Julie Poteet, OD, MS, CNS, FOWNS, has spent enough time in eyecare to know that some of the most important changes in medicine begin quietly — not with a dramatic breakthrough in the exam room, but with a shift in how clinicians think about disease, prevention and patient education.
That is how she sees the growing attention on B vitamins and ocular health.
For Dr. Poteet, the launch of PreserVision AREDS 3 represents more than a new product. It signals, she says, a broader recognition that supporting the retina may begin long before visible structural damage appears. “This gets us to think about is the level of cellular energetics, intervening at a time before structural damage occurs.”
That idea sits at the center of her enthusiasm. In her view, the conversation around macular degeneration has long focused on what can be done once the disease is already well established. But newer thinking, she says, emphasizes earlier intervention—and the role nutrition can play in that effort.
THE ROLE OF B
“Emerging data is pointing in the direction that mitochondrial dysfunction is a key driver in AMD,” Dr. Poteet says. “Elevated homocysteine is a key driver. Both of those processes are B vitamin dependent.”
She describes the B vitamins as working in concert. “B vitamins act like a symphony, not a solo,” she says.
That metaphor, she says, reflects how the nutrients function in the body: not as isolated pieces, but as part of a larger biochemical system that helps support mitochondrial health, retinal resiliency and healthy blood flow.
“The retina is a very energy-dependent tissue,” Dr. Poteet says. “It has high energy demands. When we support the systems that power it, we’re helping prevent disease.”
Dr. Poteet says the timing of this new attention matters just as much as the science itself. “Once we see drusen in the retina, that’s a disease process. It’s been going on for a while,” she says. “Drusen just doesn’t happen overnight.”
PERSONALIZING THE RECOMMENDATION
That is why she sees the current conversation as a chance to move upstream—especially for patients who already have risk factors. Those can include patients with a family history of AMD, who use metformin or proton pump inhibitors, follow vegetarian or vegan diets and even those who take GLP-1 medications that can compress overall nutrition because patients are eating less.
“If I’ve got a 45-year-old on metformin who also uses PPIs and they’ve got a family history of macular degeneration, I’m going to be talking to them about PreserVision AREDS 3,” Dr. Poteet says.
She says the same principles apply when she’s looking at lab work. Patients may be told they are “fine” based on a standard B12 result, but that does not always tell the full story. “There’s a difference between deficiency and insufficiency,” Dr. Poteet says. “Oftentimes, they don’t know.”
She points to a newer understanding of B12 testing and related markers such as homocysteine and methylmalonic acid, which can help clarify whether a patient may benefit from supplementation. “If it’s below 500, that’s a patient for whom B12 supplementation from the data could benefit,” she says.
For Dr. Poteet, that is where the conversation becomes more individualized — and more practical. “Nutrition is not a one-size-fits-all,” she says. “It’s going to require a little more work on the practitioner side.”
Still, she believes it is worth the effort. The goal, she says, is not to replace the established science behind AREDS 2, but to expand the discussion for the right patients. AREDS 3, she says, offers another layer of support for those in whom B vitamin deficiency is suspected.
What makes this development meaningful is that it gives clinicians a new way to discuss prevention without waiting for disease to become advanced. It also broadens the conversation beyond the eye itself.
BRAIN BENEFITS?
Dr. Poteet notes that elevated homocysteine is also a strong independent risk factor for cognitive decline. That means the same nutritional support that may benefit the retina could also have implications for the brain. “The brain and retina are an extension of each other,” she says.
That connection, she says, makes the message even more compelling. Protecting the retina is not just about preserving sight in the present; it is about supporting long-term health in a more comprehensive way. “It makes sense,” Dr. Poteet says. “If you can protect your eyesight and protect your brain health, why not?”
For Dr. Poteet, the recognition of B vitamins in ocular health is part of a larger shift toward earlier, smarter and more personalized care. And that, she says, is where the field needs to be headed. “The earlier we intervene, the more we can influence the disease trajectory,” she says. “That has been the goal for a long time.”
Read About the PreserVision AREDS3 Launch
In May, Bausch + Lomb Corporation announced the U.S. launch of PreserVision AREDS3 eye vitamins, which combine the clinically proven AREDS2 nutrients recommended by the NEI to help reduce the risk of moderate-to-advanced AMD progression with a unique B-vitamin complex.*
*This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
