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Ophthalmology Oct 2013To evaluate the association between refractive errors and age-related macular degeneration (AMD). (Meta-Analysis)
Meta-Analysis Review
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.
Topics: Humans; Macular Degeneration; Refractive Errors
PubMed: 23706699
DOI: 10.1016/j.ophtha.2013.03.028 -
The Lancet. Global Health Feb 2021To contribute to the WHO initiative, VISION 2020: The Right to Sight, an assessment of global vision impairment in 2020 and temporal change is needed. We aimed to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
To contribute to the WHO initiative, VISION 2020: The Right to Sight, an assessment of global vision impairment in 2020 and temporal change is needed. We aimed to extensively update estimates of global vision loss burden, presenting estimates for 2020, temporal change over three decades between 1990-2020, and forecasts for 2050.
METHODS
We did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018. Only studies with samples representative of the population and with clearly defined visual acuity testing protocols were included. We fitted hierarchical models to estimate 2020 prevalence (with 95% uncertainty intervals [UIs]) of mild vision impairment (presenting visual acuity ≥6/18 and <6/12), moderate and severe vision impairment (<6/18 to 3/60), and blindness (<3/60 or less than 10° visual field around central fixation); and vision impairment from uncorrected presbyopia (presenting near vision
FINDINGS
In 2020, an estimated 43·3 million (95% UI 37·6-48·4) people were blind, of whom 23·9 million (55%; 20·8-26·8) were estimated to be female. We estimated 295 million (267-325) people to have moderate and severe vision impairment, of whom 163 million (55%; 147-179) were female; 258 million (233-285) to have mild vision impairment, of whom 142 million (55%; 128-157) were female; and 510 million (371-667) to have visual impairment from uncorrected presbyopia, of whom 280 million (55%; 205-365) were female. Globally, between 1990 and 2020, among adults aged 50 years or older, age-standardised prevalence of blindness decreased by 28·5% (-29·4 to -27·7) and prevalence of mild vision impairment decreased slightly (-0·3%, -0·8 to -0·2), whereas prevalence of moderate and severe vision impairment increased slightly (2·5%, 1·9 to 3·2; insufficient data were available to calculate this statistic for vision impairment from uncorrected presbyopia). In this period, the number of people who were blind increased by 50·6% (47·8 to 53·4) and the number with moderate and severe vision impairment increased by 91·7% (87·6 to 95·8). By 2050, we predict 61·0 million (52·9 to 69·3) people will be blind, 474 million (428 to 518) will have moderate and severe vision impairment, 360 million (322 to 400) will have mild vision impairment, and 866 million (629 to 1150) will have uncorrected presbyopia.
INTERPRETATION
Age-adjusted prevalence of blindness has reduced over the past three decades, yet due to population growth, progress is not keeping pace with needs. We face enormous challenges in avoiding vision impairment as the global population grows and ages.
FUNDING
Brien Holden Vision Institute, Fondation Thea, Fred Hollows Foundation, Bill & Melinda Gates Foundation, Lions Clubs International Foundation, Sightsavers International, and University of Heidelberg.
Topics: Aged; Aged, 80 and over; Blindness; Cataract; Eye Diseases; Female; Forecasting; Glaucoma; Global Burden of Disease; Global Health; Humans; Macular Degeneration; Male; Middle Aged; Presbyopia; Vision, Low; Visual Acuity
PubMed: 33275950
DOI: 10.1016/S2214-109X(20)30425-3 -
Journal of Clinical Medicine Jan 2022The use of anti-vascular endothelial growth factor (VEGF) agents has profoundly changed the prognosis of neovascular age-related macular degeneration (nAMD). As clinical... (Review)
Review
The use of anti-vascular endothelial growth factor (VEGF) agents has profoundly changed the prognosis of neovascular age-related macular degeneration (nAMD). As clinical experiences have accumulated, it has become mandatory to summarize data to give information that can be useful in everyday practice. We conducted a systematic review to identify randomized controlled trials (RCTs) and observational studies that reported 12-month changes in best-corrected visual acuity (BCVA) in patients with nAMD on anti-VEGF monotherapy. Data were analyzed in a random-effects meta-analysis with BCVA change as the primary outcome. Meta-regression was conducted to evaluate the impact of multiple covariates. Four hundred and twelve heterogeneous study populations (109,666 eyes) were included. Anti-VEGFs induced an overall improvement of +5.37 ETDRS letters at 12 months. Meta-regression showed that mean BCVA change was statistically greater for RCTs ( = 0.0032) in comparison with observational studies. Populations following a proactive regimen had better outcomes than those following a reactive treatment regimen. Mean BCVA change was greater in younger populations, with lower baseline BCVA and treated with a higher number of injections ( < 0.001). Our results confirm that anti-VEGFs may produce a significant functional improvement at 12 months in patients with nAMD.
