Occupational Exposure to Solar Radiation at Different Latitudes and Pterygium: A Systematic Review of the Last 10 Years of Scientific Literature

The Safety of Office-Based Pterygium Surgery

PURPOSE

Hospital and ambulatory eye surgical procedures continue to transition to the office setting. Pterygium surgery is the most commonly performed ocular surface surgical procedure in the world. No studies to date have evaluated its safety in the office-based surgical setting. Our study evaluates the safety, complication rate, cost-savings, and cosmetic satisfaction of office-based pterygiectomy.

DESIGN

Retrospective case series.

METHODS

A retrospective review was performed. Procedures were performed in an office-based suite with a Zeiss surgical microscope by two board-certified ophthalmologists under topical anesthesia and oral sedation. Over a 3 year period (2013-2016), 1071 office-based pterygiectomies were performed. Follow-up was performed via in-person office visits. Data collected included: date of service; location of pterygium (nasal, temporal, or both); primary or recurrent; use of mitomycin C, fibrin glue, and amniotic membrane; preoperative and postoperative refraction; intraocular pressure (IOP); endothelial cell density (ECD); patient-reported pain (as measured by an eleven-point visual analog scale, 0-10); cosmetic satisfaction; intraoperative surgical time; speculum width; incidence of ptosis (defined as a decrease in MRD1 by 2 mm) postoperatively at 12 weeks and 1 year and postoperative complications. Postoperative measures were checked at 1 day, 2 weeks, 1 month, 2 months, 3 months, 6 months, and 1 year. The average operational and procedural costs were compared between in-office and comparable surgical centers and academic hospital cases in our area.

RESULTS

A total of 1015 pterygia from 992 eyes were examined postoperatively. One case of central retinal artery occlusion due to peribulbar anesthetic injection with epinephrine at postoperative week 2 was noted, leading to the removal of epinephrine from the anesthetic regimen. At the 1-year follow-up, 393 pterygium cases in 343 eyes were assessed. One-year complication rates included overall recurrence (N = 8/393; 2.04%), dellen (N = 12/393; 3.05%), and granuloma (N = 15/393; 3.82%), ptosis 2.6% (N = 9/343). There were no cases of infection. Patient-reported pain scores remained less than 1.0 peri‑ and postoperatively, and cosmetic satisfaction was greater than 88% at 1 year. The average cost of office-based pterygium surgery was $1795 ($1700-$1890, depending on supplies used). In comparison, the costs at local surgical centers and hospitals were $3812.50 ($2625-$5000) and $5562 ($5095-$6029), respectively.

CONCLUSION

Office-based pterygiectomy is safe, cost-effective, and offers low recurrence rates and high patient satisfaction.

Contribution of Matrix Metalloproteinase-2 Genotypes to Taiwan Pterygium Risk

BACKGROUND/AIM

In the literature, the studies about the role of matrix metalloproteinase-2 (MMP-2) in pterygium diagnosis are mainly based on its protein expression. The role of MMP-2 variants has never been examined. The aim of this study was to examine the association of MMP-2 genotypes with pterygium risk.

MATERIALS AND METHODS

MMP-2 rs243865 and rs2285053 were genotyped in 140 pterygium cases and 280 non-pterygium controls by typical polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) genotyping technology.

RESULTS

The genotypic frequency of MMP-2 rs243865 CC, CT and TT were 86.4%, 12.9% and 0.7% in the pterygium group and 81.1%, 17.1% and 1.8% in the non-pterygium group (p for trend=0.3389). The variant CT and TT carriers had a 0.70- and 0.38-fold pterygium risk (95%CI=0.39-1.26 and 0.04-3.25, p=0.2982 and 0.6686, respectively). As for MMP-2 rs2285053, the genotypic frequency of CC, CT and TT were 67.1%, 28.6% and 4.3% in the pterygium group, non-significantly different from those in non-pterygium group (p for trend=0.7081). The CT and TT carriers had a 0.88- and 0.71-fold pterygium risk (95%CI=0.56-1.38 and 0.27-1.88, p=0.6612 and 0.6456, respectively). The allelic analysis results showed that MMP-2 rs243865 variant T allele was not associated with pterygium risk (7.1% versus 10.4%, OR=0.67, 95%CI=0.39-1.13, p=0.1649). As for MMP-2 rs2285053, the T allele was not associated with pterygium risk either (18.6% versus 21.1%, OR=0.85, 95%CI=0.59-1.23, p=0.4136).

CONCLUSION

The genotypes at MMP-2 rs243865 or rs2285053 played minor role in determining individual susceptibility for pterygium among Taiwanese.

Occupational Exposure to Solar Radiation and the Eye: A Call to Implement Health Surveillance of Outdoor Workers

Globally, hundreds of millions of outdoor workers are exposed to solar radiation (SR) for the majority of their working life. Such occupational exposure is known to induce various adverse health effects to the eyes, mainly related to its ultraviolet (UV) component. The present work is a call-to-action aimed at raising the awareness on the need of health surveillance for the prevention of the chronic ocular diseases in outdoor workers. Photo-chemical chronic damage can induce pterygium at the outer layer of the eye and cataract in the lens. Considering carcinogenic effects, rare squamous-cells tumors of the cornea and/or of the conjunctiva and the ocular melanomas are associated with UV radiation exposure. Solar UV-related eye diseases should be considered as "occupational diseases" when there is sufficient exposure in workers, but they are often not recognized, and/or frequently not reported to the national compensation authorities. Therefore, to prevent the burden of these work-related eye pathologies, an adequate risk assessment with identification of appropriate preventive measures, and a provision of periodic health surveillance to the exposed workers, in particular considering those at higher risk of exposure or with individual susceptibility, should be urgently implemented.

