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Bhattacharya P, Edwards K, Harkin D, Schmid KL. Corneal Epithelial Cell Density Is Reduced in Young Adults With Conjunctival Ultraviolet Autofluorescence. Cornea 2024; 43:693-701. [PMID: 37713663 DOI: 10.1097/ico.0000000000003389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/08/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE The aim of this study was to investigate the effects of chronic ultraviolet (UV) radiation exposure on the corneal microstructure using conjunctival UV autofluorescence (CUVAF) as a marker of exposure. METHODS Young healthy adults aged 18 to 35 years were recruited. Participant's demographics and sun exposure behavior were recorded using questionnaires. Images of the bulbar conjunctiva from the right eye were captured and analyzed for the CUVAF area. Corneal microstructure was assessed by in vivo confocal microscopy and anterior segment optical coherence tomography. The presence of palisades of Vogt in all 4 limbal quadrants was recorded. RESULTS CUVAF was observed in 31 of 52 eyes (60%), with a mean (±SD) nasal, temporal, and total CUVAF area of 5.39 ± 4.16 mm 2 , 4.29 ± 4.27 mm 2 , and 9.67 ± 7.01 mm 2 , respectively. Individuals with CUVAF were significantly more likely to report undertaking moderate-intensity to high-intensity outdoor exercise ( P = 0.021). Individuals with CUVAF were less likely to have visible nasal and temporal palisades of Vogt ( P = 0.011). Corneal basal cell densities anterior to the nerve whorl ( P < 0.001) and nasally ( P = 0.005) were lower in individuals with CUVAF. Wing cell density anterior to the nerve whorl was lower in individuals with CUVAF ( P = 0.011). No significant changes in the central and limbal corneal epithelial thickness were observed. CONCLUSIONS Significant reductions in corneal epithelial cell density were observed in individuals with CUVAF, a biomarker of chronic UV exposure. This observation suggests that chronic UV exposure is damaging to the corneal microstructure.
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Affiliation(s)
- Pradipta Bhattacharya
- School of Optometry and Vision Science, Centre for Vision and Eye Research, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia; and
| | - Katie Edwards
- School of Optometry and Vision Science, Centre for Vision and Eye Research, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia; and
| | - Damien Harkin
- School of Biomedical Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Katrina L Schmid
- School of Optometry and Vision Science, Centre for Vision and Eye Research, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia; and
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de la Puente M, Irigoyen-Bañegil C, Ortega Claici A, González-Zamora J, Bilbao-Malavé V, Fernandez-Robredo P, Hernández M, Barrio J, García-Layana A, Recalde S. Could Children's Myopization Have Been Avoided during the Pandemic Confinement? The Conjunctival Ultraviolet Autofluorescence (CUVAF) Biomarker as an Answer. Biomedicines 2024; 12:347. [PMID: 38397949 PMCID: PMC10886979 DOI: 10.3390/biomedicines12020347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The objective of this study was to evaluate the association of the presence of conjunctival ultraviolet autofluorescence (CUVAF) with the level and progression of myopia and the impact of reduced sunlight exposure during the COVID-19 pandemic confinement (PC). METHODS A retrospective observational study was carried out using three cohorts, children (9-17 years old), young adults (18-25 years old), and adults (>40 years old) with myopia (≤0.75D) and at least three annual eye examinations (before and after PC). All participants underwent an automatic objective refraction and CUVAF area analysis. All the participants filled out a questionnaire regarding lifestyle and myopia history. RESULTS The 298 recruited participants showed that during the PC, children's and young adults' myopia progression rate increased on average by -0.50 and -0.30 D/year, respectively, compared with the pre-pandemic level (p < 0.0001 and p < 0.01). A significantly greater progression was observed in those with low baseline myopia compared to those with moderate or high myopia (p < 0.01). CUVAF shows its protective effect associated with outdoor activity (OA) with regard to the age of onset of myopia and mean diopters (p < 0.01). In fact, although there were no differences in the increase in diopters between children with and without CUVAF during the PC, those who had CUVAF started with lower gains (-0.3 D/year) compared to those who did not (-0.5 D/year; p < 0.05). The myopia treatments (atropine drops, Ortho-K, and MiSight® contact lenses) showed a reduction effect in myopic progression rate post-PC in comparison with non-treated children (p < 0.0001, p < 0.0001 and p < 0.01, respectively). CONCLUSIONS The strict restriction of OA during PC led to the rate of myopia progression doubling among children and young adults. This progression occurred mainly in children with previously low myopia, and CUVAF, as a biomarker of OA, reflects its potential to provide benefits in the form of recommended behavioral changes to protect against the development of myopia.
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Affiliation(s)
- Miriam de la Puente
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (M.d.l.P.); (C.I.-B.); (A.O.C.); (J.G.-Z.); (V.B.-M.); (P.F.-R.); (M.H.); (A.G.-L.)
- Department of Ophthalmology, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
- Navarra Institute for Health Research, IdiSNA, 31008 Pamplona, Spain
| | - Cristina Irigoyen-Bañegil
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (M.d.l.P.); (C.I.-B.); (A.O.C.); (J.G.-Z.); (V.B.-M.); (P.F.-R.); (M.H.); (A.G.-L.)
- Department of Ophthalmology, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
- Navarra Institute for Health Research, IdiSNA, 31008 Pamplona, Spain
| | - Aura Ortega Claici
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (M.d.l.P.); (C.I.-B.); (A.O.C.); (J.G.-Z.); (V.B.-M.); (P.F.-R.); (M.H.); (A.G.-L.)
- Faculty of Medicine, Universidad de Navarra, 31008 Pamplona, Spain
| | - Jorge González-Zamora
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (M.d.l.P.); (C.I.-B.); (A.O.C.); (J.G.-Z.); (V.B.-M.); (P.F.-R.); (M.H.); (A.G.-L.)
- Department of Ophthalmology, Bellvitge University Hospital, 08907 Barcelona, Spain
| | - Valentina Bilbao-Malavé
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (M.d.l.P.); (C.I.-B.); (A.O.C.); (J.G.-Z.); (V.B.-M.); (P.F.-R.); (M.H.); (A.G.-L.)
- Department of Ophthalmology, Bellvitge University Hospital, 08907 Barcelona, Spain
| | - Patricia Fernandez-Robredo
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (M.d.l.P.); (C.I.-B.); (A.O.C.); (J.G.-Z.); (V.B.-M.); (P.F.-R.); (M.H.); (A.G.-L.)
- Department of Ophthalmology, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
- Navarra Institute for Health Research, IdiSNA, 31008 Pamplona, Spain
| | - María Hernández
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (M.d.l.P.); (C.I.-B.); (A.O.C.); (J.G.-Z.); (V.B.-M.); (P.F.-R.); (M.H.); (A.G.-L.)
- Department of Ophthalmology, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
- Navarra Institute for Health Research, IdiSNA, 31008 Pamplona, Spain
| | - Jesús Barrio
- Department of Ophthalmology, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
- Navarra Institute for Health Research, IdiSNA, 31008 Pamplona, Spain
| | - Alfredo García-Layana
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (M.d.l.P.); (C.I.-B.); (A.O.C.); (J.G.-Z.); (V.B.-M.); (P.F.-R.); (M.H.); (A.G.-L.)
- Department of Ophthalmology, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
- Navarra Institute for Health Research, IdiSNA, 31008 Pamplona, Spain
| | - Sergio Recalde
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (M.d.l.P.); (C.I.-B.); (A.O.C.); (J.G.-Z.); (V.B.-M.); (P.F.-R.); (M.H.); (A.G.-L.)
