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Cited by 854Retinal Diseases and TreatmentsRetinal Imaging and AnalysisOphthalmology and Visual Impairment Studies

Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis

Open access
Chakravarthy, Usha, Wong, Tien Y, Fletcher, Astrid, Piault, Elisabeth, Evans, Christopher, Zlateva, Gergana, Buggage, Ronald, Pleil, Andreas +1 more·2010·BMC Ophthalmology
DOI 10.1186/1471-2415-10-31PMC PMC3009619
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Abstract

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and meta-analysis found increasing age, current smoking, previous cataract surgery, and family history of AMD were strong and consistent risk factors for late AMD, with cardiovascular/metabolic factors showing moderate associations. It synthesizes 45 retained articles to identify risk factors that can be assessed by primary care physicians and general ophthalmologists.

Key findings

  • Strong and consistent associations with late AMD were reported for increasing age, current cigarette smoking, previous cataract surgery, and family history of AMD. Smoking: prospective RR 1.86 (95% CI 1.27–2.73), cross-sectional OR 3.58 (2.68–4.79), case-control OR 1.78 (1.52–2.09). Cataract surgery: prospective RR 3.05 (2.05–4.55), cross-sectional OR 1.59 (1.08–2.34), case-control OR 1.54 (1.24–1.91). Family history: cross-sectional OR 3.95 (1.35–11.54); case-control OR 6.18 (0.98–38.90) in Table 3.
  • Moderate and consistent associations were reported for higher BMI (case-control OR 1.52, 1.15–2.00; prospective RR 1.28, 0.98–1.67), history of cardiovascular disease (case-control OR 2.20, 1.49–3.26), hypertension (case-control OR 1.48, 1.22–1.78), and higher plasma fibrinogen (cross-sectional OR 1.45, 1.22–1.73).
  • Weaker and inconsistent associations were reported for gender, ethnicity, diabetes, iris colour, history of cerebrovascular disease, and serum total and HDL cholesterol and triglyceride levels. Diabetes was significant in prospective studies (RR 1.66, 1.05–2.63) but not in cross-sectional or case-control analyses.
  • Increasing age was strongly associated with late AMD in all studies; prevalence rose with age, e.g. 12.0% in the ≥80-year Blue Mountains white cohort (Table 4).

Methods

  • Systematic review and meta-analysis of 16 pre-selected risk factors considered readily measured in nonspecialist settings; ocular, genetic, and nutritional factors were excluded. Searches were conducted in Medline and Cochrane, completed 28 February 2007 and repeated November 2008; 295 references were initially yielded, 147 articles were assessed, 70 fulfilled eligibility criteria, and 45 articles were retained.
  • Included prospective cohort, cross-sectional, and case-control studies reporting an OR or RR between late AMD and at least one risk factor; adjusted estimates were selected. Fixed-effects meta-analyses were used unless heterogeneity was present (I² p<0.10), in which case random-effects models were used; funnel plots explored publication bias.
  • The abstract reports 18 prospective and cross-sectional studies and 6 case-control studies involving 113,780 persons with 17,236 late AMD cases; the Results section reports 18 prospective/cross-sectional and 8 case-control studies contributing 94,058 patients and 3,178 late AMD cases.

Limitations

  • The paper states that appropriateness or completeness of adjustment could not be ascertained; some data were crude and subject to measurement error (e.g. “history of cardiovascular disease” spanning asymptomatic angina to myocardial infarction), likely diluting effects. It excluded ocular factors, dietary factors, and genetic factors; included only English-language articles; searched only Medline and Cochrane (not EMBASE); and notes that prognostic use requires further research, with generally small observed odds ratios and limited preventive interventions.
  • Evident from the text: study counts and sample sizes are inconsistent between the abstract and Results (113,780 persons/17,236 cases and 6 case-control studies vs 94,058 patients/3,178 cases and 8 case-control studies), and the family-history confidence interval in the narrative (1.94–6.61) differs from Table 3 (0.98–38.90).

