{"doi":"10.1016/j.xops.2023.100436","title":"Association between Diabetes and Exfoliation Syndrome","abstract":"TopicThis systematic review and meta-analysis summarizes the existing evidence for the association of diabetes mellitus (DM) and exfoliation syndrome (XFS).Clinical RelevanceUnderstanding and quantifying these associations may aid clinical guidelines or treatment strategies and shed light on disease pathogenesis. The role of DM in determining XFS risk may also be of interest from an individual or public health perspective.MethodsThe study protocol was pre-registered on the International Prospective Register of Systematic Reviews (PROSPERO) with registration number CRD42023429771. We systematically searched PubMed and Embase from inception to June 15, 2023. Screening and full-text review were conducted by two independent reviewers. All observational studies reporting an age-adjusted odds ratio (OR) and 95% confidence interval (CI) for the association between DM and XFS among adults were included. Quantitative synthesis involved a random-effects meta-analysis using the DerSimonian-Laird method to generate a pooled OR. Risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS).ResultsFourteen studies (9 cross-sectional and 5 case-control) comprising 47,853 participants were included in the systematic review and meta-analysis. Random-effects meta-analysis indicated no overall association between DM and XFS (OR 0.94; 95% CI, 0.73-1.21; I2 = 68.5%). However, subgroup analysis revealed a significant inverse association among individuals ≥65 years (OR 0.71; 95% CI, 0.54-0.93) versus individuals <65 years (OR 1.22; 95% CI, 0.80-1.87; Peffect modification = 0.04). The relation between DM and XFS was also inverse in case-control studies (OR 0.75; 95% CI, 0.58-0.97) but was non-significant in cross-sectional studies (OR 1.17; 95% CI, 0.83-1.66; Peffect modification = 0.04). Overall risk of bias was low, with tests for publication bias showing P ≥ 0.06.ConclusionThis meta-analysis suggests no association between DM and XFS overall, with possible inverse associations of DM with XFS in older populations. However, given the substantial heterogeneity and borderline significance for publication bias, these findings should be interpreted with caution. Our results give insight into the unique etiology and clinical relevance of XFS while proposing the need for larger longitudinal and genetic biomarker studies.","journal":"Ophthalmology Science","year":2023,"id":382751,"datarank":0.20794415416798362,"base_score":1.3862943611198906,"endowment":1.3862943611198906,"self_citation_contribution":0.20794415416798362,"citation_network_contribution":0.0,"self_endowment_contribution":0.20794415416798362,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.962,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1149668,"name":"Hannah H. Hwang","orcid":null,"position":1,"is_corresponding":false},{"id":6851,"name":"Janey L. Wiggs","orcid":"0000-0003-1890-3278","position":2,"is_corresponding":false},{"id":6895,"name":"Louis R. Pasquale","orcid":"0000-0002-5835-3496","position":3,"is_corresponding":false},{"id":6854,"name":"Jae H. Kang","orcid":"0000-0003-4812-0557","position":4,"is_corresponding":false},{"id":1149216,"name":"Megan Yu","orcid":"0000-0002-5329-9152","position":0,"is_corresponding":true}],"reference_count":82,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T01:17:20.969491Z","pmid":"38250562","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}