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We thank Dr Friedman for his interest in our article1 and for his comments regarding a model of the pathogenesis of age-related macular degeneration.2 We agree that there is little evidence to suggest that fatty plaques, characteristic of atherosclerosis in large vessels, accumulate in choroidal vessels. However, some studies have shown that risk factors for atherosclerosis are related to the presence of age-related macular degeneration. In a study of Dutch elderly, the risk for age-related macular degeneration was higher among people with plaques in the carotid artery and at the carotid bifurcation and in those with lower-extremity arterial disease.3 The presence of shared risk factors for arterial disease in several locations is consistent with the possibility that some processes in the pathogenesis of small-vessel arteriosclerosis, atherosclerosis, and age-related maculopathy may be shared. Experimental investigations are required to predict the pathogenic interrelationships of these conditions.
Mares-Perlman JA, Brady WE, Klein R, VandenLangenberg GM, Klein BEK, Palta M. Dietary Fat and Age-Related Maculopathy-Reply. Arch Ophthalmol. 1996;114(2):236. doi:10.1001/archopht.1996.01100130229032