo in patients with moderate to severe DED. The Ocular Surface Disease Index scores improved equally with both and the DED signs did not differ between the groups. The trial used the highest omega-3 dose of any DED study, achieved high compliance, and enrolled real-world patients. Large cardiovascular studies showed no reduction in serious vascular events with omega-3s.²

The effectiveness of vitamin D is inconsistent.^3-5 The TFOS Lifestyle report rates vitamin A and omega-3s as supportive and reported that curcumin, vitamin B₁₂, probiotics, and the Mediterranean diet as possibly supportive.⁶ The FDA has not evaluated DED supplements.

Asbell encouraged clinicians to be honest with patients about what the evidence shows.

AMD: diet and lifestyle have strong support

Johanna M. Seddon, MD, ScM, Professor and Residency Program Director in the Department of Ophthalmology and Visual Sciences at UMass Chan Medical School, Worcester, MA, presented prospective evidence that certain dietary patterns reduce the risk of AMD progression by 20% to 56%. The effective patterns are rich in lutein, zeaxanthin, and omega-3 fatty acids. People in the highest quintile of lutein–zeaxanthin intake had a 56% lower risk of AMD. The proactive steps include eating at least two servings/week of fatty fish (~20% progression decrease) and strict adherence to a Mediterranean diet (26% progression decrease to advanced AMD). Smoking, a higher body mass index, and abdominal adiposity raise the risk. Physical activity and quitting smoking lower it. In patients at high genetic risk, modifiable factors account for more than half of advanced AMD cases.⁷

AREDS2 supplements (Bausch & Lomb) remain the standard for intermediate AMD, but diet matters because whole foods supply synergistic nutrients that isolated supplements cannot. The 2025 Preferred Practice Pattern of the American Academy of Ophthalmology recommends counseling for patients with intermediate AMD or advanced AMD in one eye about adhering to the Mediterranean diet. Seddon called for nutrition training in medical school and residency, ocular nutrition as a continuing education competency, and counseling supported by handouts and referral to dietitians.⁷

Glaucoma: observational signals only

Jae Hee Kang, ScD, from the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Harvard T.H. Chan School of Public Health, both in Boston, described that most studies have focused on diet and glaucoma have not evaluated disease progression, but are concerned with risk, prevalence, or intraocular pressure (IOP). The following are the key takeaways:

Caffeine transiently raises IOP and consuming at least three cups/day was linked to a higher risk of high-tension glaucoma in patients with a family history.^8,9

Alcohol shows null to adverse associations with primary open-angle glaucoma. Higher intake has been linked to conversion to glaucoma in glaucoma suspects. Moderate drinking after diagnosis was associated with a lower rate of severe visual impairment over 10 years.^10,11

Nitrates and flavonoids increase IOP-lowering nitric oxide. Eating green leafy vegetables at least three times/week and drinking at least one cup of tea/day were associated with lower risk.^12,13

A low-fat diet trial had a null overall effect on glaucoma. Diets high in ultra-processed foods were associated with higher risk, and the MIND diet with lower risk. No dietary measure replaces established glaucoma therapy.¹⁴

Non-glaucomatous optic neuropathies: treat the specific cause

Banik described that the optic nerve depends on B vitamins, copper, selenium, zinc, and iron. In a case treated with copper replacement with vitamin B12, the bilateral vision improved from 20/400 to 20/25, but this supplement has not been tested in large studies. In a second study, subgroup analysis showed the benefit of idebenone,¹⁵ an analogue of coenzyme Q10, for Leber hereditary optic neuropathy, but she advised that improvement should not be promised. A third study, the Idiopathic Intracranial Hypertension Treatment Trial, found a modest improvement in visual fields with acetazolamide when patients adhered to a low-sodium, weight-reduction diet. Weight management is the foundation of treatment.

No nutritional treatment is effective for optic neuritis, nonarteritic anterior ischemic optic neuropathy, optic disc drusen, or traumatic optic neuropathy.

From evidence to practice

Banik recommended lifestyle changes in diet, activity, weight, metabolic control, smoking cessation, and sleep before introducing supplements to address ocular disorders. She advised screening for restrictive diets, malabsorption, medications, and documented deficiencies. When used, supplements need a defined indication, the dose that was studied, and a check for interactions. Ophthalmologists can refer to registered dietitians, gastrointestinal or bariatric specialists, and health coaches. The overall message was to start with food and lifestyle, use supplements selectively, and match each recommendation to the diagnosis, the evidence, and the patient.¹⁵