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

• Published in: Ophthalmology (Rochester, Minn.) Vol. 120; no. 10; pp. 2058 - 2065
• Main Authors: Pan, Chen-Wei, MD, PhD, Ikram, M. Kamran, PhD, Cheung, Carol Y., PhD, Choi, Hyung-Won, PhD, Cheung, Chiu-Ming Gemmy, MD, Jonas, Jost B., MD, Saw, Seang-Mei, MPH, PhD, Wong, Tien-Yin, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2013
• Subjects: Humans; Macular Degeneration - complications; Ophthalmology; Refractive Errors - etiology
• ISSN: 0161-6420; 1549-4713
• DOI: 10.1016/j.ophtha.2013.03.028

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.