Purpose : Long-term blood pressure variability (BPV) has emerged as a risk factor for various health problems, including eye diseases. Yet, its role on age-related macular degeneration (AMD) onset remains unknown. This population-based longitudinal cohort study aimed to test the hypothesis that a higher BPV is associated with an increased risk of early or advanced AMD in older adults. Methods : The ALIENOR (Antioxidants, LIpides Essentiels, Nutrition et maladies OculaiRes) study included 963 participants aged 73 years and older from the 3-City study (3C), followed every 2-3 years in Bordeaux, France (2006-2020). We analyzed those who had at least two blood pressure (BP) measurements, and were free of early and/or advanced AMD at baseline, according to the form studied. BP was measured every 2-3 years in 3C (1999-2017). Systolic (SBPV), diastolic (DBPV) and pulse (PPV) BPV were determined by the standard deviation method at each visit and considered as time-dependent variables. AMD was classified using retinal color photographs and optical coherence tomography imaging. After multiple imputation on covariates, shared random effects joint models fitted individual BPV trajectories (longitudinal data) and quantified their effect on AMD onset (survival data). Using the R package JMbayes2, the Bayesian approach yielded mean adjusted Hazard Ratios (aHR) of AMD and their 95% credible intervals (95%CrI). Results : Of 475 and 692 participants analyzed, 36% and 10% developed respectively early and advanced AMD, after a mean follow-up of 8 years. BPV was not associated with an increased risk of early AMD (aHR: 0.95, 95%CrI: 0.81–1.09, p=0.47; aHR: 0.95, 95%CrI: 0.71–1.30, p=0.75; and aHR: 0.90, 95%CrI: 0.75–1.06, p=0.21; for a 5-mmHg increase in SBPV, DBPV and PPV respectively). Conversely, the risk of advanced AMD was significantly 60% higher for a 5-mmHg increase in DBPV (aHR: 1.60, 95%CrI: 1.05–2.43, p=0.03), whereas significance was not reached for a 5-mmHg increase in SBPV (aHR: 1.20, 95%CrI: 0.95–1.52, p=0.12) and PPV (aHR: 1.13, 95%CrI: 0.85–1.49, p=0.39). Complete case analysis revealed similar results. Conclusions : Among BPV components, only higher DBPV was associated with an increased risk of advanced AMD, and none was associated with an increased risk of early AMD. However, replicating the study in other contexts is necessary to confirm these results.< Réduire