Previous observational studies,44- 57 including 5 prospective studies,48,49,53,55,56 are suggestive of an inverse association between fish and ω-3 long-chain fatty acid intake and risks of advanced AMD (ie, neovascular AMD or central geographic atrophy). For example, recent prospective data from the Age-Related Eye Disease Study indicated that those with the highest consumption of DHA and EPA, compared with the lowest, had an approximate 30% lower risk of progression to advanced AMD that was apparent even after 12 years of follow-up.56 However, the data for early AMD are more limited and inconsistent. Of 5 cross-sectional studies that included cases of early AMD, 3 reported an inverse relation with advanced AMD only,45,46,51 and 2 reported no association with either early or advanced AMD.44,54 Interestingly, recent cross-sectional data from the Carotenoids in Age-Related Eye Disease Study indicated an increased risk of intermediate AMD for those with high intake of DHA and EPA.58 Data from 3 previous prospective studies provide only modest support for an inverse link between early AMD and fish and ω-3 long-chain fatty acid intake. A report based on 567 cases of visually significant (visual acuity 20/30 or worse) AMD identified during 10 to 12 years of follow-up of 42 000 women in the Nurses' Health Study and 30 000 men 50 years and older in the Health Professionals Follow-up Study found that higher intake of DHA was associated with a 30% lower risk of AMD (multivariable RR [high vs low quintile], 0.70; 95% CI, 0.52-0.93).59 However, the RR was attenuated and no longer significant after further adjustment for other fats. A similar nonsignificant inverse relation was observed for EPA in that study, while intake of α-linolenic acid was directly related to risks of AMD in a fully adjusted model (RR, 1.41; 95% CI, 1.00-1.98). That study also found that men and women who reported eating fish 4 or more times per week, compared with those who ate fish less than 4 times a month, had a 35% lower risk of AMD (RR, 0.65; 95% CI, 0.46-0.91). This lower risk appeared to be due largely to intake of canned tuna fish (RR, 0.61; 95% CI, 0.45-0.83); no association was observed for intake of dark- or white-meat fish in that study.59 In the Blue Mountains Eye Study, a repeated eye examination at 5 years for 2335 men and women 49 years and older documented 130 new cases of early AMD and 22 cases of late AMD.49 Participants in the highest quintile of intake for ω-3 long-chain fatty acids (DHA, docosapentaenoic acid, and EPA), compared with the lowest quintile, had a significantly lower risk of early AMD (odds ratio, 0.41; 95% CI, 0.22-0.75). Consumption of fish was also associated with significantly lower risks of early AMD (and late AMD) at the 5-year follow-up.49 However, at 10 years, the inverse relation between early AMD and intake of ω-3 long-chain fatty acids (DHA, docosapentaenoic acid, and EPA) and fish was attenuated and no longer significant.55 In a third study, conducted among 846 men and women in Reykjavik, Iceland, 50 years and older, a repeated eye examination at 5 years of follow-up documented 126 new cases of early AMD. Those who reported eating herring 2 times per week or more, vs less than once a month, had a 39% lower risk of early AMD (RR, 0.61; 95% CI, 0.37-1.00).60 Our data, based on 10 years of follow-up of a large cohort of female health professionals, are broadly consistent with these earlier findings and appear to be the strongest observational evidence to date in support of a possible role for intake of ω-3 long-chain fatty acids and fish in the primary prevention of AMD. Moreover, because early AMD is associated with an increased risk of developing advanced AMD (eg, 1 study showed that eyes with soft indistinct drusen or RPE abnormalities were approximately 20 to 40 times more likely to develop late AMD than were eyes without these lesions4), our data further suggest that dietary intake of ω-3 long-chain fatty acids and fish by persons at usual risk may ultimately reduce the number of persons who have advanced AMD.