- Department of Ophthalmology, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
- Navarra Institute for Health Research, IdiSNA, 31008 Pamplona, Spain
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Rodriguez NG, Claici AO, Ramos-Castaneda JA, González-Zamora J, Bilbao-Malavé V, de la Puente M, Fernandez-Robredo P, Garzón-Parra SJ, Garza-Leon M, Recalde S. Conjunctival ultraviolet autofluorescence as a biomarker of outdoor exposure in myopia: a systematic review and meta-analysis. Sci Rep 2024; 14:1097. [PMID: 38212604 PMCID: PMC10784576 DOI: 10.1038/s41598-024-51417-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024] Open
Abstract
Outdoor exposure is considered the primary modifiable risk factor in preventing the development of myopia. This effect is thought to be attributed to the light-induced synthesis and release of dopamine in the retina. However, until recent years, there was no objective quantifiable method available to measure the association between time spent outdoors and myopia. It is only recently that the conjunctival ultraviolet autofluorescence (CUVAF) area, serving as a biomarker for sun exposure, has begun to be utilized in numerous studies. To provide a comprehensive summary of the relevant evidence pertaining to the association between the CUVAF area and myopia across different geographic regions and age groups, a systematic review and meta-analysis were conducted. The search encompassed multiple databases, including MEDLINE, SCIENCE DIRECT, GOOGLE SCHOLAR, WEB OF SCIENCE, and SCOPUS, and utilized specific search terms such as "conjunctival ultraviolet autofluorescence", "CUVAF", "UVAF", "objective marker of ocular sun exposure", "myopia", "degenerative myopia", and "high myopia". The bibliographic research included papers published between the years 2006 and 2022. A total of 4051 records were initially identified, and after duplicates were removed, 49 articles underwent full-text review. Nine articles were included in the systematic review. These studies covered myopia and outdoor exposure across different regions (Australia, Europe and India) with a total population of 3615 individuals. They found that myopes generally had smaller CUVAF areas compared to non-myopes. The meta-analysis confirmed this, revealing statistically smaller CUVAF areas in myopic patients, with a mean difference of - 3.30 mm2 (95% CI - 5.53; - 1.06). Additionally, some studies showed a positive correlation between more outdoor exposure and larger CUVAF areas. In terms of outdoor exposure time, myopic patients reported less time outdoors than non-myopic individuals, with a mean difference of - 3.38 h/week (95% CI - 4.66; - 2.09). Overall, these findings highlight the connection between outdoor exposure, CUVAF area and myopia, with regional variations playing a significant role. The results of this meta-analysis validate CUVAF as a quantitative method to objectively measure outdoor exposure in relation with myopia development.
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Grants
- 01/0022-23 Doctoral fellowship funded by Miniciencias Bogotá, Colombia.
- PI20/00251 Instituto de Salud Carlos III through the project Co-funded by European Regional Development Fund "A way to make Europe"
- CUN 2019 Multiópticas
- (RD21/0017/0027) Redes de Investigación Cooperativa Orientadas al Resultado en Salud (RICORS) de Terapias avanzadas , Enfermedades Inflamatorias and Enfermedades vasculares cerebrales , Ministerio de Ciencia, Innovación y Universidades, Instituto de Salud Carlos III
- (RD21/0002/0010) Redes de Investigación Cooperativa Orientadas al Resultado en Salud (RICORS) de Terapias avanzadas , Enfermedades Inflamatorias and Enfermedades vasculares cerebrales , Ministerio de Ciencia, Innovación y Universidades, Instituto de Salud Carlos III
- (RD21/0006/0008) Redes de Investigación Cooperativa Orientadas al Resultado en Salud (RICORS) de Terapias avanzadas , Enfermedades Inflamatorias and Enfermedades vasculares cerebrales , Ministerio de Ciencia, Innovación y Universidades, Instituto de Salud Carlos III
- 01-20/21 Fundación Jesús Gangoiti Barrera
- Instituto de Salud Carlos III through the project Co-funded by European Regional Development Fund “A way to make Europe”
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Affiliation(s)
- Natali Gutierrez Rodriguez
- Grupo de Investigación en Optometría-Facultad de Optometría de la Universidad Antonio Nariño, Bogotá, Colombia
| | - Aura Ortega Claici
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, Pamplona, Spain
- Faculty of Medicine, Universidad de Navarra, Pamplona, Spain
| | - Jorge A Ramos-Castaneda
- Research Group Innovación y Cuidado, Faculty of Nursing, Universidad Antonio Nariño, Neiva, Colombia
| | - Jorge González-Zamora
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, Pamplona, Spain
- Department of Ophthalmology, Clínica Universidad de Navarra, Madrid, Spain
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain
| | - Valentina Bilbao-Malavé
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, Pamplona, Spain
- Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain
| | - Miriam de la Puente
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, Pamplona, Spain
- Department of Ophthalmology, Clínica Universidad de Navarra, Madrid, Spain
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain
| | - Patricia Fernandez-Robredo
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, Pamplona, Spain
- Department of Ophthalmology, Clínica Universidad de Navarra, Madrid, Spain
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain
| | - Sandra Johanna Garzón-Parra
- Grupo de Investigación en Optometría-Facultad de Optometría de la Universidad Antonio Nariño, Bogotá, Colombia
| | - Manuel Garza-Leon
- Clinical Science Department, Science of Health Division, University of Monterrey, San Pedro Garza García, Nuevo León, México
| | - Sergio Recalde
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, Pamplona, Spain.
- Department of Ophthalmology, Clínica Universidad de Navarra, Madrid, Spain.
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain.
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Wolffsohn JS. 2022 Glenn A. Fry Award lecture: Enhancing clinical assessment for improved ophthalmic management. Optom Vis Sci 2024; 101:12-24. [PMID: 38350054 DOI: 10.1097/opx.0000000000002102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
ABSTRACT Detailed clinical assessment is critical to allow sensitive evaluation of the eye and its management. As technology advances, these assessment techniques can be adapted and refined to improve the detection of pathological changes of ocular tissue and their impact on visual function. Enhancements in optical medical devices including spectacle, contact, and intraocular lenses have allowed for a better understanding of the mechanism and amelioration of presbyopia and myopia control. Advancements in imaging technology have enabled improved quantification of the tear film and ocular surface, informing diagnosis and treatment strategies. Miniaturized electronics, large processing power, and in-built sensors in smartphones and tablets capacitate more portable assessment tools for clinicians, facilitate self-monitoring and treatment compliance, and aid communication with patients. This article gives an overview of how technology has been used in many areas of eye care to improve assessments and treatment and provides a snapshot of some of my studies validating and using technology to inform better evidence-based patient management.
