TL;DR
If you’re a smoker or former smoker concerned about age-related macular degeneration (AMD), you may have heard conflicting information about eye health supplements.
The good news is that AREDS2 supplements are specifically designed to be safe for smokers – unlike their predecessor.
This article explains the crucial differences between AREDS and AREDS2 formulations, why the changes were made, and what current research tells us about supplement safety for those who smoke.
Why was AREDS2 developed?
The Age-Related Eye Disease Study 2 (AREDS2) was a landmark clinical trial conducted by the US National Eye Institute to build upon the original AREDS research from 2001. The study followed over 4,000 participants and demonstrated that specific vitamin and mineral combinations could reduce the risk of AMD progression by approximately 25%.
However, the original AREDS formula contained a component that raised serious safety concerns for smokers: beta-carotene. This discovery led researchers to develop a modified formulation that would be both effective and safe for all populations, including those with a smoking history.
The critical problem with beta-carotene
Beta-carotene is a naturally occurring carotenoid that the body converts to vitamin A. For decades, it was considered a beneficial antioxidant, particularly for eye health. However, research revealed an alarming connection between high-dose beta-carotene supplementation and lung cancer risk in smokers.
Key research findings
Two major clinical trials completely changed how the medical community views beta-carotene supplementation for smokers:
- The Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study: This Finnish study of 29,133 male smokers found an 18% increase in lung cancer incidence among those taking 20mg of beta-carotene daily.
- The Beta-Carotene and Retinol Efficacy Trial (CARET): This trial showed a 28% increase in lung cancer cases amongst smokers taking beta-carotene supplements.
A comprehensive meta-analysis of 109,394 subjects conclusively demonstrated a 24% increase in lung cancer risk amongst current smokers who received high-dose beta-carotene supplements (typically 20-30mg daily).
Why does this happen?
Scientists believe that in the high-oxygen environment of smokers’ lungs, beta-carotene may undergo oxidation when exposed to tobacco smoke constituents. This oxidative process can lead to the formation of potentially carcinogenic metabolites that promote cellular proliferation—a key mechanism in cancer development. The harmful substances in tobacco smoke, including tar and nicotine, appear to interact negatively with beta-carotene at supplemental doses.
Importantly, this increased risk applies specifically to high-dose supplements. Eating foods naturally rich in beta-carotene remains beneficial and doesn’t carry the same risks.
How AREDS2 solved the safety problem
In direct response to these concerning findings, the AREDS2 study removed beta-carotene entirely and replaced it with two alternative carotenoids: lutein and zeaxanthin. This modification proved to be both safer and equally effective.
The AREDS2 formula contains
Notably, the AREDS2 study also tested omega-3 fatty acids (DHA and EPA) but found they provided no additional benefit for AMD progression, so they’re not part of the core recommended formula.
Long-term safety data
A crucial 10-year follow-up study published in 2022 provided definitive evidence of AREDS2’s safety for smokers. The research found:
- The group receiving AREDS2 supplements with lutein and zeaxanthin had no increased risk of lung cancer
- These participants actually experienced a 20% greater reduction in late AMD progression compared to those who had received beta-carotene
- Of the people who developed lung cancer whilst taking beta-carotene, 90% were former smokers—demonstrating that past smoking history still matters
- Lutein and zeaxanthin did not cause the same problems as beta-carotene, even after a decade of supplementation.
Current guidance in the UK
In the UK, AREDS2 supplements are available over the counter but are not typically provided on NHS prescription. According to RNIB guidance, the NHS does not usually fund supplements for AMD. However, many optometrists and ophthalmologists recommend AREDS2 formulations for appropriate patients.
Who should consider AREDS2 supplements?
Evidence supports AREDS2 supplementation for:
- People with intermediate AMD in one or both eyes
- Those with advanced AMD in one eye but not the other
- Individuals with large drusen (yellow deposits under the retina) visible during eye examinations
- Recent research suggests benefits even for late-stage dry AMD (geographic atrophy).
AREDS2 supplements have not been shown to benefit people with:
- No existing AMD
- Only early-stage AMD with minimal drusen
- No increased risk factors
Related read: Side Effects Of AREDS2 Supplements
UK availability and regulation
When purchasing AREDS2 supplements in the UK, it’s important to verify you’re getting the correct formulation. The Medicines and Healthcare products Regulatory Agency (MHRA) maintains a register of approved online retailers. Look for products that specifically state they follow the AREDS2 formula rather than the original AREDS formulation.
Important considerations for smokers and former smokers
If you currently smoke
AREDS2 supplements are safe for current smokers because they contain no beta-carotene. However, the single most important thing you can do for your eye health – and overall health – is to stop smoking.
Smoking alone doubles the risk of developing AMD. According to Milton Keynes University Hospital NHS guidance, stopping smoking reduces AMD risk by 25%, which is equivalent to the protective effect of the supplements themselves.
If you’re a former smoker
Even if you quit smoking decades ago, you should still use the AREDS2 formulation rather than the original AREDS formula. Research has shown that former smokers remain at elevated risk for lung cancer from beta-carotene supplementation, though the risk is not as high as for current smokers.
Before starting any supplement
Always consult with your GP or optometrist before beginning AREDS2 supplements, especially if you:
- Take other medications or supplements
- Have other health conditions
- Are concerned about potential interactions
High-dose zinc supplementation, for instance, can compete with copper absorption, which is why copper is included in the formula. Your healthcare provider can review your complete medication list to ensure there are no contraindications.
The science behind lutein and zeaxanthin
These two carotenoids are naturally present in the human eye, particularly concentrated in the macula—the part of the retina responsible for central vision. They provide several protective mechanisms:
- Blue light filtration: Both compounds absorb potentially harmful blue light before it reaches sensitive retinal tissues
- Antioxidant protection: They neutralise free radicals that can damage retinal cells
- Macular pigment density: Higher levels of these carotenoids are associated with better visual function and lower AMD risk.
Unlike beta-carotene, lutein and zeaxanthin have not shown any increased cancer risk in smokers or any other population, even at supplemental doses.
The bottom line
Yes, AREDS2 supplements are safe for smokers. The removal of beta-carotene and its replacement with lutein and zeaxanthin has created a formulation that carries no increased lung cancer risk whilst maintaining effectiveness in slowing AMD progression.
The evolution from AREDS to AREDS2 represents a significant advance in nutritional science, ensuring that everyone – regardless of smoking history – can safely benefit from evidence-based supplements for macular degeneration.
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Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with qualified healthcare professionals, including your GP and optometrist, before starting any new supplement regimen or making changes to your eye care routine.
