Review highlights potential role of vitamin B in AMD prevention and progression

A narrative review examining the role of B vitamins in age-related macular degeneration (AMD) suggests that vitamins B6, B9, and B12 may help reduce the risk of developing AMD and slow its progression, alongside established antioxidant supplement strategies.¹ The review was led by first author Julie Poteet, OD, MS, CNS, FOWNS, of MyEyeDr in Acworth, Georgia.

Findings from the study support Bausch + Lomb’s new PreserVision AREDS3™ eye vitamins, which combine a unique B-vitamin complex with AREDS2 nutrients, according to a news release.² The vitamins are now available in the US and are expected to be available at most major retailers by June 2026.

AMD remains a leading cause of blindness and visual impairment worldwide, and no current treatments are curative. Existing management focuses on slowing disease progression, particularly from intermediate to advanced stages such as geographic atrophy or neovascular AMD.

The review highlights findings from the Age-Related Eye Disease Study (AREDS) and AREDS2, which demonstrated that combinations of antioxidant vitamins and minerals can reduce progression to advanced AMD. AREDS found that supplementation with vitamin C, vitamin E, beta-carotene, zinc, and copper reduced progression from intermediate to advanced AMD by 25% over five years. AREDS2 later showed that a modified formulation including lutein and zeaxanthin, and excluding beta-carotene, reduced the risk of progression to late AMD by 18% and neovascular AMD by 22% compared with the original AREDS formula.

“Scientific evidence shows that AMD develops through a combination of oxidative stress, impaired mitochondrial function, and chronic inflammation,” said Poteet in the release. “The data reviewed in this paper suggest that some B vitamins may play a critical role in regulating homocysteine, a compound linked to retinal damage and increased AMD risk. Collectively, these findings support B-vitamin supplementation in offering additional protective benefits, especially for patients with early AMD.”

Researchers noted growing evidence supporting an additional role for B vitamins. Observational studies have linked lower dietary intake or lower serum concentrations of B vitamins with a higher risk of AMD development.

A 2015 meta-analysis of 11 case-control studies found that patients with AMD had lower average plasma vitamin B12 concentrations than controls. In patients with neovascular AMD, lower serum vitamin B9 concentrations were also reported.

Data from the Blue Mountains Eye Study found that low serum vitamin B12 concentration was associated with more than a twofold increase in AMD risk, while vitamin B12 supplementation was associated with a 42% reduction in incident early AMD and a 47% reduction in any AMD.

The Alienor Study reported that normal serum vitamin B9 concentrations were associated with a 51% lower risk of advanced AMD. Greater dietary intake of vitamins B5 and B6 was also associated with reduced risk.

Analysis of US National Health and Nutrition Examination Survey (NHANES) data showed that patients with AMD had significantly lower dietary intake of vitamins B1, B2, B6, B9, and B12 compared with participants without AMD. Higher dietary vitamin B12 intake was associated with lower AMD risk in men, while increased vitamin B1 intake was linked to lower risk of late AMD.

For disease progression, longitudinal data from AREDS and AREDS2 suggested that higher dietary intake of vitamins B6 and B9 was associated with lower risk of progression to late AMD, geographic atrophy, and neovascular AMD. The association with vitamin B9 remained significant after adjustment for covariates.

The review also examined supplementation studies. In the Women’s Antioxidant and Folic Acid Cardiovascular Study (WAFACS), women randomized to daily supplementation with vitamins B6, B9, and B12 had a 34% lower risk of developing AMD and a 41% lower risk of developing visually significant AMD compared with placebo.

Researchers noted that the vitamin doses used in WAFACS were higher than those typically found in standard B-complex supplements and formed the basis for concentrations selected for the upcoming AREDS3 clinical trial.

AREDS3, currently in development with the National Eye Institute, will test a supplement that adds a B vitamin complex—including B1, B2, B3, B5, B6, B7, B9, and B12—to current AREDS-based formulations.

The review states that one proposed mechanism for B vitamins in AMD protection is the reduction of homocysteine, which can contribute to oxidative stress, inflammation, and retinal pigment epithelium damage. Vitamins B6, B9, and B12 are involved in homocysteine metabolism, and deficiency may lead to elevated homocysteine levels.

Additional proposed mechanisms include support of mitochondrial metabolism, suppression of retinal pigment epithelium dysfunction, and reduced inflammatory signaling.

The authors concluded that “B vitamins have the capacity to counteract several mechanisms believed to be involved in the pathogenesis of AMD, including oxidative stress, mitochondrial dysfunction, and inflammatory activation.”

They added that combining high-dose B vitamins with established AREDS formulations “has the potential to offer a new option for clinicians and their patients to reduce the risk of AMD progression.”

“This publication demonstrates that nutritional supplementation plays a key role in helping reduce the risk of AMD. It also underscores our commitment to science-driven innovation,” said John Ferris, president, of Consumer, Bausch + Lomb, in the release. “Through clinical research and collaboration with leading eye care professionals, we’re focused on finding ways to help support eye health for a broader population of individuals, including those with early-stage AMD. We are turning this strong existing evidence into action with the availability of PreserVision AREDS3 eye vitamins, enhanced with B vitamins.

“While the existing human evidence strongly supports action today, we are finalizing plans for a long-term clinical trial to advance the science further by evaluating this new formulation with patients. This approach ensures patients and clinicians have access to timely innovation now and through a planned long-term clinical trial that continues to elevate the standard of care.”

References:

1. Poteet J, Koetting C, Vakharia PS. Role of B vitamins in preventing the development and progression of age-related macular degeneration. Ophthalmology and Therapy. 2026;15:1-19. https://doi.org/10.1007/s40123-025-01281-1

2. Bausch + Lomb announces published review examining the role of B vitamins in reducing risk and progression of age-related macular degeneration. News release. Bausch + Lomb. April 23, 2026. Accessed April 29, 2026. https://www.bausch.com/newsroom/news/?id=331