Synergistic effects of glaucoma, degeneration of macula and posterior pole, and diabetic ophthalmic complications on vision loss

Abstract

Background/Aims Major age-related ocular diseases (ARODs)-glaucoma, degeneration of macula and posterior pole (DMPP) and diabetes mellitus with ophthalmic complications (DOC)-often coexist in ageing populations, but their combined impact on severe visual impairment (VI) remains unclear. This study aimed to determine the coincidence rate of ARODs and evaluate the association between concomitant ARODs and the risk of developing severe VI.Methods This nationwide, longitudinal cohort study used data from the Korea National Health Insurance System (KNHIS) National Health Screening Cohort from 2004 to 2019. Incident ARODs were identified by diagnostic codes combined with medication prescriptions. Severe VI was identified through KNHIS health check-up records and the National Disability Registration. Adjusted HRs (aHRs) and 95% CIs were estimated, adjusting for demographic, behavioural and comorbidities.Results Among 0.5 million participants followed over 7 495 390 person-years, 7296 (1.45%) developed glaucoma, 1051 (0.21%) DMPP and 3062 (0.61%) DOC. Compared with those without AROD, the aHRs for severe VI were 4.78 (95% CI 4.00 to 5.72) for glaucoma, 8.27 (95% CI 5.95 to 11.51) for DMPP and 3.23 (95% CI 2.38 to 4.37) for DOC. A total of 595 individuals (0.12%) developed two or more ARODs. For patients with one AROD, the risk of severe VI (aHR 4.96; 95% CI 4.33 to 5.68) increased 1.93-fold with a second AROD (aHR 9.54; 95% CI 6.37 to 14.30) and 2.54-fold with a third AROD (aHR 12.59; 95% CI 2.32 to 68.44).Conclusion The presence of multiple ARODs significantly elevates the risk of severe VI. These findings emphasise the need for integrated eye care, including prevention of developing additional ARODs.