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A Meta-analysis of Observational Studies

Mona Akbari, MPH; Sara Akbari, MD; Louis R. Pasquale, MD

Arch Ophthalmol. 2009;127(2):204-210.

Objective  To conduct a meta-analysis to estimate the relationship between primary open-angle glaucoma (POAG) and mortality.

Methods  A systematic search of the PubMed, Embase, and Web of Science databases yielded 9 cohort studies with relative risk (RR) estimates for all-cause mortality. The studies were critically reviewed by an expert in the field. The data were extracted and analyzed in a pooled analysis by the random-effects model. Meta-regression to assess for heterogeneity by several covariates and subgroup analysis on cardiovascular mortality were performed.

Results  A significant risk was not detected in the final pooled analysis (RR, 1.13; 95% confidence interval [CI], 0.97-1.31) for all-cause mortality. A meta-regression across mean follow-up time, age, and sex was not significant. A meta-regression across diabetes status in 3 of the 9 studies did not demonstrate significant results (P = .94). Subgroup analysis on cardiovascular mortality from 4 of the 9 studies was marginally significant (RR, 1.20; 95% CI, 1.00-1.43; P = .05), but insignificant after removal of a study in which POAG was ascertained by self and proxy report (RR, 1.12; 95% CI, 0.87-1.46).

Conclusion  This meta-analysis does not demonstrate an association between POAG and all-cause or cardiovascular mortality.

Author Affiliations: Harvard University School of Public Health, Boston, Massachusetts (Ms M. Akbari); Columbia University College of Physicians & Surgeons, New York, New York (Ms M. Akbari); University of Michigan Kellogg Eye Center, Ann Arbor (Dr S. Akbari); and the Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston (Dr Pasquale).

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