AREDS vs. AREDS2: Which Formula Is Right for You?
How the Two Formulas Compare
AREDS and AREDS2 are high-dose nutritional supplements developed through large clinical trials to slow the progression of AMD. Understanding what changed between the two formulas, and why, helps explain why one is now recommended over the other for nearly all patients.
The original AREDS formula was developed from a large clinical trial that enrolled thousands of participants between the ages of 55 and 80. It contained vitamin C 500 mg, vitamin E 400 IU, beta-carotene 15 mg, zinc 80 mg, and copper 2 mg. This was the first supplement formula shown in a major trial to meaningfully slow AMD progression.
The AREDS2 formula, developed through a follow-up trial of over 4,000 participants aged 50 to 85, replaced beta-carotene with lutein 10 mg and zeaxanthin 2 mg. A lower zinc dose of 25 mg was also tested. Lutein and zeaxanthin are natural pigments found in the retina, the light-sensitive tissue at the back of the eye, and they provided equal or better AMD protection than beta-carotene without its associated risks.
A ten-year follow-up analysis found that participants taking lutein and zeaxanthin without beta-carotene had a lower risk of progressing to late-stage AMD compared to those taking beta-carotene. AREDS2 is now the formula recommended for all qualifying patients. The original formula is no longer considered the preferred option for any group.
Who Should Take AREDS2
These supplements are not general eye health vitamins and are not appropriate for everyone. Your eye care provider must evaluate your specific AMD stage before recommending supplementation.
Both AREDS and AREDS2 were shown to benefit only people with intermediate AMD, meaning they have large drusen (deposits under the retina) in both eyes, or large drusen in one eye and advanced AMD in the other. Clinical trials found no measurable benefit for people with early AMD or for those who do not have AMD. Starting supplements without the right diagnosis provides no protection and carries avoidable risks from high-dose nutrients.
The original AREDS formula poses a serious risk to smokers. Beta-carotene in the original formula was found to nearly double lung cancer risk in former smokers, with the vast majority of those who developed lung cancer being former or current smokers. Current and former smokers must take only the AREDS2 formula, as there is no safe way for them to use the original formula. This risk does not exist with the lutein and zeaxanthin found in AREDS2.
If you are currently taking the original AREDS formula containing beta-carotene, we encourage you to speak with your eye care provider about making the switch to AREDS2. The long-term data shows that the AREDS2 formula provides equal or better AMD protection with a safer nutrient profile. Most eye care providers now recommend AREDS2 for all patients, regardless of smoking history.
Zinc Dose: What You Should Know
Both the original and updated formulas include zinc, which plays a role in retinal health. The AREDS2 trial tested two different zinc doses, and understanding the findings can help guide your conversation with your eye care provider.
The AREDS2 trial found no significant difference in AMD outcomes between the 80 mg zinc dose used in the original formula and a lower 25 mg dose. Despite this finding, many commercial AREDS2 products still use the higher 80 mg dose. Some patients experience nausea or stomach upset with the higher amount, and those individuals may benefit from discussing the lower-dose option with their provider.
High-dose zinc can interfere with the body's ability to absorb copper, which is why both formulas include 2 mg of copper to offset this risk. It is important to use a supplement that includes this copper component when taking either zinc dose. Do not take high-dose zinc without copper unless specifically directed by your provider.
Some research has suggested that long-term use of high-dose zinc may be associated with an increased risk of prostate cancer. Men considering AREDS2 supplementation, particularly those with other prostate cancer risk factors, should discuss this with their physician before starting. This is a conversation worth having as part of an overall health review, not a reason to avoid the supplements without guidance.
What These Formulas Cannot Do
It is just as important to understand what AREDS2 does not do as it is to understand its benefits. Having realistic expectations helps patients make informed decisions and stay engaged in their broader eye care plan.
AREDS2 supplements do not slow progression in people with early AMD, and they offer no proven preventive benefit for people who do not have the condition. They are not a general eye health supplement. Taking them without a qualifying AMD diagnosis means accepting the risks of high-dose nutrients without receiving any known benefit.
Neither formula cures AMD or restores vision that has already been lost. The goal of supplementation is to slow the progression from intermediate AMD to advanced AMD, which can cause significant central vision loss. Patients should approach AREDS2 as a protective measure that supports their overall care, not as a treatment for existing vision damage.
Taking AREDS2 does not reduce the need for ongoing eye exams and monitoring. Patients with intermediate AMD still require regular dilated eye exams so their provider can track any changes. Those who develop wet AMD, a form of advanced AMD involving abnormal blood vessel growth, may need additional treatments such as anti-VEGF injections (medications injected into the eye to reduce abnormal vessel activity), which supplements cannot replace.
Frequently Asked Questions
Here are answers to questions we commonly hear from patients navigating AREDS2 supplementation for the first time.
Standard multivitamins do not contain the specific nutrient doses that were tested in the AREDS2 clinical trial and cannot substitute for the clinical formula. The doses in AREDS2, particularly for zinc, lutein, zeaxanthin, and vitamin C, are far higher than what is found in typical daily vitamins. Ask your eye care provider to recommend a product that closely matches the tested AREDS2 formulation.
AREDS2 supplements are available over the counter at most pharmacies without a prescription. However, you should only begin taking them after your eye care provider confirms that your AMD stage qualifies. When selecting a product, check the label carefully to make sure it matches the AREDS2 formula, as not all 'eye vitamin' products on store shelves use the clinically tested doses.
Yes, interactions are possible. The high-dose vitamin E in AREDS2 can interact with blood-thinning medications, and high-dose zinc can affect the absorption of certain antibiotics. Bringing your full list of medications and supplements to your eye appointment allows your provider and pharmacist to check for potential interactions before you start.
Most patients with intermediate AMD take AREDS2 supplements on a long-term basis, as the ten-year follow-up data shows sustained benefit over time. Stopping supplementation is not recommended without speaking to your provider first. Your eye care provider will advise you on duration based on your AMD stage, overall health, and any changes observed during your ongoing monitoring visits.
No. The AREDS2 formula performs as well as or better than the original formula for AMD protection, regardless of smoking history. Since AREDS2 offers the same or greater benefit with no lung cancer risk from beta-carotene, there is no clinical advantage to choosing the original formula. Your provider will recommend AREDS2 as the default for all qualifying patients.
Nausea or stomach discomfort from the high zinc dose is the most commonly reported side effect. If this happens, contact your eye care provider before stopping the supplement entirely. Switching to a lower zinc dose formulation (25 mg) or taking the supplement with food often resolves the issue. Do not switch to a different formula or stop supplementation without guidance, as doing so could interrupt protection during a critical period in your AMD management.
Get Expert Guidance on AMD Supplements at Rhode Island Eye Institute
Choosing the right AMD supplement starts with a thorough evaluation from a qualified eye care provider. At Rhode Island Eye Institute, our team of specialists has the expertise and technology to accurately assess your AMD stage and guide your treatment plan, including whether AREDS2 is appropriate for you. We are committed to giving every patient clear, evidence-based guidance they can trust for the long term. We welcome patients from across Rhode Island and surrounding communities who are looking for experienced, compassionate eye care.