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Astrid E. Fletcher, PhD; Graham C. Bentham, PhD; Maureen Agnew, PhD; Ian S. Young, MD, PhD; Cristina Augood, MBBS; Usha Chakravarthy, MD, PhD; Paulus T. V. M. de Jong, MD, PhD; Mati Rahu, PhD; Johan Seland, MD; Gisele Soubrane, MD, PhD; Laura Tomazzoli, MD; Fotis Topouzis, MD; Johannes R. Vingerling, MD, PhD; Jesus Vioque, PhD

Arch Ophthalmol. 2008;126(10):1396-1403.

Objective  To examine the association of sunlight exposure and antioxidant level with age-related macular degeneration (AMD).

Methods  Four thousand seven hundred fifty-three participants aged 65 years or older in the European Eye Study underwent fundus photography, were interviewed for adult lifetime sunlight exposure, and gave blood for antioxidant analysis. Blue light exposure was estimated by combining meteorologic and questionnaire data.

Results  Data on sunlight exposure and antioxidants were available in 101 individuals with neovascular AMD, 2182 with early AMD, and 2117 controls. No association was found between blue light exposure and neovascular or early AMD. Significant associations were found between blue light exposure and neovascular AMD in individuals in the quartile of lowest antioxidant level—vitamin C, zeaxanthin, vitamin E, and dietary zinc—with an odds ratio of about 1.4 for 1 standard deviation unit increase in blue light exposure. Higher odds ratios for blue light were observed with combined low antioxidant levels, especially vitamin C, zeaxanthin, and vitamin E (odds ratio, 3.7; 95% confidence interval, 1.6-8.9), which were also associated with early stages of AMD.

Conclusions  Although it is not possible to establish causality between sunlight exposure and neovascular AMD, our results suggest that people in the general population should use ocular protection and follow dietary recommendations for the key antioxidant nutrients.

Author Affiliations: Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, England (Drs Fletcher and Augood); Centre for Environmental Risk, University of East Anglia, Norwich, England (Drs Bentham and Agnew); Centre for Clinical and Population Sciences (Dr Young), and Department of Ophthalmology (Dr Chakravarthy), Queen's University Belfast, Belfast, Northern Ireland; the Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, Department of Ophthalmology, Academic Medical Centre Amsterdam, Amsterdam, and Department of Epidemiology and Biostatistics, Erasmus Medical Center, Rotterdam, the Netherlands (Dr de Jong); Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia (Dr Rahu); Øyeavdelingen, Haukeland Sykehus University of Bergen, Bergen, Norway (Dr Seland); Clinique Ophthalmologique, Universitaire de Créteil, Paris, France (Dr Soubrane); Clinica Oculistica, Università degli Studi di Verona, Verona, Italy (Dr Tomazzoli); Department of Ophthalmology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (Dr Topouzis); Department of Epidemiology and Biostatistics and Department of Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands (Dr Vingerling); and Departamento de Salud Pública, Universidad Miguel Hernandez, Alicante, and El Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Barcelona, Spain (Dr Vioque).

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