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The risk of fracture in age-related macular degeneration according to the presence of visual disability: a nationwide cohort study



To evaluate the association between age-related macular degeneration (AMD) with or without visual disability (VD) and the risk of fracture using the National Health Insurance data in South Korea.


In total, 3,894,702 individuals who had taken part in health-screening programs between January 1, 2009, and December 31, 2009, were included in the cohort and followed until December 31, 2019. The participants with VD, which could be related to the severity of AMD, were defined as those with a loss of vision or visual field defect as certified by the Korean government’s Ministry of Health and Welfare. The hazard ratio was calculated for groups (control and AMD with/without VD) using the multivariable-adjusted cox regression analysis.


In total, 466,890 participants (11.99%) were diagnosed with fractures during the study period. An increased risk of fracture was observed in individuals with AMD compared with the control (adjusted hazard ratio (aHR), 1.09, 95% confidence interval (CI), 1.06–1.11). Furthermore, among the AMD individuals, an increased risk of fracture was prominent in individuals with VD (aHR 1.17, 95% CI 1.08–1.27) than those without VD (aHR 1.08, 95% CI 1.06–1.11) compared with the reference group (control).


AMD was associated with an increased risk of fracture even without VD. Prevention for fracture should be considered in AMD patients, especially when accompanied by VD.

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Fig. 1: Flow diagram for identifying the study population for incident fractures.
Fig. 2: Kaplan–Meier curves displaying the estimated incidence probability of fracture according to the presence of age-related macular degeneration with/without visual disability.

Data availability

The data supporting the findings of this study are available from the corresponding authors upon reasonable request.


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This work was supported by a National Research Foundation of Korea grant provided by the Korean government Ministry of Education (NRF-2021R1C1C1007795; Seoul, Korea), which was received by DHL. This research was partially supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI20C1073). The funding organizations had no role in the design or conduct of the study.

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Authors and Affiliations



JMY and DHL designed the research and wrote the main manuscript. BSK and KH performed the data collection and analysis. YL, HYK, SYJ, DWS and DIH reviewed the design and the results, and edited the final version of the manuscript.

Corresponding authors

Correspondence to Dong Wook Shin or Don-Il Ham.

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The authors declare no competing interests.

Ethical approval

All records in our database were anonymized. This study adhered to the Declaration of Helsinki and the study protocol was reviewed and approved by the institutional review board of Samsung Medical Center (SMC IRB no. 2022-03-060). Furthermore, the Deliberative Committee of the NHIS approved the conditional use of the database for this study.

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Yoon, J.M., Lim, D.H., Lee, YB. et al. The risk of fracture in age-related macular degeneration according to the presence of visual disability: a nationwide cohort study. Eye 38, 364–371 (2024).

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