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/1471-2415-10-31

Cites

83 of 83 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 31 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    History of cardiovascular disease is not significantly associated with late AMD in prospective and cross-sectional studies.

    “No significant association was found in the prospective cohort and the cross-sectional studies (RR 1.22, 95% CI 0.92 - 1.63 and OR 1.12; 95% CI 0.86 - 1.47).”
    Quote in the paperSubstantial claim
  • Findingown data

    History of cardiovascular disease is associated with approximately double the odds of late AMD in case-control studies (OR 2.20; 95% CI 1.48 - 3.26).

    “A significant association was observed in the case control studies, with around double the odds of late AMD in individuals with cardiovascular disease (OR 2.20; 95% CI 1.48 - 3.26) (Figure 12).”
    Quote in the paperSubstantial claim
  • Findingown data

    An AMD family history is a strong and consistent risk factor for late AMD.

    “Our systematic review and meta-analysis identified four strong and consistent risk factors for late AMD (increasing age, current smoking, previous cataract surgery and an AMD family history)”
    Quote in the paperSubstantial claim
  • Findingown data

    Based only on US data, people of European origin were at increased risk of late AMD compared to other ethnic groups.

    “based only on US data, people of European origin were at increased risk compared to other ethnic groups”
    Quote in the paperSubstantial claim
  • Findingown data

    Cross-sectional or case-control studies did not show a significant association between diabetes and late AMD.

    “this was not significant in the cross-sectional or case-control studies”
    Quote in the paperSubstantial claim
  • May combine two claims. 13
  • Classified as probably not a substantial claim. 13

  • May combine two claims.

    Findingown data

    High BMI is a risk factor for late AMD showing significant and moderate strength of association.

    “a further four risk factors showing significant and moderate strength of associations (high BMI, history of cardiovascular disease, hypertension and plasma fibrinogen)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Serum total cholesterol and HDL cholesterol are not significantly associated with late AMD.

    “The pooled odds ratios and relative risks were non-significant for both serum cholesterol measures.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The systematic review included 18 prospective and cross-sectional studies and 8 case control studies, contributing 94,058 patients and 3,178 late AMD cases.

    “In total, data from 18 prospective, cross-sectional studies and 8 case control studies [12,24-26,28,30,31,33-47,49-54,57-73] were included in the final analysis, contributing a sample of some 94,058 patients (ranging from 261 to 22,071) including 3,178 (ranging from 8 to 776) late AMD cases.”
    Quote in the paperSubstantial claim0 of 10 sources checked
    • cites [12] Chakravarthy U, Augood C, Bentham GC, De Jong PT, Rahu M, Seland J, et al: Cigarette Smoking and Age-Related Macular Degeneration in the EUREYE Study. Ophthalmology. 2007, 114: 1157-63. 10.1016/j.ophtha.2006.09.022. source

      Not checked in the free run.

    • cites [24] Wang JJ, Klein R, Smith W, Klein BE, Tomany S, Mitchell P: Cataract surgery and the 5-year incidence of late-stage age-related maculopathy: pooled findings from the Beaver Dam and Blue Mountains eye studies. Ophthalmology. 2003, 110: 1960-7. 10.1016/S0161-6420(03)00816-9. source

      Not checked in the free run.

    • cites [25] Smith W, Assink J, Klein R, Mitchell P, Klaver CC, Klein BE, et al: Risk factors for age-related macular degeneration: Pooled findings from three continents. Ophthalmology. 2001, 108: 697-704. 10.1016/S0161-6420(00)00580-7. source

      Not checked in the free run.

    • cites [26] Tomany SC, Wang JJ, Van Leeuwen R, Klein R, Mitchell P, Vingerling JR, et al: Risk factors for incident age-related macular degeneration: pooled findings from 3 continents. Ophthalmology. 2004, 111: 1280-7. 10.1016/j.ophtha.2003.11.010. source

      Not checked in the free run.

