SMOKING AND AGE-RELATED MACULOPATHY - THE BLUE-MOUNTAINS EYE STUDY

Objective: To assess the associations between stage of age-related mac ulopathy (ARM) and current, past, and passive smoking. Methods: A cros s-sectional study of 3654 subjects from a defined geographic area west of Sydney, Australia, identified subjects with late age-related macul ar degeneration (AMD) and early ARM by ocular examination and detailed grading of retinal photographs. Interviewer-administered questionnair es provided data about smoking history for subjects and spouses. Logis tic regression, adjusting for age and sex, and 2-way analysis of varia nce were used to assess associations. Results: Current tobacco smoking was significantly associated with late AMD (odds ratio [OR], 3.92), i ncluding neovascular AMD (OR, 3.20) and geographic atrophy (OR, 4.54), and early ARM (OR, 1.75). Having ever smoked was significantly associ ated with late AMD (OR, 1.83) but nor early ARM. Passive smoking was a ssociated with increased but insignificant odds for late AMD. The risk was slightly higher among women compared with men for most exposure c ategories. Conclusions: These findings provide convincing evidence tha t smoking may be causally associated with ARM. The strongest risk was found for current smokers, suggesting potential benefits of targeting education to older people who are current smokers and have signs of ea rly ARM.