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Associations of ophthalmic and systemic conditions with incident dementia in the UK Biobank
  1. Xianwen Shang1,2,
  2. Zhuoting Zhu1,2,
  3. Yu Huang1,2,
  4. Xueli Zhang1,2,
  5. Wei Wang3,
  6. Danli Shi3,
  7. Yu Jiang3,
  8. Xiaohong Yang1,
  9. Mingguang He1,3,4
  1. 1 Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
  2. 2 Guangdong Cardiovsacular Institute, Guangzhou, Guangdong, People's Republic of China
  3. 3 State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center State Key Laboratory of Ophthalmology, Guangzhou, China
  4. 4 Centre for Eye Research Australia, Melbourne, Victoria, Australia
  1. Correspondence to Dr Mingguang He, Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangzhou, China; mingguang_he{at}; Dr Xiaohong Yang; syyangxh{at}


Aims To examine independent and interactive associations of ophthalmic and systemic conditions with incident dementia.

Methods Our analysis included 12 364 adults aged 55–73 years from the UK Biobank cohort. Participants were assessed between 2006 and 2010 at baseline and were followed up until the early of 2021. Incident dementia was ascertained using hospital inpatient, death records and self-reported data.

Results Over 1 263 513 person-years of follow-up, 2304 cases of incident dementia were documented. The multivariable-adjusted HRs (95% CI) for dementia associated with age-related macular degeneration (AMD), cataract, diabetes-related eye disease (DRED) and glaucoma at baseline were 1.26 (1.05 to 1.52), 1.11 (1.00 to 1.24), 1.61 (1.30 to 2.00) and (1.07 (0.92 to 1.25), respectively. Diabetes, heart disease, stroke and depression at baseline were all associated with an increased risk of dementia. Of the combination of AMD and a systemic condition, AMD-diabetes was associated with the highest risk for incident dementia (HR (95% CI): 2.73 (1.79 to 4.17)). Individuals with cataract and a systemic condition were 1.19–2.29 times more likely to develop dementia compared with those without cataract and systemic conditions. The corresponding number for DRED and a systemic condition was 1.50–3.24. Diabetes, hypertension, heart disease, depression and stroke newly identified during follow-up mediated the association between cataract and incident dementia as well as the association between DRED and incident dementia.

Conclusions AMD, cataract and DRED but not glaucoma are associated with an increased risk of dementia. Individuals with both ophthalmic and systemic conditions are at higher risk of dementia compared with those with an ophthalmic or systemic condition only.

  • glaucoma
  • contact lens
  • macula
  • epidemiology

Data availability statement

Data are available in a public, open access repository. Data are available in a public, open access repository (

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Data availability statement

Data are available in a public, open access repository. Data are available in a public, open access repository (

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  • Contributors XS, XY and MH conceived the study. XS and ZZ did the literature search, data analysis and data interpretation. DS and YJ did data acquisition. XS drafted the initial manuscript. All authors critically revised the manuscript.

  • Funding This work was supported by the Fundamental Research Funds of the State Key Laboratory of Ophthalmology, Project of Investigation on Health Status of Employees in Financial Industry in Guangzhou, China (Z012014075) and Science and Technology Program of Guangzhou, China (202002020049). MH received support from the University of Melbourne at Research Accelerator Program and the CERA Foundation. The Centre for Eye Research Australia received Operational Infrastructure Support from the Victorian State Government.

  • Disclaimer The sponsor or funding organisation had no role in the design, conduct, analysis or reporting of this study. The funding sources did not participate in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript and decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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