Lifestyle Factors May Prevent up to 60% of Advanced AMD in Patients with High Genetic Risk

When counseling patients with a strong genetic susceptibility to advanced AMD, consider educating them on the actionable steps they can take to reduce their risk, such as quitting smoking and consuming more green leafy vegetables and fatty fish, which are high in lutein, zeaxanthin and omega-3 fatty acids. Photo: Mohammad Rafieetary, OD. Click image to enlarge. While genetic risk serves as a powerful predictor of progression from early to advanced stages of age-related macular degeneration (AMD), a recent study highlights that embracing healthier lifestyle choices—such as quitting smoking and improving BMI and dietary habits—can significantly reduce the likelihood of developing advanced disease, even among individuals with a high genetic susceptibility. For patients in that high-risk category, the data showed that adopting these health-promoting behaviors could potentially reduce the incidence of advanced AMD by up to 60%.To conduct the study, researchers collected longitudinal data from the Age-Related Eye Disease Study (AREDS), including subjects aged 55 to 80 years with early or intermediate AMD. Only participants with a high genetic risk—defined as the third tertile of a genetic risk score—were included in the analysis and tracked over five years. Lifestyle behaviors were assessed using questionnaires focusing on smoking habits, caloric intake and consumption of green leafy vegetables and fish.The findings revealed that among 898 eyes with high genetic risk, 207 progressed to advanced AMD, translating to a 23% progression rate. It was found that a risk-inducing lifestyle raised the incidence of advanced AMD by threefold in never smokers and fivefold in ever smokers. Notably, the study authors determined that 56% to 60% of advanced AMD incidence was attributed to the following modifiable risk factors examined in this study: smoking, high BMI, high caloric intake and low intake of foods rich in lutein-zeaxanthin and omega-3 fatty acids.The influence of lifestyle factors was found to be more pronounced in the development of geographic atrophy (GA) compared to neovascular subtypes. Specifically, the results indicated that a high-risk lifestyle profile conferred an eight- to 12-fold increased risk of progression to GA, while the associated risk for progression to neovascular AMD was markedly lower, at twofold to threefold. Researchers attributed these differential impacts to varying pathogenic mechanisms related to oxidative stress, inflammation and their interactions with genetic predispositions.These results have a few implications for clinicians, which the authors describe in their paper. First, they argue, “It is high priority to identify people with high genetic risk who have a much higher risk of progressing to advanced AMD and therefore have the highest potential gain from lifestyle modifications.” Secondly, they note that eye doctors should convey to patients with a strong family history of AMD that they are not inevitably destined to develop the condition; rather, consider educating these individuals on how lifestyle choices like smoking cessation and increased intake of leafy greens and fatty fish—rich in lutein, zeaxanthin and omega-3s—can lower disease risk.Click here for the journal source. Seddon JM, De D, Rosner B. Quantifying effects of lifestyle changes on progression to advanced age-related macular degeneration in high genetic risk individuals. Ophthalmology. October 9, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.