Associations Between Ambient Air Pollution and Five Common Vision-Threatening Ocular Diseases in Middle-Aged and Older Adults: A Large Prospective Cohort Study.

Abstract

Ambient air pollution may exacerbate ocular conditions; however, comprehensive research on the effects of various pollutants remains limited. This study aims to evaluate the association between multiple air pollutants and the incidence of five common vision-threatening ocular diseases: cataracts, glaucoma, macular degeneration, diabetic retinopathy, and retinal detachment. Prospective cohort study. We included 114,930 participants with refractometry at baseline in this prospective cohort study based on data from the UK Biobank. Annual average concentrations of nitrogen oxides (NO_x), nitrogen dioxide (NO₂), and particulate matter (PM) with diameters <2.5 µm (PM_2.5) and <10 µm (PM₁₀) were assessed using land use regression models. Restricted cubic spline models and Cox proportional hazards regression were used to estimate the association between air pollution exposure and ocular disease incidence, with stratified analyses based on myopia status. An interquartile range increase in PM₁₀ and NO_x was significantly associated with a higher risk of diabetic retinopathy among participants with myopia, with hazard ratios of 1.11 (95% confidence interval: 1.01-1.23) and 1.22 (95% confidence interval: 1.02-1.45), respectively. PM₁₀ was linked to a 9% increase in retinal detachment incidence in the myopic population, and PM_2.5 was linked to an 8% increase in glaucoma incidence in the nonmyopic population. High PM₁₀ exposure was associated with a 61% higher risk of diabetic retinopathy in the myopic group. Further stratified analysis revealed that the impact of PM₁₀ on diabetic retinopathy was more pronounced in individuals with low-to-moderate myopia than in those with high myopia. High PM₁₀ exposure also correlated with a 67% higher risk of retinal detachment and a 44% higher risk of macular degeneration in the low-to-moderate myopic population. Exposure to high levels of PM₁₀ was associated with an increased risk of diabetic retinopathy and retinal detachment, highlighting the importance of addressing air pollutants as an intervention for vision-threatening ocular diseases.