Surgical Time and Postoperative Symptoms Study in Pterygium Excision and Amniotic Membrane Graft Using Celularity Triple Layer Dehydrated Amniotic Membrane

Purpose

To evaluate a novel sutureless glueless technique using a triple-layer dehydrated amniotic membrane (TLDAM) for pterygia excisions in surgical time, postoperative pain, epiphora, irritation, and FBS.

Methods

Twenty eyes with pterygia underwent excision with mitomycin C. The conjunctival defect was closed with TLDAM placed on the dried scleral bed with the edges of the amniotic membrane tucked under the edges of the conjunctival defect. Surgical times were measured from injection of lidocaine to final placement of bandage contact lens. After a bandage contact lens was placed, the eye was patched until POD1. Patients graded self-administered questionnaires to rate pain, FBS, irritation, and epiphora on a scale of 1-5 (1-none; 5-severe) at POD1 and POW1.

Results

Surgical times ranged from 6:55 to 12:00, with mean of 8:29. Compared with a previous study of sutureless glueless methodology, the difference in mean surgical time was 11.9 (p < 0.0001). Mean questionnaire scores were as follows: POD1 pain 1.8, FBS 2.3, irritation 1.0, and epiphora 2.6; POW1 pain 1.5, FBS 1.6, irritation 1.6, and epiphora 1.6. Compared to previous studies, this technique showed significantly improved pain at POD1 (p=0.0086, p<0.0001, p<0.0001, p<0.0001) and POW1 (p=0.0002, p=0.0016, p<0.0001). Significant improvement in irritation and FBS was noted at POD1 and POW1. See Table 1 for full analysis.

Conclusion

The sutureless glueless technique using TLDAM is a safe and effective technique compared to current standard methods. There appears to be a significant benefit regarding surgical time and postoperative pain, irritation, epiphora, and FBS compared to previous studies.

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.

Current social determinants of health and social risk factors in conditions of the cornea: a scoping review

PURPOSE OF REVIEW

To achieve health equity in eye health and vision care, social determinants of health (SDoH) and the associated social risk factors must be addressed. To address SDoH and social risk factors in ophthalmology, they must first be identified. The purpose of this review was to determine the SDoH and social risk factors in conditions of the cornea that have most recently been explored.

RECENT FINDINGS

This review identified social risk factors associated with all five domains of SDoH, as outlined by Healthy People 2030. The neighborhood and built environment was the domain identified the most for both exploration and observation. The social and community context domain was the least explored, and healthcare access and quality and social and community context domains were the least observed. The cornea condition explored the most in relation to SDoH was dry eye syndrome.

SUMMARY

The findings from this review can inform clinicians on the social risk factors that could be screened for in eye care facilities, so patients can be connected with services to minimize the impact of social risk factors on cornea conditions. Furthermore, the findings have identified cornea conditions and domains of SDoH that are understudied which can be an area for future studies by vision researchers.

TFOS lifestyle: Impact of societal challenges on the ocular surface

Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.

Ultraviolet light exposure and its penetrance through the eye in a porcine model

AIM

To determine the amount of ultraviolet (UV) light irradiance that various layers of the eye receive as sunlight passes through the eye, and to investigate the protective benefits of UV light-blocking contact lenses.

METHODS

Twenty-four porcine eyes were prepared in one of three ways: isolated cornea, cornea and lens together, or whole eye preparation. UV light irradiance was measured with a UV-A/B light meter before and after the eye preparations were placed over the meter to measure UV light penetration in each eye structure. In the whole eye preparation, a hole was placed in the fovea to measure light as it passed through the vitreous. Subsequently, UV-protective contact lenses were placed over the structures, and UV light penetrance was measured. Measurements of UV light exposure were taken outdoors at various locations and times.

RESULTS

Cornea absorbed 63.56% of UV light that reached the eye. Cornea and lens absorbed 99.34% of UV light. Whole eye absorbed 99.77% of UV light. When UV-protective contact lenses were placed, absorption was 98.90%, 99.55%, and 99.87%, respectively. UV light exposure was dependent on directionality and time of day, and was greatest in areas of high albedo that reflect significant amounts of light, such as a beach.

CONCLUSION

Cornea absorbs the majority of UV light that reaches the eye in this model. UV-protective contact lenses reduce UV exposure to the eye. Locations with high albedo expose the eye to higher levels of UV light.

Prevalence and associated factors for pterygium in a Chinese rural population with type 2 diabetes in a cross-sectional study: Jiangsu Diabetic Eye Disease Study (JDEDS)

PURPOSE

To investigate the pterygium prevalence and evaluate risk factors of pterygium in rural type 2 diabetic (D2M) patients aged 50 years and above in Funing Country, Jiangsu Province, China.