    • cites [28] Cackett P, Wong TY, Aung T, Saw SM, Tay WT, Rochtchina E, et al: Smoking, cardiovascular risk factors, and age-related macular degeneration in Asians: the Singapore Malay Eye Study. Am J Ophthalmol. 2008, 146: 960-7. 10.1016/j.ajo.2008.06.026. source

      Not checked in the free run.

    • cites [30] Kawasaki R, Wang JJ, Ji GJ, Taylor B, Oizumi T, Daimon M, et al: Prevalence and risk factors for age-related macular degeneration in an adult Japanese population: the Funagata study. Ophthalmology. 2008, 115: 1376-81. 10.1016/j.ophtha.2007.11.015. 1381 source

      Not checked in the free run.

    • cites [31] Kawasaki R, Wang JJ, Aung T, Tan DT, Mitchell P, Sandar M, et al: Prevalence of age-related macular degeneration in a Malay population: the Singapore Malay Eye Study. Ophthalmology. 2008, 115: 1735-41. 10.1016/j.ophtha.2008.02.012. source

      Not checked in the free run.

    • cites [33] Buch H, Vinding T, la Cour M, Jensen GB, Prause JU, Nielsen NV: Risk factors for age-related maculopathy in a 14-year follow-up study: the Copenhagen City Eye Study. Acta Ophthalmologica Scandinavica. 2005, 83: 409-18. 10.1111/j.1600-0420.2005.00492.x. source

      Not checked in the free run.

    • cites [34] Christen WG, Glynn RJ, Manson JE, Ajani UA, Buring JE: A prospective study of cigarette smoking and risk of age-related macular degeneration in men. JAMA. 1996, 276: 1147-51. 10.1001/jama.276.14.1147. source

      Not checked in the free run.

    • cites [35] Cugati S, Mitchell P, Rochtchina E, Tan AG, Smith W, Wang JJ: Cataract surgery and the 10-year incidence of age-related maculopathy: the Blue Mountains Eye Study. Ophthalmology. 2006, 113: 2020-5. 10.1016/j.ophtha.2006.05.047. source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Hypertension is a risk factor for late AMD showing significant and moderate strength of association.

    “a further four risk factors showing significant and moderate strength of associations (high BMI, history of cardiovascular disease, hypertension and plasma fibrinogen)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Plasma fibrinogen is a risk factor for late AMD showing significant and moderate strength of association.

    “a further four risk factors showing significant and moderate strength of associations (high BMI, history of cardiovascular disease, hypertension and plasma fibrinogen)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    History of cardiovascular disease is a risk factor for late AMD showing significant and moderate strength of association.

    “a further four risk factors showing significant and moderate strength of associations (high BMI, history of cardiovascular disease, hypertension and plasma fibrinogen)”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    We only included articles identified in the Medline and Cochrane databases.

    “we only included articles that were identified in the Medline and Cochrane databases”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    We could not ascertain the appropriateness or completeness of adjustment in the included studies.

    “we could not ascertain the appropriateness or completeness of adjustment in the studies”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Large, epidemiological, cohort studies remove temporal or causal ambiguity because exposure precedes disease, and if follow-up is not biased, selection bias is less of a problem than in other study designs.

    “Large, epidemiological, cohort studies had the advantage over other study designs in that they removed any temporal or causal ambiguity as the exposure precedes the disease and if follow-up is not biased selection bias is less of a problem than in other study designs [90].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [90] Wong TY, Hyman L: Population-based studies in ophthalmology. Am J Ophthalmol. 2008, 146: 656-63. 10.1016/j.ajo.2008.07.048. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    We selected only studies that reported some adjustment for confounding factors.

    “we selected only studies that reported some adjustment for confounding factors”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Our meta-analysis confirmed the increased risks of late AMD associated with advancing age, current cigarette smoking, and previous cataract surgery.

    “Our meta-analysis confirmed the increased risks of late AMD associated with advancing age (especially for the oldest age groups of 80 years and over), current cigarette smoking, and previous cataract surgery.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Study design and conductreasoning

    It is unlikely that any relevant articles were missed.

