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American author and humorist Mark Twain once remarked that it was easy to quit smoking. He had done it a hundred times!

But unlike Twain, the effects of smoking are far from funny. It can lead to various diseases, including age-related macular degeneration (AMD).

AMD currently affects 30 million people worldwide and is the leading cause of blindness in people over 50. By 2020, experts say that as many as 7.5 million people over 65 may have AMD and lose their vision.

Non-modifiable risk factors for AMD are age and a family history of the disease. One modifiable risk factor that you can control and avoid is smoking.

The role of smoking in the development of AMD is no longer controversial since several studies have already established this fact.

One of them is the Physicians' Health Study, a randomized, double-blind, placebo-controlled trial of aspirin in reducing the risks of cardiovascular disease among 22,071 American male physicians aged 40 to 84 years.

In that study, participants were asked about their smoking habits ' whether they were current smokers, past smokers or non-smokers. Through annual mailed questionnaires, the subjects were asked how many cigarettes a day they smoked, including the age at which they started and stopped smoking. Information on whether the subjects had AMD with or without vision loss was also collected and confirmed by medical record review.

Based on the information they acquired, researchers found that 11 percent of the subjects were current smokers, 39 percent were past smokers, and 50 percent never smoked. During an average of 12.2 person-years of follow up, 268 cases of AMD with vision loss were confirmed.

'These prospective data from a large population of male physicians indicate that cigarette smoking increases the risk of AMD in a dose-dependent fashion. Current smokers of one pack or more of cigarettes daily had a two- to three-fold increased risk of AMD with vision loss compared with non-smokers,' according to W. Christen in 'A prospective study of cigarette smoking and risk of age-related macular degeneration in men' published in the Journal of the American Medical Association.

'Current smokers of less than a pack of cigarettes daily had no significant increase in risk of AMD. Former smokers of one pack or more per day continued to have a 40 percent to 80 percent excess risk of AMD with vision loss for many years following smoking cessation,' Christen added.

How does smoking lead to AMD? No one knows for sure but several explanations have been presented. One is that smoking triggers the activation of free radicals that damage the retina. Another is that smoking reduces blood flow to the eye and causes changes that lead to the development of AMD.

If you're serious about reducing your risk of AMD, now is the best time to stop smoking. If you've never smoked at all, don't start! Incidentally, smoking has also been linked to the development of wrinkles and other signs of aging. That may partly explain why you have eye bags, dark circles, and fine lines in that area.