Risk factors for exudative age-related macular degeneration in a large French case-control study

Graefes Arch Clin Exp Ophthalmol. 2014 Jun;252(6):899-907. doi: 10.1007/s00417-013-2537-7. Epub 2013 Dec 21.


Purpose: The purpose of the CAP (Creteil AMD PHRC-funded) Study was to analyze risk factors of exudative age-related macular degeneration (AMD) in a large French case-control population.

Patients and methods: One thousand and twenty-four patients with exudative AMD and 275 controls were recruited. Information about lifestyle, medical history, and dietary intake were collected. Associations of risk factors were estimated using logistic regression.

Results: After multivariate adjustment, CFH Y402H and ARMS2 A69S polymorphisms were associated with very high risk for exudative AMD (OR = 6.21 and OR = 11.7, respectively, p < 0.0001). Risk for exudative AMD was increased in current smokers (OR = 3.79, p = 0.0003) and former smokers having quitted since less than 20 years ago (OR = 2.30, p = 0.002), but not in former smokers having quitted since 20 years or more ago (OR = 0.81, p = 0.43). Heavy smokers (at least 25 pack-years) were particularly at risk (OR = 3.61, p < 0.0001). Use of cooking oils rich in omega 3 fatty acids was significantly associated with a reduced risk of exudative AMD (OR = 0.55, 95 % CI: 0.36-0.84, p = 0.006), as well as a high consumption of fruits (OR = 0.60, 95 % CI: 0.37-0.98, p = 0.04), but not the consumption of fish, vegetables or oils rich in omega 6. High waist circumference was associated with increased risk for exudative AMD (OR = 2.53, p < 0.0001), but not hypercholesterolemia, hypertension, or body mass index.

Conclusions: The CAP Study confirms major genetic risk factors for exudative AMD. It further documents the high risk in heavy smokers and the long persistence of risk after smoking cessation, and the associations with waist circumference and fruit consumption. Furthermore, we observed an inverse correlation between AMD and cooking oils harboring a beneficial omega-3 fatty acid profile.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Case-Control Studies
  • Coloring Agents
  • Complement Factor H / genetics
  • Fatty Acids, Omega-3 / administration & dosage
  • Female
  • Fluorescein Angiography
  • France / epidemiology
  • Fruit
  • Genotyping Techniques
  • Humans
  • Indocyanine Green
  • Male
  • Polymerase Chain Reaction
  • Polymorphism, Single Nucleotide
  • Proteins / genetics
  • Risk Factors
  • Smoking / adverse effects
  • Tomography, Optical Coherence
  • Wet Macular Degeneration / epidemiology*
  • Wet Macular Degeneration / genetics
  • Wet Macular Degeneration / prevention & control


  • ARMS2 protein, human
  • CFH protein, human
  • Coloring Agents
  • Fatty Acids, Omega-3
  • Proteins
  • Complement Factor H
  • Indocyanine Green