![](https://assets.reachrx.ai/images/10.1038%E2%98%8Ds41433-025-04211-4/_page_0_Picture_1.jpeg) # **EDITORIAL** ![](https://assets.reachrx.ai/images/10.1038%E2%98%8Ds41433-025-04211-4/_page_0_Picture_3.jpeg) # An association between atrial fbrillation and age-related macular degeneration: looking beyond mere coincidence © The Author(s), under exclusive licence to The Royal College of Ophthalmologists 2026 *Eye*; Age-related macular degeneration (AMD) is a leading cause of visual loss in developed countries [[1](#page-1-0)]. Advanced age, smoking, and cardiovascular disorders such as hypertension, coronary artery disease, and hypercholesterolemia are among the signifcant risk factors for AMD [\[2](#page-1-0)]. Loss of vision is often due to destruction of normal macular structure from acute choroidal neovascularisation development (wet AMD) or progressive macular atrophy (dry AMD). Pathophysiologic mechanisms of AMD are indeed complex, initiated by drusen formation, chronic oxidative stress, and infammation leading to retinal pigment epithelium dysfunction, photoreceptor loss, and hypoxia-induced VEGF secretion, eventual development of choroidal neovascularisation [\[3\]](#page-1-0). In addition, abnormal markers of angiogenesis (VEGF), hemorheological factors, haemostasis, and endothelial dysfunction have been reported in AMD with an interaction with the components of Virchow's triad for thrombogenesis [[4](#page-1-0)]. Atrial fbrillation (AF), the most common arrhythmia worldwide, is associated with increased mortality and morbidity [\[5](#page-1-0)]. Age, hypertension, structural heart disease, sleep apnoea, and metabolic disorders are among the risk factors for AF [\[6\]](#page-1-0). Oxidative stress and infammation also play an important role in aforementioned pathophysiological mechanisms [[7](#page-1-0)], as well as abnormal endothelial damage/dysfunction and angiogenic factors [[8](#page-1-0)]. Given the above, AMD and AF share common features in terms of both risk factors and pathophysiological mechanisms (Fig. 1). Some studies have tried to shed light on the associations between these two conditions [\[9,](#page-2-0) [10\]](#page-2-0). The question is whether these disorders occur concomitantly in individuals of advancing age and comorbidities such as hypertension, diabetes, and dyslipidaemia. In Table [1,](#page-1-0) fndings of the studies evaluating association between AF and AMD are summarised. One cross-sectional study in participants undergoing coronary angiography reported a signifcant association was observed between early AMD (dry AMD, drusen formation only) and AF on univariate analysis, but not after adjustment for covariates [\[9](#page-2-0)]. Analysis of the prospective angiography INSPIRE database demonstrated that the long-term rate of AMD in the patients with AF over a mean 5.9 years of follow-up was signifcantly higher compared to those without AF (2.1% vs. 1.2%) [[10\]](#page-2-0). After adjustment for components of CHA2DS2-VASc score and cardiovascular medications, there was no signifcant association between AF and subsequent AMD at 1 or 5-years evaluation [[10\]](#page-2-0). In a retrospective observational study published in this journal, Tsai et al. [\[11](#page-2-0)] analysed the National Health Insurance Research Database of Taiwan to evaluate whether the incidence of AF was associated according to the AMD and vice versa. They reported the risk of developing AF was higher among AMD patients compared to those without AMD (incidence rate 9.85% vs 8.95%). ![](https://assets.reachrx.ai/images/10.1038%E2%98%8Ds41433-025-04211-4/_page_0_Figure_12.jpeg) **Fig. 1** Shared pathophysiological mechanisms and risk factors between atrial fbrillation and age-related macular degeneration. Received: 15 July 2025 Revised: 15 July 2025 Accepted: 19 December 2025 | | | | Diagnoses according to
patients to different AF | Diagnoses according to
patients to different AF | |-----------------------------------------------------------------------------------------------------------|---------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | | Comments | No sub-group analysis
Limited sample size
for wet vs dry AMD
No follow-up | No sub-group analysis
No sub-grouping AF
for wet vs dry AMD
ICD 9/10 codes
sub types | No sub-grouping AF
ICD 9/10 codes
sub types | | Summary of the studies evaluating association of atrial fbrillation and age-related macular degeneration. | Main fnding | Early AMD is not independently associated with AF
on a multivariable logistic regression (OR 0.66; 95%
CI 0.23–1.87). | Unadjusted AF–AMD association was signifcant
(HR 1.80; 95% CI 1.52–2.12) but didn't remain
signifcant after adjustment (HR 1.03; 95% CI
0.86–1.23) | (HR 1.10; 95% CI 1.04–1.17) and AMD is associated
AF is associated with developing new-onset AMD