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Sureshkumar I, Gunalan V, Nareshkumar RN, Sripriya K, Ronnie G, Sharada R, Asokan R. Evaluating the impact of ocular UV exposure for the development for pseudoexfoliation syndrome in a South Indian population. Clin Exp Optom 2023; 106:734-740. [PMID: 36375140 DOI: 10.1080/08164622.2022.2134762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/16/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022] Open
Abstract
CLINICAL RELEVANCE Pathophysiology of pseudoexfoliation syndrome (XFS) can be influenced by environmental factors such as solar exposure/occupational factors and genetic factors. BACKGROUND The study aims to assess the association of lifetime ocular UV exposure and its impact on the risk of development of XFS. METHODS All eligible subjects underwent a comprehensive ocular examination. XFS was defined as precipitates on the pupillary border, cornea, and angle of anterior chamber or lens in at least one eye without any clinical signs of glaucoma. A standardised questionnaire was administered to assess the lifetime UV exposure. Conjunctival ultraviolet autofluorescence (CUVAF) photography was taken to detect the conjunctival changes with exposure to UV radiation. Ascorbic acid concentration in the aqueous humour was measured. RESULTS A total of 404 subjects of which 274 (controls) and 130 (XFS cases) were studied. There were 204 males (50.5%) and 200 females (49.5%).Lifetime UV exposure (OR: 1.14, 95% CI: 1.02-1.30, p: 0.032), CUVAF damage (OR: 1.03, 95% CI: 1.01-1.06, p: 0.008) and outdoor worker (OR: 1.87, 95% CI: 1.18-3.00, p: 0.008) were positively associated with XFS. Usage of spectacles (OR: 0.63, 95% CI: 0.39-0.95, p: 0.030) and ascorbic acid concentration in aqueous (OR: 0.47, 95% CI: 0.23-0.99, p: 0.038) were found to be protective against XFS. CONCLUSION Besides genetic factors, environmental factors such as lifetime ocular UV exposure and outdoor work are significantly associated with the risk of XFS. CUVAF can be used as a non-invasive tool to detect preclinical sun damage in outdoor workers.
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Affiliation(s)
- Ishwarya Sureshkumar
- Research Fellow, Vision Research Foundation, Glaucoma services Sankara Nethralaya, Chennai, India
| | - Vaishaali Gunalan
- Research Fellow, Vision Research Foundation, Glaucoma services Sankara Nethralaya, Chennai, India
| | - R N Nareshkumar
- RS Mehta Jain Department of Biochemistry and Cell Biology, Vision Research Foundation Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Krishnamoorthy Sripriya
- Glaucoma Services, Medical Research Foundation Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - George Ronnie
- Research Fellow, Vision Research Foundation, Glaucoma services Sankara Nethralaya, Chennai, India
- Glaucoma Services, Medical Research Foundation Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Ramasubramanyan Sharada
- RS Mehta Jain Department of Biochemistry and Cell Biology, Vision Research Foundation Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Rashima Asokan
- Research Fellow, Vision Research Foundation, Glaucoma services Sankara Nethralaya, Chennai, India
- Glaucoma Services, Medical Research Foundation Sankara Nethralaya, Chennai, Tamil Nadu, India
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Heilenbach N, Hu G, Lamrani R, Prasad J, Ogunsola T, Iskander M, Elgin CY, McGowan R, Vieira D, Al-Aswad LA. Environmental influences on ophthalmic conditions: A scoping review. Clin Exp Ophthalmol 2023; 51:516-545. [PMID: 37309709 DOI: 10.1111/ceo.14262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/05/2023] [Accepted: 05/18/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Environmental factors have been implicated in various eye pathologies. The purpose of this review is to synthesise the published research on environmental effects on eye disease. METHODS Four databases were searched for terms relating to environmental exposures and ophthalmic disease. Titles and abstracts were screened followed by full-text review. Data was extracted from 118 included studies. Quality assessment was conducted for each study. RESULTS Air pollutants, including nitrogen dioxide, nitrites, sulphur dioxide, particulate matter, carbon monoxide, ozone and hydrocarbons are associated with ocular conditions ranging from corneal damage to various retinopathies, including central retinal artery occlusion. Certain chemicals and metals, such as cadmium, are associated with increased risk of age-related macular degeneration. Climate factors, such as sun exposure, have been associated with the development of cataracts. Living in rural areas was associated with various age-related eye diseases whereas people living in urban settings had higher risk for dry eye disease and uveitis. CONCLUSION Environmental exposures in every domain are associated with various ophthalmic conditions. These findings underscore the importance of continued research on the interplay between the environment and eye health.
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Affiliation(s)
- Noah Heilenbach
- Grossman School of Medicine, Department of Ophthalmology, New York University, New York, New York, USA
| | - Galen Hu
- Grossman School of Medicine, Department of Ophthalmology, New York University, New York, New York, USA
| | - Ryan Lamrani
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Jaideep Prasad
- Grossman School of Medicine, Department of Ophthalmology, New York University, New York, New York, USA
| | - Titilola Ogunsola
- Department of Ophthalmology, Howard University College of Medicine, Washington, District of Columbia, USA
| | - Mina Iskander
- Miller School of Medicine, Department of Medicine, University of Miami, Miami, Florida, USA
| | - Cansu Yuksel Elgin
- Department of Ophthalmology, Istanbul Universitesi-Cerrahpaşa, Istanbul, Turkey
| | - Richard McGowan
- Health Sciences Library, New York University, New York, New York, USA
| | - Dorice Vieira
- Health Sciences Library, New York University, New York, New York, USA
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Rajasingam P, Shaw A, Davis B, Alonso-Caneiro D, Hamwood J, Collins M. The association between conjunctival and scleral thickness and ocular surface ultraviolet autofluorescence. Sci Rep 2023; 13:7931. [PMID: 37193731 DOI: 10.1038/s41598-023-35062-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/11/2023] [Indexed: 05/18/2023] Open
Abstract
Ultraviolet autofluorescence (UVAF) imaging is used to visualise ocular surface changes due to sunlight exposure and so is considered to be a biomarker for UV damage. The conjunctival and scleral thicknesses of participants with and without ocular surface UVAF were measured to examine the UVAF associated tissue thicknesses. The presence of UVAF on the ocular surface was associated with significant differences in tissue thickness including thinner conjunctival epitheliums and thicker scleras but predominantly thickening of the conjunctival stroma. Participants were also classified into four groups according to the presence and absence of UVAF on both the temporal and nasal conjunctivas. It was noted that for those that had only nasal UVAF, the temporal conjunctival stroma was significantly thicker even without the presence of UVAF. Some participants with temporal UVAF had signs of pinguecula observed with slit lamp examination and some had OCT SLO enface imaging darkening. These findings highlight the potential of techniques other than slit lamp examination, including tissue thickness measurement and UVAF photography, in the detection of early UV-related changes to the ocular surface.
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Affiliation(s)
- Pryntha Rajasingam
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia
| | - Alyra Shaw
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia.
| | - Brett Davis
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia
| | - David Alonso-Caneiro
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia
| | - Jared Hamwood
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia
| | - Michael Collins
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia
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Bilbao-Malavé V, González-Zamora J, Gándara E, de la Puente M, Escriche E, Bezunartea J, Marizkurrena A, Alonso E, Hernández M, Fernández-Robredo P, Sáenz de Viteri M, Barrio-Barrio J, García-Layana A, Recalde S. A Cross-Sectional Observational Study of the Relationship between Outdoor Exposure and Myopia in University Students, Measured by Conjunctival Ultraviolet Autofluorescence (CUVAF). J Clin Med 2022; 11:jcm11154264. [PMID: 35893353 PMCID: PMC9331436 DOI: 10.3390/jcm11154264] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022] Open
Abstract
Myopia is the most common refractive error worldwide. This cannot be explained by genetic factors alone, therefore, environmental factors may play an important role. Hence, the main objective of this study was to analyse whether outdoor exposure could exert a protective effect against the development of myopia in a cohort of young adults and to investigate ultraviolet autofluorescence (CUVAF), as a biomarker of time spent outdoors. A cross-sectional observational study was carried out using two cohorts. A total of 208 participants were recruited, 156 medical students and 52 environmental science students. The data showed that 66.66% of the medical students were myopic, while 50% of the environmental science students were myopic (p = 0.021). Environmental science students spent significantly more hours per week doing outdoor activities than medical students (p < 0.0001), but there was no significant difference with respect to near work activities between them. In both cohorts, the degree of myopia was inversely associated with CUVAF, and a statistically significant positive correlation was observed between spherical equivalent and CUVAF (Pearson’s r = 0.248). In conclusion, outdoor activities could reduce the onset and progression of myopia not only in children, but also in young adults. In addition, CUVAF represents an objective, non-invasive biomarker of outdoor exposure that is inversely associated with myopia.
