{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T02:02:54Z","timestamp":1784772174023,"version":"3.55.0"},"reference-count":26,"publisher":"BMJ","issue":"8","funder":[{"DOI":"10.13039\/501100002551","name":"Seoul National University","doi-asserted-by":"publisher","award":["2023"],"award-info":[{"award-number":["2023"]}],"id":[{"id":"10.13039\/501100002551","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2025,11,2]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background\/Aims<\/jats:title>\n                    <jats:p>Major age-related ocular diseases (ARODs)\u2014glaucoma, degeneration of macula and posterior pole (DMPP) and diabetes mellitus with ophthalmic complications (DOC)\u2014often 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 0.5\u2009million participants followed over 7\u2009495\u2009390 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%\u2009CI 4.33 to 5.68) increased 1.93-fold with a second AROD (aHR 9.54; 95%\u2009CI 6.37 to 14.30) and 2.54-fold with a third AROD (aHR 12.59; 95%\u2009CI 2.32 to 68.44).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjo-2025-327643","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T18:20:19Z","timestamp":1763403619000},"page":"949-954","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Synergistic effects of glaucoma, degeneration of macula and posterior pole, and diabetic ophthalmic complications on vision loss"],"prefix":"10.1136","volume":"110","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8431-4768","authenticated-orcid":false,"given":"Sooyeon","family":"Choe","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Ajou University School of Medicine, Suwon-si, Korea (the Republic of)"},{"name":"Department of Ophthalmology, Ajou University Hospital, Suwon-si, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Xi","sequence":"additional","affiliation":[{"name":"Ranelagh Center for Biosocial Informatics, Seoul National University College of Medicine, Seoul, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong Young","family":"Park","sequence":"additional","affiliation":[{"name":"Faculty of Science, Engineering and Medicine, Warwick Medical School, Coventry, UK"},{"name":"Department of Ophthalmology, University Hospitals Coventry and Warwickshire, Coventry, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung Hae","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahnul","family":"Ha","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Jeju National University Hospital, Jeju-si, Korea (the Republic of)"},{"name":"Department of Ophthalmology, Jeju National University School of Medicine, Jeju-si, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Su Hwan","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Information Statistics, Gyeongsang National University, Jinju-si, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6037-8449","authenticated-orcid":false,"given":"Young Kook","family":"Kim","sequence":"additional","affiliation":[{"name":"Ranelagh Center for Biosocial Informatics, Seoul National University College of Medicine, Seoul, Korea (the Republic of)"},{"name":"Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea (the Republic of)"},{"name":"Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,17]]},"reference":[{"key":"2026072202101931000_110.8.949.1","doi-asserted-by":"crossref","first-page":"e144","DOI":"10.1016\/S2214-109X(20)30489-7","article-title":"Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study","volume":"9","author":"Steinmetz","year":"2021","journal-title":"Lancet Glob Health"},{"key":"2026072202101931000_110.8.949.2","unstructured":"He W . 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