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.

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.