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Affiliation(s)
- Valentina Bilbao-Malavé
- Department of Opthalmology, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (V.B.-M.); (J.G.-Z.); (E.G.); (M.d.l.P.); (J.B.); (A.M.); (E.A.); (M.H.); (M.S.d.V.); (J.B.-B.); (A.G.-L.); (S.R.)
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Universidad de Navarra, 31008 Pamplona, Spain
| | - Jorge González-Zamora
- Department of Opthalmology, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (V.B.-M.); (J.G.-Z.); (E.G.); (M.d.l.P.); (J.B.); (A.M.); (E.A.); (M.H.); (M.S.d.V.); (J.B.-B.); (A.G.-L.); (S.R.)
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Universidad de Navarra, 31008 Pamplona, Spain
| | - Elsa Gándara
- Department of Opthalmology, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (V.B.-M.); (J.G.-Z.); (E.G.); (M.d.l.P.); (J.B.); (A.M.); (E.A.); (M.H.); (M.S.d.V.); (J.B.-B.); (A.G.-L.); (S.R.)
| | - Miriam de la Puente
- Department of Opthalmology, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (V.B.-M.); (J.G.-Z.); (E.G.); (M.d.l.P.); (J.B.); (A.M.); (E.A.); (M.H.); (M.S.d.V.); (J.B.-B.); (A.G.-L.); (S.R.)
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Universidad de Navarra, 31008 Pamplona, Spain
| | - Elena Escriche
- Faculty of Medicine, Universidad de Navarra, 31008 Pamplona, Spain;
| | - Jaione Bezunartea
- Department of Opthalmology, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (V.B.-M.); (J.G.-Z.); (E.G.); (M.d.l.P.); (J.B.); (A.M.); (E.A.); (M.H.); (M.S.d.V.); (J.B.-B.); (A.G.-L.); (S.R.)
- Navarra Institute for Health Research, IdiSNA, 31008 Pamplona, Spain
- Red Temática de Investigación Cooperativa en Salud (RD16/0008/0011), Ministerio de Ciencia, Innovación y Universidades, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ainara Marizkurrena
- Department of Opthalmology, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (V.B.-M.); (J.G.-Z.); (E.G.); (M.d.l.P.); (J.B.); (A.M.); (E.A.); (M.H.); (M.S.d.V.); (J.B.-B.); (A.G.-L.); (S.R.)
| | - Elena Alonso
- Department of Opthalmology, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (V.B.-M.); (J.G.-Z.); (E.G.); (M.d.l.P.); (J.B.); (A.M.); (E.A.); (M.H.); (M.S.d.V.); (J.B.-B.); (A.G.-L.); (S.R.)
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Universidad de Navarra, 31008 Pamplona, Spain
- Navarra Institute for Health Research, IdiSNA, 31008 Pamplona, Spain
- Red Temática de Investigación Cooperativa en Salud (RD16/0008/0011), Ministerio de Ciencia, Innovación y Universidades, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - María Hernández
- Department of Opthalmology, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (V.B.-M.); (J.G.-Z.); (E.G.); (M.d.l.P.); (J.B.); (A.M.); (E.A.); (M.H.); (M.S.d.V.); (J.B.-B.); (A.G.-L.); (S.R.)
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Universidad de Navarra, 31008 Pamplona, Spain
- Navarra Institute for Health Research, IdiSNA, 31008 Pamplona, Spain
- Red Temática de Investigación Cooperativa en Salud (RD16/0008/0011), Ministerio de Ciencia, Innovación y Universidades, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Patricia Fernández-Robredo
- Department of Opthalmology, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (V.B.-M.); (J.G.-Z.); (E.G.); (M.d.l.P.); (J.B.); (A.M.); (E.A.); (M.H.); (M.S.d.V.); (J.B.-B.); (A.G.-L.); (S.R.)
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Universidad de Navarra, 31008 Pamplona, Spain
- Navarra Institute for Health Research, IdiSNA, 31008 Pamplona, Spain
- Red Temática de Investigación Cooperativa en Salud (RD16/0008/0011), Ministerio de Ciencia, Innovación y Universidades, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-948-425600 (ext. 6499-6290)
| | - Manuel Sáenz de Viteri
- Department of Opthalmology, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (V.B.-M.); (J.G.-Z.); (E.G.); (M.d.l.P.); (J.B.); (A.M.); (E.A.); (M.H.); (M.S.d.V.); (J.B.-B.); (A.G.-L.); (S.R.)
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Universidad de Navarra, 31008 Pamplona, Spain
- Navarra Institute for Health Research, IdiSNA, 31008 Pamplona, Spain
- Red Temática de Investigación Cooperativa en Salud (RD16/0008/0011), Ministerio de Ciencia, Innovación y Universidades, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Jesús Barrio-Barrio
- Department of Opthalmology, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (V.B.-M.); (J.G.-Z.); (E.G.); (M.d.l.P.); (J.B.); (A.M.); (E.A.); (M.H.); (M.S.d.V.); (J.B.-B.); (A.G.-L.); (S.R.)
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Universidad de Navarra, 31008 Pamplona, Spain
- Navarra Institute for Health Research, IdiSNA, 31008 Pamplona, Spain
- Red Temática de Investigación Cooperativa en Salud (RD16/0008/0011), Ministerio de Ciencia, Innovación y Universidades, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Alfredo García-Layana
- Department of Opthalmology, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (V.B.-M.); (J.G.-Z.); (E.G.); (M.d.l.P.); (J.B.); (A.M.); (E.A.); (M.H.); (M.S.d.V.); (J.B.-B.); (A.G.-L.); (S.R.)
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Universidad de Navarra, 31008 Pamplona, Spain
- Navarra Institute for Health Research, IdiSNA, 31008 Pamplona, Spain
- Red Temática de Investigación Cooperativa en Salud (RD16/0008/0011), Ministerio de Ciencia, Innovación y Universidades, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Sergio Recalde
- Department of Opthalmology, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (V.B.-M.); (J.G.-Z.); (E.G.); (M.d.l.P.); (J.B.); (A.M.); (E.A.); (M.H.); (M.S.d.V.); (J.B.-B.); (A.G.-L.); (S.R.)
