The DOI matches its Crossref record; 83 of the 85 references it cites were found in a registry or an index; none of the 31 sources its claims cite is checked for support yet.
Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis
Open accessAbstract
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.
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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).
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![Figure 2 Prevalence of late AMD by age (adapted from Varma et al[61]and Kawasaki et al[19]).](/paper-figures/af8ae4b37ccf4ef09e7fe140a3b6fd25/clinical-risk-factors-for-age-related-macular-degeneration-a-systematic-review-figure-2.jpg)
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Claims the paper makes
30 Own result · 15 Own method · 10 Not checked yet · 9 Own interpretation · 1 No basis given
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Results > History of Cardiovascular Disease
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Results > History of Cardiovascular Disease
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Conclusions
boostedcorrelational- Asserted: passes — The authors put it forward as true.
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- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“based only on US data, people of European origin were at increased risk compared to other ethnic groups”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Discussion
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“this was not significant in the cross-sectional or case-control studies”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Discussion
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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None of the sources cited for this claim have been checked yet.
In the paper
“All studies found a strong association with increasing age (Table 4 and Figure 2) [31,74].”
- Also stated in: § Results · boosted
“Increasing age, current cigarette smoking, previous cataract surgery, and a family history of AMD showed strong and consistent associations with late AMD.”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Results > Age
What the sources say
- Not checked yetcites [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 yetcites [74] Varma R, Ying-Lai M, Francis BA, Nguyen BB, Deneen J, Wilson MR, et al: Prevalence of open-angle glaucoma and ocular hypertension in Latinos: the Los Angeles Latino Eye Study. Ophthalmology. 2004, 111: 1439-48. 10.1016/j.ophtha.2004.01.025. source
boostedcorrelational- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Results · boosted
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Analysis of the prospective cohort studies showed that previous cataract surgery is a strong risk factor for neovascular AMD (RR 3.05; CI 2.05 - 4.55).”
- Also stated in: § Results · boosted
“Increasing age, current cigarette smoking, previous cataract surgery, and a family history of AMD showed strong and consistent associations with late AMD.”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Results > Cataract surgery
boostedcorrelational- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Results · boosted
In the paper
“There was only one estimate from a prospective study [46] and it did not support this finding (OR 1.03; 95% CI 0.81 - 1.32) of significance in the cross-sectional studies (Figure 14).”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Results > Biological markers
What the sources say
- Not checked yetcites [46] Tan JS, Mitchell P, Smith W, Wang JJ: Cardiovascular Risk Factors and the Long-term Incidence of Age-Related Macular Degeneration The Blue Mountains Eye Study. Ophthalmology. 2007, 114: 1143-50. 10.1016/j.ophtha.2006.09.033. source
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“None of the analyses showed statistically significant associations (prospective cohort RR 1.02; 95% CI 0.77 - 1.35; cross-sectional studies OR 1.15; 95% CI: 0.88 - 1.51).”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Results > Hypertension
plain- Asserted: passes — The authors put it forward as true.
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- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Conclusions
boostedcorrelational- Asserted: passes — The authors put it forward as true.
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- It may state two separate claims as one. 13
- Probably not a substantial claim. 13
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“a further four risk factors showing significant and moderate strength of associations (high BMI, history of cardiovascular disease, hypertension and plasma fibrinogen)”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Conclusions
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The pooled odds ratios and relative risks were non-significant for both serum cholesterol measures.”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Results > Biological markers
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Results
What the sources say
- Not checked yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [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
hedgedn = 3,178- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“a further four risk factors showing significant and moderate strength of associations (high BMI, history of cardiovascular disease, hypertension and plasma fibrinogen)”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Conclusions
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“a further four risk factors showing significant and moderate strength of associations (high BMI, history of cardiovascular disease, hypertension and plasma fibrinogen)”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Conclusions
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“a further four risk factors showing significant and moderate strength of associations (high BMI, history of cardiovascular disease, hypertension and plasma fibrinogen)”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Conclusions
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“we only included articles that were identified in the Medline and Cochrane databases”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Discussion
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“we could not ascertain the appropriateness or completeness of adjustment in the studies”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Discussion
hedged- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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].”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Discussion
What the sources say
- Not checked yetcites [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
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“we selected only studies that reported some adjustment for confounding factors”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Discussion
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“we feel it is unlikely any relevant articles were missed.”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Discussion
hedged- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We did not include studies that reported only the unadjusted results (i.e., crude ORs).”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Methods > Studies and Participants
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
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In the paper
“the assessment of the quality of the publications was performed as part of this study”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Discussion
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Methods > Studies and Participants
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“we included only English language articles”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Discussion
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Smoking, previous cataract surgery and a family history of AMD are consistent risk factors for AMD.”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Abstract > Conclusions
plaincorrelational- Asserted: passes — The authors put it forward as true.
