A new systematic review and meta-analysis found a significant association between periodontitis and age-related macular degeneration (AMD), suggesting gum disease may be an underrecognized modifiable risk factor for the most common cause of irreversible vision loss among the elderly.
The study, published in the Journal of Personalized Medicine, analyzed data from seven observational studies comprising a total of 149,217 individuals. The pooled results showed that individuals with periodontitis are 42% more likely to develop AMD, even after accounting for confounding factors such as age, sex, and cardiovascular comorbidities.
Periodontitis has been increasingly linked to systemic low-grade inflammation, and the researchers found that this systemic inflammatory burden, characterized by elevated levels of pro-inflammatory cytokines (IL-1, IL-6, TNF-α) and C-reactive protein (CRP), overlaps mechanistically with the inflammatory pathways implicated in AMD pathogenesis.
AMD itself is a complex disease driven by the interplay of genetic predisposition, age-related retinal changes, and immune dysregulation. Systemic inflammation is known to exacerbate AMD progression, with elevated CRP levels serving as a biomarker of increased risk.
The researchers conducted a comprehensive search across 11 scientific databases, screening 1,081 records and including 7 studies that met predefined criteria. These studies varied in design, diagnostic approaches, and geographic locations, with populations from the US, Europe, and Asia.
While definitions of periodontitis and AMD differed among studies—ranging from clinical periodontal examinations to registry-based diagnosis codes—the association remained robust across methodologies. Sensitivity analyses confirmed the stability of the findings, with odds ratios consistently ranging between 1.23 and 1.49.
Interestingly, some studies suggested an age-dependent association. Severe periodontitis was more strongly linked to AMD in individuals younger than 60, while the effect appeared attenuated in older cohorts, potentially due to the dominance of other age-related risk factors.
Unlike established risk factors for AMD such as genetics and advanced age, periodontitis represents a potentially modifiable risk factor. Targeting periodontal health could offer a new avenue for AMD risk reduction.
The study authors advocate for heightened attention to oral health in patients at risk of AMD and suggest future interventional studies explore whether intensive periodontal care can reduce AMD incidence or progression.
“Unlike other important but unmodifiable risk factors such as genetic predisposition and high age, periodontitis is a risk factor that can be treated and potentially eliminated, thus allowing for a personalized approach for risk elimination in AMD,” writes lead author Sophie Boberg-Ans. “Attention should be given to the dental health of patients at risk of AMD.”
The authors acknowledge significant heterogeneity in the included studies, particularly in diagnostic criteria for periodontitis and AMD. The reliance on registry codes or self-reported diagnoses in some studies introduces potential misclassification bias. Additionally, unmeasured confounders such as diet and obesity—factors associated with both diseases—may influence the observed association.
Despite these limitations, the study builds on prior meta-analyses and provides an updated synthesis of the evidence. The findings reinforce the need for prospective, well-controlled studies that can clarify the relationship and assess the impact of periodontal treatment on AMD risk.
