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Background: There is accumulating evidence of the associations between age-related eye diseases (AREDs) and smoking or dietary factors. We aimed to provide an umbrella review of the published literature pertaining to smoking or dietary intake as risk factors for major AREDs including cataract, glaucoma, age-related macular degeneration (AMD) and diabetic retinopathy., Methods: We searched for pertinent systematic reviews or meta-analyses in PubMed and Web of Science until 16 April 2022. We reperformed the meta-analysis of each association using random effects models. The heterogeneity and 95% prediction interval were calculated. The presence of small-study effect or excess significance bias was also assessed., Results: In total, 64 associations from 25 meta-analyses and 41 associations from 10 qualitative systematic reviews were evaluated. There was convincing (class I) evidence for only one association, namely current smoking and cataract. Two factors had highly suggestive (class II) evidence, namely ever smoking associated with cataract and fish consumption associated with AMD. We also found suggestive (class III) evidence for associations between the dietary intake of omega-3 polyunsaturated fatty acid, lutein, zeaxanthin, vitamin C and the risk of cataract., Conclusions: Smoking as a risk factor for cataract was the most robust association we identified. We also identified several dietary elements associated with AREDs. Large prospective studies are warranted to further examine the associations discussed in this review., Prospero Registration Number: CRD42022339082., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To assess the impacts of area-level socioeconomic and environmental measures on reduced visual acuity (VA)., Methods: This ecological study used the nationally representative cross-sectional data from the Chinese National Survey on Students' Constitution and Health in 2014 (CNSSCH 2014), which included 261,833 participants aged 7 to 22 years randomly selected from 30 mainland provinces in China. Area-level socioeconomic measures assessed included gross domestic product (GDP), population density, density of hospital beds, and nighttime light data measured as the mean digital number (DN) of each region; environmental factors assessed included latitude, annual sunlight duration, and park green space density. The main outcome measure was the prevalence of reduced VA in each province of Mainland China., Results: GDP (coefficient: 0.221; P < 0.001), mean DN (coefficient: 0.461; P < 0.001), latitude (coefficient: 0.093; P < 0.001), and annual sunlight duration (coefficient: 0.112; P < 0.001) were positively associated with the prevalence of reduced VA, while population density (coefficient: -0.256; P < 0.001), park green space per 10,000 people (coefficient: -0.145; P < 0.001), and number of hospital beds per 10,000 people (coefficient: -0.146; P < 0.001) were negatively associated with reduced VA prevalence. Factor analysis indicated a marginally nonsignificant positive correlation between socioeconomic factors and the prevalence of reduced VA (coefficient: 0.034; P = 0.07)., Conclusions: Increased GDP and mean DN, which reflect economic development, were associated with a higher prevalence of reduced VA, while larger park green space and number of hospital beds per 10,000 people seemed to play a protective role, which could be targeted to design preventive strategies for myopia.