PubMed: 35054021
DOI: 10.3390/jcm11020325 -
Canadian Journal of Ophthalmology.... Apr 2008Because of the prevalence and devastating consequences of age-related macular degeneration (AMD), a systematic review devoted to low-vision rehabilitation and AMD seems... (Review)
Review
BACKGROUND
Because of the prevalence and devastating consequences of age-related macular degeneration (AMD), a systematic review devoted to low-vision rehabilitation and AMD seems timely and appropriate.
METHODS
Several electronic databases were searched for studies from 1980 to 2006 involving individuals with low vision or visual impairment and rehabilitation interventions. Studies were assessed for quality and level of evidence.
RESULTS
The findings indicate that standard low-vision rehabilitation programs, conventional in-clinic assessments, and optical devices are effective ways of managing and living with vision loss. Areas of unmet need include determining which types of orientation and mobility programs and devices are most effective and developing methods of matching assistive technologies with the individual's visual and environmental requirements.
INTERPRETATION
Additional randomized controlled trials with similar intervention comparisons and outcome measures are needed to form stronger conclusions for the most effective low-vision rehabilitation interventions for individuals with AMD.
Topics: Humans; Macular Degeneration; Quality of Life; Randomized Controlled Trials as Topic; Sensory Aids; Vision, Low
PubMed: 18347620
DOI: 10.3129/i08-001 -
Ophthalmic Epidemiology Jun 2023In response to the recommendations of the World Health Organization (WHO) World report on vision, the WHO is developing a Package of Eye Care Interventions (PECI) to... (Review)
Review
BACKGROUND
In response to the recommendations of the World Health Organization (WHO) World report on vision, the WHO is developing a Package of Eye Care Interventions (PECI) to support the integration of eye care into health systems within countries. This study was done to systematically review clinical practice guidelines (CPGs) related to age-related macular degeneration (AMD) to provide evidence-based recommendations.
METHODS
All AMD-related CPGs published between 2010 and 2020 were reviewed and evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool.
RESULTS
Of 3778 CPGs identified, 48 underwent full-text screening and eight underwent quality appraisal. Five National Institute for Health and Care Excellence (NICE, UK) guidelines for AMD were finally selected for data extraction. Intravitreal anti-vascular endothelial growth factor (VEGF) treatment was strongly recommended for advanced, active neovascular AMD based on high-quality evidence. Photodynamic therapy and laser photocoagulation were not recommended as an adjunct to anti-VEGF therapy as first-line treatment for AMD. Recommendations on other interventions, including epiretinal brachytherapy, miniature lens system implantation, and limited macular translocation, were weak and evidence mostly came from low-quality case series studies. Hence these interventions were recommended to be used only with special arrangements or research. Existing evidence on treating geographic atrophy was limited, an implantable miniature telescope might be an effective intervention to improve vision but was still under investigation.
DISCUSSION
Current CPGs recommend anti-VEGF therapy for patients with late active neovascular AMD, while other interventions should be used with caution and further researches are warranted.
Topics: Humans; Angiogenesis Inhibitors; Vascular Endothelial Growth Factor A; Visual Acuity; Wet Macular Degeneration; Geographic Atrophy
PubMed: 35417274
DOI: 10.1080/09286586.2022.2059812 -
Molecular Diagnosis & Therapy Nov 2021The purpose of the review was to identify structural, functional, blood-based, and other types of biomarkers for early, intermediate, and late nonexudative stages of...