METHODS

A cross-sectional ophthalmic survey was conducted in type 2 diabetes mellitus (D2M) patients aged ≥ 50 years in Funing County, Jiangsu Province, China, which was named Jiangsu Diabetic Eye Disease Study (JDEDS). All participants underwent a comprehensive questionnaire and ocular examination. Pterygium was diagnosed by slit lamp examination. The risk factors associated with pterygium were evaluated with logistic regression models.

RESULTS

The prevalence of pterygium was 22.37% (n = 427) and 95% confidence interval (CI) (20.50-24.24%) in D2M patients aged 50 years and above in JDEDS. The prevalence of pterygium was 18.32% (95% CI 15.33-21.32%) in men and 24.43% (95% CI 22.06-26.80%) in women. Women had a higher prevalence than men (p = 0.001). Multivariate analysis showed, for male participants with D2M, pterygium was independently associated with increasing age [70-79 years: OR and 95% CI 2.49(1.20-5.18), p = 0.014; ≥ 80 years: 4.84(2.04-11.47), p < 0.001], while cigarette smoking was the protective factors, especially in current smoker [OR and 95% CI 0.79(0.67-0.92); p = 0.003]. For female participants with D2M, age [60-69 years OR and 95% CI 1.68(1.07-2.62), p = 0.023; 70-79 years: 2.62(1.69-4.06), p < 0.001; ≥ 80 years:3.24(1.70-5.90), p < 0.001], hypertension [OR and 95% CI 1.40(1.05-1.87), p = 0.024], BMI 24-27.9 [OR and 95% CI 1.20(1.00-1.44), p = 0.047], higher HbA1c [(5.6-7.9) % OR and 95% CI 1.42(1.10-1.82), p = 0.006; (8.0-9.9) %: 1.32(1.10-1.58), p = 0.003] were risk factors.

CONCLUSIONS

D2M patients aged over 50 years has a high prevalence of pterygium in JDEDS. The pterygium prevalence is higher in female D2M participants. Diabetes and related factors may be risk factors of pterygium in female D2M patients. Further studies are needed to explore the gender difference in the pathogenesis of pterygium in D2M subjects.

Ocular health among industrial workers: a prevalence study of foreign body injury, refractive error, dry eye, pterygium and pingueculae

BACKGROUND

Workplaces play a critical role in developing ocular diseases, owing to the risk of accidents. This study aimed to evaluate the ocular health of industrial workers by determining the prevalence of foreign body injury, refractive error, dry eye, and pterygium/pingueculae, as well as the factors influencing these diseases.

METHODS

This study involved on-site examinations of workers from an industrial area hosting marble processing factories and metal sectors. Data such as refractive error, foreign body injury-related corneal nephelium, pterygium/pingueculae presence, and Schirmer test-assisted dry eye evaluation were all collected.

RESULTS

The average age of workers was 35.78±10.05 years, with a female-to-male ratio of 20:220. The majority of workers had completed primary school (56.3%), smoked >1 cigarette/day (57.6%), and did not use any assistive devices for bodily functions (88.3%). On average, working hours/week were 55.07±8.79, and working years were 5.99±7.00. Dry eyes were found in 31 (22%), and 35 (34%) marble and metal workers, respectively (p=0.042). 11 (7.9%) marble workers and 29 (28%) metal workers had foreign body ocular injury-related corneal nephelium (p=0.0001). Furthermore, pterygium/pingueculae were revealed in 17 marble workers (12.3%) and three metal workers (3%) (p=0.009).

CONCLUSIONS

Ocular health is essential, and routine ocular health screening in industrial workers, as well as workplace safety measures, should be implemented to prevent potential occupational accidents.

High HDL-C and high LDL-C are risk factors of pterygium in a population-based cross-sectional study in Southern China: the Dongguan Eye Study

OBJECTIVES

To investigate the relationship between serum lipids and pterygium in a large-scale rural population aged 40 years or older from Southern China.

STUDY DESIGN

The Dongguan Eye Study was a cross-sectional population-based study from September 2011 to February 2012.

SETTING

The area was set in the rural area of Dongguan, Southern China.

PARTICIPANTS

Adult rural population aged 40 or older.

METHODS

Participants underwent physical, haematological and ophthalmic examinations.

PRIMARY AND SECONDARY OUTCOME MEASURES

The frequency and risk factors of pterygium.

RESULTS

A total of 11 357 participants were eligible for inclusion and 8952 (78.8%) participants were enrolled for the systemic and ophthalmic examinations. The prevalence of pterygium was 17.3% after adjusting the sex and age distribution, 22.0% in participants with hypercholesterolaemia (total cholesterol ≥6.22 mmol/L (240 mg/dL)) and 21.8% in those with low-density lipoprotein-cholesterol (LDL-C) ≥4.14 mmol/L (160 mg/dL), respectively. After adjusting for multiple confounding factors, higher level of high-density lipoprotein-cholesterol (HDL-C) (OR: 1.23, 95% CI: 1.06 to 1.41) and LDL-C (OR: 1.13, 95% CI: 1.06 to 1.20) were positively associated with the risk of pterygium. The ORs for HDL-C or LDL-C with pterygium were significantly greater in participants aged 40-49 years than those aged 50 years or above (P for interaction <0.001). Furthermore, increased HDL-C showed greater association with pterygium in normal body mass index (BMI) group compared with overweight group (P for interaction=0.002).

