Nutrition as Prevention: Diet Patterns That Protect Vision

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Patients want to know about nutrition as prevention; start the conversation today

By Jessica Licausi, OD, FAAO, FOVDR, and Miki Lyn Zilnicki, OD, FOVDR

May 4, 2026

In our practice, many patients come to their exam inquiring about specific holistic care recommendations for their ocular health. We lean into the opportunity to educate curious patients.

We believe you are what you eat. Having these conversations with our patients regarding how their diet and lifestyle impacts their vision can have a lasting effect. You can have a conversation about nutrition with every patient, regardless of age. Early lifestyle habits can significantly influence long-term ocular and systemic health and be more impactful for longevity.

That said, these conversations become more important in patients over 40. These patients have a more significant risk of developing conditions such as macular degeneration, cataracts and other age-related ocular disease. Their nutrition choices and lifestyle choices are the few modifiable risk factors that they have control over.

TALKING ABOUT NUTRITION BENEFITS YOUR BUSINESS

Spending time with your patients and investing not just in ocular health, but their overall well-being, plays a huge role in building trust and building your practice. Patients want to know that their doctors are as invested in them as they are and will refer friends and family ten-fold if they know how much you care. It’s well worth a few minutes of your exam time.

Additionally, networking with patients’ primary care physicians (PCP) builds your network with local providers. Send a report detailing findings and recommendations. We often refer back to PCPs if our patients have multiple systemic diseases and are on a lot of medications to ensure there will be no adverse interactions with other medications and supplements.

HOW WE START THE CONVERSATION

We start the nutrition conversation broadly, highlighting two main areas of nutrition to consider for overall well-being and the best visual outcomes:

The Mediterranean Diet

This has been a long well-documented diet that is rich in fruits, vegetables, fish, nuts and olive oil and has been proven to significantly reduce the risk of heart disease, stroke, type 2 diabetes, overall inflammation and certain cancers.¹  From an eye standpoint, this diet helps to reduce cardiovascular related vision issues as well as macular degeneration due to its high antioxidant and omega-3 consumption.

Talk to patients about:

• Including foods like leafy green vegetables (spinach, kale), colorful vegetables (peppers, tomatoes), whole grain, fish (salmon and sardines), poultry over red meat, nuts/seed and olive oil as the main fat source.

Low Glycemic or Stable Blood Sugar

This diet is aimed at reducing blood sugar spikes, which even if you are not diabetic, can cause stress on our vascular system.²

Talk to patients about:

• Focusing on whole grains instead of refined carbohydrates and minimizing excess sugar/processed foods
• Combining this approach with other diets to be conscientious of balanced meals with a protein, a fiber and a fat present

THE GOAL OF THIS INTRODUCTION

We want to make the connection of how what we consume has an overall impact on our health and our eyes.

Make simple, approachable suggestions:

• Swapping olive oil for butter
• Putting ground flax seed in your breadcrumbs
• Just adding a small handful of spinach to your smoothie

DIET RECOMMENDATIONS WITH PATHOLOGY

When there is active ocular disease pathology, our conversation about health and nutrition gets more specific. We deal with these conditions daily:

Dry Eye Syndrome

The quality of our tear film can be very tied to our gut health.³ Decreasing inflammatory factors can improve the health of the tear film.

While there are wonderful dry eye medications as treatment options available, not every patient wants to be prescribed a medication. Recommending lifestyle modifications can be a great first step to improving tear production and quality of the tear film.

Talk to patients about:

• Increasing food intake that is high in fish oil (fish, walnuts, and flaxseed), increase vitamin A dense foods (carrots, sweet potatoes), prioritize hydration and focus on anti-inflammatory foods
• A recommendation for a high-quality supplement that is high in EPA/DHA for 1000-2000 mg/day, if a patient is unable to get enough omega 3 fatty acids into their diet

Age-Related Macular Degeneration

We discuss nutrition with patients in all stages of macular degeneration and those with high genetic risk.

