8 Macular Degeneration Causes and Risk Factors

Advancing Age

Age is the most significant risk factor for macular degeneration. Being 50 or older increases your chance of developing age-related macular degeneration.

You may begin to notice gradual changes, or more rapid vision loss in some cases. Symptoms of AMD include:

• Blurred vision
• Difficulty recognizing people
• Straight lines that appear wavy
• A blind spot in the center of your vision

Gender

Some studies suggest you have a slightly higher risk of developing macular degeneration if you are female. However, the research results are mixed and it's unclear if males are diagnosed at a lower rate.

Earlier studies identified a link between early menopause and AMD, with a possible role for estrogen as a macular degeneration treatment option. Yet a 2022 study of more than 131, 000 people (about 25% of them postmenopausal) did not find a link between menopause and AMD.

Females do tend to live longer than males, which may contribute to a higher risk of severe vision loss when diagnosed with AMD since it can progress with time.

Genetics

There may be a genetic component to AMD, although researchers continue to work to understand the genes involved and how they contribute to disease development.

It can sometimes depend on the type of AMD (wet or dry) and how far advanced it has become. For example, with a condition associated with late-stage dry AMD called geographic atrophy, studies suggest 70% of the underlying drivers of development are genetic.

A large study from the International AMD Genomics Consortium identified 34 separate genetic changes associated with late-stage AMD. Among them are CFH and ARMS2-HTRA1, linked to a high risk of AMD.

Other heritable risk factors include:

• Family History: A family history of age-related macular degeneration has been shown to increase your risk. If you have family members with macular degeneration, you should pay particular attention to other risk factors and be sure to go for regular vision checks.
• Race: AMD affects White people more than other ethnic groups. Researchers who studied four racial groups in six U.S. cities found Black people had the least risk, and Chinese and Hispanic groups were intermediate.
• Eye Color: People who have light eye color appear to be at greater risk of macular degeneration than people who have darker eyes. Lighter skin also contributes to risk and may be a factor with the race connection to AMD.
• Stargardt’s Disease: Stargardt’s disease is the most common form of juvenile macular degeneration, affecting one in 20,000 children in the United States. A genetic defect causes vision loss as the photoreceptors of the eye die. Stargardt’s disease can be diagnosed as early as 6 years of age and is usually noticeable before age 20. It affects both males and females.
• Vitelliform Macular Dystrophy: Another common form of juvenile macular degeneration is vitelliform macular dystrophy. It also occurs in an adult-onset form with yellow, fatty tissue observed in the macula on eye examination.

Obesity

Obesity and being overweight may be associated with developing age-related macular degeneration.

Studies suggest that there's a link to the AMD diagnosis but not necessarily its progression in overweight people. When people lose as little as 3% of their waist to hip ratio (a measure of their body mass), there is an associated lower risk of AMD.

Additional studies have found that physical activity, which can contribute to maintaining healthy body weight, also reduces the risk of both early and late AMD.

Underlying Health Conditions

High blood pressure, stroke, and other cardiovascular (heart) conditions increase the likelihood of developing macular degeneration.

Macular degeneration is associated with substantial vascular changes in the eye, and it is believed that the factors that contribute to heart disease and hypertension (high blood pressure) may also contribute to macular degeneration.

Other health conditions in which co-occurring AMD is common include:

• Chronic respiratory diseases
• High cholesterol
• Osteoporosis
• Diabetes
• Liver cirrhosis
• Chronic kidney disease
• Alzheimer’s disease
• Depression
• Charles Bonnet syndrome (a condition that leads to visual hallucinations)
• Gout
• Cancer

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Smoking

Research shows that smoking increases the risk of macular degeneration, though the reasons why remain unclear. Early research reports were mixed on the extent of the influence of smoking on AMD.

Smoking may increase the risk of vascular disease more broadly, or worsen the risk of abnormal blood vessel changes. A 2021 report suggests that smoking:

• More than doubles your risk of AMD
• Causes oxidative stress (a type of cell damage) and inflammation
• Is correlated with dry AMD types

Air pollution may also have similar effects to smoking, but more study is needed.

Sun Exposure

Spending too much time in the sun without ultraviolet-protective sunglasses appears to speed the development of macular degeneration. So, too, can:

• Welding light exposure
• Video display screens
• Fluorescent lighting
• High-intensity lamps used for night sports

It's important to protect your eyes when younger, too. Researchers have discovered that people with histories of prolonged, unprotected exposure to sunlight had more cases of severe macular degeneration than those without such exposure.

This can include people who work as police officers, lifeguards, construction workers, truck drivers, and others who work outdoors. It also includes people who take medications that make their eyes more sensitive to light.

Nutrition and Diet

Antioxidants may protect your cells from oxidative damage, which is partially responsible for many of the effects of aging, including macular degeneration.

If you have low levels of antioxidant vitamins and minerals such as zinc, vitamin A, vitamin C, and vitamin E, you might have a higher risk of developing vision loss related to macular degeneration.

Numerous studies show that some types of high-fat and saturated fat diets may be associated with macular degeneration. Diets rich in lutein and zeaxanthin, found in leafy green vegetables like spinach, collard green and kale, can help lower risk.

So can omega-3 polyunsaturated fatty acids, found in a Mediterranean diet that increases fresh produce and healthy oil intake, while lowering red meat and fried or processed foods.