CONCLUSION

Increased HDL-C and LDL-C are risk factors of pterygium, especially in people <50 years or those with normal BMI level. Strict control of HDL-C and LDL-C may be a new prevention method in reducing the risk of pterygium.

Modeling and investigating the effect of parasol installation on solar radiant temperature reduction using COMSOL Multiphysics

Objectives. Occupational activities in open spaces can experience excessive heat exposure caused by sunlight and other artificial sources in these professional environments can be one of the current and future challenges of occupational safety and health due to increasing global warming. Use of lightweight portable parasols is the first available control measure to reduce the radiation emitted by the sun in outdoor workplaces, which has been used for a long time. Methods. Due to the lack of study and results on the effect of using parasols in scientific literature, this modeling study was conducted to investigate the effect of sunshade installation on radiant temperature reduction of the sun in outdoor work using COMSOL Multiphysics version 5.5. Results. In general, six different shapes of portable parasols in different positions were modeled and the average radiant temperature reduction effectiveness (TRE) was about 30% in the presence of different parasols. The designed conical, simple and pyramidal sunshades showed the most effectiveness, respectively. Conclusions. The results show that changing variables such as the axis, installation height and shape is more effective for improving parasol efficiency to reduce the radiant temperature below it.

Occupational Ocular Injuries and Utilization of Eye Protective Devices among Sawmill Workers in the Ojo Local Government Area of Lagos State, Nigeria

In this work, we carried out a cross-sectional study to assess occupational ocular injuries and utilization of eye protective devices among sawmill workers in the Ojo local government area of Lagos State, Nigeria A structured questionnaire was used to conduct face-to-face interviews among the sawmill workers. Pearson’s chi-squared test and t-test were used to test associations between variables. A p-value of less than 0.05 was considered statistically significant. A total of 215 sawmill workers with a mean age of 37.08 ± 12.07 years participated in the study. A majority (55.8%) of the participants were male (93.7%), and a majority were 21–40 years old (55.8%). Of the participants, 78.6% were aware of occupational ocular injuries and 17.7% used ocular safety devices. The major barrier to the use of eye protective devices was unavailability (43%). Workers who were ≥20 years old (p < 0.001), who received a monthly salary of less than USD 100 (p < 0.043), who had work experience of ≥10 years (p < 0.04), who were aware of ocular hazards (p < 0.03), and who did not use protective eye devices (p < 0.02) were significantly associated with occupational ocular injuries compared to others. The prevalence of occupational ocular injuries and the utilization of eye safety devices among the sawmill workers in the current study were comparable to findings from other studies. Based on the results of our study, we advise the provision of ocular protective devices for sawmill workers and policies to enforce regular utilization.

Phytochemical Profile and Antioxidant and Antiproliferative Activity of Sedum dendroideum on Pterygium Fibroblasts

Background

Sedum dendroideum has antioxidant effects that are beneficial for different diseases. We aimed to analyze the antiproliferative activity of S. dendroideum in human pterygium fibroblasts (HPFs).

Methods

HPFs were treated for 24 h with 0–1000 μg/mL of S. dendroideum lyophilized to analyze its effect on cell viability using the CellTiter assay. RNA from HPF treated with 250 μg/mL of S. dendroideum lyophilized was isolated, and the expression of VEGF and CTGF genes was evaluated by qPCR. A dermal fibroblast cell line (HDFa) was used as a healthy control. The total phenolic content, antioxidant activity, and chemical profile of S. dendroideum lyophilized were determined.

Results

Viability of HPF decreased after 24 h treatment of S. dendroideum in a dose-dependent manner. The expression of VEGF and CTGF significantly decreased (P < 0.01) in HPF treated with 250 μg/mL of S. dendroideum when compared with untreated HPF. The total phenolic concentration in the S. dendroideum lyophilized was 33.67 mg gallic acid equivalents (GAE)/g. Antioxidant activity was 384.49 mM Trolox equivalents/mL. The main phenolic compounds identified by HPLC analysis were the kaempferol-3-O-glycoside, kaempferol-3-O-rhamnoside, kaempferol-3-O-neohesperidoside-7-O-α-rhamnopyranoside, and kaempferol-3-O-glycoside-7-O-rhamnoside.

Conclusions

S. dendroideum decreases the proliferation of HPF and the expression of VEGF and CTGF. The phenolic compound concentration, antioxidant activity, and phytochemical profile may play a role in these effects.

