ABSTRACT

Purpose

Age-related macular degeneration (AMD), a leading cause of irreversible blindness, increases fall risk through impaired central vision. Falls place an enormous economic burden on healthcare systems. We hypothesized that AMD treatments may reduce patients’ falls risk. This systematic review (ID #: 172623) synthesized the current understanding of wet and dry AMD treatments’ impact on patient falls and mobility, connecting these two public health issues.

Methods

On April 17, 2020, PubMed, Scopus, CINAHL, and the Cochrane Central Register of Controlled Trials were queried. Clinical trials and observational studies were included, while non-English and non-primary studies were excluded. Two authors screened, extracted data, and assessed bias using RoB-2 and ROBINS-I. A third author served as a tie breaker.

Results

This database search resulted in 3,525 studies, with an additional 112 identified through bibliography review. Ten articles met eligibility criteria. Most studies featured the outcome of interest as a secondary outcome (n = 4) and patient-reported adverse events (n = 5), rather than a primary focus (n = 2). Ten out of the 11 outcomes had a moderate to serious risk of bias. No two studies used the same instrument to measure falls or mobility.

Conclusion

Despite the potential positive impact of AMD treatments on patient falls and mobility, quality data on this relationship are lacking. This work underscores the need to broaden ophthalmologic research outcomes beyond visual parameters to include patient-centred, functional measures. Incorporating standardized methods to track falls and screen for difficulty with walking and balance would enable evaluation of AMD treatments on functional outcomes, potentially helping guide management.

中文翻译：

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年龄相关性黄斑变性 (AMD) 治疗会影响患者跌倒和活动能力吗？系统评价

摘要

目的

年龄相关性黄斑变性 (AMD) 是导致不可逆失明的主要原因，它会因中心视力受损而增加跌倒风险。跌倒给医疗保健系统带来了巨大的经济负担。我们假设 AMD 治疗可以降低患者跌倒的风险。该系统评价 (ID #: 172623) 综合了目前对湿式和干式 AMD 治疗对患者跌倒和活动能力的影响的理解，并将这两个公共卫生问题联系起来。

方法

2020 年 4 月 17 日，PubMed、Scopus、CINAHL 和 Cochrane Central Register of Controlled Trials 被查询。临床试验和观察性研究被纳入，而非英语和非主要研究被排除在外。两位作者使用 RoB-2 和 ROBINS-I 筛选、提取数据并评估偏倚。第三位作者担任了决胜局。

结果

该数据库搜索产生了 3,525 项研究，另外 112 项通过参考书目审查确定。十篇文章符合资格标准。大多数研究将感兴趣的结果作为次要结果（n = 4）和患者报告的不良事件（n = 5），而不是主要关注点（n = 2）。11 个结果中有 10 个具有中度至严重的偏倚风险。没有两项研究使用相同的仪器来测量跌倒或移动性。

结论

尽管 AMD 治疗对患者跌倒和行动有潜在的积极影响，但缺乏关于这种关系的质量数据。这项工作强调了将眼科研究成果扩大到视觉参数之外的必要性，以包括以患者为中心的功能测量。采用标准化方法来跟踪跌倒并筛查行走和平衡困难，将能够评估 AMD 治疗的功能结果，可能有助于指导管理。