    “we feel it is unlikely any relevant articles were missed.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Studies reporting only unadjusted results were excluded.

    “We did not include studies that reported only the unadjusted results (i.e., crude ORs).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The assessment of the quality of the publications was performed as part of this study.

    “the assessment of the quality of the publications was performed as part of this study”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    All included studies adjusted for age; when multiple adjusted estimates were available, the multivariate adjusted estimate was selected.

    “All studies included adjusted for age; when studies reported more than one adjusted estimate, the multivariate adjusted estimate was selected (i.e., if a study reported either age adjusted or age, gender and smoking adjusted results, the latter was chosen).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    We included only English language articles.

    “we included only English language articles”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Smoking, previous cataract surgery and a family history of AMD are consistent risk factors for AMD.

    “Smoking, previous cataract surgery and a family history of AMD are consistent risk factors for AMD.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Two researchers independently reviewed abstracts and recorded relevant data on a study-specific abstraction form.

    “The abstracts of these articles were independently reviewed by two researchers (LP and CE) and relevant data (e.g., study design, risk factor, type of AMD) was recorded on a study-specific abstraction form.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Of the 16 risk factors, age, current smoking, cataract surgery, and potentially family history were strongly and consistently associated with late AMD.

    “Of the 16 risk factors identified in our systematic review and meta-analysis, age, current smoking, cataract surgery, and potentially family history were strongly and consistently associated with late AMD.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Fixed-effects and random-effects meta-analyses were conducted, with model selection based on the reported I-squared value and associated p-value.

    “We conducted fixed-effects and random-effects meta-analyses to combine these outcomes across included studies by study design, estimating overall raw point estimates of each risk factor and their associated 95% confidence intervals (CI). The selection of fixed-effects vs. random-effects models was based on the reported I-squared value and associated p-value.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    We decided to present the data based on the type of study design reported in the publication: cohort, cross sectional and case control.

    “we decided to present the data based on the type of study design reported in the publication: cohort, cross sectional and case control”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    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.

    “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.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 16 selected risk factors are readily measured in nonspecialist settings.
    • Rests on an assumption: The risk factors are easily assessed through discussions with patients and do not entail a lengthy medical history taking or laboratory evaluations.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The relationship of cataract surgery and late AMD was previously reported in a pooled analysis of 3 studies in different continents.

    “The relationship of cataract surgery and late AMD was previously reported in a pooled analysis of 3 studies in different continents [26].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Tomany SC, Wang JJ, Van Leeuwen R, Klein R, Mitchell P, Vingerling JR, et al: Risk factors for incident age-related macular degeneration: pooled findings from 3 continents. Ophthalmology. 2004, 111: 1280-7. 10.1016/j.ophtha.2003.11.010. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Funnel plots were reviewed and no evidence of publication bias was observed.

    “Funnel plots were reviewed and no evidence of publication bias was observed.”
    Quote in the paperNot a substantial claim
24 of 24

  • The paper relies on this without support.

    The 16 selected risk factors are readily measured in nonspecialist settings.

    “Following review by an expert panel (UC, AF, PM, TYW), 16 factors that were considered to be readily measured in nonspecialist settings were selected for the full systematic review.”

  • The paper relies on this without support.

    The risk factors identified as associated with cardiovascular disease are also likely to be measured and monitored in the primary care setting.

    “All of these factors are associated with cardiovascular disease and are also likely to be measured and monitored in the primary care setting.”

  • The paper relies on this without support.

    The risk factors are easily assessed through discussions with patients and do not entail a lengthy medical history taking or laboratory evaluations.

    “All of these are easily assessed through discussions with patients and do not entail a lengthy medical history taking or laboratory evaluations.”

  • The paper relies on this without support.

    Vascular diseases, including myocardial infarction, stroke, angina, and hypertension, are pathogenic factors for the development of late AMD.

    “Vascular diseases, including myocardial infarction, stroke, angina, and hypertension are thought to be pathogenic factors for the development of late AMD.”

