Purpose To assess and compare refractive error and smoking habits in patients with exudative age-related macular degeneration (AMD) in a clinical setting. Methods The clinical comparative study included 379 patients (379 eyes) who underwent intravitreal application of an antivascular growth factor drug for the treatment of exudative AMD, and 191 patients without exudative macular degeneration and who underwent surgery for age-related cataract. Smoking status was compared with an agematched control group of the German population described in the census of 2003. The main outcome measures were refractive error, axial length, and data from a questionnaire on smoking habits. Results The AMD group compared with the cataract group showed a significantly shorter axial length (23.31 ± 0.75 vs 24.20 ± 1.56 mm; Po0.001) and was significantly more hyperopic (0.65 ± 2.14 vs À1.71 ± 4.57 dioptres; Po0.001). After the exclusion of pseudophakic AMD patients and matching by age and gender, the difference of refractive error and axial length between both groups remained to be statistically significant (Po0.001). The AMD group and the matched population group did not vary significantly in smoking history (age group: 55-75 years, current smokers: 18.4% vs 16.8% (P ¼ 0.64); former smokers: 23.2% vs 24.9% (P ¼ 0.66); age group 475 years, current smokers: 6.3% vs 6.4% (P ¼ 0.97); former smokers: 19.7% vs 22.8% (P ¼ 0.25)). Conclusions In our setting, an association was found between short axial length and AMD. We were not able to confirm the previously reported link between smoking and AMD. Eye Keywords: exudative age-related macular degeneration; hyperopia; smoking; macular degeneration; visual impairment Population-based studies, such as the Rotterdam Study, the Beaver Dam Study, and the Blue Mountains Eye Study have shown that smoking is a major risk factor for age-related macular degeneration (AMD). [1][2][3][4][5][6][7][8][9][10][11][12] In contrast, the findings of an association between hyperopia and AMD have been inconclusive so far. Although the Rotterdam Study, the AgeRelated Eye Disease Study, the Blue Mountains Eye Study, the French DMLA Study, and the Beijing Eye Study found an association between hyperopia and AMD, other large-scaled population-based investigations did not detect a correlation between both parameters.