Article Text

Download PDFPDF
Smoking, dietary factors and major age-related eye disorders: an umbrella review of systematic reviews and meta-analyses
  1. Jia-Yan Kai1,
  2. Miao Zhou2,3,
  3. Dan-Lin Li1,
  4. Ke-Yao Zhu4,
  5. Qian Wu1,
  6. Xiao-Feng Zhang5,
  7. Chen-Wei Pan1
  1. 1School of Public Health, Medical College of Soochow University, Suzhou, China
  2. 2Department of Ophthalmology, Peking University People's Hospital, Beijing, China
  3. 3Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
  4. 4Pasteurien College of Soochow University, Suzhou, China
  5. 5Department of Ophthalmology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
  1. Correspondence to Prof Chen-Wei Pan, School of Public Health, Medical College of Soochow University, Suzhou, China; pcwonly{at}; Dr Xiao-Feng Zhang, Department of Ophthalmology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China; zhangxiaofeng{at}


Background There is accumulating evidence of the associations between age-related eye diseases (AREDs) and smoking or dietary factors. We aimed to provide an umbrella review of the published literature pertaining to smoking or dietary intake as risk factors for major AREDs including cataract, glaucoma, age-related macular degeneration (AMD) and diabetic retinopathy.

Methods We searched for pertinent systematic reviews or meta-analyses in PubMed and Web of Science until 16 April 2022. We reperformed the meta-analysis of each association using random effects models. The heterogeneity and 95% prediction interval were calculated. The presence of small-study effect or excess significance bias was also assessed.

Results In total, 64 associations from 25 meta-analyses and 41 associations from 10 qualitative systematic reviews were evaluated. There was convincing (class I) evidence for only one association, namely current smoking and cataract. Two factors had highly suggestive (class II) evidence, namely ever smoking associated with cataract and fish consumption associated with AMD. We also found suggestive (class III) evidence for associations between the dietary intake of omega-3 polyunsaturated fatty acid, lutein, zeaxanthin, vitamin C and the risk of cataract.

Conclusions Smoking as a risk factor for cataract was the most robust association we identified. We also identified several dietary elements associated with AREDs. Large prospective studies are warranted to further examine the associations discussed in this review.

PROSPERO registration number CRD42022339082.

  • Glaucoma
  • Macula
  • Retina
  • Degeneration

Data availability statement

Data are available in a public, open access repository.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available in a public, open access repository.

View Full Text


  • J-YK, MZ and D-LL contributed equally.

  • Contributors C-WP, X-FZ, MZ and QW contributed substantially to the conception and design of this paper. J-YK and K-YZ conducted the literature searches and extracted the data from published papers. J-YK and MZ drafted the paper and carried out the statistical analysis. J-YK and D-LL revised the article. C-W P is guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • 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.