with developing new-onset AF (HR 1.08; 95% CI
1.02–1.15) | | | Country | Australia | USA | Taiwan | | | Study design | Cross-sectional | Retrospective
longitudinal | Retrospective
longitudinal | | | Study population, AF and AMD patients, and
follow-up | 1576 Australian participants aged ≥ 75 y; Among
total study population, 147 AF patients and
1521 patients without AF, and 107 patients
had AMD. | 38,746 patients without prior AMD; among them
7187 had prevalent AF and 4600 developed AF;
312 developed AMD; mean follow-up of 6.4
years. | Adults ≥ 50 y from Taiwan's NHIRD; AMD cohort
n =∠31,726 and non-AMD n =∠31,997; AF cohort
n =∠33,958 and non-AF n =∠35, 827; mean follow
up of 6.40–6.46 years. | | Table 1. | publication year
First author, | Phan [9], 2014 | Bunch [10], 2025 | Tsai [11], 2025 | Similarly, the risk of developing AMD was higher among AF patients compared to those without (incidence rate 11.98% vs 10.88%). Although dry AMD was associated with developing AF (HR 1.09; 95% CI 1.02–1.16), this trend was not observed in patients with wet AMD (HR 0.94; 95% CI 0.74–1.19). Although this study had a large population-based cohort (31,766 patients in the AF cohort and 34,236 in the AMD cohort) with a follow-up of 6.4 years, the development of AMD, especially the dry type, can take much longer. Patients with AF have more comorbidities and more clinical visits; consequently, they have a higher likelihood of being diagnosed with AMD and vice versa. Also, the reported HRs for developing AMD/AF and developing AF/AMD indicate an absolute risk increase of 1.0–1.1 extra case(s) in 1000 patient-years, which is a small and perhaps not a clinically signifcant increased risk. Another important factor is that this study analysed east Asian patients and the generalisability of the results for other ethnicities remains limited, given the reported differences between Asians and non-Asians in terms of cardio vascular clinical epidemiology and complications [\[12](#page-2-0) –[14\]](#page-2-0). Given the above, it would not be unreasonable to regularly monitor visual acuity of older patients with AF and comorbidities and advise self-check symptoms of metamorphopsia or blurry central vision which would be highly indicative of early development of wet AMD. Further studies should evaluate the benefcial effect of risk-based screening for AF patients who are at higher risk of developing AMD. Lifestyle modifcation, healthy diet, smoking cessation, and management of comorbidities such as hypertension, diabetes, and dyslipidaemia might be benefcial for both conditions since they share common pathophysiological mechanisms and risk factors. Holistic, integrated approach should be implemented in clinically complex patients with advanced ages and social risk factors who are at higher risk of developing AF or AMD. Management of modifable risk factors, and closer follow-ups, and checking early sign of AMD in clinically complex AF patients are recommended. Amir Askarinejad [\]\]\]](http://orcid.org/0000-0003-2803-079X) 1 , Gregory Y. H. Lip [\]\]\]](http://orcid.org/0000-0002-7566-1626) 1 2 , 3 ✉ and Peck Lin Lip 4 *1 Liverpool Centre for Cardiovascular Sciences at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK. 2 Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. 3 Medical University of Bialystok, Bialystok, Poland. 4 Birmingham & Midland Eye Centre, City Hospital, Birmingham, UK.* ✉*email: [gregory.lip@liverpool.ac.uk](mailto:gregory.lip@liverpool.ac.uk)* ## **REFERENCES** - 1. GBD 2021 Global AMD Collaborators. Global burden of vision impairment due to age-related macular degeneration, 1990-2021, with forecasts to 2050: a sys tematic analysis for the Global Burden of Disease Study 2021. Lancet Glob Health. 2025;13:e1175–e90. - 2. Saigal K, Salama JE, Pardo AA, Lopez SE, Gregori NZ. Modifable lifestyle risk factors and strategies for slowing the progression of age-related macular degeneration. Vision. 2025;9:16. - 3. Ochoa Hernández ME, Lewis-Luján LM, Burboa Zazueta MG, Del Castillo Castro T, De La Re Vega E, Gálvez-Ruiz JC, et al. Role of oxidative stress and infammation in age related macular degeneration: insights into the retinal pigment epithe lium (RPE). Int J Mol Sci. 2025;26:3463. - 4. Lip PL, Blann AD, Hope-Ross M, Gibson JM, Lip GY. Age-related macular degeneration is associated with increased vascular endothelial growth factor, hemorheology and endothelial dysfunction. Ophthalmology. 2001;108:705–10. - 5. Askarinejad A, Lane DA, Sadeghipour P, Haghjoo M, Lip GYH. 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Thrombosis Haemost. 2024;124:883–92. ### **AUTHOR CONTRIBUTIONS** AA, GL, and PL jointly drafted and fnalised the text for the Editorial #### **RESEARCH FUNDING** None relevant to this Editorial. #### **COMPETING INTERESTS** The authors declare no competing interests. Eye