Primary prevention

Smoking is a strong risk factor for age-related macular degeneration (AMD); smoking avoidance is recommended.[4][14]​​​​​ Lifestyle choices that are known to reduce cardiovascular risk should be recommended as these may reduce risk of AMD. Adherence to a mediterranean diet may reduce the risk of developing the disease.[17][33]​​[34]​​ ​​Diets rich in docosahexaenoic acid and with a low glycaemic index may protect against AMD progression and could prevent the onset of disease.[17][35][36]

In some countries, routine dilated eye examinations are recommended and may be useful to screen for earlier stages of the disease. Based on the results of the initial screening, an ophthalmologist may advise the necessary intervals for follow-up examinations.[37][38]​​

Secondary prevention

Vision rehabilitation and follow-up are important for patients with AMD and may improve vision-related quality of life.[4][39][131]​​​​​ Provide information about vision rehabilitation to patients with any degree of vision loss, because even early loss can be associated with disability. Vision rehabilitation should then be individualised to each patient and extend beyond medical therapies to improve other meaningful outcomes (e.g., reading, daily living activities, safety, community participation, and psychosocial well-being).[132][133]​​​​ Consider referral to consultant rehabilitation services where these are available. Remote, internet-based services may improve access to visual rehabilitation, but more evidence as to its efficacy compared with face-to-face services is needed.[134]

Patients with AMD are encouraged to stop smoking; to eat a balanced diet that has a low glycaemic index and is rich in fruits, vegetables, and fish high in omega-3 fatty acids; and to modify cardiovascular risk factors (including lowering cholesterol and saturated fat intake and controlling hypertension).[35][135]​ Adherence to a mediterranean diet, including lower consumption of red meat, has been associated with reduced risk of AMD progression.[17]​[136]​​​ However, supplementation with omega-3 long-chain polyunsaturated fatty acids does not influence the risk of progressing to late AMD.[55] [ Cochrane Clinical Answers logo ] ​​​ For appropriate patients, high-dose vitamin and mineral supplementation can be recommended (using the AREDS2 formulation from the Age-Related Eye Disease Study Group studies). Evidence from randomised controlled trials and one Cochrane review suggest that antioxidant vitamin and mineral supplementation may reduce the development of late AMD in patients with intermediate AMD, or progression in the less involved eye in patients with late AMD in one eye.[4]​[52]​[56]​[57]​

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