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Cigarette Smoking and Age-Related Macular Degeneration in the EUREYE Study
Abstract
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 > or =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.
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“In total, data from 18 prospective, cross-sectional studies and 8 case control studies [12,24-26,28,30,31,33-47,49-54,57-73] were included in the final analysis, contributing a sample of some 94,058 patients (ranging from 261 to 22,071) including 3,178 (ranging from 8 to 776) late AMD cases.”
From Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis (2010) · cites this paper as [12]
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“Cigarette smoke further affects AMD by promoting progression from atrophic to neovascular AMD (Chakravarthy et al. 2007).”
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“Smoking and sunlight exposure are significant risk factors for AMD in studies conducted in Nepal and elsewhere [33–37].”
BackgroundEFFECT OF SMOKING ON MACULAR FUNCTION AND STRUCTURE IN ACTIVE SMOKERS VERSUS PASSIVE SMOKERS
El-Shazly, A. A. E.-F., Farweez, Y. A. T., Elzankalony, Y. A., Elewa, L. S., & Farweez, B. A. T. (2017) · Retina · doi:10.1097/iae.0000000000001632 · Cited by 37
Prevalence of Age-Related Macular Degeneration in Portugal: The Coimbra Eye Study - Report 1
Cachulo, M. L., Lobo, C. L., Figueira, J., Ribeiro, L., Laíns, I., Vieira, A., Nunes, S. G., Costa, M. A., Simão, S., Rodrigues, V., et al. (2015) · Ophthalmologica · doi:10.1159/000371584 · Cited by 38
Molecular Genetic Mechanisms in Age-Related Macular Degeneration
Shughoury, A., Sevgi, D. D., & Ciulla, T. A. (2022) · Genes · doi:10.3390/genes13071233 · Cited by 42
Age-related macular degeneration: current treatment and future options
Moutray, T., & Chakravarthy, U. (2011) · Therapeutic Advances in Chronic Disease · doi:10.1177/2040622311415895 · Cited by 37
“Cigarette smoking is a wellestablished risk factor for the development of AMD [Thornton et al. 2005] and cessation is advised as there is a dose response relationship with pack-years of smoking [Chakravarthy et al. 2007; Khan et al. 2006].”
BackgroundSelf-citationMukhtar, S., & Ambati, B. K. (2019) · International Ophthalmology · doi:10.1007/s10792-019-01140-6 · Cited by 35
“Positive behavioral modifications include smoking cessation [5], exercise, and healthy diet; there have been investigations of the utility of supplements to slow down progression of AMD.”
BackgroundÜney, G., Ünlü, N., Acar, M. A., Hazırolan, D., Altıparmak, U. E., Yalnız-Akkaya, Z., & Örnek, F. (2013) · Retina · doi:10.1097/iae.0b013e318295f72e · Cited by 34
Tosi, G. M., Giustarini, D., Franci, L., Minetti, A., Imperatore, F., Caldi, E., Fiorenzani, P., Aloisi, A. M., Sparatore, A., Rossi, R., et al. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22020600 · Cited by 34
Droz, I., Mantel, I., Ambresin, A., Faouzi, M., Schorderet, D. F., & Munier, F. L. (2008) · British Journal of Ophthalmology · doi:10.1136/bjo.2007.127811 · Cited by 35
Update on the role of genetics in the onset of age-related macular degeneration
Francis, P. J. (2011) · Clinical ophthalmology · doi:10.2147/opth.s11627 · Cited by 32
Effects of Age-Related Macular Degeneration on Postural Sway
Chatard, H., Tépenier, L., Jankowski, O., Aussems, A., Allieta, A., Beydoun, T., Salah, S. B., & Bucci, M. P. (2017) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2017.00158 · Cited by 31
“Other studies have reported that there is two AMD with choroidal neovascularization for one AMD with geographic atrophy (Chakravarthy et al., 2007).”
