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

Yin-Hao Wang; Chen Huang; Yu-Lin Tseng; Jing Zhong; Xue-Min Li

doi:10.3389/fmed.2021.759767

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

Front Med (Lausanne). 2021 Nov 4:8:759767. doi: 10.3389/fmed.2021.759767. eCollection 2021.

Authors

Yin-Hao Wang^{1

2}, Chen Huang^{1

3}, Yu-Lin Tseng^{1

2}, Jing Zhong^{1

2}, Xue-Min Li^{1

2}

Affiliations

¹ Department of Ophthalmology, Peking University Third Hospital, Beijing, China.
² Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China.
³ Center of Basic Medical Research, Peking University Third Hospital, Beijing, China.

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.

Publication types

Systematic Review