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Universidad de Navarra, 31008 Pamplona, Spain
- Navarra Institute for Health Research, IdiSNA, 31008 Pamplona, Spain
- Red Temática de Investigación Cooperativa en Salud (RD16/0008/0011), Ministerio de Ciencia, Innovación y Universidades, Instituto de Salud Carlos III, 28029 Madrid, Spain
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9
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Wolffsohn JS, Dhallu S, Aujla M, Laughton D, Tempany K, Powell D, Gifford K, Gifford P, Wan K, Cho P, Stahl U, Woods J. International multi-centre study of potential benefits of ultraviolet radiation protection using contact lenses. Cont Lens Anterior Eye 2022; 45:101593. [DOI: 10.1016/j.clae.2022.101593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 11/03/2022]
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10
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Lingham G, Kugelman J, Charng J, Lee SS, Yazar S, McKnight CM, Coroneo MT, Lucas RM, Brown H, Stevenson LJ, Mackey DA, Alonso-Caneiro D. Conjunctival ultraviolet autofluorescence area decreases with age and sunglasses use. Br J Ophthalmol 2021; 107:614-620. [PMID: 34815236 DOI: 10.1136/bjophthalmol-2021-320284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/06/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Conjunctival ultraviolet autofluorescence (CUVAF) is a method of detecting conjunctival damage related to ultraviolet radiation exposure. In cross-sectional studies, CUVAF area is positively associated with self-reported time spent outdoors and pterygium and negatively associated with myopia; however, longitudinal studies are scarce. AIMS To use a novel deep learning-based tool to assess 8-year change in CUVAF area in young adults, investigate factors associated with this change and identify the number of new onset pterygia. METHODS A deep learning-based CUVAF tool was developed to measure CUVAF area. CUVAF area and pterygium status were assessed at three study visits: baseline (participants were approximately 20 years old) and at 7-year and 8-year follow-ups. Participants self-reported sun protection behaviours and ocular history. RESULTS CUVAF data were available for 1497 participants from at least one study visit; 633 (43%) participants had complete CUVAF data. Mean CUVAF areas at baseline and the 7-year and 8-year follow-ups were 48.4, 39.3 and 37.7 mm2, respectively. There was a decrease in mean CUVAF area over time (change in total CUVAF area=-0.96 mm2 per year (95% CI: -1.07 to -0.86)). For participants who wore sunglasses ≥1/2 of the time, CUVAF area decreased by an additional -0.42 mm2 per year (95% CI: -0.72 to -0.12) on average. Fourteen (1.5%) participants developed a pterygium. CONCLUSIONS In this young adult cohort, CUVAF area declined over an 8-year period. Wearing sunglasses was associated with a faster reduction in CUVAF area. Deep learning-based models can assist in accurate and efficient measurement of CUVAF area.
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Affiliation(s)
- Gareth Lingham
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia
| | - Jason Kugelman
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jason Charng
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia
| | - Samantha Sy Lee
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia
| | - Seyhan Yazar
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia.,Garvan-Weizmann Centre for Cellular Genomics, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Charlotte M McKnight
- Ophthalmology, St John of God Health Care, West Perth, Western Australia, Australia
| | - Minas T Coroneo
- Department of Ophthalmology, University of New South Wales, Sydney, New South Wales, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Holly Brown
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia
| | - Louis J Stevenson
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia
| | - David A Mackey
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia
| | - David Alonso-Caneiro
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
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11
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Yadav S, Gupta N, Singh R, Patil M, Meel R, Vanathi M, Kashyap S, Tandon R. Role of Conjunctival Ultraviolet Autofluorescence in Ocular Surface Squamous Neoplasia. Ocul Oncol Pathol 2020; 6:422-429. [PMID: 33447592 DOI: 10.1159/000509578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/19/2020] [Indexed: 11/19/2022] Open
Abstract
Objective To evaluate the adjunctive role of conjunctival autofluorescence in the management of ocular surface squamous neoplasia (OSSN). Materials and Methods Seventeen patients with clinically diagnosed OSSN were included. Morphological characteristics, type of OSSN, and autofluorescence photographs of the lesion were captured. Presence and area of conjunctival ultraviolet autofluorescence (CUVAF) were the main outcome measures. Results Overall, 17 patients with 15 (88%) primary and 2 (12%) recurrent OSSN were included. Common locations were temporal (n = 10), nasal (n = 5), and diffuse variety (n = 2). Morphologically, there were 4 (22.2%) nodular, 4 (22.2%) leucoplakic, 3 (16.7%) gelatinous, and 1 (5.5%) each of papillary, nodulo-ulcerative, and diffuse variety. Mixed morphology was present in 4 eyes (22.2%). Sixteen of 18 eyes (88.9%) with OSSN displayed autofluorescence on CUVAF images. The mean area of CUVAF was 15.82 mm2 (10.77-19.59 mm2). Autofluorescence was reported in 8 eyes (44.4%) which had negative reports on impression cytology. Conclusions Conjunctival autofluorescence was seen in the majority of cases with OSSN, in spite of negative cytology reports. Our study demonstrates that CUVAF may serve as an effective ancillary, non-invasive, and resource-friendly tool for supplementing the clinical diagnosis of OSSN, especially in diffuse and recurrent lesions that are not amenable to surgical intervention.
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Affiliation(s)
- Saumya Yadav
- Cataract, Cornea, Refractive and Ocular Oncology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Noopur Gupta
- Cataract, Cornea, Refractive and Ocular Oncology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmi Singh
- Cataract, Cornea, Refractive and Ocular Oncology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mukesh Patil
- Cataract, Cornea, Refractive and Ocular Oncology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rachna Meel
- Oculoplasty and Ocular Oncology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Murugesan Vanathi
- Cataract, Cornea, Refractive and Ocular Oncology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Kashyap
- Ocular Pathology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Radhika Tandon
- Cataract, Cornea, Refractive and Ocular Oncology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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12
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Stevenson LJ, Mackey DA, Lingham G, Burton A, Brown H, Huynh E, Tan IJ, Franchina M, Sanfilippo PG, Yazar S. Has the Sun Protection Campaign in Australia Reduced the Need for Pterygium Surgery Nationally? Ophthalmic Epidemiol 2020; 28:105-113. [PMID: 32729768 DOI: 10.1080/09286586.2020.1797120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Slip! Slop! Slap! Sunsmart safety campaign was an Australian initiative implemented in the 1980s. To assess this campaign's effect on pterygium, we examined the rate of pterygium surgery across Australia and described the prevalence and associations of pterygium in Perth, Australia's sunniest capital city. METHODS The rate of pterygium surgery was examined using Australian Medicare data. A cross-sectional analysis of the Generation 1 (Gen1) cohort of the Raine Study was performed to investigate the prevalence of pterygium in Perth. We investigated the association between pterygium and conjunctival ultraviolet autofluorescence (CUVAF) area, an objective biomarker of sun exposure, and demographics and health variables derived from a detailed questionnaire. RESULTS Between 1994 and 2017, the rate of Medicare funded pterygium surgery in Western Australia fell 11%, well below the national average decline of 47%. Of the 1049 Gen1 Raine Study participants, 994 (571 females; mean age 56.7 years, range = 40.9-81.7) were included in the analysis. The lifetime prevalence of pterygium was 8.4% (n = 83). A higher prevalence of pterygium was associated with outdoor occupation (p-trend = 0.007), male sex (p-trend 0.01) and increasing CUVAF area (p-value <0.001). CONCLUSIONS The effect of Australia's Slip! Slop! Slap! Sunsmart safety campaign on pterygium been mixed. Since 1994, the rate of private pterygium surgery has declined significantly in all Australian states except Western Australia. Perth, Western Australia, has the highest pterygium prevalence of any mainland-Australian cohort. Higher CUVAF area, male sex, and outdoor occupation were associated with an increased risk of pterygium.
