Climate and season: the effects on ophthalmic diseases

TFOS Lifestyle Report: Impact of environmental conditions on the ocular surface

Environmental risk factors that have an impact on the ocular surface were reviewed and associations with age and sex, race/ethnicity, geographical area, seasonality, prevalence and possible interactions between risk factors are reviewed. Environmental factors can be (a) climate-related: temperature, humidity, wind speed, altitude, dew point, ultraviolet light, and allergen or (b) outdoor and indoor pollution: gases, particulate matter, and other sources of airborne pollutants. Temperature affects ocular surface homeostasis directly and indirectly, precipitating ocular surface diseases and/or symptoms, including trachoma. Humidity is negatively associated with dry eye disease. There is little data on wind speed and dewpoint. High altitude and ultraviolet light exposure are associated with pterygium, ocular surface degenerations and neoplastic disease. Pollution is associated with dry eye disease and conjunctivitis. Primary Sjögren syndrome is associated with exposure to chemical solvents. Living within a potential zone of active volcanic eruption is associated with eye irritation. Indoor pollution, "sick" building or house can also be associated with eye irritation. Most ocular surface conditions are multifactorial, and several environmental factors may contribute to specific diseases. A systematic review was conducted to answer the following research question: "What are the associations between outdoor environment pollution and signs or symptoms of dry eye disease in humans?" Dry eye disease is associated with air pollution (from NO2) and soil pollution (from chromium), but not from air pollution from CO or PM10. Future research should adequately account for confounders, follow up over time, and report results separately for ocular surface findings, including signs and symptoms.

[Validation of identification criteria for patientshaving surgery for rhegmatogenous retinal detachment at Toulouse University Hospital]

INTRODUCTION

Seasonal variations seem to modify the incidence of rhegmatogenous retinal detachment (RRD), with a summer peak, although the meteorological parameters involved have not been studied in France. In order to conduct a national study evaluating the association between the occurrence of RRD and various climatological variables (METEO-POC study), we need to establish a national cohort of patients having undergone surgery for RRD. The data of the National Health Data System (SNDS) allow the realization of epidemiological studies concerning various pathologies. However, as these databases were initially intended for medical administrative use, the identification of the pathologies coded in these databases must be validated before any use for research purposes. In order to carry out a cohort study using SNDS data, the objective of this study is to validate the identification criteria for patients having undergone RRD surgery at Toulouse University Hospital.

METHODS

We compared the cohort of RRD surgery patients at Toulouse University Hospital from January to December 2017 assembled from SNDS data with the cohort of patients meeting the same selection criteria assembled from Softalmo software data.

RESULTS

With a positive predictive value of 82.0%, a sensitivity of 83.8%, a specificity of 69.9%, and a negative predictive value of 72.5%, we can consider that our eligibility criteria are performing well.

CONCLUSION

Since the selection of patients via SNDS data is reliable at Toulouse University Hospital, we can use it at the national level for the METEO-POC study.

A Google Trends Approach to Identify Distinct Diurnal and Day-of-Week Web-Based Search Patterns Related to Conjunctivitis and Other Common Eye Conditions: Infodemiology Study

Background

Studies suggest diurnal patterns of occurrence of some eye conditions. Leveraging new information sources such as web-based search data to learn more about such patterns could improve the understanding of patients’ eye-related conditions and well-being, better inform timing of clinical and remote eye care, and improve precision when targeting web-based public health campaigns toward underserved populations.

Objective

To investigate our hypothesis that the public is likely to consistently search about different ophthalmologic conditions at different hours of the day or days of week, we conducted an observational study using search data for terms related to ophthalmologic conditions such as conjunctivitis. We assessed whether search volumes reflected diurnal or day-of-week patterns and if those patterns were distinct from each other.

Methods

We designed a study to analyze and compare hourly search data for eye-related and control search terms, using time series regression models with trend and periodicity terms to remove outliers and then estimate diurnal effects. We planned a Google Trends setting, extracting data from 10 US states for the entire year of 2018. The exposure was internet search, and the participants were populations who searched through Google’s search engine using our chosen study terms. Our main outcome measures included cyclical hourly and day-of-week web-based search patterns. For statistical analyses, we considered P<.001 to be statistically significant.

