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The Rotterdam Study

Johannes R. Vingerling, MD, PhD; Albert Hofman, MD, PhD; Diederick E. Grobbee, MD, PhD; Paulus T. V. M. de Jong, MD, PhD, FRCOphth

Arch Ophthalmol. 1996;114(10):1193-1196.

Abstract
Objective
To assess the relation between cigarette smoking and age-related macular degeneration (AMD) in a population of elderly persons.

Design
A cross-sectional, community-based study.

Setting
City district of Rotterdam, the Netherlands.

Participants
A total of 6174 persons 55 years and older who participated in the Rotterdam Study. In 36 persons atrophic AMD and in 65 persons neovascular AMD were diagnosed.

Main Outcome Measures
Age-related macular degeneration was diagnosed by evaluating fundus transparencies, smoking behavior was identified by interviewing subjects, and the presence of atherosclerosis was assessed by the ankle-arm systolic blood pressure index. Relative risks and 95% confidence intervals (CIs) were calculated using multivariate logistic regression analysis.

Results
In subjects younger than 85 years, current smokers had a 6.6-fold increased risk of neovascular AMD vs those who had never smoked (95% CI, 2.8-15.9). Former smokers had a 3.2-fold increased risk of neovascular AMD vs nonsmokers in this age group (95% CI, 1.4-7.4). These associations were not observed in subjects 85 years or older. Smoking was not associated with atrophic AMD. A strong increased risk of neovascular AMD was present in those who had smoked more than 10 pack-years (relative risk, 6.5; 95% CI, 2.9-14.8). Adjusting the results for atherosclerosis did not change the association. Persons who had quit smoking 20 or more years before the eye examination had no increased risk.

Conclusions
The results provide evidence for a doseresponse relationship between smoking and AMD, particularly in persons with the neovascular form of the disease.

Author Affiliations
From the Departments of Ophthalmology (Dr Vingerling) and Epidemiology and Biostatistics (Drs Vingerling, Hofman, Grobbee, and de Jong), Erasmus University Medical School, Rotterdam, and the Netherlands Ophthalmic Research Institute (Dr de Jong) and the Department of Ophthalmology, Academic Medical Center (Dr de Jong), Amsterdam, the Netherlands.

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