BackgroundCompromised Integrity of Central Visual Pathways in Patients With Macular Degeneration
Malania, M., Konrad, J., Jägle, H., Werner, J. S., & Greenlee, M. W. (2017) · Investigative Ophthalmology & Visual Science · doi:10.1167/iovs.16-21191 · Cited by 31
Woodell, A. S., Jones, B. W., Williamson, T., Schnabolk, G., Tomlinson, S., Atkinson, C., & Rohrer, B. (2016) · Investigative Ophthalmology & Visual Science · doi:10.1167/iovs.15-18471 · Cited by 30
Estimated Prevalence and Risk Factor for Age-related Maculopathy
Roh, M., Kim, J. H., Byeon, S. H., Koh, H. J., Lee, S. C., & Kwon, O. W. (2008) · Yonsei Medical Journal · doi:10.3349/ymj.2008.49.6.931 · Cited by 31
Differential effects of nicotine on retinal and vascular cells in vitro
Patil, A. J., Gramajo, A. L., Sharma, A., Seigel, G. M., Kuppermann, B. D., & Kenney, M. C. (2009) · Toxicology · doi:10.1016/j.tox.2009.02.004 · Cited by 29
Gastaldello, A., Giampieri, F., Quiles, J. L., Navarro‐Hortal, M. D., Obregón, S. A., Villena, E. G., Pifarré, K. T., Giuseppe, R. D., Grosso, G., Cianciosi, D., et al. (2022) · Nutrients · doi:10.3390/nu14102028 · Cited by 30
“Among the former, increasing age, female sex, certain genetic polymorphisms, having a family history of AMD, light skin colour, and light iris colour, are associated with an increased risk of AMD [10,11]; among the latter, smoking is the strongest-recognized determinant of a heightened risk of late AMD [12,13], whilst…”
BackgroundTamura, H., Tsujikawa, A., Yamashiro, K., Akagi-Kurashige, Y., Nakata, I., Nakanishi, H., Hayashi, H., Ooto, S., Otani, A., & Yoshimura, N. (2012) · American Journal of Ophthalmology · doi:10.1016/j.ajo.2012.03.042 · Cited by 27
Cachulo, M. L., Laíns, I., Lobo, C. L., Figueira, J., Ribeiro, L., Marques, J. P., Costa, J. C., Vieira, A., Rodrigues, J., Alves, D., et al. (2016) · Acta Ophthalmologica · doi:10.1111/aos.12950 · Cited by 27
“Despite the weak associations reported for early AMD (Smith et al. 2001; Klein et al. 2002; Mitchell et al. 2002; Khan et al. 2006; Chakravarthy et al. 2007; Tan et al. 2007), it is currently well established that current smokers present an increased risk for late AMD (2.”
BackgroundInfluentialNielsen, M. K., Hector, S. M., Allen, K., Subhi, Y., & Sørensen, T. L. (2017) · Immunity & Ageing · doi:10.1186/s12979-017-0100-9 · Cited by 28
“The increase in risk is most pronounced in current smokers, but is also markedly higher in former smokers [34].”
BackgroundPresent and Possible Therapies for Age-Related Macular Degeneration
Khan, M. A., Agarwal, K., Loutfi, M., & Kamal, A. (2014) · ISRN Ophthalmology · doi:10.1155/2014/608390 · Cited by 26
“The casual relationship between smoking and AMD has been noted to significantly increase the risk of developing AMD by two- to threefold; therefore smoking cessation is heavily emphasised [22].”
BackgroundPeriodontal Diseases and Age-Related Macular Degeneration: Is There a Link? A Review
Pockpa, Z. A. D., Struillou, X., Koné, D., Mobio, G. S., Soueidan, A., & Badran, Z. (2019) · The Permanente Journal · doi:10.7812/tpp/18.260 · Cited by 26
Biomarkers as Predictive Factors of Anti-VEGF Response
Bobadilla, M., Pariente, A., Ana, I., Peláez, R., Pérez-Sala, Á., & Larráyoz, I. M. (2022) · Biomedicines · doi:10.3390/biomedicines10051003 · Cited by 26
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Arnold, C., Jentsch, S., Dawczynski, J., & Böhm, V. (2013) · Nutrition · doi:10.1016/j.nut.2013.05.012 · Cited by 26
“However, data suggest that there are mainly three strategies of prevention: abstinence from cigarette smoking [1–3], protection of the eyes from extended sunlight exposure [4–6], and a balanced diet rich in dark green, leafy vegetables [7–9].”
