PurposeTo elucidate the prevalence and risk factors of age-related macular degeneration (AMD) in people with diabetes.MethodsOf the 5495 subjects ≥60 years of age recruited in the population-based study in south India, 4791 subjects with gradable images on 30° three-field retinal photographs were analyzed. AMD and diabetic retinopathy (DR) were graded based on the International ARM Epidemiological Study Group classification and International Clinical Diabetic Retinopathy Disease Severity Scale, respectively. All subjects underwent a detailed history, physical examination, and a comprehensive ocular examination.ResultsOf the 4791 subjects, 1256 had diabetes. In those with diabetes, 166 (13.2%) had DR: of which, 9.6% had AMD. Of those with diabetes but no DR, 15.6% had AMD. Presence of DR (OR=0.57, 95% CI: 0.33-0.99, P=0.046) was a protective factor for AMD in diabetes. When adjusted for potential confounding factors, those with AMD and diabetes were from urban areas (OR=1.65, 95% CI: 1.09-2.49, P=0.018), had raised systolic blood pressure (OR=1.02, 95% CI: 1.00-1.03, P=0.01), higher BMI (OR=1.06, 95% CI: 1.02-1.10, P=0.005), and higher serum triglycerides (OR=1.00, 95% CI: 1.00-1.01, P=0.011). A higher level of high-density lipoprotein (HDL) (OR=0.98, 95% CI: 0.96-0.99, P=0.038) was a protective factor for AMD in subjects with diabetes.ConclusionsThe presence of DR and higher serum HDL are protective factors whereas obesity and higher systolic blood pressure are risk factors for AMD in subjects with diabetes.