When we talk about looking after our eyes, most of us think about eye exams, sunglasses, eye drops or perhaps supplements. But increasingly, what we put on our plate is becoming part of the eye-health conversation too.
One eating pattern keeps appearing in the research: the Mediterranean Diet.
It has long been associated with broader health benefits, but research is now building around its potential role in dry eye disease, age-related macular degeneration (AMD, sometimes called ARMD), diabetic eye disease and healthy ageing of the eyes.
So, should we all be eating like we live somewhere overlooking the Mediterranean?
Possibly, although you don't need to move to Greece or start making every meal from scratch. It is the pattern of eating that seems to matter.
What is the Mediterranean diet?
Despite its name, the Mediterranean diet isn't really a strict "diet". It is a style of eating traditionally associated with countries around the Mediterranean and is largely based around vegetables, fruit, legumes, whole grains, nuts, seeds, olive oil and fish, with smaller amounts of dairy and meat and relatively little processed food, refined sugar and processed meat.
That combination naturally provides many nutrients relevant to eye health, including omega-3 fatty acids, lutein, zeaxanthin, vitamins A, C and E, polyphenols and other antioxidant and anti-inflammatory compounds.
And rather than focusing on one "superfood", the Mediterranean approach is interesting because these nutrients are consumed together as part of an overall dietary pattern.
What does nutrition have to do with dry eye?
Quite a lot, although the science is still evolving.
The Tear Film & Ocular Surface Society (TFOS) devoted an entire report in its Lifestyle Workshop to the impact of nutrition on the ocular surface.
TFOS highlighted the complex relationship between diet, systemic inflammation, metabolic health, the gut microbiome and the health of the cornea, conjunctiva, eyelids, tear film and associated glands. It also identified associations between ocular surface health and nutrients including vitamins A, B12 and D, hydration and the balance between omega-3 and omega-6 fatty acids.
Importantly, the TFOS report classified the Mediterranean diet as having a probable positive association with ocular surface health, while also acknowledging that the clinical evidence is not yet completely consistent.
One small intervention involving people with ocular surface discomfort compared two Mediterranean-style dietary programmes. After six months, dry eye symptoms, tear break-up time, tear production and ocular surface staining improved in both groups, with greater improvements in several clinical measures in the group receiving the more intensive diet, exercise and weight-management programme.
More recently, a 2025 study involving people with Sjögren's syndrome found that better adherence to a Mediterranean diet correlated with less severe ocular dryness, particularly with dietary components containing polyunsaturated fatty acids. It was an observational study, so it can't prove that the diet itself caused the improvement, but it adds another interesting piece to the puzzle.
The strongest eye-health evidence? Macular degeneration
This is where things get particularly interesting.
In 2026, researchers led by the US National Eye Institute published a perspective in the American Journal of Ophthalmology asking a wonderfully practical question:
What should patients with age-related macular degeneration eat?
Their conclusion was that people with AMD should adopt a Mediterranean-style diet, or a similar predominantly plant-based eating pattern, because closer adherence was consistently associated with slower AMD progression across multiple stages of the disease.
The researchers drew heavily on data from the landmark AREDS and AREDS2 studies, as well as large European and North American studies.
Among the findings, people with early AMD who adhered most closely to a Mediterranean diet were around 21% less likely to progress to large drusen, an important feature of intermediate AMD.
For people with intermediate AMD, those with the highest Mediterranean diet adherence had around a 23% lower risk of progressing to late AMD. The association was particularly strong for geographic atrophy, with approximately a 29% lower risk, compared with a 16% reduction for neovascular or "wet" AMD.
In people who already had geographic atrophy, greater Mediterranean diet adherence was associated with approximately 15% slower enlargement of the atrophic area, and around 30% slower progression towards the central fovea in those whose geographic atrophy initially sat outside the centre of their vision.
Those are meaningful associations for a condition where protecting central vision for as long as possible matters enormously.
Is there one food that's particularly good for the macula?
Probably not one — but several foods stood out.
In people with intermediate AMD, fish appeared to be particularly influential. Participants with the highest fish intake had around a 31% lower risk of progressing to late AMD than those eating the least fish.
Higher vegetable consumption was associated with a 23% lower risk, while higher red meat intake was associated with a 20% greater risk of progression.
For people with geographic atrophy, fruit and vegetable intake and lower red meat consumption appeared especially important.
This fits nicely with what we already know about the retina. Colourful vegetables and fruit provide carotenoids and antioxidants; leafy greens are important dietary sources of lutein and zeaxanthin; fish provides long-chain omega-3 fatty acids; nuts and seeds contribute healthy fats and vitamin E; and extra-virgin olive oil provides monounsaturated fats and polyphenols.