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Affiliation(s)
- Louis J Stevenson
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, New South Wales, Australia
| | - David A Mackey
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia
| | - Gareth Lingham
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia
| | - Alex Burton
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia
| | - Holly Brown
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia
| | - Emily Huynh
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia
| | - Irene J Tan
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia
| | - Maria Franchina
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia
| | - Paul G Sanfilippo
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Victoria, Australia
| | - Seyhan Yazar
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia
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13
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Haworth K, Belair C. Effect of UV-absorbing Contact Lenses on Conjunctival Ultraviolet Autofluorescence. Curr Eye Res 2019; 45:940-944. [PMID: 31852305 DOI: 10.1080/02713683.2019.1707230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The intended purpose of UV-absorbing contact lenses is to protect the cornea and posterior ocular structures from UV-induced damage. Few studies report conjunctival effects of UV-absorbing contact lens materials. The purpose of this study was to evaluate conjunctival ultraviolet autofluorescence (UVAF) for contact lens wearers of UV-absorbing and minimally UV-absorbing materials. METHODS Forty-four volunteers enrolled in the cross-sectional study. Three groups were recruited; non-contact lens wearers (n = 15), minimally UV-absorbing contact lens wearers (n = 15), and UV-absorbing contact lens wearers (n = 14). Ocular sun exposure was calculated using self-reported measures. Conjunctival UVAF images of temporal and nasal conjunctiva, acquired using a Nikon D7000 camera system adapted with appropriate flash and filter system, were analyzed using ImageJ. A sub-group of participants including only subjects with measurable UVAF was analyzed. RESULTS No significant differences were present between groups found similar for age, gender, and ocular sun exposure. The area of UVAF significantly increased following lens removal for UV-absorbing contact lens wearers compared with non-contact lens wearers. Furthermore, for contact lens wearers compared with non-lens wearers, area of UVAF was significantly greater between right and left eyes (p = .04 minimally UV-absorbing, p = .01 UV-absorbing), and between nasal (p = .046 minimally UV-absorbing, p = .01 UV-absorbing), and temporal (p = .01 UV-absorbing) areas. However, no significant difference was found between contact lens wearers of the two groups. No difference was found between nasal and temporal UVAF regions during contact lens wear (p = .28) or after lens removal (p = .16) (Mann-Whitney U). CONCLUSIONS Contact lens materials have conjunctival effects, with increased UVAF in both UV-absorbing and minimally UV-absorbing contact lens wearers compared with non-lens wearers. UV-absorbing and minimally UV-absorbing contact lens materials appear to influence nasal and temporal areas of the ocular surface equally.
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14
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Lucas RM, Yazar S, Young AR, Norval M, de Gruijl FR, Takizawa Y, Rhodes LE, Sinclair CA, Neale RE. Human health in relation to exposure to solar ultraviolet radiation under changing stratospheric ozone and climate. Photochem Photobiol Sci 2019; 18:641-680. [PMID: 30810559 DOI: 10.1039/c8pp90060d] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Montreal Protocol has limited increases in the UV-B (280-315 nm) radiation reaching the Earth's surface as a result of depletion of stratospheric ozone. Nevertheless, the incidence of skin cancers continues to increase in most light-skinned populations, probably due mainly to risky sun exposure behaviour. In locations with strong sun protection programs of long duration, incidence is now reducing in younger age groups. Changes in the epidemiology of UV-induced eye diseases are less clear, due to a lack of data. Exposure to UV radiation plays a role in the development of cataracts, pterygium and possibly age-related macular degeneration; these are major causes of visual impairment world-wide. Photodermatoses and phototoxic reactions to drugs are not uncommon; management of the latter includes recognition of the risks by the prescribing physician. Exposure to UV radiation has benefits for health through the production of vitamin D in the skin and modulation of immune function. The latter has benefits for skin diseases such as psoriasis and possibly for systemic autoimmune diseases such as multiple sclerosis. The health risks of sun exposure can be mitigated through appropriate sun protection, such as clothing with both good UV-blocking characteristics and adequate skin coverage, sunglasses, shade, and sunscreen. New sunscreen preparations provide protection against a broader spectrum of solar radiation, but it is not clear that this has benefits for health. Gaps in knowledge make it difficult to derive evidence-based sun protection advice that balances the risks and benefits of sun exposure.
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Affiliation(s)
- R M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia. and Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
| | - S Yazar
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia and MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | | | - M Norval
- Biomedical Sciences, University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - F R de Gruijl
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Y Takizawa
- Akita University School of Medicine, National Institute for Minamata Disease, Nakadai, Itabashiku, Tokyo, Japan
| | - L E Rhodes
- Centre for Dermatology Research, School of Biological Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester and Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - R E Neale
- QIMR Berghofer Institute of Medical Research, Herston, Brisbane, Australia and School of Public Health, University of Queensland, Australia
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15
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Grupcheva CN, Grupchev DI, Radeva MN, Hristova EG. UV damage of the anterior ocular surface - microstructural evidence by in vivo confocal microscopy. Cont Lens Anterior Eye 2018; 41:482-488. [PMID: 30458934 DOI: 10.1016/j.clae.2018.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 06/10/2018] [Accepted: 06/24/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate and describe the microstructural changes at the ocular surface in response to habitual ocular sun exposure, correlate them with the UV protection habits and follow their dynamics using in vivo confocal microscopy(ICM). METHODS For a period of minimum 4 months 200 subjects (400 eyes), aged 28 ± 7.3 years, were recruited with the agreement that they will spend their summer exclusively in the region of the Black Sea coast at 43 °N latitude and will be examined before and after the summer. All subjects filled in a questionnaire about habitual UV protection and were examined clinically and by ICM. RESULTS Questionnaire results demonstrated that 83.5% (167 participants) of the subjects considered the sun dangerous for their eyes, but 78% (156 subjects) believed that there is danger exclusively during the summer period. Although no clinical changes were detected, microstructural analysis of the cornea demonstrated statistically significant (p = 0.021) decrease of the basal epithelial density - from 6167 ± 151 cells/mm2 before to 5829 ± 168 cells/mm2 after the summer period. Microstructural assessment of the conjunctiva demonstrated characteristic cystic lesions with dark centres and bright borders encountered in only 25 eyes(6%) before, and affecting 118 eyes(29.5%) after the summer. The total area of the cysts after the summer increased fivefold. Spearman analysis proved negative correlation between sun protection habits and number of cysts. CONCLUSION Summer sun exposure for one season leads to clinically undetectable, microstructural changes affecting the cornea, bulbar and palpebral conjunctiva with transient, but possibly cumulative nature.
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Affiliation(s)
- Christina N Grupcheva
- Department of Ophthalmology and Visual Science, Medical University, 55 Marin Drinov Str., Varna, 9002, Bulgaria.
| | - Dimitar I Grupchev
- Department of Ophthalmology and Visual Science, Medical University, 55 Marin Drinov Str., Varna, 9002, Bulgaria.
| | - Mladena N Radeva
- Department of Ophthalmology and Visual Science, Medical University, 55 Marin Drinov Str., Varna, 9002, Bulgaria.
| | - Elitsa G Hristova
- Department of Ophthalmology and Visual Science, Medical University, 55 Marin Drinov Str., Varna, 9002, Bulgaria.
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16
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Lingham G, Burton A, Brown HA, Huynh E, Yazar S, Coroneo MT, Mackey DA. Repurposing blue laser autofluorescence to measure ocular sun exposure. Clin Exp Ophthalmol 2018; 47:445-452. [PMID: 30345715 DOI: 10.1111/ceo.13423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/05/2018] [Accepted: 10/15/2018] [Indexed: 11/29/2022]
Abstract
IMPORTANCE Excessive ocular sun exposure is linked to various eye pathologies. Conjunctival ultraviolet autofluorescence (CUVAF) is a method of detecting sun-related conjunctival damage; however, the custom-built camera system required is not readily available. BACKGROUND We investigated whether blue laser autofluorescence (BAF) on a commonly used confocal scanning laser ophthalmoscope (cSLO) can be utilized to measure CUVAF area. DESIGN Cross-sectional evaluation of a diagnostic technology at a medical research institute. PARTICIPANTS Sixty-four participants recruited from three on-going observational eye studies in Western Australia. METHODS All participants had four images, two of each eye, captured using the CUVAF camera and BAF on the same day. Participants with pterygium or poor quality images were excluded from the analysis. Two graders measured CUVAF area in each image twice. CUVAF area measured by BAF was then compared to measurements determined with the conventional camera system. MAIN OUTCOME MEASURES CUVAF area. RESULTS After exclusions, 50 participants' images were analysed. Intra- and inter-observer repeatability were similar between the two systems. When comparing CUVAF area measured by BAF to the camera measurement, grader 1 had a mean difference of +1.00 mm2 , with 95% limits of agreement -5.75 to 7.77 mm2 . Grader 2 had a mean difference of +0.21mm2 , with 95% limits of agreement -7.22 to 7.64 mm2 . CONCLUSIONS AND RELEVANCE BAF on a commercially available cSLO is a valid method for measuring CUVAF area. This finding provides broader opportunity for identifying, monitoring and educating patients with sun-exposure-related ocular conditions and for researching the ocular impacts of sun exposure.
