Multiple Risk Factors On AMD - Part 2 of 2

Hello Everyone, Dr. Steve Ferrucci here talking AMD. 

Last time we spoke about the non-modifiable risk factors for AMD, such as age, genetics and race. While its important to know these, it is also important to understand the modifiable risk factors for AMD that we can control and decrease our chance of getting AMD or having it progress.

Smoking has been shown in multiple studies to be the #1 modifiable risk factor for developing AMD and its progression. Studies show an increase risk ranges from 2X in past smokers to almost a 3.6X increased risk in current smokers. More recent studies have also shown patients who smoke do not respond as well to anti-VEGF treatments and had worse visual outcomes in years 1 & 2. The evidence is quite compelling; advise your patients not to smoke.  Unfortunately, a recent study showed 90% of patients with AMD have not been advised quit smoking.

Diet also plays a large role in AMD. More recent studies have evaluated the role of a Mediterranean diet, which is rich in fish, vegetables, fruits, whole grains, olive oil and low in red meat and dairy. A 2018 study from Europe showed that a strict adherence to a Mediterranean diet reduced the risk of advanced AMD by 41%. Fish consumption has also shown to be protective for AMD. Studies show as fish consumption increases the risk of AMD decreases. One such study showing approximately a 25% reduced risk across the board. On the other side, increased red meat consumption also has been associated with increased risk of developing AMD, with one study revealing that consuming red meat more than 10X a week versus less that 5X was associated with a 47% increased risk of developing AMD, specifically early AMD. Further, consuming chicken, specifically white meat, more than 3.5X a week was associated with 60% less risk of late AMD. Lastly, another study showed that a diet high in vegetables, fruit, and fish were associated with a 24% reduced risk of AMD, but sadly less than 4% of the study group adhered to the recommend levels.

Exercise is another modifiable factor that plays a role. Physical activity was associated with reduced rates of both early and late AMD by about 40% in a white population. Further, the results showed even a small amount of physical activity (e.g., walking a few blocks a day) helps lower the rates of AMD.

The last modifiable risk factor I discuss with patients is UV protection. Studies seem to show UV exposure is a risk factor, but it’s somewhat controversial. What these studies seem to suggest is that current UV exposure is not as important, but rather past sunlight exposure is. Therefore, once a patient is diagnosed with AMD, UV protection is probably not that critical, but is more important earlier in life. So encouraging sunglass use in younger patents, especially those with a family history of AMD, is more important in my mind than counseling an older patient about the risk of UV.

I truly feel we can have a meaningful impact on our patients with AMD or at risk of AMD by counseling them about these modifiable risk factors. Decreasing high risk tendencies, such as smoking and poor diet, as well as frequent exams and vitamin supplementation when indicated is a powerful message for our patients.