Nighttime Outdoor Artificial Light and Risk of Age-Related Macular Degeneration

Key Points Question Is exposure to outdoor artificial light at night (OALAN) associated with the occurrence of exudative age-related macular degeneration (EAMD)? Findings In this population-based case-control study of 4078 patients newly diagnosed with EAMD and 122 340 individuals without EAMD, a positive association between higher levels of residential OALAN and the risk of developing incident EAMD was observed. The association between exposure to light and EAMD followed a nonlinear pattern, with a concave upward slope that became more pronounced at higher levels of light exposure. Meaning These findings suggest that OALAN may be a risk factor for EAMD.


eMethods. Assessment of Air Pollution and Nighttime Noise
We estimated the annual concentration of particulate matter of aerodynamic diameter ≤ 10 μm (PM10) in each participant's administrative district of residence using validated machine-learning-based models.The model was constructed by ensemble method entailing random forest regression, gradient boosting, and neural network.Additional methodological details are previously reported and available upon request (www.datascience4health.com).
To measure night-time noise levels, we obtained data from the National Noise Information System (https://www.noiseinfo.or.kr/).Average yearly district-level noise was used as a proxy for individual exposure.

eFigure 1 .
Flowchart of Enrollment of Study Population EAMD = exudative age-related macular degeneration; PM10 = particulate matter with aerodynamic diameter ≤ 10 μm eFigure 2. Exposure-Response Curve for Association Between OALAN at Residential Address and Risk of Incident Exudative Age-Related Macular Degeneration OALAN was fitted as a smooth term using a penalized smoothing spline with four degrees of freedom.The solid line represents urban areas, the dashed line represents rural areas' outcomes.The shaded area represents the 95% confidence interval.HR = hazard ratio.© 2024 Kim SH et al.JAMA Network Open.

eTable 1 .
Definitions of Covariates and Clinical Outcome

Health exam questionnaire Alcohol consumption (daily alcohol intake amount)
Summary Statistics for the Participants' Baseline Characteristics by Quartile of Outdoor Artificial Light at Night eTable 2. Assessment of Proportional Hazard Assumption OALAN, outdoor artificial light at night; BMI, body mass index; COPD, chronic obstructive pulmonary disease; PM10, particulate matter with aerodynamic diameter ≤ 10 μm Schoenfeld residual plot analysis for diabetes eTable 3. Summary of Multicollinearity Analysis GVIF, Generalized variance inflation factor; OALAN, outdoor artificial light at night; BMI, body mass index; COPD, chronic obstructive pulmonary disease; PM10, particulate matter with aerodynamic diameter ≤ 10 μm.GVIF (0.5*df) > 2 indicates presence of multicollinearity.eTable 4.

Variable HR per OALAN IQR increase with linearity assumption HRs for Top three OALAN Q vs. lowest Q HR curve with a penalized smoothing spline
Association Between Outdoor Nighttime Light Exposure and the Risk of Exudative Age-Related Macular Degeneration in the 3 Largest Cities in South Korea Stratified Analyses of Hazard Ratios for Incident Exudative Age-Related Macular Degeneration by Personal Characteristics at Baseline Models were adjusted for all but the relevant characteristic among the following factors: age, sex, BMI, drinking status, exercise status, income level, comorbidities including hypertension, diabetes mellitus, dyslipidemia, CKD, COPD, cancer, fine particulate matter (PM10), and night-time traffic noise at the residential address.Sensitivity Analysis of the Association Between Outdoor Nighttime Light Exposure and the Risk of Exudative Age-Related Macular Degeneration in the Cohort That Excludes Participants With Conditions That May Impair Sleep Quality HR, hazard ratio; CI, confidence interval; EAMD, exudative age-related macular degeneration; IQR, interquartile range.*Modelsincluded age and sex.†Models were additionally adjusted for baseline body mass index, drinking status, exercise status, income level, comorbidities including hypertension, diabetes mellitus, dyslipidamia, chronic kidney disease, chronic obstructive pulmonary disease, cancer, fine particulate matter (PM10), and night-time traffic noise at the residential address.‡Test for trend is based on the median value for each quartile.§An IQR increase in outdoor light at night at the residential address is 55.8 nW/cm 2 /sr.eTable 8. * eTable 9.