If you smoke — or have smoked at any point — the choice of AMD supplement matters more than most people realise. Not all AREDS products are equivalent. Here’s what you need to know, clearly.

The Original AREDS Formula Had a Serious Problem

The 2001 AREDS trial used a formula that included 15mg of beta-carotene — a supplemental form of vitamin A. At the time, this seemed reasonable.

But separate research had already shown that high-dose beta-carotene supplements significantly increase lung cancer risk in current and former smokers. The ATBC trial (Finland) and the US CARET trial both produced these findings, and they’ve been consistently replicated. The NHS and other UK health bodies are clear: current and former smokers should not take high-dose beta-carotene supplements.

The original AREDS formula — with its 15mg beta-carotene — falls squarely into that category. It is not appropriate for smokers or ex-smokers.

What AREDS 2 Changed

The AREDS 2 trial (JAMA, 2013) was partly motivated by this concern. The US National Eye Institute removed beta-carotene entirely from the formula and replaced it with:

• Lutein 10mg
• Zeaxanthin 2mg

These are the carotenoids that actually concentrate in the macula — the nutrients the retina specifically needs. Crucially, they do not carry the lung cancer risk associated with beta-carotene. They are safe for current smokers, ex-smokers, and non-smokers alike.

The rest of the formula — Vitamin C 500mg, Vitamin E 400 IU, Zinc 80mg, Copper 2mg — remained unchanged, and efficacy was maintained at approximately 25% lower risk of progression to advanced AMD over five years.

Is PreserVision AREDS 2 Safe for Smokers?

Yes. Bausch + Lomb PreserVision AREDS 2 uses the 2013 formula with lutein and zeaxanthin. It does not contain beta-carotene. It is considered safe for current and former smokers.

If you’re buying any product marketed as “AREDS” or “AREDS-formula”, always check the ingredients. Some products are still based on the original 2001 formula and contain beta-carotene. Look specifically for “AREDS 2” on the label, and verify there is no beta-carotene listed in the ingredients.

Does Smoking Affect AMD Risk?

Significantly. Smoking is one of the strongest modifiable risk factors for AMD — it roughly doubles the risk of developing the condition and accelerates progression once it’s present. It impairs blood flow to the retina and increases oxidative stress in the macular cells.

The most impactful thing a smoker can do for their long-term eye health is stop. AREDS 2 is not a substitute for that — it’s a separate, additional consideration for people at intermediate or advanced AMD stage.

Does AREDS 2 Still Help If You Smoke?

Yes. The AREDS 2 trial included both smokers and former smokers, and they saw similar relative risk reduction to non-smokers. Smoking status doesn’t make the AREDS 2 formula less effective for macular nutrition — it just means the formula choice matters even more.

If you smoke, have AMD, and have been advised to take AREDS 2 supplements by your optician, you should be taking the AREDS 2 formula specifically — not the original AREDS. PreserVision AREDS 2 is the right choice.

A Note on Dosing

The AREDS 2 dose is 2 soft gels per day — the dose studied in the trial. Taking more doesn’t provide additional AMD benefit and risks excessive zinc intake. The 80mg zinc in the formula is already a high therapeutic dose; if you take other supplements containing zinc, discuss this with your GP.

More about the AREDS 2 formula and who it’s suitable for.