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Eye disease and mortality, cognition, disease, and modifiable risk factors: an umbrella review of meta-analyses of observational studies

Abstract

Globally, 2.2 billion people live with some form of vision impairment and/or eye disease. To date, most systematic reviews examining associations have focused on a single eye disease and there is no systematic evaluation of the relationships between eye diseases and diverse physical and mental health outcomes. Moreover, the strength and reliability of the literature is unclear. We performed an umbrella review of observational studies with meta analyses for any physical and/or mental comorbidities associated with eye disease. For each association, random-effects summary effect size, heterogeneity, small-study effect, excess significance bias and 95% prediction intervals were calculated, and used to grade significant evidence from convincing to weak. 34 studies were included covering 58 outcomes. No outcomes yielded convincing evidence, six outcomes yielded highly suggestive results (cataract positively associated with type 2 diabetes, open-angled glaucoma positively associated with myopia and diabetes, diabetic retinopathy positively associated with cardiovascular disease and cardiovascular mortality, and retinopathy of prematurity positively associated with chorioamnionitis), eight outcomes yielded suggestive results (diabetic retinopathy positively associated with all-cause mortality and depression, diabetic macular oedema positively associated with dyslipidaemia, cataract positively associated with gout, nuclear sclerosis positively associated with all-cause mortality, open angled glaucoma positively associated with migraine and hypertension, and age-related macular degeneration positively associated with diabetes), and 18 outcomes yielded weak evidence. Results show highly suggestive or suggestive evidence for associations between several types of eye diseases with several comorbid outcomes. Practitioners and public health policies should note these findings when developing healthcare policies.

摘要

全球22亿人患有视力障碍和/或各种眼疾。到目前为止, 大多数系统综述都是针对眼病而进行的, 没有系统地评价眼病与各种生理和心理健康结果之间的关系。此外, 文献的影响力和可靠性尚不清楚。我们对与眼病相关的任何全身和/或精神共患疾病的meta分析的观察性研究进行了伞形评价。对于每项研究, 我们都计算了随机效应的总效应量、异质性、小型研究效应、显著性偏差和95%的可信区间, 并将显著性证据等级从信服到较弱进行了划分。共纳入34项研究, 包括58项结果。其中没有一项结果的证据等级达到信服, 6个结果的证据等级达到高度有意义 (白内障与2型糖尿病正相关, 开角型青光眼与近视和糖尿病正相关, 糖尿病视网膜病变与心血管疾病和心血管死亡率正相关, 早产儿视网膜病变与绒毛膜羊膜炎呈正相关, 8项结果的证据等级为有意义 (糖尿病视网膜病变与全因死亡率和抑郁呈正相关, 糖尿病黄斑水肿与血脂异常呈正相关, 白内障与痛风呈正相关, 核硬化与全因死亡率呈正相关, 开角型青光眼与偏头痛和高血压呈正相关, 年龄相关性黄斑变性与糖尿病呈正相关, 18项结果的证据不足。结果显示多种眼病与多种共患疾病之间的相关性为高度有意义或有意义等级的证据。相关人员在制定公共卫生保健政策时应注意这些发现。

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Fig. 1: Significant associations between various eye diseases and health outcomes.

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MT: conceptualisation, data collection, writing manuscript. LS: conceptualisation, supervision, critical appraisal of manuscript and revision writing; NV: conceptualisation, data analysis, writing manuscript, revision of manuscript; DP: conceptualisation, data analysis, writing manuscript, revision of manuscript; YB: conceptualisation, writing manuscript, critical appraisal; TG: conceptualisation, writing manuscript, critical appraisal; SP: conceptualisation, supervision, critical appraisal of manuscript and revision writing.

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Correspondence to Mike Trott.

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Trott, M., Smith, L., Veronese, N. et al. Eye disease and mortality, cognition, disease, and modifiable risk factors: an umbrella review of meta-analyses of observational studies. Eye 36, 369–378 (2022). https://doi.org/10.1038/s41433-021-01684-x

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