Risk Factors for Age-Related Macular Degeneration
Non-Modifiable Risk Factors
Advanced age is the single most important risk factor for AMD, with prevalence increasing from 1% in those aged 65-69 years to 17% in those older than 80 years. 1
Age: AMD prevalence is 6.5% in adults 40 years or older, increasing to 2.8% in those aged 40-59 years and 13.4% in those 60 years or older 2
Genetic factors and family history: A positive family history strongly correlates with AMD risk, with genetics playing a more significant role than previously recognized, particularly in younger patients 2, 1, 3
Race/ethnicity: While not explicitly detailed in the highest-quality guidelines, genetic predisposition varies across populations 4
Modifiable Risk Factors
Smoking - The Most Critical Modifiable Risk Factor
Cigarette smoking is the only proven modifiable risk factor for AMD and must be addressed aggressively in all patients. 1, 5
Current smokers face a 2-3 times higher risk of AMD compared to non-smokers, with risk increasing proportionally to pack-years smoked 1, 3
Smoking cessation is mandatory and non-negotiable, as it represents the key modifiable risk factor that clinicians can address 1
Cardiovascular and Metabolic Factors
Obesity: Elevated body mass index is associated with increased AMD risk 1, 6
Cardiovascular disease: Presence of cardiovascular disease correlates with higher AMD risk 2, 1
Elevated cholesterol levels: Hyperlipidemia is thought to contribute to AMD development 2
Hypertension: High blood pressure has been identified as a contributing risk factor 6
Dietary Factors
Diet low in green leafy vegetables: Inadequate intake of lutein and zeaxanthin from dark green or yellow vegetables increases AMD risk 2, 5
Poor overall diet quality: Suboptimal nutritional intake, particularly of antioxidants, is associated with increased risk 1, 6
Dietary fat intake: While controversial and requiring further study, some evidence suggests certain dietary fat patterns may influence AMD risk, though specific recommendations remain unclear 5
Socioeconomic Factors
Lower socioeconomic or educational status is associated with higher prevalence of impaired visual acuity from AMD 2
Lack of private health insurance correlates with increased AMD prevalence 2
Other Potential Risk Factors Requiring Further Study
UV light exposure: Exposure to ultraviolet light has been suggested as a potential risk factor, though evidence remains inconsistent 3, 7
Alcohol consumption: Moderate alcohol consumption is unlikely to increase AMD risk, but this requires further investigation 3, 7
Clinical Implications for Risk Stratification
High-risk features that warrant AREDS2 supplementation include bilateral soft drusen, confluent drusen, RPE clumping or atrophy, and family history. 1