AMD: What are the risk factors and how do we prevent the disease?

Age-related macular degeneration (AMD) impairs and impacts greatly on the quality of life of sufferers as there are only limited therapeutic options available¹

AMD (atrophic and exudative) has a multifactorial pathogenesis. Naturally, age is the main non-modifiable factor; the disease appears from the age of 50 while its prevalence increases from the age of 75. There is also a genetic predisposition involved².

Given the increased incidence of this pathology, it is vital to identify the risk factors that can be modified to prevent the development or alter the natural course of AMD¹.

Smoking

Tobacco is considered a major risk factor for respiratory and cardiovascular diseases and numerous studies also show its relationship with the evolution of AMD. Part of the population may not be aware of the strong link between smoking and vision diseases. For this reason, campaigns in the media aimed at changing attitudes towards tobacco and investment in anti-smoking initiatives are essential³.

Obesity and Food

Excess body weight represents a threat with regard to systemic diseases. The relationship between obesity and AMD is also evident in various studies that use the body mass index¹.

One of the preventive measures that has acquired greater importance in recent years is eating properly as this can play a protective role against AMD.

The high consumption of antioxidant vitamins, carotenoids such as lutein and zeaxanthin, as well as a diet rich in omega-3, beta carotene, vitamin C and E and zinc is associated with a reduction in disease risk^4,5.

In addition, engaging in physical activity at least three times a week reduces the risk of progression by about 25%^6,7.

Hypertension

Hypertension is a recognised risk factor in atherosclerosis. There is a small but statistically significant relationship between high blood pressure and AMD. Even though little research has been conducted so far, several studies indicate that some normotensive values can help to prevent the disease^1,6

References

1. Singh N, Srinivasan S, Muralidharan V, Roy R, Jayprakash V, Raman R. Prevention of age-related macular degeneration. Asia-Pacific J Ophthalmol. 2017;6(6):520–6.
2. Fritsche LG, Igl W, Bailey JNC, Grassmann F, Sengupta S, Bragg-Gresham JL, et al. A large genome-wide association study of age-related macular degeneration highlights contributions of rare and common variants. Nat Genet [Internet]. 2016 Feb 1 [cited 2020 Feb 25];48(2):134–43. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26691988
3. Thornton J, Edwards R, Mitchell P, Harrison RA, Buchan I, Kelly SP. Smoking and age-related macular degeneration: A review of association. Eye. 2005;19(9):935–44.
4. Chew EY, Clemons TE, SanGiovanni JP, Danis R, Ferris FL, Elman M, et al. Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration: The Age-Related Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA - J Am Med Assoc [Internet]. 2013 May 15 [cited 2020 Feb 25];309(19):2005–15. Available from: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2013.4997
5. Kassoff A, Kassoff J, Buehler J, Eglow M, Kaufman F, Mehu M, et al. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 8. Arch Ophthalmol. 2001;119(10):1417–36.
6. Rusiñol Rodríguez E. Epidemiología y cuantificación de los factores de riesgo cardiovascular en la DMAE exudativa. 2014;229.
7. Fernández-Araque A, Aranda AG, Pardos CL, Rojo Aragüés AA. Los antioxidantes en el proceso de patologías oculares. Nutr Hosp. 2017;34(2):469–78.

Author: Cristina Romero, optometrist at the Institut de la Màcula.