A recent systematic review and meta-analysis revealed a significant association between periodontitis and age-related macular degeneration (AMD), suggesting that gum disease may be an important but underappreciated modifiable risk factor for irreversible vision loss in the elderly.
The study, published in the Journal of Personalized Medicine, integrated data from seven observational studies involving a total of 149,217 subjects.
The comprehensive analysis showed that even after adjusting for confounding factors such as age, sex, and cardiovascular comorbidities, patients with periodontitis still had a 42% increased risk of AMD.
As the understanding of the relationship between periodontitis and systemic low-grade inflammation deepens, studies have found that the systemic inflammatory state accompanied by elevated levels of proinflammatory cytokines (such as IL-1, IL-6, TNF-α) and C-reactive protein (CRP) overlaps with the inflammatory pathways in the pathogenesis of AMD.
AMD is a multifactorial disease involving complex factors such as genetic susceptibility, age-related retinal changes, and immune dysfunction.
Systemic inflammation is believed to accelerate the development of AMD, and elevated CRP is considered an important biomarker of increased risk.
The research team conducted a comprehensive search of 11 scientific databases and screened out 7 studies that met the inclusion criteria from 1,081 records.
These studies covered different designs, diagnostic criteria and geographical regions, with subjects from the United States, Europe and Asia.
Although the definitions of periodontitis and AMD varied from study to study – ranging from clinical periodontal examination to diagnosis based on registration codes – the association between the two remained robust regardless of the criteria used. Sensitivity analysis also supported this conclusion, with the odds ratio ranging from 1.23 to 1.49.
Interestingly, some studies have pointed out that the association between severe periodontitis and AMD is more significant in people under 60 years old, while this association is weakened in the elderly, possibly because the influence of other age-related risk factors is more prominent.
Unlike unchangeable AMD risk factors such as genetics and age, periodontitis is a potential risk factor that can be intervened. Strengthening periodontal health management may open up new possibilities for reducing the risk of AMD.
The authors call for more attention to the oral health of patients at high risk for AMD and recommend future intervention studies to explore whether intensive periodontal treatment can effectively reduce the incidence and progression of AMD.
Lead author Sophie Boberg-Ans said: “Unlike immutable risk factors such as genetic susceptibility and advanced age, periodontitis is a risk factor that can be treated and hopefully eliminated, so the risk of AMD can be reduced through personalized strategies. Special attention should be paid to the dental health of high-risk patients.”
The authors also acknowledged that there was great heterogeneity in the included studies, especially in the diagnostic criteria for periodontitis and AMD.
Some studies relied on registry data or self-reporting, which may introduce misclassification bias. In addition, unmeasured confounders such as diet and obesity may also affect the observed associations.
Nevertheless, this study provides the latest comprehensive evidence based on previous meta-analyses. The study emphasizes the urgent need for prospective, well-designed controlled studies to clarify the impact of periodontal treatment on AMD risk and its potential mechanisms of action.
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