Diabetes Mellitus and Risk of Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis

Abstract

Age-related macular degeneration (AMD) is a major cause of severe vision loss in elderly people. Diabetes mellitus is a common endocrine disorder with serious consequences, and diabetic retinopathy (DR) is the main ophthalmic complication. DR and AMD are different diseases and we seek to explore the relationship between diabetes and AMD. MEDLINE, EMBASE, and the Cochrane Library were searched for potentially eligible studies. Studies based on longitudinal cohort, cross-sectional, and case-control associations, reporting evaluation data of diabetes as an independent factor for AMD were included. Reports of relative risks (RRs), hazard ratios (HRs), odds ratio (ORs), or evaluation data of diabetes as an independent factor for AMD were included. Review Manager and STATA were used for the meta-analysis. Twenty four articles involving 27 study populations were included for meta-analysis. In 7 cohort studies, diabetes was shown to be a risk factor for AMD (OR, 1.05; 95% CI, 1.00–1.14). Results of 9 cross-sectional studies revealed consistent association of diabetes with AMD (OR, 1.21; 95% CI, 1.00–1.45), especially for late AMD (OR, 1.48; 95% CI, 1.44–1.51). Similar association was also detected for AMD (OR, 1.29; 95% CI, 1.13–1.49) and late AMD (OR, 1.16; 95% CI, 1.11–1.21) in 11 case-control studies. The pooled ORs for risk of neovascular AMD (nAMD) were 1.10 (95% CI, 0.96–1.26), 1.48 (95% CI, 1.44–1.51), and 1.15 (95% CI, 1.11–1.21) from cohort, cross-sectional and case-control studies, respectively. No obvious divergence existed among different ethnic groups. Therefore, we find diabetes a risk factor for AMD, stronger for late AMD than earlier stages. However, most of the included studies only adjusted for age and sex; we thus cannot rule out confounding as a potential explanation for the association. More well-designed prospective cohort studies are still warranted to further examine the association.

Visual complications in diabetes mellitus: beyond retinopathy

“…Risk factors for AMD include diabetes, prior eye diseases and cardiovascular comorbidities. A meta‐analysis of nine cross‐sectional studies showed that diabetes was a risk factor for AMD (OR 1.21; 95% CI 1.00–1.45), especially for late neovascular AMD (OR 1.48; 95% CI 1.44–1.51), but not for geographic atrophy . By contrast, the Blue Mountains Eye Study showed that diabetes was a predictor of incident geographic atrophy but not neovascular AMD .…”

Common eye diseases in older adults of southern Germany: results from the KORA-Age study

“…Besides these differences in ethnical association, association with diabetes is frequently being reported for (late) AMD, too [7]. …”

Visual and Morphologic Outcomes in Eyes with Hard Exudate in the Comparison of Age-Related Macular Degeneration Treatments Trials

“…18,19 Both diabetes and hypertension have been reported to be strong risk factors for NVAMD. 20–23 Although the presence of HE might indicate a severe form of diabetic and hypertensive retinopathy, the proportion of patients with diabetes or hypertension in the group with HE was similar to the proportion without HE. However, the CATT study eligibility criteria excluded patients who had any concurrent intraocular condition such as diabetic retinopathy that might require medical or surgical intervention during the two years of the study or, that could likely contribute to loss of vision over the two year follow-up period.…”