Obstructive Sleep Apnea and the Risk of Age-Related Macular Degeneration

Purpose: To evaluate the association between obstructive sleep apnea and age-related macular degeneration (AMD) and to characterize disease subtype distribution, age trends, and treatment patterns. Methods: A retrospective cross-sectional study was performed between January 1, 2020, and July 30, 2025, of patients aged 50 or older registered in the Epic electronic health record (EHR) system at the University of Miami. AMD prevalence was compared between patients with and without obstructive sleep apnea. Subanalyses included age distribution, AMD subtypes (exudative vs nonexudative), end-stage AMD, and intravitreal injections. Fisher exact test, χ² test, and Mann-Whitney U test were performed as appropriate. Results: The prevalence of AMD was higher in patients with obstructive sleep apnea compared with controls (1.996% of patients with obstructive sleep apnea vs 1.023% of controls; P < 4.4×10⁻⁷⁰). Patients with AMD who had obstructive sleep apnea were younger (mean ≈ 80.8 vs 84.9 years; P < 1.3×10⁻³⁵). Both exudative (odds ratio [OR], 1.71, P < .001) and nonexudative (OR, 1.47, P < .001) AMD were more common in patients with obstructive sleep apnea. Advanced nonexudative AMD, which was defined as nonexudative AMD with subfoveal involvement, was less frequent in patients with obstructive sleep apnea (7.7% vs 13.8%; OR, 0.52; P < 1×10⁻⁶). Number of intravitreal injections was higher among patients with exudative AMD who had obstructive sleep apnea (60.6% vs 48.0%; OR, 1.83; P < 1×10⁻⁸). Conclusions: Obstructive sleep apnea is associated with nearly double the prevalence of AMD, earlier age of onset, greater risk of both exudative and nonexudative subtypes, and higher intravitreal injection rates. These findings suggest obstructive sleep apnea may contribute to AMD pathogenesis and progression.