TOPIC
The purpose of the review was to identify structural, functional, blood-based, and other types of biomarkers for early, intermediate, and late nonexudative stages of age-related macular degeneration (AMD) and summarize the relevant data for proof-of-concept clinical trials.
CLINICAL RELEVANCE
AMD is a leading cause of blindness in the aging population, yet no treatments exist for its most common nonexudative form. There are limited data on the diagnosis and progression of nonexudative AMD compared to neovascular AMD. Our objective was to provide a comprehensive, systematic review of recently published biomarkers (molecular, structural, and functional) for early AMD, intermediate AMD, and geographic atrophy and to evaluate the relevance of these biomarkers for use in future clinical trials.
METHODS
A literature search of PubMed, ScienceDirect, EMBASE, and Web of Science from January 1, 1996 to November 30, 2020 and a patent search were conducted. Search terms included "early AMD," "dry AMD," "intermediate AMD," "biomarkers for nonexudative AMD," "fundus autofluorescence patterns," "color fundus photography," "dark adaptation," and "microperimetry." Articles were assessed for bias and quality with the Mixed-Methods Appraisal Tool. A total of 94 articles were included (61,842 individuals).
RESULTS
Spectral-domain optical coherence tomography was superior at highlighting detailed structural changes in earlier stages of AMD. Fundus autofluorescence patterns were found to be most important in estimating progression of geographic atrophy. Delayed rod intercept time on dark adaptation was the most widely recommended surrogate functional endpoint for early AMD, while retinal sensitivity on microperimetry was most relevant for intermediate AMD. Combinational studies accounting for various patient characteristics and machine/deep-learning approaches were best suited for assessing individualized risk of AMD onset and progression.
CONCLUSION
This systematic review supports the use of structural and functional biomarkers in early AMD and intermediate AMD, which are more reproducible and less invasive than the other classes of biomarkers described. The use of deep learning and combinational algorithms will gain increasing importance in future clinical trials of nonexudative AMD.
Topics: Aged; Angiogenesis Inhibitors; Biomarkers; Geographic Atrophy; Humans; Vascular Endothelial Growth Factor A; Visual Acuity; Wet Macular Degeneration
PubMed: 34432254
DOI: 10.1007/s40291-021-00551-5 -
Frontiers in Pharmacology 2022To investigate the association between long-term use of aspirin and age-related macular degeneration (AMD). An updated systematic literature search was conducted in...
To investigate the association between long-term use of aspirin and age-related macular degeneration (AMD). An updated systematic literature search was conducted in PubMed, Medline, Cochrane Library, and embase from conception to February 26, 2021, without any language restriction. All studies that evaluated the relationship between long-term aspirin use and AMD were included. In the current study, 16 articles were pooled. Overall, no significant association was observed (estimate ratio = 1.108, 95% confidence interval (CI): 0.886-1.385). When the subgroups were evaluated according to various standards, aspirin use was significantly correlated with AMD in studies with volunteer participants (estimate ratio = 0.899, 95% CI: 0.830-0.974, < 0.01), studies followed up for >10 years (estimate ratio = 2.206, 95% CI: 2.124-2.292, < 0.01), duration of aspirin use >10 years (estimate ratio = 2.323, 95% CI: 2.234-2.416, < 0.01), and cohort studies (estimate ratio = 1.961, 95% CI: 1.893-2.032, < 0.01). Therefore, the association of aspirin and AMD can be demonstrated with a long-term follow-up or aspirin use, appropriate study design and participant source. The findings in our study might provide practical information on intervention strategies.
PubMed: 35401184
DOI: 10.3389/fphar.2022.824745 -
Nutrients May 2022Age-related macular degeneration (AMD) is a serious degenerative disease affecting the eyes, and is the main cause of severe vision loss among people >55 years of age in... (Review)
Review
Age-related macular degeneration (AMD) is a serious degenerative disease affecting the eyes, and is the main cause of severe vision loss among people >55 years of age in developed countries. Its onset and progression have been associated with several genetic and lifestyle factors, with diet appearing to play a pivotal role in the latter. In particular, dietary eating patterns rich in plant foods have been shown to lower the risk of developing the disease, and to decrease the odds of progressing to more advanced stages in individuals already burdened with early AMD. We systematically reviewed the literature to analyse the relationship between the adherence to a Mediterranean diet, a mainly plant-based dietary pattern, and the onset/progression of AMD. Eight human observational studies were analysed. Despite some differences, they consistently indicate that higher adherence to a Mediterranean eating pattern lowers the odds of developing AMD and decreases the risk of progression to more advanced stages of the disease, establishing the way for preventative measures emphasizing dietary patterns rich in plant-foods.