Green Tea Catechins Attenuate Human Primary Pterygium Cell Survival and Migration Via Modulation of ERK p42/p44 and p38 Pathways

Pterygium belongs to an ocular surface disease with triangular-shaped hyperplastic growth, characterized by conjunctivalization, inflammation, and connective tissue remodeling. We previously demonstrated neoplastic-like properties of pterygium cells. Green tea catechin, (-)-epigallocatechin gallate (EGCG), has been shown to possess antitumorigenic properties; herein, we aimed to determine the effects of green tea catechins on human primary pterygium cell survival and migration and compared to that on patients' conjunctival cells. Both human primary pterygium and conjunctival cells expressed EGCG receptor, the 67 kDa laminin receptor. Seven-day treatment of green tea extract (Theaphenon E; 16.25 μg/mL) and EGCG (25 μM) attenuated pterygium cell proliferation by 16.78% (p < 0.001) and 24.09% (p < 0.001) respectively, without significantly influencing conjunctival cells. Moreover, green tea extract (16.25 μg/mL) and EGCG (25 μM) treatments also hindered pterygium cell migration by 35.22% (p < 0.001) and 25.20% (p = 0.019), respectively, but not conjunctival cells. Yet, green tea extract and EGCG treatments did not significantly induce pterygium cell apoptosis. Furthermore, green tea extract and EGCG treatments significantly increased the phosphorylation of p38 protein but reduced the phosphorylation of p42/p44 protein in pterygium cells. In summary, this study revealed that green tea extract and EGCG attenuated human primary pterygium cell survival and migration in vitro without damaging conjunctival cells, suggesting a novel potential therapeutic approach for primary pterygium treatment.

Association among pterygium, cataracts, and cumulative ocular ultraviolet exposure: A cross-sectional study in Han people in China and Taiwan

Purpose

Pterygium is an ocular surface disorder mainly caused by ultraviolet (UV) light exposure. This study explored the relationships between six cataract types with pterygium and UV exposure.

Methods

We have previously studied cataracts in residents of three regions in China and Taiwan with different UV intensities. From that study, we identified 1,547 subjects with information on the presence or absence of pterygium. Pterygium severity was graded by corneal progress rate. Cataracts were graded by classification systems as three main types (cortical, nuclear, posterior subcapsular) and three subtypes (retrodots, waterclefts, fiber folds) with high prevalence in middle-aged and elderly people. We calculated the cumulative ocular UV exposure (COUV) based on subject data and National Aeronautics and Space Administration data on UV intensities and used logistic regression to calculate odds ratios for the associations of COUV, cataract, and pterygium.

Results

We found an overall pterygium prevalence of 23.3%, with significant variation among the three regions. Four cataract types (cortical, nuclear, posterior subcapsular, and retrodots) were significantly associated with the presence of pterygium.

Conclusions

There was a significant association between COUV and pterygium, indicating that COUV is associated with the risk of pterygium development and that pterygium is useful as an index of UV exposure. Furthermore, the type of cataract in eyes with pterygium may indicate the level of UV exposure.

Characteristics and recurrence of pterygium in Saudi Arabia: a single center study with a long follow-up

Background

This study described the clinical features of patients with pterygium and analyzed the recurrence rate of conjunctival autografting alone, conjunctival autografting combined with intraoperative mitomycin C, and amniotic membrane grafting.

Methods

A retrospective cohort study of primary pterygium was conducted between January 2017 and February 2020. Factors associated with pterygium severity and recurrence were analyzed by univariate analysis and logistic regression models.

Results

The study included 292 patients with an average age of 53.3 ± 14.1 years, while the number of operated cases was 94. Pterygia involving the cornea were observed in 55 % of the cases. The overall rate of recurrence for the three procedures was 17 %. The average time of recurrence was 14.2 ± 11.9 months, with 37 % of the recurrences occurring after the first year. The only factor associated with a significant risk of recurrence was dry eye disease in both univariate (p = 0.021) and multivariate analysis (p = 0.026). The recurrence rates following conjunctival autografting with and without mitomycin C were 15.6 and 15.8 %, respectively. The recurrence rate following the amniotic membrane graft was  twofold (OR= 2.02)  (27 %) that following the conjunctival autograft (15.8 %).

Conclusions

The only factor associated with the recurrence of pterygium was dry eye disease. More than one-third of recurrences developed after the first year, which stresses the importance of a long follow-up. The recurrence rate in our study following conjunctival graft was slightly higher compared to the literature mainly due to differences in study areas, populations, and follow-up periods.

Effect of Protective Measures on Eye Exposure to Solar Ultraviolet Radiation

In this study, ocular biologically effective exposure to solar ultraviolet radiation (UVBE) is investigated with six kinds of sun protective measures (spectacle lenses, sunglasses, cap, bonnet, straw hat and under parasol). Ocular UV exposure measurements were performed on manikins during the summer period in Shenyang city (41.64° N, 123.50° E, 66 m a.s.l.), China. The measurements include the ocular UV exposure of an unprotected eye and the ambient UV as a control concurrently. Based on the relative spectral weighting factors of the International Commission on Non-Ionizing Radiation Protection (ICNIRP), the ocular biologically effective UV is calculated and compared with the 8-h exposure limits of ICNIRP (30 J m^-2 ). The UV index (UVI) of the measurement days is 0-8, and the 8-h (8:00-16:00 China Standard Time, CST) cumulated UVBE of the unprotected eye is 452.0 J m^-2 . The 8-h cumulated UVBE of the eye with spectacle lenses, sunglasses, cap, bonnet, straw hat and under parasol are 364.2, 69.1, 51.4, 49.0, 56.8 and 110.2 J m^-2 , respectively. Importantly, it should be noted that the eye could be exposed to risk despite protective measures. The 8-h cumulated UVBE of the eye with protection is ca 1.6-15.1 times the exposure limit, respectively. As indicated in the present study, during summer months, high exposure to the sun for more than 30 min without eye protection and more than 1 h with eye protection is not advisable. The protection measures could effectively reduce the UVBE reaching the eye, yet there is still a high degree of risk when compared with the ICNIRP 8-h exposure limits.

