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      Association between sunlight exposure and risk of age-related macular degeneration: a meta-analysis

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          Abstract

          Background

          A substantial number of epidemiological studies have investigated the possible associations between sunlight exposure and Age-related Macular Degeneration (AMD), but the results from studies are inconsistent. The aim of this meta-analysis was to evaluate the association between sunlight exposure and the risk of AMD.

          Methods

          Relevant studies were searched using databases including PubMed, EMBASE, and Web of Science database. Two authors independently extracted data and assessed study quality. The random-effects model was used to calculate the pooled covariates-adjusted odds ratio (OR). Subgroup analyses based on study design, stage of AMD, method of exposure assessment, and study latitude were carried out. The heterogeneity across the studies was tested, as was publication bias.

          Results

          Fourteen eligible studies including 43,934 individuals based on the inclusion criteria were analyzed. The pooled OR for sunlight exposure and AMD was 1.10 (95% CI = 0.98–1.23). In addition, similar insignificant results were observed in further subgroup analyses based on stage of AMD, method of exposure assessment, and study latitude. Sun-avoidance behavior did not decrease the risk of AMD (OR = 1.12, 95% CI = 0.76–1.67). Moderate heterogeneity was observed in most of analyses.

          Conclusion

          The results indicate that sunlight exposure may not be associated with increased risk of AMD based on current published data.

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          Most cited references34

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          Global data on visual impairment in the year 2002.

          This paper presents estimates of the prevalence of visual impairment and its causes in 2002, based on the best available evidence derived from recent studies. Estimates were determined from data on low vision and blindness as defined in the International statistical classification of diseases, injuries and causes of death, 10th revision. The number of people with visual impairment worldwide in 2002 was in excess of 161 million, of whom about 37 million were blind. The burden of visual impairment is not distributed uniformly throughout the world: the least developed regions carry the largest share. Visual impairment is also unequally distributed across age groups, being largely confined to adults 50 years of age and older. A distribution imbalance is also found with regard to gender throughout the world: females have a significantly higher risk of having visual impairment than males. Notwithstanding the progress in surgical intervention that has been made in many countries over the last few decades, cataract remains the leading cause of visual impairment in all regions of the world, except in the most developed countries. Other major causes of visual impairment are, in order of importance, glaucoma, age-related macular degeneration, diabetic retinopathy and trachoma.
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            An international classification and grading system for age-related maculopathy and age-related macular degeneration. The International ARM Epidemiological Study Group.

            A common detection and classification system is needed for epidemiologic studies of age-related maculopathy (ARM). Such a grading scheme for ARM is described in this paper. ARM is defined as a degenerative disorder in persons > or = 50 years of age characterized on grading of color fundus transparencies by the presence of the following abnormalities in the macular area: soft drusen > or = 63 microns, hyperpigmentation and/or hypopigmentation of the retinal pigment epithelium (RPE), RPE and associated neurosensory detachment, (peri)retinal hemorrhages, geographic atrophy of the RPE, or (peri)retinal fibrous scarring in the absence of other retinal (vascular) disorders. Visual acuity is not used to define the presence of ARM. Early ARM is defined as the presence of drusen and RPE pigmentary abnormalities described above; late ARM is similar to age-related macular degeneration (AMD) and includes dry AMD (geographic atrophy of the RPE in the absence of neovascular AMD) or neovascular AMD (RPE detachment, hemorrhages, and/or scars as described above). Methods to take and grade fundus transparencies are described.
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              The Wisconsin age-related maculopathy grading system.

              A new system for grading age-related maculopathy is described and measures of reliability are reported. A number of characteristics of age-related maculopathy are graded in a semiquantitative fashion from stereoscopic 30 degrees color fundus photographs, using a grid to define subfields, standard circles printed on plastic to assess size and area, and a specially designed lightbox to allow better discrimination of subtle drusen. The degree of exact agreement achieved between two trained graders across a variety of lesions ranged from 67.1% for drusen size to 99.6% for geographic atrophy. Kappa scores ranged from 0.55 (for drusen confluence) to 0.95 for geographic atrophy. This system will be useful in epidemiologic studies and clinical trials.
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                Author and article information

                Contributors
                +86-571-87165207 , zhjwood@163.com
                Journal
                BMC Ophthalmol
                BMC Ophthalmol
                BMC Ophthalmology
                BioMed Central (London )
                1471-2415
                20 December 2018
                20 December 2018
                2018
                : 18
                : 331
                Affiliations
                [1 ]Hangzhou Hospital for the Prevention and Treatment of Occupational Diseases, Zhejiang, Hangzhou China
                [2 ]GRID grid.412465.0, Department of Ophthalmology, College of Medicine, , the 2nd Affiliated Hospital of Zhejiang University, ; Zhejiang, Hangzhou China
                Author information
                http://orcid.org/0000-0002-7156-188X
                Article
                1004
                10.1186/s12886-018-1004-y
                6302450
                30572865
                1c7262d2-fecf-4239-b7e3-f249b9f115cb
                © The Author(s). 2018

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 20 May 2018
                : 10 December 2018
                Funding
                Funded by: The Medical and Health Science and Technology Program of Zhejiang Province
                Award ID: 2018242126
                Award Recipient :
                Funded by: Zhejiang Provincial Natural Science Foundation of China
                Award ID: LQ19H120006
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Ophthalmology & Optometry
                sunlight,macular degeneration,meta-analysis,risk factor
                Ophthalmology & Optometry
                sunlight, macular degeneration, meta-analysis, risk factor

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