Diabetes mellitus and risk of age-related macular degeneration: a systematic review and meta-analysis

PLoS One. 2014 Sep 19;9(9):e108196. doi: 10.1371/journal.pone.0108196. eCollection 2014.


Age-related macular degeneration (AMD) is a major cause of severe vision loss in elderly people. Diabetes mellitus is a common endocrine disorder with serious consequences, and diabetic retinopathy (DR) is the main ophthalmic complication. DR and AMD are different diseases and we seek to explore the relationship between diabetes and AMD. MEDLINE, EMBASE, and the Cochrane Library were searched for potentially eligible studies. Studies based on longitudinal cohort, cross-sectional, and case-control associations, reporting evaluation data of diabetes as an independent factor for AMD were included. Reports of relative risks (RRs), hazard ratios (HRs), odds ratio (ORs), or evaluation data of diabetes as an independent factor for AMD were included. Review Manager and STATA were used for the meta-analysis. Twenty four articles involving 27 study populations were included for meta-analysis. In 7 cohort studies, diabetes was shown to be a risk factor for AMD (OR, 1.05; 95% CI, 1.00-1.14). Results of 9 cross-sectional studies revealed consistent association of diabetes with AMD (OR, 1.21; 95% CI, 1.00-1.45), especially for late AMD (OR, 1.48; 95% CI, 1.44-1.51). Similar association was also detected for AMD (OR, 1.29; 95% CI, 1.13-1.49) and late AMD (OR, 1.16; 95% CI, 1.11-1.21) in 11 case-control studies. The pooled ORs for risk of neovascular AMD (nAMD) were 1.10 (95% CI, 0.96-1.26), 1.48 (95% CI, 1.44-1.51), and 1.15 (95% CI, 1.11-1.21) from cohort, cross-sectional and case-control studies, respectively. No obvious divergence existed among different ethnic groups. Therefore, we find diabetes a risk factor for AMD, stronger for late AMD than earlier stages. However, most of the included studies only adjusted for age and sex; we thus cannot rule out confounding as a potential explanation for the association. More well-designed prospective cohort studies are still warranted to further examine the association.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Age Factors
  • Diabetes Mellitus / pathology*
  • Female
  • Humans
  • Macular Degeneration / complications*
  • Macular Degeneration / epidemiology
  • Male
  • Odds Ratio
  • Proportional Hazards Models
  • Risk Factors

Grant support

This work was supported by National Key Basic Research Program of China (2013CB967500); National Natural Science Foundation of China (No. 81222009 and 81170856); Thousand Youth Talents Program of China (to C.Z.); Jiangsu Outstanding Young Investigator Program (BK2012046); Jiangsu Province's Key Provincial Talents Program (RC201149); Jiangsu Province's Scientific Research Innovation Program for Postgraduates (CXZZ13_0590 to X.C.); an Endowment Fund for the Lim Por-Yen Eye Genetics Research Centre; the General Research Fund from the Research Grants Council of Hong Kong (No. 473410); and A Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD). The sponsor or funding organization had no role in the design or conduct of this research.