Results

Distinct diurnal (P<.001 for all search terms) and day-of-week search patterns for eye-related terms were observed but with differing peak time periods and cyclic strengths. Some diurnal patterns represented those reported from prior clinical studies. Of the eye-related terms, “pink eye” showed the largest diurnal amplitude-to-mean ratios. Stronger signal was restricted to and peaked in mornings, and amplitude was higher on weekdays. By contrast, “dry eyes” had a higher amplitude diurnal pattern on weekends, with stronger signal occurring over a broader evening-to-morning period and peaking in early morning.

Conclusions

The frequency of web-based searches for various eye conditions can show cyclic patterns according to time of the day or week. Further studies to understand the reasons for these variations may help supplement the current clinical understanding of ophthalmologic symptom presentation and improve the timeliness of patient messaging and care interventions.

Seasonal variation in acute post-cataract surgery endophthalmitis incidences in South Korea

PURPOSE

Previous studies have reported conflicting results on the influence of seasons on post-cataract surgery endophthalmitis incidences. This study aimed to investigate the seasonality associated with the incidence of postoperative endophthalmitis, and to evaluate its association with climate variables in South Korea.

SETTING

South Korea.

DESIGN

Retrospective cohort study.

METHODS

The postoperative endophthalmitis incidences were identified using the Health Insurance Review and Assessment Service claim data from July 2014 to June 2017. The monthly climate data were obtained from the Korea Meteorological Administration. The incidences of endophthalmitis were analyzed by the month of the year, and by the season. The association between postoperative endophthalmitis and the climatic variables, including mean temperature, relative humidity, precipitation, and hours of sunshine, was investigated.

RESULTS

The incidences were the highest in July, and they were the most prevalent during the summer months, although fewer cataract surgeries were performed in the summer months than during the rest of the year. The postoperative endophthalmitis incidences tended to increase with increasing relative humidity and increasing precipitation.

CONCLUSIONS

The incidences of post-cataract surgery endophthalmitis peaked during the hot and humid months. Understanding the seasonal and climatic influences on postoperative infection might help in risk stratification and outcome improvisation after the cataract surgery is performed.

Epidemiological variations and trends in health burden of glaucoma worldwide

PURPOSE

To evaluate the trends and variations in global health burden of glaucoma by year, age and sex, region and socio-economic status, using disability-adjusted life years (DALYs).

METHOD

The DALY numbers, crude DALY rate and age-standardized DALY rate globally and in each country were obtained the GBD 2015 study database. The corresponding human development index (HDI) and gross domestic product (GDP) per capita were obtained from the United Nations and World Bank. Environmental data were obtained from the WHO Global Health Observatory data repository.

RESULTS

From 1990 to 2015, the DALY number and age-standardized DALY rate due to glaucoma increased by 122% and 15%, respectively. Both male and female showed similar increasing trend with ageing, with the peak at 60 years old and increasing again since 75 years old. Sex disparities in DALY number were noted, with higher burden among female than male in each age group (all p < 0.001). The health burden of glaucoma was substantial unequal, with Gini coefficient of 0.865 for DALY number, 0.235 for crude DALY rate and 0.254 for age-standardized DALY rate, respectively. The age-standardized DALY was significantly associated with HDI, accounting for 22.2% variance across countries (R²  = 0.222, p < 0.001). Similarly, the GDP per capita was inversely associated with age-standardized DALY rate but can explain only 10.6% variations in age-standardized DALY rate (R²  = 0.106, p < 0.001). The age-standardized DALY rate due to glaucoma was positively associated with national levels of ultraviolet radiation and PM_2.5 .

CONCLUSION

The health burden of glaucoma continuously increased in the past 25 years and distributed unequally. Lower socio-economic level, older age, female, higher ambient ultraviolet radiation and higher level of air pollution were significantly associated with higher burden of glaucoma.