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Affiliation(s)
- Gareth Lingham
- Centre for Ophthalmology and Visual Science and the Lions Eye Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Alex Burton
- Centre for Ophthalmology and Visual Science and the Lions Eye Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Holly A Brown
- Centre for Ophthalmology and Visual Science and the Lions Eye Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Emily Huynh
- Centre for Ophthalmology and Visual Science and the Lions Eye Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Seyhan Yazar
- Centre for Ophthalmology and Visual Science and the Lions Eye Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Minas T Coroneo
- Department of Ophthalmology, University of New South Wales, Kensington, New South Wales, Australia
| | - David A Mackey
- Centre for Ophthalmology and Visual Science and the Lions Eye Institute, University of Western Australia, Nedlands, Western Australia, Australia
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Kearney S, O'Donoghue L, Pourshahidi LK, Richardson P, Laird E, Healy M, Saunders KJ. Conjunctival ultraviolet autofluorescence area, but not intensity, is associated with myopia. Clin Exp Optom 2018; 102:43-50. [PMID: 30114725 DOI: 10.1111/cxo.12825] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 07/08/2018] [Accepted: 07/12/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Conjunctival ultraviolet autofluorescence (CUVAF) has been used as a biomarker of time spent outdoors. Smaller CUVAF area is associated with myopia in southern hemisphere cohorts. Further research is required to determine if this association is replicated in northern latitudes and whether average CUVAF intensity is a valuable metric. This prospective study explored the association between myopia, CUVAF (area and intensity) and additional indicators of sun exposure (vitamin D3 and self-reported sun exposure preferences) across seasons at a location of 55° north. METHODS Young adults (age 18-20) provided blood samples biannually (March/April and September/October) over an 18-month period (four phases) for the assessment of 25-hydroxyvitamin D (25(OH)D3 ) concentrations (liquid chromatography-tandem mass spectrometry). CUVAF (total area, average intensity) and self-reported sun exposure preferences were recorded at each phase. Axial length and corneal radius were measured. Refractive error was measured by autorefractor and spherical equivalent refraction used to classify participants into refractive groups: myopic (spherical equivalent refraction ≤ -0.50 DS) or non-myopic. RESULTS Fifty-four participants (24 myopes, 30 non-myopes) participated. CUVAF area was negatively associated with the presence of myopia (odds ratio = 0.94, 95 per cent confidence interval = 0.90-0.98, p = 0.002). Myopes = 4.5 mm2 (interquartile range [IQR] 0.95-6.4 mm2 ), non-myopes = 7.0 mm2 (IQR = 2.0-10.7 mm2 ). No significant association was found between CUVAF intensity and refractive group (p = 0.17). There was no significant association between sun exposure preferences or serum concentration of 25(OH)D3 and refractive status (all p ≥ 0.21). CUVAF measures were not associated with ocular biometry measures (all p ≥ 0.084). CUVAF area was unaffected by season (all p ≥ 0.45) and variations in CUVAF area over the study period did not exceed the repeatability of the measurement technique. CONCLUSION Myopia was associated with smaller areas of CUVAF indicative of less cumulative ultraviolet-B exposure. These findings suggest that CUVAF measures are a useful, non-invasive biomarker of the time spent outdoors in adults in northern hemisphere populations.
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Affiliation(s)
- Stephanie Kearney
- Department of Optometry and Vision Science, Optometry and Vision Science Research Group, University of Ulster, Coleraine, UK
| | - Lisa O'Donoghue
- Department of Optometry and Vision Science, Optometry and Vision Science Research Group, University of Ulster, Coleraine, UK
| | - Laura K Pourshahidi
- Department of Biomedical Sciences, Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine, UK
| | - Patrick Richardson
- Department of Optometry and Vision Science, Optometry and Vision Science Research Group, University of Ulster, Coleraine, UK
| | - Eamon Laird
- Department of Biochemistry and Immunology, Trinity College Dublin, Dublin, Ireland
| | - Martin Healy
- School of Medicine, Trinity College Dublin, Dublin, Ireland.,Department of Biochemistry, St James's Hospital, Dublin, Ireland
| | - Kathryn J Saunders
- Department of Optometry and Vision Science, Optometry and Vision Science Research Group, University of Ulster, Coleraine, UK
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18
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Abstract
PURPOSE To evaluate feasibility and repeatability of measures for ocular sun exposure and conjunctival ultraviolet autofluorescence (UVAF), and to test for relationships between the outcomes. METHODS Fifty volunteers were seen for two visits 14 ± 2 days apart. Ocular sun exposure was estimated over a 2-week time period using questionnaires that quantified time outdoors and ocular protection habits. Conjunctival UVAF was imaged using a Nikon D7000 camera system equipped with appropriate flash and filter system; image analysis was done using ImageJ software. Repeatability estimates were made using Bland-Altman plots with mean differences and 95% limits of agreement calculated. Non-normally distributed data was transformed by either log10 or square root methods. Linear regression was conducted to evaluate relationships between measures. RESULTS Mean (±SD) values for ocular sun exposure and conjunctival UVAF were 8.86 (±11.97) hours and 9.15 (±9.47) mm, respectively. Repeatability was found to be acceptable for both ocular sun exposure and conjunctival UVAF. Univariate linear regression showed outdoor occupation to be a predictor of higher ocular sun exposure; outdoor occupation and winter season of collection both predicted higher total UVAF. Furthermore, increased portion of day spent outdoors while working was associated with increased total conjunctival UVAF. CONCLUSIONS We demonstrate feasibility and repeatability of estimating ocular sun exposure using a previously unreported method and for conjunctival UVAF in a group of subjects residing in Ohio. Seasonal temperature variation may have influenced time outdoors and ultimately calculation of ocular sun exposure. As winter season of collection and outdoor occupation both predicted higher total UVAF, our data suggests that ocular sun exposure is associated with conjunctival UVAF and, possibly, that UVAF remains for at least several months after sun exposure.
