Modifiable Lifestyle Risk Factors and Strategies for Slowing the Progression of Age-Related Macular Degeneration

Abstract

Age-related macular degeneration (AMD) is a multifactorial disorder influenced by genetic, lifestyle, nutritional, and systemic health factors that contribute to increased oxidative stress and chronic inflammation in the retina. This article reviews the recent literature on modifiable lifestyle risk factors for the development and progression of AMD. Smoking (current and former), physical inactivity, prolonged sunlight exposure, as well as conditions such as diabetes, hypertension, cardiovascular disease, and obesity have all been associated with an increased risk of early AMD and its progression. The Age-Related Eye Disease Studies (AREDS and AREDS2) have shown that a specific combination of vitamins E and C, zinc, copper, lutein, and zeaxanthin can significantly reduce the risk of AMD progressing from dry to wet form. Additionally, adherence to a Mediterranean diet, rich in vegetables, fruits, legumes, whole grains, and nuts, has been linked to a lower risk of both early and late AMD. Emerging evidence suggests that these benefits may be influenced by the gut microbiota, as well as genetic and epigenetic factors. Further research into the interactions between these risk factors could pave the way for targeted therapies aimed at preventing or slowing AMD progression.

Keywords: AMD; AREDS; AREDS2; age-related macular degeneration; diet; genetics; lifestyle factors; microbiome; nutrition; sleep; supplements; systemic health factors.

Figure 1

Examples of category 3 age-related macular degeneration. (A) Shows multiple large drusen. (B,C) Show several large drusen and many intermediate drusen. (D) Demonstrates non-fovea involving geographic atrophy without frank drusen in the macula. Drusen are indicated by the black arrows depicted in (A,B,D), and non-fovea involving geographic atrophy is indicated with white arrows in (D).