BackgroundProtection of human retinal pigment epithelial cells from oxidative damage using cysteine prodrugs
Kularatne, R. N., Bulumulla, C., Catchpole, T., Takacs, A., Christie, A. H., Stefan, M. C., & Csaky, K. G. (2020) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2020.03.024 · Cited by 26
Wang, Z., Zhang, Y., Xu, C., Peng, A., Qin, H., & Yao, K. (2025) · Biochemical Pharmacology · doi:10.1016/j.bcp.2025.116902 · Cited by 25
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Risk factors for exudative age-related macular degeneration in a large French case–control study
Zerbib, J., Delcourt, C., Puche, N., Querques, G., Cohen, S. Y., Sahel, J., Korobelnik, J., Goff, M. L., & Souied, E. H. (2013) · Graefe s Archive for Clinical and Experimental Ophthalmology · doi:10.1007/s00417-013-2537-7 · Cited by 28
“With regard to smoking, the present study provides details on the effect of the level of smoking and of time to smoking cessation [9, 23–29].”
BackgroundAge-Related Macular Degeneration and Incident Stroke: A Systematic Review and Meta-Analysis
Fernández, A. B., Panza, G. A., Benjamin, C., Chatterjee, S., Jayaraman, R., & Wu, W. (2015) · PLoS ONE · doi:10.1371/journal.pone.0142968 · Cited by 25
“Although the precise etiology of AMD remains unclear, the disease has been associated with various traditional cardiovascular risk factors, such as age [7], elevated serum cholesterol levels [8], hypertension [9], and cigarette smoking [10], which raises the question as to whether AMD itself is an independent risk fac…”
BackgroundRisk Stratification and Clinical Utility of Polygenic Risk Scores in Ophthalmology
Qassim, A., Souzeau, E., Hollitt, G. L., Hassall, M., Siggs, O. M., & Craig, J. E. (2021) · Translational Vision Science & Technology · doi:10.1167/tvst.10.6.14 · Cited by 24
Rohrer, B., Frazer‐Abel, A. A., Leonard, A. P., Ratnapriya, R., Ward, T., Pietraszkiewicz, A. A., O’Quinn, E. C., Adams, K., Swaroop, A., & Wolf, B. J. (2019) · Europe PMC (PubMed Central) · Cited by 23
Épidémiologie de la dégénérescence maculaire liée à l’âge
Leveziel, N., Delcourt, C., Zerbib, J., Dollfus, H., Kaplan, J., Benlian, P., COSCAS, G. J., Souied, E. H., & Soubrane, G. (2009) · Journal Français d Ophtalmologie · doi:10.1016/j.jfo.2009.04.009 · Cited by 23
Self-citation
Metadata
- Authors
- Chakravarthy, U., Augood, C., Bentham, G. C., de Jong, P. T. V. M., Rahu, M., Seland, J., Soubrane, G., Tomazzoli, L., Topouzis, F., Vingerling, J. R., Vioque, J., Young, I. S., & Fletcher, A. E.
- Affiliations
- Queen's University Belfast (GB)
- London School of Hygiene & Tropical Medicine (GB)
- University of East Anglia (GB)
- National Institute for Health Development (EE)
- Haukeland University Hospital (NO)
- University of Verona (IT)
- Aristotle University of Thessaloniki (GR)
- Erasmus MC (NL)
- Corresponding author
- Fletcher, A.E.
- Venue
- Ophthalmology
- Publisher
- Elsevier BV
- Published
- 2007-06
- Volume
- 114
- Issue
- 6
- Pages
- 1157-1163
- ISSN
- 0161-6420 (ISSN-L)
- OpenAlex
- W1966367482
- Cited by
- 230
- References
- 38
- Citations by year
- 2026: 4 · 2025: 16 · 2024: 8 · 2023: 13 · 2022: 12 · 2021: 11 · 2020: 8 · 2019: 13 · 2018: 9 · 2017: 16 · 2016: 11 · 2015: 11 · 2014: 13 · 2013: 15 · 2012: 12
- FWCI
- 13.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Ophthalmology (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Research Portal (Queen's University Belfast) (submittedVersion)
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
- Keywords
- cigarette smoking, age-related macular degeneration, age-related maculopathy, neovascular AMD, geographic atrophy, smoking cessation, attributable fraction, older adults, risk factors
- MeSH terms
- Aged, Cross-Sectional Studies, Environment, Europe, Female, Humans, Life Style, Macular Degeneration, Male, Photography, Surveys and Questionnaires, Risk Factors, Smoking, Tobacco Smoke Pollution, Odds Ratio, Smoking Cessation, Choroidal Neovascularization
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