Letters to the Editor

Smoking and Age-Related Macular Degeneration


Am Fam Physician. 2001 Jan 15;63(2):225.

to the editor: The recent article entitled “Age-related Macular Degeneration: Update for Primary Care”1 is a good overview of the subject, but it underemphasizes the role that smoking plays as a risk factor for age-related macular degeneration (AMD). Of the potential risk factors for AMD, only smoking has been demonstrated to be associated with the disease consistently across studies of different design and within different populations.2 Another recent study3 on cardiovascular risk factors and AMD reported that the only factors significantly associated with age-related maculopathy included smoking (odds ratio: 4.1) and family history (odds ratio: 4.2). Many other studies confirm the strong association between smoking and AMD.

Smoking cessation is, therefore, potentially of great benefit in preventing AMD. Because the risk of AMD conferred by smoking remains strong even up to 20 years after smoking cessation,4 physicians should discuss the potential for smoking-related AMD as a risk factor early on in our attempts to help patients stop smoking.


show all references

1. Fong DS. Age-related macular degeneration: update for primary care. Am Fam Physician. 2000;61:3035–42....

2. Hawkins BS, Bird A, Klein R, West SK. Epidemiology of age-related macular degeneration. Mol Vis. 1999;5:26.

3. Smith W, Mitchell P, Leeder SR, Wang JJ. Plasma fibrinogen levels, other cardiovascular risk factors, and age-related maculopathy: the Blue Mountains Eye Study. Arch Ophthalmol. 1998;116:583–7.

4. Delcourt C, Diaz JL, Ponton-Sanchez A, Papoz L. Smoking and age-related macular degeneration. The POLA Study. Pathologies Oculaires Liees a l'Age. Arch Ophthalmol. 1998;116:1031–5.

in reply: I agree with Dr. Houston that smokers should be counseled about the dangers of smoking. As discussed in Table 1 of my article,1 smoking is an established risk factor for age-related macular degeneration (AMD). Prevention of AMD is one additional reason why patients who smoke should stop.


1. Fong DS. Age-related macular degeneration: update for primary care. Am Fam Physician. 2000;61:3035–42.

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This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.



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