Cigarette Smoking and Age-Related Macular Degeneration in the EUREYE Study

Received 21 February 2006; accepted 20 September 2006. published online 05 March 2007.

Objective

To examine the association between cigarette smoking and age-related maculopathy (ARM) including age-related macular degeneration (AMD) in the European population.

Design

Cross-sectional study.

Participants

Four thousand seven hundred fifty randomly sampled ≥65-year-olds from 7 study centers across Europe (Norway, Estonia, United Kingdom, France, Italy, Greece, and Spain).

Methods

Participants underwent an eye examination and digital retinal photography. The images were graded at a single center. Smoking history was ascertained by a structured questionnaire administered by trained fieldworkers. Multinomial and binary logistic regressions were used to examine the association between smoking history and ARM grade and type of AMD, taking account of potential confounders and the multicenter study design.

Main Outcome Measures

Photographic images were graded according to the International Classification System for ARM and stratified using the Rotterdam staging system into 5 exclusive stages (ARM 0–3 and ARM 4, also known as AMD). Age-related macular degeneration also was classified as neovascular AMD or geographic atrophy (GA).

Results

One hundred fifty-eight cases were categorized as AMD (109 neovascular AMD and 49 GA); 2260 had no signs of ARM (ARM 0). Current smokers had increased odds of neovascular AMD (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.4–4.8) or GA (OR, 4.8; 95% CI, 2.1–11.1), whereas for ex-smokers the odds were around 1.7. Compared with people with unilateral AMD, those with bilateral AMD were more likely to have a history of heavy smoking in the previous 25 years (OR, 5.1; 95% CI, 1.3–20.0). The attributable fraction for AMD due to smoking was 27% (95% CI, 19%–33%). There was no consistent association with ARM grades 1 to 3 and smoking.

Conclusions

These findings highlight the need for increasing public awareness of the risks associated with smoking and the benefit of quitting smoking. Patients with unilateral disease who are current smokers should be advised of the risk of second-eye disease.

1 Department of Ophthalmology, Queen’s University of Belfast, Belfast, United Kingdom.

2 Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.

3 Centre for Environmental Risk, University of East Anglia, Norwich, United Kingdom.

4 Netherlands Ophthalmic Research Institute, Royal Netherlands Academy of Arts and Sciences, and Department of Ophthalmology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.

5 Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia.

6 Øyeavdelingen, Haukeland Sykehus University of Bergen, Bergen, Norway.

7 Clinique Ophthalmologique, Universitaire de Créteil, Paris, France.

8 Clinica Oculistica, Università degli Studi di Verona, Verona, Italy.

9 Department of Ophthalmology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece.

10 Departments of Ophthalmology and Epidemiology & Biostatistics, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands.

11 Dipartimento Salud Publica Universidad Miguel Hernandez, Alicante, Spain.

12 Centre for Clinical and Population Sciences, Queen’s University of Belfast, Belfast, United Kingdom.

Correspondence and reprint requests to Prof Astrid Fletcher, Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, WCIE 7HT, London, United Kingdom.

Manuscript no. 2006-225.

Financial support: European Commission Vth Framework, Brussels, Belgium (contract no. QLK6-CT-1999-02094). Additional funding for cameras was provided by the Macular Disease Society, Andover, United Kingdom. Prof Rahu was financed by the Ministry of Education and Science, Tallinn, Estonia (target funding no. 01921112s02). Additional funding in Alicante was received from the Fondo de Investigacion Sanitaria, Madrid, Spain (grant nos. FIS 01/1692E, RCESP C 03/09), and Oficina de Ciencia y Tecnologia Generalitat Valenciana, Valencia, Spain (grant no. CTGCA/2002/06). European Eye investigator meetings were supported by travel grants from Novartis, Basel, Switzerland, and Pfizer Inc., New York, New York.

PII: S0161-6420(06)01324-8

doi:10.1016/j.ophtha.2006.09.022

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