Talk to patients about:

• Incorporating foods that are high in lutein and zeaxanthin into their diet which can be found in leafy greens, fatty fish and colorful vegetables such as orange peppers
• Limiting excessive saturated fats, such as red meat and dairy, which can be oxidative in nature
• How smoking can have a tremendous impact on the progression of the disease and ways to help our patients manage cessation

For those that have active macular degeneration, we will recommend supplements based on the AREDs 2 clinical trial and if the patient meets the appropriate disease level to add a vitamin. The AREDs 2 formulation has a similar goal of our above food recommendations: increase antioxidants, zinc and lutein/zeaxanthin, along with vitamin C/E and copper.

Diabetes

Address nutrition with all of your diabetic patients, regardless of the absence or presence of retinopathy. These patients can benefit most from our above nutrition model of combining the Mediterranean diet along with a low-glycemic index diet to help regulate blood sugar without spikes and in turn maintain healthy retinal vasculature.

Talk to patients about:

• Substituting whole grains in place of simple carbohydrates (an easy change: swap in quinoa or brown rice)
• Incorporating smart fruit choices that are high in antioxidants can be beneficial (an easy change: focus on berries and citrus)
• Supplements that have been noted in the literature to be beneficial (vitamin B complex and curcumin to reduce swelling, vitamin D and various antioxidants⁴)
• The impact on the eye using their retinal images, for those with active disease processes such as diabetic retinopathy or macular degeneration

FACING RESISTANCE

Resistance is commonly found in the aging population, especially when what we are presenting is a new concept to them. Approach the conversation as an expert with empathy. We want to be partners in their journey of optimal visual outcomes.

Connect to the “why.” For example, explain how eating green leafy vegetables or orange peppers can have a positive effect on reducing the progression of macular degeneration. This helps patients better understand their role in slowing disease progression and preserving vision, as well as why and how their daily choices can impact their vision and, ultimately, their independence as an aging adult.

Present bite-size recommendations. Start with just one suggestion of a change to increase the follow-through on their end. Things like adding blueberries to their daily yogurt or chopping spinach into their ground beef is a great place to start making meaningful changes.

Staying informed on current nutritional guidelines. Build trust in your knowledge and recommendations. Leading by example. We both eat a diet that reflects our recommendations, along with incorporating movement and hydration into our days. We share this so that our recommendations feel more relatable and achievable by our patients.

Collaborate with their other health care professionals. These connections demonstrate the importance of the recommendations as we take a broader, cohesive approach to their health. These PCP relationships can help when patients are reluctant to take nutrition/vitamin advice from their eye care provider.

YOU CAN START TODAY

Make it a priority to start incorporating nutrition into the conversation. A healthy diet, tied in with prioritizing good sleep habits, exercise and water intake, are the key to a long life with reduced risk for disease.

References

Tosti V, Bertozzi B, Fontana L. Health Benefits of the Mediterranean Diet: Metabolic and Molecular Mechanisms. J Gerontol A Biol Sci Med Sci. 2018 Mar 2;73(3):318-326. doi: 10.1093/gerona/glx227. PMID: 29244059; PMCID: PMC7190876.
Kawano H, Motoyama T, Hirashima O, Hirai N, Miyao Y, Sakamoto T, Kugiyama K, Ogawa H, Yasue H. Hyperglycemia rapidly suppresses flow-mediated endothelium-dependent vasodilation of brachial artery. J Am Coll Cardiol. 1999 Jul;34(1):146-54. doi: 10.1016/s0735-1097(99)00168-0. PMID: 10400004.
Bai, Xudong et al. “The Gut-Eye Axis: Correlation Between the Gut Microbiota and Autoimmune Dry Eye in Individuals With Sjögren Syndrome.” Eye & contact lens vol. 49,1 (2023): 1-7. doi:10.1097/ICL.0000000000000953
Ruamviboonsuk V, Grzybowski A. The Roles of Vitamins in Diabetic Retinopathy: A Narrative Review. J Clin Med. 2022 Nov 1;11(21):6490. doi: 10.3390/jcm11216490. PMID: 36362717; PMCID: PMC9656452.

Read more on nutrition and aging here.

Read more from Dr. Zilnicki and Dr. Licausi here.

Miki Lyn Zilnicki, OD, FCOVD, and Jessica Licausi, OD, FAAO, FCOVD, are co-owners of Twin Forks Optometry and Vision Therapy in Riverhead, New York. To contact Dr. Zilnicki: DrZilnicki@twinforksoptometry.com To contact Dr. Licausi: DrLicausi@twinforksoptometry.com