Abstract
Purpose: To explore the associations between refractive errors and multiple eye health outcomes.Methods: This is an umbrella review based on systematic reviews with meta-analyses. In our study, refractive errors included myopia, hyperopia, astigmatism, and anisometropia. We reconducted the meta-analyses whose primary data were available in sufficient detail by random effect model. Heterogeneity was assessed by I2. The main outcomes included myopic macular degeneration (MMD), retinal detachment (RD), cataract, open-angle glaucoma (OAG), strabismus, age-related macular degeneration (AMD), and diabetic retinopathy (DR).Results: Myopia was associated with increased risk of MMD (relative risk = 102.11, 95% CI 52.6–198.22), RD (3.45, 1.08–11.00), nuclear cataract (2.15, 1.53–3.03), posterior subcapsular (PSC) cataract (1.74, 1.41–2.15), OAG (1.95, 1.74–2.19), exotropia (5.23, 2.26–12.09), but decreased risk of DR (0.83, 0.66–1.04), and early AMD (0.80, 0.67–0.94). From mild-to-high myopia, the association strengthened for MMD, RD, nuclear cataract, PSC cataract, OAG, and DR. Hyperopia was associated with an increased risk of early AMD (1.09, 1.01–1.18) and esotropia (22.94, 10.20–51.62). Astigmatism and anisometropia were associated with increased risk of both exotropia and esotropia.Conclusions: Myopia, especially high myopia, demonstrated the highest risk for eye health outcomes, such as MMD, RD, OAG, nuclear and PSC cataracts, and exotropia. However, myopia was associated with a lower risk of early AMD and DR. Individuals with hyperopia are more likely to suffer early AMD and esotropia. Astigmatism and anisometropia predispose to strabismus. A lot of research studies on the mechanism of the associations are needed.Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=239744; identifier: 239744
Highlights
In refractive error, parallel light cannot focus on the fovea to form a clear image after passing through the ocular refractive system; refractive errors include myopia, hyperopia, astigmatism, anisometropia, and presbyopia [1]
When we focused on cohort studies, there were no significant associations between refractive error and incident age-related macular degeneration (AMD), incident early AMD, or incident late AMD (Figures 2, 5)
All four types of refractive error were significantly associated with strabismus, of which anisometropia had the highest risk of strabismus, while myopia had the lowest risk
Summary
Parallel light cannot focus on the fovea to form a clear image after passing through the ocular refractive system; refractive errors include myopia, hyperopia, astigmatism, anisometropia, and presbyopia [1]. In 2010, uncorrected refractive error was the leading cause of vision impairment and the second leading cause of blindness worldwide, affecting 108 million people [2]. Ametropia and Eye Health degeneration (MMD), cataract, glaucoma, diabetic retinopathy (DR), and age-related macular degeneration (AMD), greatly impair vision [3, 4]. Eyes with a refractive error have a changed intraocular environment, globe structure, and accommodation, which can influence multiple aspects of eye health [5,6,7]. Several studies have explored the associations between refractive errors and eye health. A comprehensive and systematic summary of these associations is lacking, which limits the thorough understanding of refractive errors
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