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Jost B. Jonas, MD; Liang Xu, MD

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We read with great interest the recent article from the Beaver Dam Study¹ in which, after controlling for age, sex, and baseline severity of age-related macular degeneration (AMD), smoking was related to the long-term incidence and progression of AMD. It is in agreement with previous population-based studies such as the Blue Mountains Eye Study, the Rotterdam Study, and others.^2-3 We would like to raise the question of whether the described association between smoking and AMD may be due to a confounding effect. Smoking is associated with a low socioeconomic status (Beijing Eye Study, unpublished data). A low level of education is associated with hyperopic refractive error (Beijing Eye Study, unpublished data). Correspondingly, smokers vs nonsmokers were significantly more hyperopic in the Beijing Eye Study (unpublished data). Hyperopia has, however, been described as being associated with AMD.^4-5 Combing these associations, one may infer that . . . [Full Text of this Article]

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