A PROSPECTIVE-STUDY OF CIGARETTE-SMOKING AND RISK OF AGE-RELATED MACULAR DEGENERATION IN MEN

Objective.-To examine the association between cigarette smoking and th e incidence of age-related macular degeneration (AMD) in men. Design.- Prospective cohort study with average person-years of follow-up for AM D of 12.2 years. Participants.-A total of 21 157 US male physicians pa rticipating in the Physicians' Health Study who did not have a diagnos is of AMD at baseline, were followed for at least 7 years, and had kno wn levels of baseline smoking. Based on information reported at baseli ne, 11% were current smokers, 39% were past smokers, and 50% were neve r smokers. Main Outcome Measure.-Incident AMD, defined as a self-repor t that was confirmed by medical record review, first diagnosed after r andomization, and responsible for vision loss to 20/30 or worse. Resul ts.-A total of 268 incident cases of AMD with vision loss were confirm ed. In multivariate analysis, current smokers of 20 or more cigarettes per day, compared with never smokers, had an increased risk of AMD (r elative risk [RR], 2.46; 95% confidence interval [CI], 1.60-3.79). Pas t smokers had a modest elevation in risk of AMD (RR, 1.30; 95% CI, 0.9 9-1.70). For current smokers of fewer than 20 cigarettes per day, ther e was a nonsignificant 26% increased risk of AMD (RR, 1.26; 95% CI, 0. 61-2.59). Conclusions.-These prospective data provide support for the hypothesis that cigarette smoking increases the risk of developing AMD .