Findings in MESA contrast with those from the 2 earlier population-based studies.4- 6 As noted above, in the Framingham Eye Study, decreased FVC and a history of lung infection were associated with AMD, and in the Beaver Dam Eye Study, a self-reported history of emphysema at baseline was associated with the 15-year incidence of RPE depigmentation (OR, 2.5; 95% CI, 1.3-4.8; P = .006) and exudative AMD (OR, 3.0; 95% CI, 1.0-8.4; P = .04).4,6 The associations in the Beaver Dam Eye Study remained after controlling for smoking and other factors. Additionally, in the Beaver Dam Eye Study, a history of respiratory symptoms (cough/phlegm/wheezing), first obtained at the 10-year follow-up, was associated with the 5-year incidence of exudative AMD (OR, 3.6; 95% CI, 1.4-9.3; P = .01) and progression of AMD (OR, 2.9; 95% CI, 1.4-6.0; P = .004), independent of a history of smoking. While controlling for age, smoking status, and a history of emphysema, peak expiratory flow rate was inversely associated with the 5-year incidence of 2 signs of early AMD, large drusen (fourth vs first quartile, OR, 0.4; 95% CI, 0.2-0.7; P = .001) and soft drusen (OR, 0.5; 95% CI, 0.3-0.9; P = .01), and progression of AMD (OR, 0.5; 95% CI, 0.2-1.0; P = .04). These prior cohort studies suggest that airflow obstruction and COPD may be a risk factor for AMD. We did not, in general, confirm these findings cross-sectionally in MESA, using lung function and novel measures of percent emphysema on CT scan. Because the association of airflow obstruction and emphysema appear to be modified by smoking history, this difference may be due to underlying differences in the smoking history of the 3 cohorts. The MESA cohort had no clinical cardiovascular disease at baseline, and participants in the current sample had to survive to participate in the third and fourth MESA examinations. The current sample is thus drawn from a “healthy” population, and the smoking exposure is less than in other previously studied cohorts.