Primary prevention
Smoking is a strong risk factor for AMD; smoking avoidance is recommended.[9][23] Lifestyle choices that are known to reduce cardiovascular risk should be recommended as these may reduce risk of AMD. Regularly dietary intake of vegetables rich in the carotenoids lutein and zeaxanthin, and polyunsaturated fats, particularly from fish, may reduce the risk of developing the disease.[24][25][26] Diets rich in docosahexaenoic acid and with a low glycemic index appear to protect against AMD progression and could prevent the onset of disease.[27]
In some countries, routine dilated eye exams 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 exams.[28][29]
Secondary prevention
Vision rehabilitation and follow-up are important for patients with AMD.[23][30] 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 individualized 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).[109] Consider referral to specialist rehabilitation services where these are available.
Patients with AMD are encouraged to stop smoking; to eat a balanced diet that has a low glycemic 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).[27] However, supplementation with omega-3 long-chain polyunsaturated fatty acids does not influence the risk of progressing to advanced AMD.[41]
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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).
Antioxidants plus zinc significantly reduce the development of advanced AMD in patients with intermediate or advanced AMD in at least one eye.[9][34][42][43]
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