Prevalence of pterygium and its associated factors among adults aged 18 years and above in Gambella town, Southwest Ethiopia, May 2019

INTRODUCTION

A pterygium is a wing-shaped fibro-vascular growth of conjunctiva on the superficial cornea/conjunctiva. It is an elastotic degeneration of conjunctival stroma mainly due to Ultraviolet light exposure. The prevalence of pterygium varies in different environmental conditions. Its magnitude varies widely from 1.1% to 53% globally and in Ethiopia, it reaches from 8.8% to 38.7%.

OBJECTIVE

To determine the prevalence of pterygium and its associated factors among adults aged 18 years and above in Gambella town, Southwest Ethiopia, 2019.

METHODS AND MATERIALS

A community based cross-sectional study was conducted from April 15 to May 3, 2019, in Gambella town. A total of 402 study participants were selected using a systematic random sampling technique. A pre-tested semi-structured questionnaire, torch, and magnifying loops were used to collect data. The data was entered into epidemiological information 7.1 and exported to statistical package for social science version 20 for analysis. The binary and multivariate logistic regression analysis model was fitted to identify factors associated with pterygium. Odds ratio with respected 95% CI was used to identify the direction and strength of association.

RESULTS

A total of 400 participants were examined with a response rate of 99.50%. The mean age of the study participants was 39.9±9.8years. The prevalence of pterygium among adults aged 18 years and above in Gambella town was 127(31.80%), (95% CI: 27.3, 36.3). male sex (AOR = 2.10 (95% CI: 1.26, 3.45), sunlight exposure (AOR = 6.86 (95% CI: 4.00, 11.79) and outdoor works (AOR = 2.10 (95% CI: 1.21, 3.60) were positively associated with pterygium whereas wearing sunglass/hat was a protective factor.

CONCLUSION

The prevalence of pterygium was high among adults living in Gambella town. Wearing sunglass/hat and reducing exposure time to the sun was important to reduce the development of pterygium in adults.

Risk of cataract in health care workers exposed to ionizing radiation: a systematic review

Background:

The eye is an important sensory organ occupationally exposed to ionizing radiation (IR) in healthcare workers (HCWs) engaged in medical imaging (MI). New evidence highlights the possible induction of cataract at IR exposure levels to be much lower than expected in the past.

Objective:

Conduct an updated review on the current evidence on cataract risk in healthcare workers exposed to IR.

Methods:

Published scientific studies on cataract risk in IR exposed healthcare workers were collected through a systematic search of two biomedical databases (MEDLINE and Scopus). Data from included studies was extracted and summarized. Study quality was also assessed.

Results:

All 21 eligible studies reported an increased prevalence of cataract, especially posterior subcapsular cataract, in IR exposed HCWs with a higher prevalence in interventional cardiology staff.

Discussion:

Our review synthesizes the latest evidence to support the hypothesis of a significantly increased risk of occupational cataract in healthcare workers operating MI and exposed to IR, especially in interventional cardiologists. Data also support a dose-response relationship between IR exposure and the prevalence of opacities, especially posterior subcapsular opacities.

Conclusions:

Findings highlight the need for effective control measures including appropriate training, adherence to protective procedures, and a constant use of shields and eye personal protective equipment in healthcare workers with optical exposure to IR. Periodic health surveillance programs, possibly including lens evaluation, are also important to monitor cataract risk in these MI operators.

Prevalence and Associated Factors of Pterygium Among Adults Living in Kolla Diba Town, Northwest Ethiopia

Background

Pterygium is a disfiguring disease that can potentially lead to blindness. It is more common in warm, windy and dry climates of tropical and sub-tropical regions of Africa. Globally, the prevalence ranging from 0.07% to 53%. Studies conducted on the prevalence of pterygium in developing countries were limited with a wider discrepancy between them. In this study, we aimed to assess the prevalence of pterygium and its associated factors among adults in Kolla Diba town.

Methods

A community-based cross-sectional study was done in Kolla Diba town from May 30-June 16, 2019. A systematic random sampling technique was used to select 627 study participants. The basic ophthalmic examination was performed using portable slit lamp, 3x magnifying loop with torch light and a pretested structured questionnaire was completed. The data entered into EPI INFO version 7 and analyzed using SPSS version 20. Descriptive statistics and binary logistic regression analysis were employed. P-values of <0.05 were considered statistically significant.

Results

A total of 605 study participants were involved with a response rate of 96.5%. Among them, 317 (52.4%) participants were males. The mean age of the respondents was 38.18 ± 15.56 with a range of (18–95) in years. The overall prevalence of pterygium was 112 (18.5% (95% CI (15.6–21.7)). Being widowed (AOR = 7.32 (95% CI: 2.88, 18.57)), outdoor occupation (AOR = 2.50 (95% CI: 1.46, 4.29)), sun exposure (AOR = 2.38 (95% CI: 1.28, 4.43)), wind exposure (AOR = 1.97 (95% CI: 1.04, 3.72)), alcohol drinking (AOR = 2.26 (95% CI: 1.48, 4.63)), and severe blepharitis (AOR = 2.45 (95% CI: 1.48, 4.05)) had statistically significant positive association with pterygium.