  • The paper relies on this without support.

    Genetic testing is not readily available in general clinical practice.

    “we felt that genetic testing was not readily available in general clinical practice”

  • The paper relies on this without support.

    Ocular factors (e.g., presence of large drusen) cannot be easily ascertained by family physicians.

    “we felt they could not be easily ascertained by family physicians”

  • The paper relies on this without support.

    There are limited interventions to prevent AMD.

    “there are limited interventions to prevent AMD”
7 of 7

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Family-history confidence interval conflicts with Table 3

    Major

    The text reports a 95% confidence interval of 1.94-6.61 for the pooled case-control estimate, while Table 3 reports 0.98-38.90 for the same estimate. The text also calls the association insignificant, although its stated interval excludes 1.

  • Mexican-American result is called nonsignificant despite its confidence interval

    Major

    The paper says there were no significant differences in NHANES III, but the stated odds ratio for Mexican Americans has a 95% confidence interval entirely below 1.

  • Abstract and results report different study totals

    Major

    The abstract reports 6 case-control studies, 113,780 persons, and 17,236 late AMD cases. The Results section reports 8 case-control studies, approximately 94,058 patients, and 3,178 cases for the final analysis.

  • Reported race estimate lies outside its confidence interval

    Minor

    The stated estimate of nearly 15 times the risk is above the reported 95% confidence interval's upper bound of 12.6.

  • AREDS is classified as both case-control and prospective or cross-sectional

    Minor

    Table 2 includes AREDS among the prospective and cross-sectional studies, but the race/ethnicity section explicitly calls AREDS a case-control study.

5 of 5

Cites

Flagged first, then by citations

2 of the 85 references couldn’t be matched to a known paper.

Research works printed but not linked: 13

  1. Despriet DD, Klaver CC, Witteman JC, Bergen AA, Kardys I, de Maat MP, et al: Complement factor H polymorphism, complement activators, and risk of age-related macular degeneration. JAMA. 2006, 296: 301-9. 10.1001/jama.296.3.301. · DOI · Paper page
  2. Freeman EE, Munoz B, West SK, Tielsch JM, Schein OD: Is there an association between cataract surgery and age-related macular degeneration? Data from three population-based studies.[see comment]. American Journal of Ophthalmology. 2003, 135 (6): 849-56. 10.1016/S0002-9394(02)02253-5. · DOI
  3. Van Leeuwen R, Klaver CC, Vingerling JR, Hofman A, De Jong PT: The risk and natural course of age-related maculopathy: follow-up at 6 1/2 years in the Rotterdam study.[erratum appears in Arch Ophthalmol. 2003 Jul;121(7):955]. Archives of Ophthalmology. 2003, 121 (4): 519-26. 10.1001/archopht.121.4.519. · DOI · Paper page
  4. Van Leeuwen R, Klaver CC, Vingerling JR, Hofman A, De Jong PT: The risk and natural course of age-related maculopathy: follow-up at 6 1/2 years in the Rotterdam study.[erratum appears in Arch Ophthalmol. 2003 Jul;121(7):955]. Archives of Ophthalmology. 2003, 121 (4): 519-26. 10.1001/archopht.121.4.519. · DOI · Paper page
  5. Freeman EE, Munoz B, West SK, Tielsch JM, Schein OD: Is there an association between cataract surgery and age-related macular degeneration? Data from three population-based studies.[see comment]. American Journal of Ophthalmology. 2003, 135 (6): 849-56. 10.1016/S0002-9394(02)02253-5. · DOI
  6. Freeman EE, Munoz B, West SK, Tielsch JM, Schein OD: Is there an association between cataract surgery and age-related macular degeneration? Data from three population-based studies.[see comment]. American Journal of Ophthalmology. 2003, 135 (6): 849-56. 10.1016/S0002-9394(02)02253-5. · DOI
  7. Klein R, Klein BE, Franke T: The relationship of cardiovascular disease and its risk factors to age-related maculopathy. The Beaver Dam Eye Study.[see comment]. Ophthalmology. 1993, 100 (3): 406-14. · DOI
  8. Klein R, Klein BE, Franke T: The relationship of cardiovascular disease and its risk factors to age-related maculopathy. The Beaver Dam Eye Study.[see comment]. Ophthalmology. 1993, 100 (3): 406-14. · DOI
  9. Seddon JM, Francis PJ, George S, Schultz DW, Rosner B, Klein ML: Association of CFH Y402H and LOC387715 A69S with progression of age-related macular degeneration. JAMA. 2007, 297: 1793-800. 10.1001/jama.297.16.1793. · DOI · Paper page
  10. Haines JL, Pericak-Vance MA: Rapid dissection of the genetic risk of age-related macular degeneration: achieving the promise of the genomic era. JAMA. 2007, 297: 401-2. 10.1001/jama.297.4.401. · DOI · Paper page
  11. Freeman EE, Munoz B, West SK, Tielsch JM, Schein OD: Is there an association between cataract surgery and age-related macular degeneration? Data from three population-based studies.[see comment]. American Journal of Ophthalmology. 2003, 135 (6): 849-56. 10.1016/S0002-9394(02)02253-5. · DOI
  12. Klein R, Klein BE, Franke T: The relationship of cardiovascular disease and its risk factors to age-related maculopathy. The Beaver Dam Eye Study.[see comment]. Ophthalmology. 1993, 100 (3): 406-14. · DOI
  13. Van Leeuwen R, Klaver CC, Vingerling JR, Hofman A, De Jong PT: The risk and natural course of age-related maculopathy: follow-up at 6 1/2 years in the Rotterdam study.[erratum appears in Arch Ophthalmol. 2003 Jul;121(7):955]. Archives of Ophthalmology. 2003, 121 (4): 519-26. 10.1001/archopht.121.4.519. · DOI · Paper page

