A Blurred Vision of Health: Metabolic Syndrome as a Risk Factor for Glaucoma in a Large Taiwanese Population Study

Sheng Hao Chang; Jia In Lee; Szu-Chia Chen; Shu-Pin Huang; Jiun-Hung Geng

doi:10.7150/ijms.121641

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A Blurred Vision of Health: Metabolic Syndrome as a Risk Factor for Glaucoma in a Large Taiwanese Population Study

Sheng Hao Chang, Jia In Lee, Szu-Chia Chen, Shu-Pin Huang, Jiun-Hung Geng

Ivyspring International Publisher (2025) • Volume 23, Issue 1, Pages 216-226

Empirical-ClinicalCrossSectionalPDF AvailableGrade Eligible⚠️ Moderate Risk Flags

Overall Assessment

Limited Methodological Quality

Assessment created by PaperScores Medical AI v0 on Dec 14, 2025

D+

53/100

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Quality Dimensions

Bias & Integrity

COI handling, outcome switching, selective reporting

C62

Methods Rigour

Protocol clarity, sampling, controls

C-55

External Validity

Generalisability, setting, population

C+65

Transparency & Reproducibility

Data/code/materials availability, preregistration

F20

Significance & Novelty

Contribution vs prior art; context if known

C-57

Statistical Validity

Models, assumptions, multiplicity, CI priority

C60

Integrity & Transparency

Integrity checks

P-hacking risk?

?

Review recommended

Signs of selective hypothesis testing or analysis choices that could inflate false positive rates.

Outcome switching?

?

Review recommended

Evidence that primary outcomes were changed during or after the study, potentially distorting results.

Conflict of interest?

?

None suspected

Authors have financial or other relationships that could bias research findings.

Data integrity issues?

?

None suspected

Concerns about the accuracy, completeness, or authenticity of the reported data.

Open science signals

Research data

?

Upon request

Raw data used in the analyses is publicly available or accessible upon request.

Analysis code

?

Not shared

Code or scripts used to analyze the data are shared for reproducibility.

Study materials

?

Not applicable

Protocols, questionnaires, and other materials are publicly available.

Premise

Primary Research Question

Is metabolic syndrome and its components associated with glaucoma prevalence in Taiwanese adults?

Hypothesis

MetS and increasing number of components increase odds of glaucoma; impaired glucose tolerance strongest.

Hypothesis is Falsifiable

✓Yes

Tested via logistic regression with adjusted ORs and CIs.

PICO Framework

Population✓Yes

TWB adults ≥40 years after exclusions.

Intervention✓Yes

Exposure MetS defined by NCEP ATP III and Taiwanese cut-offs.

Comparison✓Yes

MetS vs no MetS; 0–5 components dose–response.

Outcome✓Yes

Self-reported physician-diagnosed glaucoma.

Literature Positioning

Literature Review Balanced

Well covered

Discusses Western and Asian cohorts with convergent/divergent findings.

Evidence: pp. 221–224 citing US, Australia, Korea, Singapore, Iran.

Research Gap Clearly Stated

Well covered

Claims first large-scale TWB evaluation of dose–response in East Asians.

Evidence: p. 218 end; p. 217 middle.

Stated Contribution Clear

Well covered

Reports MetS–glaucoma association and component-specific risks.

Evidence: Abstract p. 216; Results Tables 2–3 pp. 220–221.

Study Provenance

Peer reviewed venueGrant funding disclosedNo conflicts declaredAffiliations listed

Authors & Affiliations

Kaohsiung Medical University and affiliated hospitals/centres, Taiwan.

Funding Statement

MOE Taiwan, NSTC grants, KMU research centre, Kaohsiung Municipal Siaogang Hospital grants.

Conflicts of Interest

Authors declared no competing interest.

Peer Review

✓International Journal of Medical Sciences research paper.

Evidence: p. 216 header: International Journal of Medical Sciences; Research Paper; DOI listed.

Methodological Assessment

Observational StudySTROBEObservational

9 applicable checklist items.

Yes 7 · No 2

Study Design & Definitions

✓

Participant Selection Described

TWB source, age ≥40, exclusions described; flow in Fig.1.

Evidence: p. 218–219; Fig.1.

✓

Variable Definitions Clear

MetS criteria explicit; glaucoma via standardised question.

Evidence: p. 218 MetS Definition; Self-reported Glaucoma.

✓

Confounding Addressed

Multivariable logistic regression with many covariates; VIF checked.

Evidence: p. 219 Statistical Analysis; p. 220 notes.

✗

Temporality Established

Cross-sectional; temporality cannot be established.

Evidence: Discussion p. 224 limitations.

✓

Exposure Definition Anchored

Exposure defined per NCEP ATP III and TW cut-offs; fasting labs.

Evidence: p. 218 MetS Definition.

Bias Mitigation

✓

Selection Bias Addressed

Volunteer bias acknowledged; generalisability caveat.

Evidence: p. 225 selection bias noted.

✓

Misclassification Assessed

Self-report glaucoma misclassification discussed as limitation.

Evidence: p. 224 limitations.

Robustness

✗

Negative Controls or E-value

No negative controls or E-values reported.

Evidence: Methods/Results pp. 219–221.

✓

Model Diagnostics Reported

Collinearity checked; VIF <2 for all predictors.

Evidence: p. 219; Supp. Table 2.

Modules without applicable checklist items (8)

These designs were fully marked as not applicable but remain available for reference.

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Study Overview

Study Design

Cross Sectional

Primary classification used to evaluate this research.

Population

Taiwan Biobank participants aged ≥40 years without prior cancer, community volunteers in Taiwan.

Brief summary of who or what was studied.

Sample Size

93,905

Number of participants included in the study analyses.

Study Arms

2 arms

Total number of intervention or comparison groups.

Pre-registration

Not registered

Indicates whether the protocol or trial was registered before data collection.

Primary Outcome

Primary outcome was pre-specified in the protocol or registry.

Effect Size

adjusted OR: 1.15 (95% CI 1.02–1.30)

Reviewer Notes

Cross-sectional logistic regression of MetS exposure vs self-reported glaucoma; no randomisation or follow-up.

Publication Details

DOI

10.7150/ijms.121641

Published

November 20, 2025

Citations

0 citations

External Resources

DOI Link OpenAlex

Disclaimer: This assessment is generated by AI and should not be the sole basis for clinical or research decisions. Always review the original paper and consult with domain experts.

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