Conclusion

The prevalence of pterygium was relatively higher. Being widowed, outdoor occupation, sun exposure, wind exposure, alcohol drinking, and severe blepharitis were significantly associated with the development of pterygium.

Pterygium Prevalence and Its Associations in a Russian Population: The Ural Eye and Medical Study

PURPOSE

To assess the prevalence of pterygia and its associations in a population in Russia.

DESIGN

Population-based cross-sectional study.

METHODS

The Ural Eye and Medical Study was performed in a rural and urban area in Ufa/Bashkortostan 1300 km east of Moscow. Out of 7328 eligible individuals aged 40+ years, 5899 (80.5%) individuals participated and underwent an ocular and systemic examination. Pterygia, defined as conjunctival extensions onto the clear cornea, were diagnosed upon slit-lamp examination and on corneal photographs.

RESULTS

Mean pterygium prevalence (per individual) was 138/5888 (2.3%; 95% confidence intervals [CI]:2.0, 2.7), with bilateral occurrence in 45 individuals (32.6% of patients with pterygium; 0.8% of study population). Pterygium prevalence increased from 0.8% (95% CI: 0.02, 1.6) in the age group from 40 to <45 years to 3.6% (95% CI: 2.1, 5.1) in the age group of 75+ years. In multivariable analysis, higher pterygium prevalence was associated with older age (P = .006; odds ratio [OR]: 1.03; 95% CI: 1.01, 1.04), rural vs urban region of habitation (P < .001; OR: 2.33; 95% CI: 1.57, 3.46), and lower level of education (P = .03; OR: 0.89; 95% CI: 0.81, 0.99), while the pterygium prevalence was statistically independent of sex (P = .34), Russian vs non-Russian ethnicity (P = .59), presence of diabetes mellitus (P = 1.00), arterial hypertension (P = .86), vegetarian vs mixed diet (P = 1.00), blood lipid concentration (P > .30), history of cardiovascular disease (P = .49), or axial length (P = .52).

CONCLUSIONS

In this rural and urban, typically multiethnic Russian study population aged 40+ years, a higher pterygium prevalence (mean: 2.3%) was correlated with older age, rural region of habitation, and lower educational level, while it was statistically independent of most other systemic or ocular parameters. A pterygium was not a biomarker for an internal medical disease.

Occupational Exposure to Solar UV Radiation of a Group of Fishermen Working in the Italian North Adriatic Sea

Occupational solar radiation exposure is a relevant heath risk in the fishing sector. Our aim was to provide a detailed evaluation of individual UV exposure in three different fishing activities in Italy, with personal UV dosimeters and a simple formula to calculate the fraction of ambient erythemal UV dose received by the workers. The potential individual UV exposure of the fishermen was between 65 and 542 Joules/m². The percentages of the ambient exposure were estimated between 2.5% and 65.3%. Workers’ UV exposure was mainly influenced by the characteristics of the work activity, the postures adopted, and the type of boats. Overall, our data showed that 43% of the daily measurements could result largely above the occupational limits of 1–1.3 standard erythemal dose (i.e., 100 Joules/m²) per day, in case of exposure of uncovered skin areas. Measurements of individual UV exposure are important not only to assess the risk but also to increase workers’ perception and stimulate the adoption of preventive measures to reduce solar UV risk. Furthermore, the simple method proposed, linking ambient erythemal UV dose to the workers’ exposure, can be a promising tool for a reliable assessment of the UV risk, as time series of environmental UV dose are widely available.

Manifestações oculares em trabalhadores portuários: prevalência e fatores associados

Resumo Objetivo: Conhecer a prevalência de manifestações oculares em trabalhadores portuários e identificar fatores associados. Métodos: Estudo transversal em um Porto marítimo do extremo Sul do Brasil. Participaram 232 trabalhadores. Para coleta dos dados utilizou-se entrevista estruturada. Foi utilizado teste t de Student para amostras independentes, a fim de comparar as médias dos trabalhadores com manifestações oculares, por meio dos qualificadores em grau no mínimo moderado (presença de manifestações oculares) e aqueles sem manifestações oculares ou grau leve (ausência de manifestações oculares). O teste de Mann-Whitney foi utilizado no caso de assimetria. O teste do qui-quadrado de Pearson ou o teste exato de Fisher foram usados para comparar proporções e a análise de Regressão de Poisson foi usada para controlar os fatores de confusão. Resultados: A prevalência de manifestações oculares autorreferidos foi 92,2%. As manifestações oculares foram: coceira/prurido (49,1%), irritação (41,4%), ardor (39,2%), lacrimejamento (34,9%), sensação de cansaço (32,3%), alteração na pigmentação ocular (26,7%), dor (17,7%), ressecamento dos olhos (14,2%) e sensação de pressão atrás dos olhos (9,9). A utilização de filme para envelopar mercadoria contribuiu para maior prevalência de manifestações oculares. Já a utilização de luvas como equipamento de proteção individual auxiliou na menor prevalências dessas manifestações. Conclusão: Acredita-se que os achados do presente estudo possam subsidiar a avaliação clínica do enfermeiro na abordagem de trabalhadores portuários, assim como direcionar o planejamento e a implementação de cuidados socioambientais condizentes com as necessidades de saúde desses e de outros trabalhadores.