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Methods > Study Selection
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Discussion
boostedcorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Methods > Data Synthesis
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“we decided to present the data based on the type of study design reported in the publication: cohort, cross sectional and case control”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Discussion
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Abstract > Conclusions
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
- 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.
In the paper
“The relationship of cataract surgery and late AMD was previously reported in a pooled analysis of 3 studies in different continents [26].”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Discussion
What the sources say
- Not checked yetcites [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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Funnel plots were reviewed and no evidence of publication bias was observed.”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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”
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?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“In addition to ageing, smoking is a significant environmental risk factor for AMD, with the odds ratio for current smokers compared to ex-smokers being estimated by one meta-analysis to be 1.78 (95% confidence intervals, 1.52–2.09) [73].”
From Bruch’s Membrane: A Key Consideration with Complement-Based Therapies for Age-Related Macular Degeneration (2023) · cites this paper as [73]
Experimental — accuracy not yet measuredIn the citing paper
“Its strong genetic component, with an up to 10-fold increase in risk when a parent or sibling is affected, makes it one of the most heritable complex diseases [73,74].”
From Bruch’s Membrane: A Key Consideration with Complement-Based Therapies for Age-Related Macular Degeneration (2023) · cites this paper as [73]
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.
Rated major: it would touch a result — a value a result rests on, reported and recomputed p-values on opposite sides of the significance level, two passages that conflict with no sign which is right, or a cited work retracted before this paper was published.
In the paper
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Results > Family history
“Findings from the meta-analysis show an insignificant association between family history and late AMD (OR 6.18; 95% CI 1.94 - 6.61).”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Results
“| Family History* | 0 | | 1 | 3.95 (1.35 - 11.54) | 2 | 6.18 (0.98 - 38.90)* |”
Rated major: it would touch a result — a value a result rests on, reported and recomputed p-values on opposite sides of the significance level, two passages that conflict with no sign which is right, or a cited work retracted before this paper was published.
In the paper
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Results > Race/ethnicity
“In the NHANES III [58], there were no significant differences between Non-Hispanic White, Non-Hispanic Black (OR 0.34, 95%CI 0.10 - 1.18) and Mexican Americans (OR 0.25, 95% CI 0.07 - 0.90).”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Results > Race/ethnicity
“Mexican Americans (OR 0.25, 95% CI 0.07 - 0.90)”
Rated major: it would touch a result — a value a result rests on, reported and recomputed p-values on opposite sides of the significance level, two passages that conflict with no sign which is right, or a cited work retracted before this paper was published.
In the paper
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Abstract > Methods
“18 prospective and cross-sectional studies and 6 case control studies involving 113,780 persons with 17,236 cases of late AMD”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Results
“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.”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Results > Race/ethnicity
“individuals of Native American ancestry were nearly 15 times more likely to have geographic atrophy (95% CI 1.8 - 12.6) than Latinos.”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Results > Race/ethnicity
“(95% CI 1.8 - 12.6)”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Results
“Table: Table 2 Summary of characteristics of the 18 prospective and cross sectional studies | STUDY NAME | LOCATION | DATE OF STUDY | POPULATION | NUMBER OF LATE AMD SUBJECTS | AGE RANGE | % MALE | METHOD OF FUNDUS CAPTURE | METHOD OF CLASSIFICATION | | --- | --- | --- | --- | --- | --- | --- | --- | --- | | AREDS [64] | USA | 1992-1998 | 4,519 | 776 | 60-80 | NA | Retinal photo | WARMGS |”
§ Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis > Results > Race/ethnicity
“One case control study (AREDS) [64]”
Citations
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Self-citation
Research works printed but not linked: 13
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Chen, X., Chen, L., Lin, Y., & Li, G. (2023) · Gene · doi:10.1016/j.gene.2023.147787 · Cited by 2
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García‐Layana, A., Garhöfer, G., Aslam, T. M., da Silva, R. M., Delcourt, C., Klaver, C. C. W., Seddon, J. M., & Minnella, A. M. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10225432 · Cited by 2
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Self-citationMicroneedles for various ocular diseases
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Spooner, K., Fraser‐Bell, S., Fu, D. J., Faes, L., Romano, F., Cozzi, M., Chang, A. A., & Sivaprasad, S. (2026) · Frontiers in Ophthalmology · doi:10.3389/fopht.2026.1786309 · Cited by 1
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Choroidal Findings in Systemic Disorders
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Yaşa bağlı makular dejenerasyonu olan hastaların beslenme durumlarının değerlendirilmesi
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Age-related Macular Degeneration and Risk Factors Associated with Nutrition
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Exudative Age-Related Macular Degeneration: A Case Report and Review of the Literature
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Self-citation
Metadata
- 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
- Venue
- BMC Ophthalmology
- Published
- 2010-12
- Volume
- 10
- Issue
- 1
- Pages
- 31-31
- ISSN
- 1471-2415 (ISSN-L)
- 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
- gold
- doi.org
- 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 › Ophthalmology › 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
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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.
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