Centre for Vision Science, Queen's University Belfast, Northern Ireland, UK.
BMC Ophthalmol. 2010 Dec 13;10:31. doi: 10.1186/1471-2415-10-31.
Age-related macular degeneration (AMD) is the leading cause of blindness in Western countries. Numerous risk factors have been reported but the evidence and strength of association is variable. We aimed to identify those risk factors with strong levels of evidence which could be easily assessed by physicians or ophthalmologists to implement preventive interventions or address current behaviours.
A systematic review identified 18 prospective and cross-sectional studies and 6 case control studies involving 113,780 persons with 17,236 cases of late AMD that included an estimate of the association between late AMD and at least one of 16 pre-selected risk factors. Fixed-effects meta-analyses were conducted for each factor to combine odds ratio (OR) and/or relative risk (RR) outcomes across studies by study design. Overall raw point estimates of each risk factor and associated 95% confidence intervals (CI) were calculated.
Increasing age, current cigarette smoking, previous cataract surgery, and a family history of AMD showed strong and consistent associations with late AMD. Risk factors with moderate and consistent associations were higher body mass index, history of cardiovascular disease, hypertension, and higher plasma fibrinogen. Risk factors with weaker and inconsistent associations were gender, ethnicity, diabetes, iris colour, history of cerebrovascular disease, and serum total and HDL cholesterol and triglyceride levels.
Smoking, previous cataract surgery and a family history of AMD are consistent risk factors for AMD. Cardiovascular risk factors are also associated with AMD. Knowledge of these risk factors that may be easily assessed by physicians and general ophthalmologists may assist in identification and appropriate referral of persons at risk of AMD.
年龄相关性黄斑变性（AMD）是西方国家致盲的主要原因。已有大量报道称存在多种风险因素，但关联的证据和强度各不相同。我们旨在确定那些具有较强证据水平的风险因素，这些因素可以由医生或眼科医生轻松评估，以实施预防干预或解决当前的行为。
系统评价确定了 18 项前瞻性和横断面研究以及 6 项病例对照研究，共涉及 113780 名患者和 17236 例晚期 AMD，其中包括晚期 AMD 与至少 16 个预先选择的风险因素之间的关联估计。按研究设计对每个因素进行固定效应荟萃分析，以跨研究合并优势比（OR）和/或相对风险（RR）结果。计算每个风险因素的总体原始点估计值及其相关的 95%置信区间（CI）。
年龄增长、当前吸烟、既往白内障手术和 AMD 家族史与晚期 AMD 有很强的一致性关联。具有中度和一致性关联的风险因素是较高的体重指数、心血管疾病史、高血压和较高的血浆纤维蛋白原。与性别、种族、糖尿病、虹膜颜色、脑血管疾病史以及血清总胆固醇和高密度脂蛋白胆固醇和甘油三酯水平相关的风险因素则较弱且不一致。
吸烟、既往白内障手术和 AMD 家族史是 AMD 的一致危险因素。心血管危险因素也与 AMD 相关。了解这些风险因素，这些因素可能由医生和普通眼科医生轻松评估，可能有助于识别和适当转介有 AMD 风险的患者。
