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. 2021 Nov 4:8:759767.
doi: 10.3389/fmed.2021.759767. eCollection 2021.

Refractive Error and Eye Health: An Umbrella Review of Meta-Analyses

Yin-Hao Wang  1   2 , Chen Huang  1   3 , Yu-Lin Tseng  1   2 , Jing Zhong  1   2 , Xue-Min Li  1   2
Affiliations

Refractive Error and Eye Health: An Umbrella Review of Meta-Analyses

Yin-Hao Wang et al. Front Med (Lausanne). .

Abstract

Purpose: To explore the associations between refractive errors and multiple eye health outcomes. Methods: This is an umbrella review based on systematic reviews with meta-analyses. In our study, refractive errors included myopia, hyperopia, astigmatism, and anisometropia. We reconducted the meta-analyses whose primary data were available in sufficient detail by random effect model. Heterogeneity was assessed by I 2. The main outcomes included myopic macular degeneration (MMD), retinal detachment (RD), cataract, open-angle glaucoma (OAG), strabismus, age-related macular degeneration (AMD), and diabetic retinopathy (DR). Results: Myopia was associated with increased risk of MMD (relative risk = 102.11, 95% CI 52.6-198.22), RD (3.45, 1.08-11.00), nuclear cataract (2.15, 1.53-3.03), posterior subcapsular (PSC) cataract (1.74, 1.41-2.15), OAG (1.95, 1.74-2.19), exotropia (5.23, 2.26-12.09), but decreased risk of DR (0.83, 0.66-1.04), and early AMD (0.80, 0.67-0.94). From mild-to-high myopia, the association strengthened for MMD, RD, nuclear cataract, PSC cataract, OAG, and DR. Hyperopia was associated with an increased risk of early AMD (1.09, 1.01-1.18) and esotropia (22.94, 10.20-51.62). Astigmatism and anisometropia were associated with increased risk of both exotropia and esotropia. Conclusions: Myopia, especially high myopia, demonstrated the highest risk for eye health outcomes, such as MMD, RD, OAG, nuclear and PSC cataracts, and exotropia. However, myopia was associated with a lower risk of early AMD and DR. Individuals with hyperopia are more likely to suffer early AMD and esotropia. Astigmatism and anisometropia predispose to strabismus. A lot of research studies on the mechanism of the associations are needed. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=239744; identifier: 239744.

Keywords: age-related macular degeneration (AMD); cataract; diabetic retinopathy; eye health; glaucoma; refractive error; strabismus; umbrella review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the study selection for the meta-analysis and systematic review.
Figure 2
Figure 2
Associations of any myopia with multiple eye health outcomes.
Figure 3
Figure 3
Associations of different myopia types with multiple eye health outcomes.
Figure 4
Figure 4
High myopia vs. non-high myopia and changes (mean difference) in subfoveal choroidal thickness.
Figure 5
Figure 5
Associations of hyperopia, astigmatism, and anisometropia with multiple eye health outcomes.
Figure 6
Figure 6
Associations of changes in axial length and spherical equivalent with multiple eye health outcomes.
Figure 7
Figure 7
Evidence map of refractive error with regard to eye health outcomes. MMD, myopic macular degeneration; RD, retinal detachment; Re-RD, retinal re-detachment; SOR, silicone oil removal; OAG, open angle glaucoma; PSC, posterior subcapsular; AMD, age-related macular degeneration; DR, diabetic retinopathy; VTDR, vision-threatening diabetic retinopathy.
See this image and copyright information in PMC

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