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Kearney S, O'Donoghue L, Pourshahidi LK, Richardson PM, Saunders KJ. The use of conjunctival ultraviolet autofluorescence (CUVAF) as a biomarker of time spent outdoors. Ophthalmic Physiol Opt 2017; 36:359-69. [PMID: 27350182 DOI: 10.1111/opo.12309] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/12/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Conjunctival ultraviolet autofluorescence (CUVAF) has been used in previous Southern Hemisphere myopia research as a marker for time spent outdoors. The validity of CUVAF as an indicator of time spent outdoors is yet to be explored in the Northern Hemisphere. It is unclear if CUVAF represents damage attributed to UV exposure or dry eye. This cross-sectional study investigated the association between CUVAF measures, self-reported time spent outdoors and measures of dry eye. METHODS Participants were recruited from University staff and students (n = 50, 19-64 years; mean 41). None were using topical ocular medications (with the exception of dry eye treatments). Sun exposure and dry eye questionnaires (Ocular Surface Disease Index and McMonnies) were completed by the participant. Dryness was also assessed using slit lamp biomicroscopy and invasive tear break up time. Images of the temporal and nasal conjunctiva from the right and left eye were captured using a bespoke photography system. The total CUVAF area, average CUVAF pixel intensity per mm(2) and total CUVAF pixel intensity were analysed using MATLAB R2013a (The MathWorks Inc). RESULTS Of the 50 participants, 42% were classified as having dry eye. Self-reported sunglasses use was negatively associated with all CUVAF measures (Kruskal Wallis total CUVAF area, p = 0.04, ptrend = 0.03, average CUVAF pixel intensity p = 0.02, ptrend = 0.02, total CUVAF pixel intensity: p = 0.04, ptrend = 0.02). Time spent outdoors was positively associated with all CUVAF measures (Spearman's correlation coefficients, total CUVAF area: r = 0.37, p = 0.01, average CUVAF pixel intensity: r = 0.36, p = 0.01, total CUVAF pixel intensity: r = 0.37, p = 0.01) and remained significant when sunglasses use was controlled for (partial correlation, total CUVAF area: r = 0.32, p = 0.03, average CUVAF pixel intensity: r = 0.39, p = 0.01, total CUVAF pixel intensity: r = 0.39, p = 0.03). Neither CUVAF area nor intensity measures were associated with any dry eye measure (Ocular Surface Disease Index: all p ≥ 0.41, corneal staining: all p ≥ 0.38, McMonnies: all r ≤ 0.09 all p ≥ 0.52, slit lamp biomicroscopy: all r ≤ 0.20 all p ≥ 0.17, invasive tear break up time: all r ≤ -0.07 all p ≥ 0.31). CONCLUSIONS CUVAF area and intensity were not associated with clinical measures of dry eye. Greater CUVAF area and intensity were associated with wearing sunglasses less frequently and spending more time outdoors. If sunglass wear is accounted for, CUVAF may be a useful biomarker of time spent outdoors in future myopia studies.
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Affiliation(s)
- Stephanie Kearney
- Optometry and Vision Science Research Group, University of Ulster, Coleraine, UK
| | - Lisa O'Donoghue
- Optometry and Vision Science Research Group, University of Ulster, Coleraine, UK
| | - L Kirsty Pourshahidi
- Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, UK
| | - Patrick M Richardson
- Optometry and Vision Science Research Group, University of Ulster, Coleraine, UK
| | - Kathryn J Saunders
- Optometry and Vision Science Research Group, University of Ulster, Coleraine, UK
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Environmental effects of ozone depletion and its interactions with climate change: progress report, 2015. Photochem Photobiol Sci 2016; 15:141-74. [PMID: 26822392 DOI: 10.1039/c6pp90004f] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The Environmental Effects Assessment Panel (EEAP) is one of three Panels that regularly informs the Parties (countries) to the Montreal Protocol on the effects of ozone depletion and the consequences of climate change interactions with respect to human health, animals, plants, biogeochemistry, air quality, and materials. The Panels provide a detailed assessment report every four years. The most recent 2014 Quadrennial Assessment by the EEAP was published as a special issue of seven papers in 2015 (Photochem. Photobiol. Sci., 2015, 14, 1-184). The next Quadrennial Assessment will be published in 2018/2019. In the interim, the EEAP generally produces an annual update or progress report of the relevant scientific findings. The present progress report for 2015 assesses some of the highlights and new insights with regard to the interactive nature of the effects of UV radiation, atmospheric processes, and climate change.
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Huynh E, Bukowska DM, Yazar S, McKnight CM, Mian A, Mackey DA. Quantification of sun-related changes in the eye in conjunctival ultraviolet autofluorescence images. J Med Imaging (Bellingham) 2016; 3:034001. [PMID: 27610398 DOI: 10.1117/1.jmi.3.3.034001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/12/2016] [Indexed: 12/26/2022] Open
Abstract
Quantification of sun-related changes in conjunctival ultraviolet autofluorescence (CUVAF) images is a subjective and tedious task, in which reproducibility of results is difficult. Thus, we have developed a semiautomatic method in MATLAB(®) to analyze CUVAF images retrospectively. The algorithm was validated on 200 images from 50 randomly selected participants from the Western Australian Pregnancy Cohort (Raine) study 20-year follow-up assessment, in which CUVAF area measurements were available from previous manual analysis. Algorithm performance was compared to manual measurements and yielded better than 95% correspondence in both intra- and interobserver agreement. Furthermore, the semiautomatic method significantly reduced analysis time by 50%.
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Affiliation(s)
- Emily Huynh
- University of Western Australia , Centre for Ophthalmology and Visual Science, Lions Eye Institute, 2 Verdun Street, Nedlands, Perth, Western Australia 6009, Australia
| | - Danuta M Bukowska
- University of Western Australia , Centre for Ophthalmology and Visual Science, Lions Eye Institute, 2 Verdun Street, Nedlands, Perth, Western Australia 6009, Australia
| | - Seyhan Yazar
- University of Western Australia , Centre for Ophthalmology and Visual Science, Lions Eye Institute, 2 Verdun Street, Nedlands, Perth, Western Australia 6009, Australia
| | - Charlotte M McKnight
- University of Western Australia , Centre for Ophthalmology and Visual Science, Lions Eye Institute, 2 Verdun Street, Nedlands, Perth, Western Australia 6009, Australia
| | - Ajmal Mian
- University of Western Australia , School of Computer Science and Software Engineering, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - David A Mackey
- University of Western Australia , Centre for Ophthalmology and Visual Science, Lions Eye Institute, 2 Verdun Street, Nedlands, Perth, Western Australia 6009, Australia
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King L, Xiang F, Swaminathan A, Lucas RM. Measuring sun exposure in epidemiological studies: Matching the method to the research question. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2015; 153:373-9. [PMID: 26555640 DOI: 10.1016/j.jphotobiol.2015.10.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 10/26/2015] [Accepted: 10/28/2015] [Indexed: 12/11/2022]
Abstract
Sun exposure has risks and benefits for health. Testing these associations requires tools for measuring sun exposure that are feasible and relevant to the time-course of the health outcome. Recent sun exposure, e.g. the last week, is best captured by dosimeters and sun diaries. These can also be used for medium-term sun exposure e.g. over several weeks, but incur a high participant burden. Self-reported data on "typical time outdoors" for working and non-working days, is less detailed and not influenced by day-to-day variation. Over a longer period, e.g. the lifetime, or for particular life stages, proxies of sun exposure, such as latitude of residence or ambient ultraviolet (UV) radiation levels (from satellites or ground-level monitoring) can be used, with additional detail provided by lifetime sun exposure calendars that include locations of residence, usual time outdoors, and detail of sunburn episodes. Objective measures of lifetime sun exposure include microtopography of sun-exposed skin (e.g. using silicone casts) or conjunctival UV autofluorescence. Potential modifiers of the association between sun exposure and the health outcome, such as clothing coverage and skin colour, may also need to be measured. We provide a systematic approach to selecting sun exposure measures for use in epidemiological health research.
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Affiliation(s)
- Laura King
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra 0200, Australia.
| | - Fan Xiang
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra 0200, Australia
| | - Ashwin Swaminathan
- Acute and General Medicine Service, The Canberra Hospital, Canberra 2605, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra 0200, Australia
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