Psoriasis and AMD: a new study suggests an increased eye risk

Summary

Psoriasis is generally known for its red, scaly plaques, but it is not limited to the skin. It is a chronic inflammatory disease that can be accompanied by joint, metabolic and cardiovascular involvement.

A US study presented in 2025 now suggests that people with psoriasis may also have a higher risk of developing age-related macular degeneration, or AMD.

The researchers observed an increased risk of both dry and wet AMD in patients with psoriasis. They also found that people treated with biologic therapy had a lower risk than those treated only with topical corticosteroids.

These results are important, but remain observational. They do not allow us to state that psoriasis directly causes AMD, nor to prescribe a biologic in order to prevent a retinal disease.

What is AMD?

Age-related macular degeneration is a disease affecting the macula, the central area of the retina essential for fine vision. It can progressively impair:

• reading;
• face recognition;
• driving;
• the perception of details;
• central vision.

Peripheral vision is usually preserved. Two main forms are distinguished.

Dry AMD

The dry, or non-exudative, form is the most common. It usually progresses slowly and is characterised by the accumulation of deposits under the retina, called drusen, and sometimes by progressive atrophy of the retinal cells.

Wet AMD

The wet, or exudative, form is less common but potentially more aggressive. It involves the formation of abnormal blood vessels under the retina, which may leak or bleed. Without treatment, visual loss can be rapid.

Why study AMD in patients with psoriasis?

Psoriasis is now regarded as a systemic inflammatory disease. In some people, the inflammation does not concern only the skin. It can be associated with:

• obesity;
• insulin resistance;
• diabetes;
• high blood pressure;
• lipid abnormalities;
• an increased cardiovascular risk;
• psoriatic arthritis.

Several of these factors are also associated with AMD risk. The researchers therefore hypothesised that psoriasis and AMD might share certain biological mechanisms, notably chronic inflammation, oxidative stress and disturbances of lipid metabolism. Abnormal accumulation of lipids in retinal tissues is indeed among the mechanisms studied in AMD, while lipid dysregulation is common in systemic psoriasis.

How was the study carried out?

The University of Rochester team conducted a retrospective study based on US electronic medical records. It included 22,901 patients over 55 years old with psoriasis. The researchers compared them with three matched control groups:

• patients followed for melanocytic naevi;
• patients with major depression;
• people who had undergone an ophthalmological examination.

This choice of several control groups aimed to reduce certain biases, notably the fact that people with chronic disease consult more and may therefore receive a diagnosis more often. Patients who already had AMD at the start of the study were excluded. The database covered fifteen years, with an analysis of events over about ten years of follow-up.

What results were observed?

Compared with the major depression group, people with psoriasis had:

• an overall AMD risk 56% higher;
• a wet AMD risk 40% higher;
• a dry AMD risk 13% higher.

Compared with the group followed for melanocytic naevi, the overall AMD risk was 21% higher. These differences show that the magnitude of the risk varies according to the comparison group chosen.

It is also necessary to distinguish relative risk from absolute risk. A relative increase of 40 or 56% does not mean that the majority of patients will develop AMD. Individual risk also depends on age, smoking, genetics, family history and cardiovascular status.

Do biologics reduce the risk of AMD?

In a complementary analysis, the researchers compared psoriasis patients treated with biologic therapy with those receiving only topical corticosteroids and who had never received a biologic. Patients on biologics had a 27% lower AMD risk.

This observation is interesting, but it does not prove a direct protective effect. Several explanations are possible:

• better control of systemic inflammation;
• differences in medical follow-up;
• differences in age or comorbidities;
• a particular selection of patients receiving a biologic;
• an indirect modification of metabolic factors.

Even with statistical matching, an observational study cannot eliminate all confounding factors.

Which biologics are concerned?

The biologics used in psoriasis target different inflammatory pathways, notably TNF-α, interleukin 17, interleukin 23 and the common IL-12/23 subunit. The available study does not allow us to determine with certainty whether a particular class is more protective than another. It would therefore be wrong to conclude that an anti-TNF, an anti-IL-17 or an anti-IL-23 individually prevents AMD. More detailed analyses, by molecule and by duration of exposure, will be needed.

Does psoriasis directly cause AMD?

This is not demonstrated. The association could be linked to several common factors.

Smoking

Tobacco is a major risk factor for AMD. It is also associated with more severe psoriasis in some people.

Obesity and metabolic disorders

Excess weight, lipid abnormalities, diabetes and hypertension can contribute to vascular and retinal diseases.

