European Journal of Biomedical and Pharmaceutical Sciences

PROGNOSTIC FACTORS FOR PROGRESSION OF AGE-RELATED MACULAR DEGENERATION: A REVIEW ARTICLE

*Musa Moh’d Musa Al- Hindi, MD

ABSTRACT

Age-related macular degeneration is a leading cause of irreversible vision loss in older adults. Most of the resulting disability arises when early or intermediate disease progresses to late stages; geographic atrophy or neovascular disease. Identifying who is likely to progress is therefore a clinical priority. This narrative review summarizes published evidence on prognostic factors for progression, drawing mainly on recent systematic reviews and meta-analyses, landmark cohort studies, and randomised supplementation trials. Retinal phenotype is the strongest and most consistent predictor: large drusen burden, many small drusen, pigmentary change, and optical coherence tomography features such as hyperreflective foci and subretinal drusenoid deposits. Older age and risk variants at the CFH and ARMS2/HTRA1 loci add risk, although once early disease is present the phenotype appears more informative than genotype. Smoking is the best-supported modifiable factor, with a markedly stronger association with late disease, and the antioxidant-based AREDS formulation lowers progression risk in people with intermediate disease. Evidence for alcohol, lipids, body mass index, hypertension and diabetes is inconsistent. Important gaps remain, including social determinants, ethnic diversity, gene-environment interaction, and validated imaging-based or artificial-intelligence risk models. Many pooled estimates also combine disease onset with progression, which limits interpretation. In practice, retinal phenotype should be combined with counselling on modifiable risk when estimating individual prognosis.

Keywords: Age-related macular degeneration; Prognostic factors; Disease progression; Drusen; Smoking; Genetics.