Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis

Abstract

BackgroundAge-related macular degeneration (AMD) is the leading cause of blindness in Western countries. Numerous risk factors have been reported but the evidence and strength of association is variable. We aimed to identify those risk factors with strong levels of evidence which could be easily assessed by physicians or ophthalmologists to implement preventive interventions or address current behaviours.MethodsA systematic review identified 18 prospective and cross-sectional studies and 6 case control studies involving 113,780 persons with 17,236 cases of late AMD that included an estimate of the association between late AMD and at least one of 16 pre-selected risk factors. Fixed-effects meta-analyses were conducted for each factor to combine odds ratio (OR) and/or relative risk (RR) outcomes across studies by study design. Overall raw point estimates of each risk factor and associated 95% confidence intervals (CI) were calculated.ResultsIncreasing age, current cigarette smoking, previous cataract surgery, and a family history of AMD showed strong and consistent associations with late AMD. Risk factors with moderate and consistent associations were higher body mass index, history of cardiovascular disease, hypertension, and higher plasma fibrinogen. Risk factors with weaker and inconsistent associations were gender, ethnicity, diabetes, iris colour, history of cerebrovascular disease, and serum total and HDL cholesterol and triglyceride levels.ConclusionsSmoking, previous cataract surgery and a family history of AMD are consistent risk factors for AMD. Cardiovascular risk factors are also associated with AMD. Knowledge of these risk factors that may be easily assessed by physicians and general ophthalmologists may assist in identification and appropriate referral of persons at risk of AMD.

Defining response to anti-VEGF therapies in neovascular AMD

“…37,38 There is, however, emerging evidence that responses to anti-VEGF therapy in n-AMD may be influenced by the genetic profile of the individual. 13,15,18 It is possible that other factors such as lifestyle may also affect the responsiveness to treatment and patients should be encouraged to quit smoking even if there is no evidence of reduced effectiveness of anti-VEGF agents in smokers 39,40 given the link between smoking and AMD and the risk to the fellow eye.…”

Effect of aging and lifestyle on photoreceptors and retinal pigment epithelium: cross-sectional study in a healthy Danish population

“…Aging processes play a significant role on macular health and warrant further investigations. Our findings contribute to the understanding of how lifestyle factors such as smoking and physical activity contribute to promotion of age-related retinal diseases such as age-related macular degeneration [2,3]. …”

“…Aging and dysfunction of this system is closely linked to diseases such as age-related macular degeneration, which is the leading cause of irreversible vision loss in the developed world [1,2]. Risk factors include lifestyle factors such as physical inactivity and smoking [2,3]. …”

Smoking and choroidal thickness in patients over 65 with early-atrophic age-related macular degeneration and normals

“…3,4 Cigarette smoking is a highly prevalent modifiable risk factor for many pulmonary, cardiovascular, and additional systemic diseases. Smoking may be related to the development of AMD, [5][6][7] and has consistently been shown to lead to increased risk of all late forms of AMD. 1,[8][9][10][11][12][13] Smoking has also been demonstrated to increase the risk of choroidal neovascularization owing to polypoidal choroidal vasculopathy, 14 or ocular histoplasmosis.…”