The article by Vingerling et al,1 published in the October 1996 issue of the Archives, describes the association between smoking and age-related macular degeneration (AMD). Smoking increased the risk of macular degeneration only in persons aged 55 to 84 years; there was no increased risk for smoking in persons aged 85 years and older. The authors mentioned that the lack of association in this age group was possibly due to competitive risk factors and hypothesized that selective survival and a decreased response among the oldest persons might have influenced the results.
To be consistent with the international classification and grading system of AMD,2 we regraded the fundus transparencies from the Rotterdam Study. In addition, historical data and information from medical records were obtained to exclude other causes of maculopathy. Regrading did not alter the overall and age-specific prevalence of AMD in the Rotterdam Study. However, regrading did affect