Elsevier

Ophthalmology

Volume 120, Issue 10, October 2013, Pages 2058-2065
Ophthalmology

Original article
Refractive Errors and Age-related Macular Degeneration: A Systematic Review and Meta-Analysis

https://doi.org/10.1016/j.ophtha.2013.03.028Get rights and content

Objective

To evaluate the association between refractive errors and age-related macular degeneration (AMD).

Main Outcome Measures

A clear understanding of the relationship between refractive error and AMD provides insights into the pathophysiology of AMD.

Methods

We searched PubMed and Embase from their inception to July 2012 for population-based studies with data on refractive error and AMD assessed from retinal photographs at baseline and follow-up. We performed separate meta-analyses for cross-sectional studies and cohort studies using adjusted odds ratios (ORs) and hazard ratios (HRs) under random effects models, respectively.

Results

Analysis of the 6 cross-sectional studies showed that hyperopia was associated with higher odds of prevalent AMD (pooled OR hyperopia vs. emmetropia: 1.16; 95% confidence interval [CI], 1.04–1.29) and that myopia was associated with lower odds of prevalent AMD (pooled OR myopia vs. emmetropia: 0.75; 95% CI, 0.61–0.92). Analysis from the 3 cohort studies showed nonsignificant associations. Analysis of the 5 cross-sectional and 2 cohort studies showed that each diopter increase in spherical equivalent was associated with increased odds of both prevalent (pooled OR, 1.09; 95% CI, 1.06–1.12) and incident (pooled HR, 1.06; 95% CI, 1.02–1.10) AMD. In 3 cross-sectional studies with data on axial length, each millimeter increase in axial length was associated with a decreased odd of prevalent AMD (pooled OR, 0.76; 95% CI, 0.69–0.85).

Conclusions

Refractive error is associated with AMD, although a temporal relationship cannot be determined on the basis of current evidence. Ophthalmologists should be aware that risk of AMD clinically seems to vary by refractive status.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Eligibility Criteria

We included studies if they were population-based, reported refractive error as an independent variable, and reported AMD or early AMD as the outcome measure. “Population-based” pertains to a general population defined by geopolitical boundaries; this population is the sampling frame.9 We only included studies in which AMD was assessed from fundus photographs based on standardized protocols, such as the Wisconsin grading system10 or the International AMD Classification.11 Furthermore, we

Results

We identified 751 unique titles and abstracts, from which we retrieved 28 full text articles for review. We included 6 population-based cross-sectional studies6, 15, 20, 21 (including the Singapore Indian Eye Study) and 3 cohort studies7, 8, 21 in this review (Fig 1).

Characteristics of the 6 cross-sectional and 3 cohort studies included in the meta-analysis are summarized in Table 1. Among the 6 cross-sectional studies, 4 were conducted in Asia, 1 was conducted in Australia, and the remaining 1

Discussion

In this systematic review and meta-analysis, we found that refractive error, when analyzed as a continuous variable for each diopter toward hyperopia, is associated with both prevalent and incident AMD on the basis of 5 cross-sectional and 2 cohort studies (Table 4). When considering categorized analyses, data from 6 cross-sectional studies showed that hyperopic eyes are associated with higher odds, whereas myopic eyes are associated with lower odds of prevalent AMD compared with emmetropic

Acknowledgment

The authors thank the Central India Eye and Medical Study Group for sharing their dataset.

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      Other refractive errors can also impact ocular health. Hyperopia is a known risk factor for angle closure,6 age-related macular degeneration,3 amblyopia and strabismus.7 Astigmatism can lead to significant decreases in visual acuity, visual comfort, quality of life and independence if uncorrected,8,9 while anisometropia is associated with reduced binocular function and stereoacuity10 and can lead to amblyopia if uncorrected in children.11

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    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    This study was funded by the Biomedical Research Council, 08/1/35/19/550, and National Medical Research Council, STaR/0003/2008, Singapore.

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