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Smoking and treatment outcomes of neovascular age-related macular degeneration over 12 months
  1. Harshil Dharamdasani Detaram,
  2. Nichole Joachim,
  3. Gerald Liew,
  4. Kim Van Vu,
  5. George Burlutsky,
  6. Paul Mitchell,
  7. Bamini Gopinath
  1. Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Bamini Gopinath, Centre for Vision Research, University of Sydney, Sydney, NSW 2145, Australia; bamini.gopinath{at}


Background To assess the association of smoking with age of onset of neovascular age-related macular degeneration (nAMD), visual acuity (VA), central macular thickness (CMT) and the presence of fluid in patients with nAMD.

Methods 547 patients with nAMD were recruited from a tertiary eye clinic during 2012–2015; of these, 490 patients were followed up 12 months later. Clinical diagnosis of nAMD was confirmed by a retinal specialist. Smoking was determined from self-reported history as never, past or current. Age of onset was defined as date of first recorded diagnosis of nAMD in either eye or date of first anti-vascular endothelial growth factor injection. CMT and presence of fluid were recorded from spectral-domain optical coherence tomography images. VA was recorded as number of letters read at 3 m.

Results After multivariable adjustment, current smokers developed nAMD at an average 5.5 years younger age than never smokers and 4.4 years younger age than past smokers (p<0.0001 and p=0.0008, respectively). At baseline, adjusted mean CMT was significantly higher in current compared with past smokers (259.2 µm vs 231.9 µm, respectively, p=0.04). Current smokers versus never smokers had greater odds of presence of subretinal fluid at 12-month follow-up: multivariable-adjusted OR 1.99 (95% CI 1.09 to 3.67). Smoking status was not significantly associated with VA over 12 months.

Conclusions Current smoking was associated with a younger age of nAMD onset and key treatment outcomes such as higher mean CMT and greater odds of subretinal fluid presence. These findings suggest that smoking cessation may benefit patients being treated for nAMD.

  • Epidemiology
  • Macula
  • Degeneration
  • Neovascularisation
  • Public health

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  • HDD and NJ are joint first authors.

  • Contributors Design and conduct of the study: BG, PM, HDD. Management: PM. Analysis: GB. Interpretation of the data: BG, NJ, HDD. Preparation, review of approval of the manuscript: BG, NJ, HDD, GL, GB, KVV, PM.

  • Funding This work was supported by a Macular Disease Foundation Australia Research Grant.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval The study was approved by the Western Sydney Local Health District Human Research Ethics Committee and adhered to the tenets of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on request.

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