Geographic and Climatic Factors Associated With Exfoliation Syndrome

Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, 48105, USA.
Archives of ophthalmology (Impact Factor: 4.4). 08/2011; 129(8):1053-60. DOI: 10.1001/archophthalmol.2011.191
Source: PubMed


To identify geographic and climatic risk factors associated with exfoliation syndrome (ES).
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.
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.
Ambient temperature and sun exposure may be important environmental triggers of ES.

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    • "Stein et al. [20] reported an increased XFS frequency with increase in the annual number of sunny days, decreased mean high July temperature, decreased mean January low temperature, and lower elevation above sea level. According to data from the Turkey General Directorate of Meteorology, the mean temperatures of July and January in Sivas Province were 20.2°C and −3.3°C, respectively, and the duration of sunshine was 2421 hours/year with an altitude of 1285 meters. "
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    • "They concluded that in their mainly white study population from the United States, living in the middle or southern regions of the United States relative to living in the northern region was associated with a reduced risk of exfoliation glaucoma. In a retrospective study of 626,901 eye care recipients, northern-tier residence (above 42°N latitude) was associated with an increased hazard of PEX (adjusted hazard ratio [HR], 2.14), and Southern-tier (below 37°N latitude) was associated with a reduced hazard of PEX (HR, 0.83) [37]. After adjustment for joint environmental effects, for every 1° increase in July high temperature, the hazard of PEX decreased by 9% (HR: 0.91); for every 1° increase in January low temperature, the hazard decreased 3% (HR: 0.97). "
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