Age

The risk of AMD increases sharply with age. Age therefore remains a far more important determinant than the presence of psoriasis alone.

Chronic inflammation

Persistent activation of certain inflammatory pathways could favour vascular and tissue alterations common to the skin and the retina.

Access to care

People treated with biologics are often followed more regularly, which can influence the prevention, screening and management of other risk factors.

Can psoriasis already affect the eyes in other ways?

Yes. Psoriasis can be associated with several ocular manifestations, independently of AMD: dry eye, blepharitis, conjunctivitis, eyelid involvement, and uveitis (especially in psoriatic arthritis). Ocular discomfort in a person with psoriasis therefore does not automatically correspond to AMD. The nature of the symptoms, age and the ophthalmological examination help guide the diagnosis.

What symptoms should prompt a rapid consultation?

A rapid ophthalmological consultation is recommended in case of:

• sudden or progressive decline in central vision;
• straight lines appearing wavy;
• distortion of letters or objects;
• the appearance of a dark spot in the centre of vision;
• unusual difficulty reading;
• a new difference between the two eyes.

These signs are not specific to AMD, but they justify an evaluation. A simple test is to regularly look at an Amsler grid, one eye after the other. Any new distortion should be reported to a health professional.

Should systematic screening be organised in all psoriasis patients?

Not at this stage. The study authors recommend following the usual ophthalmological guidelines and consulting promptly in case of visual change. They specify that the data are still insufficient to establish a specific screening programme for all psoriasis patients. Closer monitoring may nevertheless be reasonable in people combining several risk factors:

• age over 55 or 60;
• smoking;
• family history of AMD;
• cardiovascular disease;
• hypertension;
• lipid disorders;
• visual symptoms;
• long-standing or severe psoriasis.

Can AMD be prevented?

There is no absolute prevention, but some factors are modifiable. The main measures are:

• stopping smoking;
• controlling blood pressure;
• managing diabetes and lipid abnormalities;
• maintaining regular physical activity;
• favouring a diet rich in green vegetables, fruit, legumes and fish;
• having ophthalmological follow-up adapted to age and risk factors.

AREDS2-type supplements are not recommended for anyone simply because they have psoriasis. They are reserved for certain forms of AMD already diagnosed, on ophthalmological advice.

Should psoriasis treatment be changed?

No, not on the basis of this study alone. A biologic must be prescribed to treat moderate-to-severe psoriasis or psoriatic arthritis, according to validated indications. It should not be started solely to prevent AMD. Likewise, a patient on a biologic should not consider themselves protected against retinal diseases. Other risk factors remain important and the usual visual follow-up remains necessary.

What this study does not demonstrate

This study does not prove that:

• psoriasis directly causes AMD;
• everyone with psoriasis will develop macular disease;
• biologics prevent AMD;
• a specific class of biologic better protects the retina;
• topical corticosteroids themselves increase the risk;
• intensive ophthalmological screening is necessary in all patients;
• treating mild psoriasis more aggressively will reduce eye risk.

This is a retrospective study presented at a congress. Its results are hypothesis-generating and will need to be reproduced in prospective studies and in complete peer-reviewed publications.

The Valorian analysis

This study reinforces an essential idea: psoriasis should no longer be seen as a disease limited to the surface of the skin. In some patients it is part of a global inflammatory context associating joint, metabolic and cardiovascular risk. The hypothesis of an association with AMD is therefore biologically credible.

However, the word "confirmed" would be premature. The study shows an association, not a cause-and-effect relationship. The reduction in risk observed with biologics may reflect better control of inflammation, but also differences between the treated populations.

For Valorian, the most reasonable clinical consequence is twofold: to integrate visual health into the overall assessment of older patients with psoriasis; and to actively control common risk factors, notably tobacco, hypertension, diabetes, obesity and lipid abnormalities. The aim is not to over-medicalise all patients, but to avoid a systemic inflammatory disease being managed solely through the visible treatment of its skin plaques.

Valorian level of evidence

Scientific quality: ★★★☆☆ (3/5) — The study is based on a large cohort, several control groups and statistical matching. However, it remains retrospective, observational and mainly derived from a congress presentation. It does not demonstrate causation.
Current clinical application: ★★★☆☆ (3/5) — The results justify visual vigilance and comprehensive management of cardiovascular and metabolic factors. They do not yet justify universal specific screening or a change in psoriasis treatment.
Future potential: ★★★★☆ (4/5) — Prospective studies integrating retinal imaging, psoriasis severity and the different classes of biologics could clarify whether controlling inflammation actually modifies the risk or course of AMD.