**3. Risk factors of AMD**

The major risk factor for AMD is older age. More than 10% of people older than 80 years have late AMD. Female sex has been inconsistently reported as a risk factor as well [3].

The major systemic risk factors include cigarette smoking [8]. Cigarette smoking in particu‐ lar is a strong and consistent risk factor for AMD. Smoking 20 cigarettes a day increases the risk of double. Obesity is further systemic risk factor. This is connected with systemic riscs of obesity. These patients are more likely to have hypertension and diabetes mellitus, which are another risk factors [9,10]. People with AMD are also at increased risk of stroke [11].

Ocular risk factors for age-related macular degeneration include darker iris pigmentation, previous cataract surgery, and hyperopic refraction. A meta-analysis suggested previous cataract surgery was a strong risk factor for age-related macular degeneration, but this asso‐ ciation was not shown in a randomized clinical trial [12].

Table 1 summarizes the risk factors for age-related macular degeneration.

### **4. Genetic factors**

Last ten years several genes have been associated to have role in pathogenesis of AMD [2].

AMD is disease that is tightly connected with inflammatory reaction. Inflammatory and im‐ munologic processes play major role in its pathogenesis. For this reason was identified com‐ plement factor H gene (CFH). Other confirmed genes in the complement pathway include C2, CFB, C3 and CFI.29-31. On the basis of large genome-wide association studies, HDL cho‐ lesterol pathway genes have been implicated, including LIPC and CETP, and possibly AB‐ CA1 and LPL.32-34 APOE in the LDL pathway might also be related to AMD [13]. The collagen matrix pathway genes COL10A1 and COL8A1 and the extracellular matrix path‐ way gene TIMP3 have also been linked to age-related macular degeneration [14]. Finally, genes in the angiogenesis pathway (VEGFA) have also been associated with age-related macular degeneration in a meta-analysis of two AMD genome-wide association studies [14].


**Table 1.** Risk factors for age-related macular degeneration (adapted from [2])

age-related macular degeneration was estimated to be 6.8% and late age-related macular de‐

Results from the Baltimore Eye Study reported epidemiological data from other ethnic groups. Late AMD was nine to ten times more prevalent in white participants than in black ones [4]. Age-specific prevalence of late age-related macular degeneration in Asians is large‐

In Asia population have often disease specific features. Many of them have polypoidal dila‐ tation of the choroidal vasculature. Polypoidal choroidal vasculopathy can account for 50%

Another variant of AMD is retinal angiomatous proliferation (RAP), which accounts for 12-15% of neovascular age-related macular degeneration [6]. RAP usually not responds to

There are few incidence studies on AMD. The US Beaver Dam Eye Study in the USA report‐ ed a 14.3% 15-year cumulative incidence for early AMD and 3.1% for late AMD in adults

The major risk factor for AMD is older age. More than 10% of people older than 80 years have late AMD. Female sex has been inconsistently reported as a risk factor as well [3].

The major systemic risk factors include cigarette smoking [8]. Cigarette smoking in particu‐ lar is a strong and consistent risk factor for AMD. Smoking 20 cigarettes a day increases the risk of double. Obesity is further systemic risk factor. This is connected with systemic riscs of obesity. These patients are more likely to have hypertension and diabetes mellitus, which are another risk factors [9,10]. People with AMD are also at increased risk of stroke [11].

Ocular risk factors for age-related macular degeneration include darker iris pigmentation, previous cataract surgery, and hyperopic refraction. A meta-analysis suggested previous cataract surgery was a strong risk factor for age-related macular degeneration, but this asso‐

Last ten years several genes have been associated to have role in pathogenesis of AMD [2]. AMD is disease that is tightly connected with inflammatory reaction. Inflammatory and im‐ munologic processes play major role in its pathogenesis. For this reason was identified com‐ plement factor H gene (CFH). Other confirmed genes in the complement pathway include

of wet AMD cases in Asians, but only 8-13% in white people [5].

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

ciation was not shown in a randomized clinical trial [12].

Table 1 summarizes the risk factors for age-related macular degeneration.

generation 1.5%[3].

aged 43-86 years [7].

**4. Genetic factors**

**3. Risk factors of AMD**

ly similar to that in white people [5].

standard management of wet AMD.

Genes modifying several biological pathways are in AMD. Complement and immune proc‐ esses, HDL cholesterol, and mechanisms involving collagen, extra-cellular matrix, and an‐ giogenesis pathways are associated with the onset, progression, and bilateral involvement of AMD [2]. But it should be noted that genetic susceptibility can be modified by environmen‐ tal factors. Genetic variations can also influence differential responses to treatments for agerelated macular degeneration, an emerging research area [2].

Table 2 summarizes major genes associated with onset and progression of AMD
