Review
Eye (2005) 19, 935–944. doi:10.1038/sj.eye.6701978
Smoking and age-related macular degeneration: a review of association
J Thornton1, R Edwards1, P Mitchell2, R A Harrison3, I Buchan1 and S P Kelly4
- 1Evidence for Population Health Unit, Division of Epidemiology and Health Sciences, University of Manchester, Manchester, UK
- 2University of Sydney Department of Ophthalmology, Centre for Vision Research, Westmead Hospital, Westmead, Australia
- 3Bolton Primary Care Trust, St Peter's House, Bolton, UK
- 4Bolton Eye Unit. Bolton Hospitals NHS Trust, Bolton, UK
Correspondence: SP Kelly, Bolton Hospitals NHS Trust, Minerva Road, Bolton BL4 0JR, UK. Tel: +44 1204 390694; Fax: +44 1204 390554. E-mail: Simon.Kelly@boltonh-tr.nwest.nhs.uk
Received 18 December 2004; Revised 9 April 2005; Accepted 12 April 2005.
Abstract
Purpose
Age-related macular degeneration (AMD) is the leading cause of severe and irreversible vision loss in the Western world. As there is no effective treatment for all types of AMD, identifying modifiable risk factors is of great importance. This review evaluates the epidemiological evidence associating smoking with AMD.
Methods
Systematic review of published epidemiological studies evaluated against established criteria for evidence of a causal relationship.
Results
In total, 17 studies (cross-sectional studies, prospective cohort studies, and case–control studies) were included in the review. A total of 13 studies found a statistically significant association between smoking and AMD with increased risk of AMD of two- to three-fold in current-smokers compared with never-smokers. Five studies found no association between smoking and AMD. There was also evidence of dose-response, a temporal relationship and reversibility of effect.
Conclusion
The literature review confirmed a strong association between current smoking and AMD, which fulfilled established causality criteria. Cigarette smoking is likely to have toxic effects on the retina. In spite of the strength of this evidence, there appears to be a lack of awareness about the risks of developing eye disease from smoking among both healthcare professionals and the general public.
Keywords:
age-related macular degeneration, age-related maculopathy, tobacco smoking, blindness, visual impairment, smoking cessation
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