**Author details**

Jane Khan1,2,3,4

treatment [208]. A number of clinical studies have investigated the role of alcohol consumption and risk of AMD and among these there are studies demonstrating no association [209-211], weak positive associations for some forms of ARM/ AMD [212-217], or even an inverse association [146;218]. In a recent systematic review of the literature pooled results showed that heavy alcohol consumption was associated with an increased risk of early AMD (pooled odds ratio, 1.47; 95% confidence interval, 1.10 to 1.95), whereas the association between heavy alcohol consumption and risk of late AMD was inconclusive. There were insufficient data to evaluate a dose-response association between alcohol consumption and AMD or the associa‐ tion between moderate alcohol consumption and AMD. The authors conclude that although this association seems to be independent of smoking, residual confounding effects from

20 Age-Related Macular Degeneration - Etiology, Diagnosis and Management - A Glance at the Future

AMD creates a huge burden on society, being the third largest cause of blindness world-wide. The impact is far reaching in terms of quality of life to the individual as well as financial and social burdens on society as a whole. AMD appears to have greater representation in white, Caucasian populations but it is becoming apparent that the prevalence in other ethnic populations is substantial. There are differences in the sub-type presentation of disease in

It appears that AMD is caused by environmental factors triggering disease in genetically susceptible individuals. Identifying modifiable risk factors is a vital part of defining the pathogenesis of AMD and enabling appropriate targeting of treatment strategies. Whilst age is the strongest risk factor for AMD, a number of environmental risk factors have been

The data demonstrate a clear association between the risk of AMD and pack-years of cigarette smoking with odds ratios in some studies demonstrating a dose-related effect. Both types of AMD show a similar relationship in most studies. Stopping smoking is associated with reduced odds of AMD. This provides strong support for a causal relationship between smoking and age-related macular degeneration. Axial length and refractive error also appear to play a role with most studies indicating increased prevalence associated with hyperopia. Other possible risk factors include blue iris colour, poor skin tanning or abnormal skin sensitivity to sunlight but generally the studies show null or only weak association. Hyper‐ tension and other cardiovascular risk factors do seem to play a role but the associations appear weaker than for smoking and genetic factors. Dietary factors associations are notoriously difficult to establish but in general there appears to be reduced risk in those with diets higher in antioxidants and fish but there is only weak evidence for an association with increased dietary fat intake. Dietary antioxidant supplements such as carotenoids and zinc may be protective for progression in the later stages of AMD and other dietary supplements are

proposed and the adverse effect of smoking is well-established.

smoking cannot be excluded completely [219].

**4. Summary**

different populations.

currently being investigated.

1 Centre for Ophthalmology and Visual Science, University of Western Australia, Australia

2 Royal Perth Hospital, Western Australia, Australia

3 Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

4 Western Eye, Perth, Western Australia, Australia
