Following national guidance from NHS England, prescribing of nutritional supplements (e.g. vitamins A, C, E, zinc, and carotenoids such as lutein and zeaxanthin) for Age-related Macular Degeneration (AMD) is not recommended due to insufficient evidence of efficacy.

Prescribers should not initiate lutein and antioxidants for any new patient. Patients currently being prescribed these products should be reviewed, and treatment stopped. Click the following link for a patient information leaflet to support deprescribing.

If patients wish to purchase preparations they should note that not all products available contain the same amount of ingredients as used in the Age-Related Eye Disease Study (AREDS) trials.

There is some evidence that the use of beta-carotene supplements could be associated with a small increase in lung cancer incidence and mortality in smokers or individuals exposed to asbestos. Vitamin E supplementation may be associated with a small increased risk of heart failure in people with diabetes or vascular disease.

For information on when to refer to specialist services, consult local clinical referral guidelines for:

• Western Locality
• South Devon and Torbay

Dietary advice

Dietary advice may be offered to patients who are concerned about AMD. There is no firm evidence that this helps to prevent AMD or slow its progression, but it is sensible and is unlikely to do any harm.

It is widely agreed that if you eat a healthy diet including at least five portions of fruit and vegetables a day, you should not need a supplement. Eating a healthy diet rich in oily fish, leafy green vegetables and fresh fruit is recommended.

It is important to eat a wide range of foods. Orange and yellow fruits and vegetables such as sweetcorn and orange peppers are a good source of zeaxanthin. Broccoli, kale, leek, lettuce, peas, red pepper, and spinach are all good sources of lutein. Eggs contain both lutein and zeaxanthin, and many of these foods also contain vitamins C and E.

Consider drug-food interactions when making dietary changes; for example cranberry juice and vitamin K (found in many foods including leafy green vegetables) both interact with warfarin; grapefruit juice interacts with simvastatin etc. For more information on interactions, consult individual Summary of Product Characteristics or the BNF.