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Authors
Chakravarthy, U., Wong, T. Y., Fletcher, A., Piault, E., Evans, C., Zlateva, G., Buggage, R., Pleil, A., & Mitchell, P.
Affiliations
  • Queen's University Belfast (GB)
  • The University of Melbourne (AU)
  • London School of Hygiene & Tropical Medicine (GB)
  • Pfizer (United States) (US)
  • Novartis (United States) (US)
  • The University of Sydney (AU)
Corresponding author
Chakravarthy, Usha
ORCID
Venue
BMC Ophthalmology
Publisher
Springer Science and Business Media LLC
Published
2010-12
Volume
10
Issue
1
Pages
31-31
ISSN
1471-2415 (ISSN-L)
DOI
10.1186/1471-2415-10-31
PMC
PMC3009619
OpenAlex
W2147322584
Semantic Scholar
1a73237caef4a0069d84dbdf668544aea301ac8f
Cited by
842
References
85
Citations by year
2026: 44 · 2025: 60 · 2024: 53 · 2023: 74 · 2022: 67 · 2021: 70 · 2020: 52 · 2019: 42 · 2018: 56 · 2017: 61 · 2016: 38 · 2015: 50 · 2014: 69 · 2013: 43 · 2012: 48
FWCI
6.20
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Ophthalmology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • National University of Singapore (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Research Portal (Queen's University Belfast) (submittedVersion)
Funders
Pfizer
Topics
  • Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
  • Health Sciences › Medicine › Epidemiology › Ophthalmology and Visual Impairment Studies
Keywords
age-related macular degeneration, late AMD, risk factors, cigarette smoking, cataract surgery, family history (medicine), body mass index, cardiovascular disease, hypertension, fibrinogen, age
MeSH terms
Aging, Cardiovascular Diseases, Cataract Extraction, Eye Color, Fibrinogen, Humans, Macular Degeneration, Obesity, Risk, Risk Factors, Sex Factors, Smoking, Odds Ratio, Evidence-Based Medicine, Genetic Predisposition to Disease, Racial Groups, Diabetes Complications

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

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Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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