Topics: Diet, Mediterranean; Eye; Feeding Behavior; Humans; Life Style; Macular Degeneration; Middle Aged
PubMed: 35631175
DOI: 10.3390/nu14102028 -
Seminars in Ophthalmology Oct 2021: Blue blocking (BB) lenses, including spectacles and intraocular lenses, work by attenuating short-wavelength light. BB glasses are being marketed with the aim to...
: Blue blocking (BB) lenses, including spectacles and intraocular lenses, work by attenuating short-wavelength light. BB glasses are being marketed with the aim to reduce eye fatigue symptoms when using digital devices, improve sleep quality and potentially confer protection from retinal phototoxicity. BB intraocular lenses following cataract surgery may be implanted because they are thought to prevent age-related macular degeneration (AMD) progression.: The present study is a systematic review aiming to analyze BB lenses clinical efficacy in preventing blue light-related ocular disorders, including AMD progression, eye fatigue, and their impact on sleep quality. We searched Medline, PubMed, Web of Science and the Cochrane Library until May 2020.:Although several studies have been performed investigating BB lenses, clinical efficacy for preventing or attenuating the above-mentioned ocular disorders is often theorical or based on laboratory or animal experiments. To date, there is a lack of consistent evidence for a larger-sclale introduction of BB lenses in the routine clinical practice.
Topics: Animals; Cataract Extraction; Humans; Lens, Crystalline; Lenses, Intraocular; Light; Macular Degeneration
PubMed: 33734926
DOI: 10.1080/08820538.2021.1900283 -
Nutrients Nov 2016The association between fish consumption and risk of age-related macular degeneration (AMD) is still unclear. The aim of the current meta-analysis and systematic review... (Meta-Analysis)
Meta-Analysis Review
The association between fish consumption and risk of age-related macular degeneration (AMD) is still unclear. The aim of the current meta-analysis and systematic review was to quantitatively evaluate findings from observational studies on fish consumption and the risk of AMD. Relevant studies were identified by searching electronic databases (Medline and EMBASE) and reviewing the reference lists of relevant articles up to August, 2016. Prospective cohort studies that reported relative risks (RRs) and 95% confidence intervals (CIs) for the link between fish consumption and risk of AMD were included. A total of 4202 cases with 128,988 individuals from eight cohort studies were identified in the current meta-analysis. The meta-analyzed RR was 0.76 (95% CI, 0.65-0.90) when any AMD was considered. Subgroup analyses by AMD stages showed that fish consumption would reduce the risk of both early (RR, 0.83; 95% CI, 0.72-0.96) and late (RR; 0.76; 95% CI, 0.60-0.97) AMD. When stratified by the follow-up duration, fish consumption was a protective factor of AMD in both over 10 years ( = 5; RR, 0.81; 95% CI, 0.67-0.97) and less than 10 years ( = 3; RR, 0.70; 95% CI, 0.51 to 0.97) follow-up duration. Stratified analyses by fish type demonstrated that dark meat fish (RR, 0.68, 95% CI, 0.46-0.99), especially tuna fish (RR, 0.58; 95% CI, 95% CI, 0.47-0.71) intake was associated with reduced AMD risk. Evidence of a linear association between dose of fish consumption and risk of AMD was demonstrated. The results of this meta-analysis demonstrated that fish consumption can reduce AMD risk. Advanced, well-designed, randomized clinical trials are required in order to validate the conclusions in this study.
Topics: Aged; Aged, 80 and over; Animals; Feeding Behavior; Female; Fishes; Humans; Incidence; Linear Models; Macular Degeneration; Male; Middle Aged; Observational Studies as Topic; Odds Ratio; Prospective Studies; Protective Factors; Risk Assessment; Risk Factors; Seafood; Time Factors
PubMed: 27879656
DOI: 10.3390/nu8110743