AREDS2 Formula vs Lutein and Zeaxanthin Alone: Who the Evidence Applies To
The AREDS2 formula was tested in people with intermediate macular degeneration; lutein and zeaxanthin alone were not shown to do the same, so who the evidence applies to matters.
Content last updated . This page has not been medically reviewed.
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Age-related macular degeneration (AMD) needs an eye clinician, not self-treatment. The National Eye Institute says that if straight lines start to look wavy, you should see your eye doctor right away. [1] Early AMD may cause no symptoms, so regular dilated eye exams matter. [1] The NCCIH advises people with AMD to ask their providers whether AREDS-type supplements are appropriate for them. [2]The short answer
The AREDS2 formula (vitamins C and E, zinc, copper, lutein and zeaxanthin) was tested in people with intermediate AMD. NEI reports that AREDS and AREDS2 supplements reduce the risk of progression to advanced AMD by about 25 percent. [3] A Cochrane review rated the evidence for the original AREDS formula as moderate certainty, and for swapping beta-carotene for lutein and zeaxanthin as exploratory. [4] Lutein and zeaxanthin on their own were not shown to do the same: a Cochrane review found low-certainty evidence of little or no effect when they were compared with placebo. [4] Neither has been shown to prevent AMD in people who do not have it. [2] There is no evidence here that applies to healthy eyes.What is in each formula
These are the contents of the formulas tested in the trials and sold as AREDS and AREDS2 formulas, as listed by the National Eye Institute (NEI). They are study and formula contents, not advice. [3]| Ingredient | AREDS formula | AREDS2 formula |
|---|---|---|
| Vitamin C | 500 mg | 500 mg |
| Vitamin E | 400 IU | 400 IU |
| Beta-carotene | 15 mg | none |
| Copper (cupric oxide) | 2 mg | 2 mg |
| Lutein | none | 10 mg |
| Zeaxanthin | none | 2 mg |
| Zinc | 80 mg | 80 mg |
Source: NEI, page updated October 2025. [3] NEI says copper was added to avoid zinc-related copper deficiency. [3]
Who the evidence applies to
- AREDS (1992 to 1998): 4,757 people aged 55 to 80 with cataract, AMD or both; the AMD results used 3,640 people who had early or worse AMD. [3]
- AREDS2 (from 2006): 4,203 people aged 50 to 85 with intermediate AMD in both eyes, or intermediate AMD in one eye and advanced in the other. People without AMD or with early AMD were excluded because AREDS had shown no benefit for them. [3]
- Size of the effect: NEI reports about a 25% reduction in progression from intermediate to advanced AMD, and no effect on onset of AMD or on cataract. [3] The Cochrane review estimated about 78 fewer progressions per 1,000 people with intermediate AMD, but about 4 fewer per 1,000 with early AMD. [4]
AREDS2 formula vs lutein and zeaxanthin alone
| Question | What the source found | Strength |
|---|---|---|
| Did adding lutein and zeaxanthin to the AREDS formula help? | NEI: no additional overall effect on advanced AMD in the main comparison, but the group taking antioxidants without beta-carotene plus lutein and zeaxanthin had an incremental benefit over the original AREDS formula. [3] | One large trial; secondary comparison |
| 10-year follow-up | Lutein/zeaxanthin vs none: hazard ratio 0.91 for late AMD (95% CI 0.84 to 0.99). Against beta-carotene directly: 0.85. [5] | Follow-up, not a new randomized comparison |
| Lutein and zeaxanthin alone vs placebo | Six studies; most evidence from AREDS2, where almost all participants also took the AREDS formula. Risk ratio for late AMD 0.94 (0.87 to 1.01). [4] | Low certainty |
| Lutein alone or vitamin E alone | NCCIH cites a 2017 review: little or no effect on progression, low-certainty evidence. [2] | Low certainty |
| Whether a pill beats leafy greens and eggs | Proper evidence not found. None of the NEI, NCCIH, Cochrane or PubMed records we read reports a trial comparing the two for AMD. | Insufficient |
Smokers, beta-carotene and zinc
- Beta-carotene: in the 10-year AREDS2 follow-up, the odds of lung cancer were 1.82 (95% CI 1.06 to 3.12) for those assigned beta-carotene and 1.15 (not statistically significant) for lutein/zeaxanthin. [5] NEI states that current and former smokers should avoid the AREDS formula with beta-carotene. [3] See beta-carotene and the ATBC and CARET trials.
- Zinc and copper: the Cochrane review notes stomach and gut symptoms as the main side effect, and more genitourinary problems in men taking zinc in AREDS. [4] The NHS says adults in the UK should not take more than 25 mg of zinc supplements a day unless advised by a doctor (NHS, 2020); AREDS formulas contain 80 mg, so a clinician should decide. [6]
- Vitamins E and C: vitamin E may raise bleeding risk and interact with anticoagulants; vitamin C may worsen iron overload in hemochromatosis. [2]
- Pregnancy, children, kidney, liver, surgery: AMD is a disease of older age; these groups are not covered in the sources we read. Ask a clinician or pharmacist. See medication interactions and supplements before surgery.
- Quality: see quality testing.
More: lutein and zeaxanthin for eye health, AREDS and AREDS2 trial results and carotenoids.
Frequently asked questions
Is AREDS2 better than lutein and zeaxanthin alone?
They were tested in different ways. The AREDS2 formula is the one with supporting results in intermediate AMD; lutein and zeaxanthin alone showed low-certainty evidence of little or no effect. [3] [4]
Should I take an AREDS2 supplement to prevent AMD?
Supplements have not been shown to prevent AMD in people who do not have it. [2] Ask an eye clinician.
Why did AREDS2 remove beta-carotene?
Beta-carotene raised lung cancer risk in smokers and former smokers, and lutein and zeaxanthin were tested as a replacement. [3] [5]
Do AREDS supplements help cataracts?
No. NEI reports that they had no effect on cataract. [3]
Are there side effects?
Digestive symptoms were the main reported effect, with more genitourinary problems in men taking zinc in AREDS. [4] Talk with your eye clinician or pharmacist about your medicines.
References
- National Eye Institute, Age-Related Macular Degeneration (AMD). Read 2026-10-23.
- National Center for Complementary and Integrative Health (NCCIH), Antioxidant Supplements: What You Need To Know. Read 2026-10-23.
- National Eye Institute, AREDS/AREDS2 Clinical Trials (updated October 2025). Read 2026-10-23.
- Evans JR, Lawrenson JG. Antioxidant vitamin and mineral supplements for slowing the progression of age-related macular degeneration. Cochrane Database Syst Rev 2023. Read 2026-10-23.
- Chew EY et al. Long-term outcomes of adding lutein/zeaxanthin and omega-3 fatty acids to the AREDS supplements on AMD progression: AREDS2 Report 28. JAMA Ophthalmol 2022. Read 2026-10-23.
- NHS, Vitamins and minerals: Others, beta-carotene and zinc (reviewed August 2020). Read 2026-10-23.
Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.