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Age, smoking, and systemic factors are associated with increased risk of age-related macular degenerationRisk Factors Linked to Age-Related Macular Degeneration

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Key Takeaway
Note that while multiple modifiable risk factors are associated with AMD, evidence quality is generally low to very low.

This umbrella review synthesized available evidence concerning 53 distinct risk factors associated with age-related macular degeneration (AMD). The scope included lifestyle factors, systemic conditions, and circulating biomarkers to evaluate the validity of epidemiological evidence.

The synthesis identified consistent associations between AMD and several key factors including age, smoking, diet, diabetes, and hypertension. Additionally, while carotenoids, C-reactive protein, and high-density lipoprotein cholesterol were associated with AMD, the strength of evidence for these specific biomarkers varied across studies. Healthy diet and physical activity were noted as potentially having protective roles.

A significant limitation of this review is that most evidence was classified as low or very low quality according to the GRADE framework; only three factors reached a moderate level of evidence. Clinical application should be approached with caution due to these limitations in certainty. The findings are based on epidemiological data, indicating associations rather than direct causality.

How this fits prior evidence

This umbrella review addresses gaps in understanding the broad range of risk factors for age-related macular degeneration by evaluating 53 distinct variables. While previous coverage identified specific clinical risks such as the association between obstructive sleep apnea and AMD, this synthesis provides a broader overview of lifestyle and systemic factors like smoking, diabetes, and hypertension.

Researchers looked at 53 different risk factors for age-related macular degeneration (AMD). This included things people can change, such as smoking habits and diet, as well as medical conditions like diabetes and high blood pressure. The study also looked at markers in the blood, including cholesterol levels and certain nutrients.

The review found consistent links between AMD and aging, smoking, and systemic issues like hypertension. While a healthy diet and regular physical activity may offer some protection, the evidence for these specific benefits is not yet strong. Other factors, such as carotenoids and C-reactive protein, showed varying levels of connection to the condition.

It is important to note that most of the data was ranked as low or very low quality by experts. Because many of these findings are based on observational data rather than controlled trials, we cannot say for certain that these factors cause AMD. These results should be viewed as a starting point for understanding risk rather than a definitive guide for treatment.

What this means for you:
Several lifestyle and medical factors are linked to AMD, but much of the evidence is currently of low quality.

Common questions

What lifestyle factors are linked to age-related macular degeneration?

The study found consistent associations between age-related macular degeneration and several factors, including smoking, diet, and hypertension. While a healthy diet and physical activity may have protective roles, the evidence for these specific benefits is currently not very strong.

How certain are these findings regarding eye health?

Most of the evidence was classified as low or very low quality by researchers. Because the data comes from observational studies rather than controlled trials, the results show a link between factors and the condition but do not prove that one causes the other.

Do blood markers like cholesterol affect macular degeneration?

The review looked at several circulating biomarkers, including carotenoids, C-reactive protein, and high-density lipoprotein cholesterol. These were associated with age-related macular degeneration, but the strength of evidence for these specific links varied across different studies.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJun 2026
View Original Abstract ↓
The objective of the current study was to conduct an umbrella review of meta-analyses to systematically assess the methodological quality, potential biases, and validity of all epidemiological evidence addressing risk factors associated with age-related macular degeneration (AMD), and to synthesize the available evidence regarding AMD risk factors. We searched PubMed, Web of Science, Embase, and the Cochrane Database of Systematic Reviews to April 2025 (last update) for systematic reviews and meta-analyses that focused on the risk factors for AMD. The methodological quality of each study was assessed independently by two reviewers using AMSTAR and the GRADE framework. Following a comprehensive systematic search, a total of 53 distinct risk factors were identified, comprising 30 factors with statistically significant associations and 23 without significant associations. Based on the GRADE framework, most of the evidence was classified as low or very low quality, with three factors achieving a moderate level of evidence. Consistent associations were observed for age and smoking, as well as for certain lifestyle and systemic factors, including diet, diabetes, and hypertension. Circulating biomarkers, including carotenoids, C-reactive protein (CRP), and high-density lipoprotein cholesterol (HDL-C), were also found to be associated with AMD, although the strength of evidence varied across studies. This umbrella review indicates that AMD risk is associated with multiple modifiable lifestyle and systemic factors. Healthy diet and physical activity may have protective roles, while several circulating biomarkers, including carotenoids and C-reactive protein, have been identified as related to AMD risk. However, given that most of the available evidence is of low or very low certainty, these findings should be considered with caution. PROSPERO, CRD420251045558, URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251045558.
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