The Effects of Lighting Problems on Eye Symptoms among Cleanroom Microscope Workers

The visual health of microscope workers is an important occupational health concern, and a previous study suggested an association between lighting problems (e.g., flashing light, insufficient lighting) and eye symptoms among cleanroom workers in the electronics industry. This study aimed to explore the association between eye symptoms and lighting problems, as well as light-related counteracting behaviors among microscope workers in the cleanroom environment. Ninety-one cleanroom workers aged 20 years or older were recruited from an electronics factory. The socio-demographic factors, work-related factors, eye symptoms, and lighting problems were assessed using a self-administered questionnaire. There were 92.3% female participants in this study. Among all participants, 41.8% and 63.7% had symptoms of dry eye and eye fatigue, respectively. The counteracting behaviors of needing to move closer (adjusted odds ratio (aOR) = 3.47, 95% CI = 1.11 to 10.88) was significantly associated with dry eye symptoms. Workers who were more experienced at the job (aOR = 1.03, 95% CI = 1.01 to 1.06) and had shorter break times (aOR = 0.94, 95% CI = 0.91 to 0.98) were more likely to have eye fatigue. As a result of these findings, this study suggests that good lighting and adequate break times are crucial to improve the visual health of cleanroom microscope workers.

Cataract frequency and subtypes involved in workers assessed for their solar radiation exposure: a systematic review

Cataract is currently the primary cause of blindness worldwide, and one of its main risk factors is solar ultraviolet radiation exposure. According to the localization of lens opacities, three main subtypes of cataract are recognized: nuclear, cortical and posterior subcapsular cataract. One of the main determinants of individual long-term solar radiation exposure is outdoor work. We systematically reviewed scientific literature from the last 20 years to update the recent development of research on the risk of cataract in outdoor workers and on the specific subtypes involved, also investigating the methods applied to evaluate the occupational risk. A total of 15 studies were included in the review, of which 12 showed a positive association. The studies confirm the relationship of long-term occupational solar radiation exposure with cortical cataract and give new support for nuclear cataract, although no substantial new data were available to support a relation with the posterior subcapsular subtype. In most of the studies, the exposure assessment was not adequate to support a representative evaluation of the ocular risk; however, outdoor work is clearly a relevant risk factor for cataract. Further research providing a better evaluation of the relation between solar radiation exposure levels and lens damage in workers is needed and aimed to establish adequate occupational exposure limits and better preventive measures, studying also their effectiveness.

Solar Radiation Exposure and Outdoor Work: An Underestimated Occupational Risk

A considerably high number of outdoor workers worldwide are constantly exposed for the majority of their working life to solar radiation (SR); this exposure is known to induce various adverse health effects, mainly related to its ultraviolet (UV) component. The skin and the eye are the principal target organs for both acute and long-term exposure. Actinic keratosis, non-melanoma skin cancers, and malignant melanoma are the main long-term adverse skin effects, whereas in the eye pterygium, cataracts, and according to an increasing body of evidence, macular degeneration may be induced. Despite this, SR exposure risk is currently undervalued, if not neglected, as an occupational risk factor for outdoor workers. SR exposure is influenced by various environmental and individual factors, and occupation is one of the most relevant. For a better understanding of this risk and for the development of more effective prevention strategies, one of the main problems is the lack of available and adequate methods to estimate SR worker exposure, especially long-term exposure. The main aims of this review were to provide a comprehensive overview of SR exposure risk of outdoor workers, including the UV exposure levels and the main methods recently proposed for short-term and cumulative exposure, and to provide an update of knowledge on the main adverse eye and skin effects. Finally, we also outline here preventive interventions to reduce occupational risk.

Macular degeneration and occupational risk factors: a systematic review

Purpose

Macular degeneration is a multi-factorial disease, leading cause of blindness for people over 50 years old in developed countries. To date, the knowledge on possible occupational factors involved in the development of the disease is scant.

Method

We performed a systematic scientific literature search on the association between macular degeneration and occupational risk factors searching the MedLine and Scopus databases.

Results

We examined 158 articles and, according to the inclusion criteria, 13 peer-reviewed studies evaluating occupational risk factors for macular degeneration or reporting the frequency of the disease in specific groups of workers were included in the review. Ten on thirteen articles evaluated the presence of macular degeneration in workers exposed to solar radiation. Only one study found that non-specific history of occupational chemical exposure was associated with the disease. Two studies showed an association between macular degeneration and the general category of “blue-collar” workers, but they did not identify the specific risk factors involved.

Conclusions

To date few studies have examined occupational risk factors for macular degeneration. Nevertheless, available data indicate that long-term occupational solar radiation exposure, in particular for its blue-light component, is associated with macular degeneration in outdoor workers.

Electronic supplementary material

The online version of this article (10.1007/s00420-018-1355-y) contains supplementary material, which is available to authorized users.