It is less about finding one heroic food and more about creating a consistently nutrient-rich environment for the eye.
What about AREDS2 supplements?
A healthy diet does not replace AREDS2 supplementation when AREDS2 is clinically indicated.
The recent AMD review suggests the two may actually be complementary. AREDS2 supplementation has evidence for reducing progression in people with appropriate stages of AMD, while Mediterranean diet adherence appears to offer additional benefit — particularly in relation to geographic atrophy.
Not everyone with drusen or early AMD needs an AREDS2 supplement, however, so this is something worth discussing after your macula has been properly assessed.
Beyond AMD and dry eye
The research doesn't stop there.
A large longitudinal UK Biobank study involving more than 113,000 people recently examined a broader "Mediterranean lifestyle", incorporating diet alongside physical activity, rest and social habits.
Over a median follow-up of 10.5 years, greater adherence was associated with a lower incidence of both cataract and AMD. People in the highest Mediterranean lifestyle group had approximately a 9% lower risk of developing cataract and a 15% lower risk of developing AMD than those with the lowest adherence. Interestingly, the overall Mediterranean lifestyle score wasn't significantly associated with glaucoma, although the physical activity, sleep and social components were associated with lower glaucoma risk.
So for glaucoma, the evidence for the diet itself remains much less certain — an important distinction.
There is also interesting research in diabetic retinopathy. In a PREDIMED analysis involving people with type 2 diabetes, a Mediterranean diet supplemented with extra-virgin olive oil was associated with a 44% lower risk of developing diabetic retinopathy compared with the control diet.
Again, diet doesn't replace good blood glucose, blood pressure and medical management. But it reinforces an important theme: healthy eyes don't exist independently of the rest of the body.
So, what might Mediterranean-style eating look like in New Zealand?
You don't need a completely new pantry or complicated recipes. Think small changes to the overall pattern, rather than dietary perfection:
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Make vegetables a major part of lunch and dinner, including plenty of leafy greens and different colours.
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Eat whole fruit regularly — berries, citrus, kiwifruit, apples and whatever is in season all count.
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Include fish regularly, particularly oily fish such as salmon, sardines or mackerel.
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Use extra-virgin olive oil as one of your main cooking and dressing oils.
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Eat nuts, seeds, beans, chickpeas and lentils more often.
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Choose whole grains over highly refined carbohydrates where possible.
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Reduce the frequency of processed meat, large amounts of red meat, highly processed foods and added sugars.
And no, you don't need to add a glass of red wine. Although alcohol appears in some traditional definitions of the Mediterranean diet, the AMD research particularly supports avoiding heavy alcohol consumption.
Does a Mediterranean diet cure dry eye?
No.
Dry eye disease has many potential drivers — including meibomian gland dysfunction, tear deficiency, inflammation, medications, hormonal changes, autoimmune disease, screen use, environment and eyelid disease.
Diet is one piece of a much larger puzzle.
But the TFOS Lifestyle research is an important reminder that managing dry eye isn't always just about choosing another bottle of eye drops. Nutrition, hydration, sleep, screen habits, environment and broader health can all be relevant when we are trying to understand why your eyes are dry in the first place.
Can a Mediterranean diet prevent macular degeneration?
We can't promise that.
Age, genetics, smoking and other factors all contribute to AMD, and most of the Mediterranean-diet evidence is observational rather than coming from randomised dietary trials.
What we can say is that the evidence connecting Mediterranean-style eating with a lower risk of AMD development and slower progression is becoming increasingly consistent. A 2025 systematic review and meta-analysis reached a similar conclusion, while the 2026 American Journal of Ophthalmology perspective now argues that nutrition deserves a place in discussions with patients at every stage of AMD.
Perhaps the nicest message from the latest research is that you don't have to eat perfectly for it to count. The AMD data show dose-response relationships, meaning moderate improvements in dietary quality may still matter.
Our take at Illume
So, should we all be eating a little more like we're in the Mediterranean?
For most of us, there is a pretty good case for it.
Not because olive oil or salmon is a magic treatment for eye disease, but because a predominantly plant-rich diet containing vegetables, fruit, fish, whole grains, legumes, nuts, seeds and healthy fats delivers many of the nutrients our eyes — and the rest of our body — need.
At Illume, we increasingly see nutrition and lifestyle as part of good eye care, particularly when we're managing dry eye and ocular surface disease, macular degeneration and conditions linked with our broader health.
Eye drops, treatments, imaging and supplements all have their place. But sometimes looking after your eyes starts somewhere much simpler:
with what's on your plate.