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Metformin and risk of age-related macular degeneration in individuals with type 2 diabetes: a retrospective cohort study
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  • Published on: 22 June 2023
    Quality of the coding and data on AMD
    • Dewi F Romdhoniyyah, PhD student Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
    • Other Contributors:
      • Nicholas Beare, Consultant ophthalmologist and senior lecturer

    We read with great interest the article of Gokhale et al [1] on their retrospective study of metformin use and risk of age-related macular degeneration (AMD) in individuals with type 2 diabetes mellitus (T2DM). In this study Gokhale and colleagues used data derived from IQVIA Medical Research Data (IMRD-UK), formerly known as The Health Improvement Network (THIN), and found no change in AMD risk in those taking metformin.

    An issue with this study is the quality of the GP coding and data on AMD. The authors cite a validation study of THIN data [2] but this study only validated cases identified as having AMD. There was no validation of the quality of data on the absence of AMD. So, the confirmation of positives was high (confirmed AMD cases quoted as 97%) but the false negative rate, is unknown. Also, the validation was by an ophthalmologist reviewing all the GP data, not using recognised diagnostic criteria or a grading scheme for AMD. Furthermore, the authors included a code for “drusen” into their AMD group which was not a code included in the validation study by Vassilev et al [2]. It is likely that this code includes patients with common physiological drusen and not an AMD diagnosis.

    We have previously performed a systematic review and meta-analysis [3] of five studies [4–8] on the relationship between metformin use and AMD, which we have now updated to include Gokhale et al [1] and Jiang et al [9]. Including their data, we found a beneficial odds ratio of...

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    Conflict of Interest:
    None declared.