High-Altitude Maculopathy in Mountaineers: A Systematic Review and Meta-Analysis
DOI:
https://doi.org/10.37275/bsm.v10i6.1613Keywords:
High-altitude maculopathy, Meta-analysis, Mountaineering, Retinopathy, Systematic reviewAbstract
Background: High-altitude maculopathy (HAM) represents a distinct form of high-altitude retinopathy affecting mountaineers at extreme elevations. Despite increased mountaineering activity, the prevalence and clinical significance of HAM remain poorly characterised in systematic reviews.
Methods: A comprehensive systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Databases searched included PubMed, Scopus, Cochrane Library, and manual review of reference lists through April 2026. Eligible studies were prospective and retrospective cohorts reporting HAM prevalence in mountaineers at altitude ≥3,500 metres. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analysis employed the Freeman-Tukey double arcsine transformation with DerSimonian-Laird random-effects modelling.
Results: Three prospective studies (n=50 mountaineers) were analysed with a pooled prevalence of 73.37% (95% confidence interval: 60.28–84.72%). Heterogeneity was absent (I²=0%, Q=0.78, p=0.678). Subgroup analysis demonstrated a higher prevalence at extreme altitude (≥5,000 m: 78.6%) versus very high altitude (3,500–4,999 m: 70%). Sensitivity ranged 67.48–83.76%. Funnel plot inspection revealed no evidence of publication bias.
Conclusion: Approximately three-quarters of mountaineers experience HAM at high altitude, with prevalence increasing at extreme elevations. HAM represents a common but underrecognised altitude-related ocular complication. Future prospective studies should employ standardised diagnostic criteria and investigate the mechanistic pathways of macular involvement.
Authors
- Rataya Paramitha Maliawan1*
- I Made Ady Wirawan2
- I Gusti Ayu Made Juliari1
- Ida Ayu Ary Pramita1
- 1Department of Ophthalmology, Faculty of Medicine, Universitas Udayana/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Indonesia
- 2Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
Corresponding author Rataya Paramitha Maliawan — maliawanrataya@gmail.com
Article history
- Submitted
- Accepted
- Published
Downloads
Published
Issue
Section
License
As our aim is to disseminate original research article, hence the publishing right is a necessary one. The publishing right is needed in order to reach the agreement between the author and publisher. As the journal is fully open access, the authors will sign an exclusive license agreement.
The authors have the right to:
- Share their article in the same ways permitted to third parties under the relevant user license.
- Retain copyright, patent, trademark and other intellectual property rights including research data.
- Proper attribution and credit for the published work.
For the open access article, the publisher is granted to the following right.
- The non-exclusive right to publish the article and grant right to others.
- For the published article, the publisher applied for the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
