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Aug 2011

Geographic and Climatic Factors Associated With Exfoliation Syndrome

Author Affiliations

Author Affiliations: Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor (Dr Stein, Kim, Reed, and Richards and Ms Talwar); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary (Drs Pasquale and Wiggs), and Department of Medicine, Channing Laboratory, Brigham and Women's Hospital (Dr Kang), Harvard Medical School, Boston, Massachusetts; and Departments of Biostatistics (Dr Nan) and Epidemiology (Dr Richards), University of Michigan School of Public Health, Ann Arbor.

Arch Ophthalmol. 2011;129(8):1053-1060. doi:10.1001/archophthalmol.2011.191

Objective To identify geographic and climatic risk factors associated with exfoliation syndrome (ES).

Methods A retrospective study of 626 901 eye care recipients, dating from 2001 to 2007 from 47 US states in a managed care network. Incident ES cases-patients (N = 3367) were identified by using billing codes. We assessed the risk of ES by geographic latitude tier in the continental United States and assigned state-level climatic data (eg, ambient temperature, elevation, and sun exposure) according to patients' residential location. The hazard of ES was calculated by using multivariable-adjusted Cox proportional hazards regression models.

Results Compared with middle-tier residence, northern-tier residence (above 42°N) was associated with an increased hazard of ES (adjusted hazard ratio [HR], 2.14; 95% confidence interval [CI], 1.94-2.35). Southern-tier (below 37°N) was associated with a reduced hazard of ES (HR, 0.83; 95% CI, 0.75-0.93). Excluding whites did not change these associations. After adjustment for joint environmental effects, for every 1° increase in July high temperature, the hazard of ES decreased by 9% (HR, 0.91; 95% CI, 0.89-0.93); for every 1° increase in January low temperature, the hazard decreased 3% (0.97; 0.96-0.98). For each additional sunny day annually, the hazard increased by 1.5% (HR, 1.02; 95% CI, 1.01-1.02) in locations with average levels of other climatic factors.

Conclusion Ambient temperature and sun exposure may be important environmental triggers of ES.