Although age and genetics play key roles in the development of age-related macular degeneration (AMD), optometrists can help patients reduce the risk of its onset or progression by educating them on the modifiable risk factors associated with it.
This article provides patient-facing scripts to do so, organized by modifiable risk factor, along with action steps to change risk-factor-causing behaviors. (See the “Defining AMD for Patients” sidebar.)
Defining AMD for Patients
“Age-related macular degeneration (AMD) primarily affects the macula, the part of your retina that is esponsible for central vision. There are 2 main types: dry and wet. Dry AMD involves a gradual loss of central vision, which some patients may notice, while others may remain symptom-free in early stages. Wet AMD is more severe; it causes blurred or distorted central vision and can progress rapidly. The good news is that you can help reduce your risk or slow its progression by making certain lifestyle changes, such as managing blood pressure, not smoking, maintaining a healthy diet, and controlling inflammation.
Smoking Cigarettes- The Script
“Smoking is the single most significant modifiable risk factor for AMD. This is because tobacco smoke contains harmful chemicals that promote damage in the retina. The retina is the part of your eye that provides images to your brain.”
Changing the Behavior
Collaborate with health care providers to offer resources for smoking cessation programs, counseling, and pharmacotherapy. (As an example, check out quitassist.com, which offers help.)
Poor Diet- The Script
“Eating processed foods, such as cookies and muffins, that are high in sugar and unhealthy fats can trigger inflammation and increase free radicals, which damage cells and allow glucose to bind to proteins and fats. These changes can harm the retina, which is the part of your eye that is responsible for sending images to your brain.”
Changing the Behavior:
- Discuss increasing intake of green leafy vegetables, such as spinach, kale, and collards.
- Discuss incorporating colorful fruits and vegetables that are high in carotenoids into the patient’s diet.
- Discuss including fatty fish (like salmon) at least twice weekly for omega-3 fatty acids.
- Discuss limiting the consumption of processed foods high in sugars and unhealthy fats.
- Provide simple, visual dietary guidelines. (As an example, see https://bit.ly/MacularDiseaseFoundationAustralia.)
- Discuss the role of ocular nutritional supplementation in intermediate-to-advanced AMD.
Obesity/Lack of Exercise- The Script
“In speaking to you about your eye health, I want to make sure you know all the ways you have in your power to change. Studies have shown that one of those ways is the amount of fat that we carry in the abdominal region. When we decrease that fat, we can improve our odds of vision preservation. Decreasing processed foods, changing food choices for those that have high nutritional value, and increasing physical activity may all help in adjusting these metrics as well. Regarding increasing physical activity, I would consider a movement habit. A brisk walk, swim, or stretch with loved ones or neighbors on a daily basis at only about 20 minutes a day has been shown to improve our overall wellbeing.”
Changing the Behavior:
- Encourage moderate physical activity, such as brisk walking, swimming, or yoga. The World Health Organization recommends at least 150 minutes per week.1
- Frame exercise as a strategy not only for eye health but also for overall wellbeing: “Think of exercise as medicine for your eyes. Regular activity can lower eye pressure, improve circulation to the retina, and reduce vascular risks to vision. It also boosts mood and helps with sleep and weight management.”
- Provide information on local options for exercise, such as community fitness programs or walking groups, to help patients get started.
Hypertension/Atherosclerosis- The Script
“High blood pressure can reduce blood flow to the macula, which is the part of the retina that is responsible for central vision. Additionally, high blood pressure can encourage abnormal, leaky blood vessels that damage retinal tissue. Something else to keep in mind: Plaque buildup in your arteries, called atherosclerosis, can starve the retina of oxygen and nutrients, harm light-sensing cells, and worsen age-related macular degeneration. Controlling blood pressure and vascular risk factors helps protect the macula and preserve central vision.”
Changing the Behaviors:
- Promote regular (routine checks that fit one’s risk) blood pressure monitoring and management. As an example, if a patient’s blood pressure is within the normal range, they should get their blood pressure checked once a year.
- Discuss lifestyle factors, such as diet, exercise, and stress reduction, that can help control blood pressure.
- Partner with patients’ primary care teams for coordinated care.
Light Exposure- The Script
“Ultraviolet and high-energy visible (blue) light, mostly from the sun, can produce free radicals that damage the macula, the part of the retina that is responsible for central vision.”
Changing the Behaviors:
- Recommend the use of sunglasses that block 100% of UVA and UVB rays.
- Suggest wide-brimmed hats for additional protection when outdoors.
- Advise on screen breaks.
Excessive Alcohol Consumption- The Script
“Excessive alcohol, such as binge drinking (4+ drinks women, 5+ men per occasion), heavy weekly drinking (8+ drinks women, 15+ men), underage drinking, or drinking during pregnancy, increases free radicals and inflammation and damages retinal cells.”2
Communication Tips for Educating Patients
Effective education hinges not just on what we say, but how we say it. Consider these strategies:
- Personalization. Relate risk factors directly to the patient’s life and circumstances.
- Clarity. Use simple, relatable language.
- Visual aids. Use diagrams, brochures, and graphics.
- Positive framing. Emphasize empowerment rather than fear. (“You have the ability to protect your vision” rather than “You’ll lose vision if you don’t change.”)
- Motivational interviewing. Use open-ended questions, such as, “can you tell me about the foods you regularly consume?” affirmations, and reflective listening to help patients find their own motivation for change.
- Follow-up. Reinforce education during future visits and acknowledge small patient successes along the way.
Changing the Behaviors:
- Advocate for moderation—no more than 1 drink per day for women and 2 for men, as per the Centers for Disease Control guidelines.
- Provide any resources on getting help, should alcohol be a problem for the patient. An example of a resource: Alcoholics Anonymous https://www.aa.org.
Periodontitis- The Script
“Periodontitis, or severe inflammation of the gums, causes or worsens AMD because the condition can cause systemic low-grade inflammation, which also occurs in AMD.”3
Changing the Behaviors:
- Discuss the importance of teeth brushing, flossing, and using mouthwash daily.
- Discuss compliance to regular visits with a dentist.
A Great Opportunity
While optometrists can’t change a patient’s age or genetic background, discussing modifiable risk factors with patients offers a significant opportunity to preserve and protect their vision. When ODs take the time to explain AMD and its associated risk factors clearly and compassionately, they foster trust and encourage meaningful behavioral changes that can make a lasting difference. (See the “Communication Tips for Educating Patients” sidebar) OM
References
- World Health Organization. WHO guidelines on physical activity and sedentary behaviour. Guideline. November 25, 2020. Accessed September 9, 2025. https://www.who.int/publications/i/item/9789240015128
- CDC. Alcohol use and your health. January 14, 2025. Accessed Sept. 9, 2025 https://www.cdc.gov/alcohol/about-alcohol-use/index.html
- Boberg-Ans S, Arnold-Vangsted F, Scheel-Bech AB, et al. A systematic review and meta-analysis association between periodontitis and age-related macular degeneration: Potential for Personalized Approach. J Pers Med. 2025;15(4):145. doi:10.3390/jpm15040145
