Age-related macular degeneration and smoking. The Rotterdam Study

Arch Ophthalmol. 1996 Oct;114(10):1193-6. doi: 10.1001/archopht.1996.01100140393005.


Objective: To assess the relation between cigarette smoking and age-related macular degeneration (AMD) in a population of elderly persons.

Design: A cross-sectional, community-based study.

Setting: City district of Rotterdam, the Netherlands.

Participants: A total of 6174 persons 55 years and older who participated in the Rotterdam Study. In 36 persons atrophic AMD and in 65 persons neovascular AMD were diagnosed.

Main outcome measures: Age-related macular degeneration was diagnosed by evaluating fundus transparencies, smoking behavior was identified by interviewing subjects, and the presence of atherosclerosis was assessed by the ankle-arm systolic blood pressure index. Relative risks and 95% confidence intervals (CIs) were calculated using multivariate logistic regression analysis.

Results: In subjects younger than 85 years, current smokers had a 6.6-fold increased risk of neovascular AMD vs those who had never smoked (95% CI, 2.8-15.9). Former smokers had a 3.2-fold increased risk of neovascular AMD vs nonsmokers in this age group (95% CI, 1.4-7.4). These associations were not observed in subjects 85 years or older. Smoking was not associated with atrophic AMD. A strong increased risk of neovascular AMD was present in those who had smoked more than 10 pack-years (relative risk, 6.5; 95% CI, 2.9-14.8). Adjusting the results for atherosclerosis did not change the association. Persons who had quit smoking 20 or more years before the eye examination had no increased risk.

Conclusions: The results provide evidence for a dose-response relationship between smoking and AMD, particularly in persons with the neovascular form of the disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Choroid / blood supply
  • Cross-Sectional Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Macular Degeneration / epidemiology*
  • Macular Degeneration / etiology*
  • Male
  • Middle Aged
  • Neovascularization, Pathologic / epidemiology
  • Neovascularization, Pathologic / etiology
  • Netherlands / epidemiology
  • Prevalence
  • Retinal Hemorrhage / epidemiology
  • Retinal Hemorrhage / etiology
  • Risk Factors
  • Smoking / adverse effects*