J Korean Med Sci.  2017 Jan;32(1):143-150. 10.3346/jkms.2017.32.1.143.

Outdoor Air Pollution and Pterygium in Korea

• Lee KW
• Choi YH
• Hwang SH
• Paik HJ
• Kim MK
• Wee WR
• Kim DH

• KMID: 2417597
• DOI: http://doi.org/10.3346/jkms.2017.32.1.143

Abstract

We investigated relationships between outdoor air pollution and pterygium in Korean adults. This study includes 23,276 adults in population-based cross-sectional data using the Korea National Health and Nutrition Examination Survey 2008-2011. Pterygium was assessed using slit lamp biomicroscopy. Air pollution data (humidity, particulate matter with aerodynamic diameter less than 10 μm [PM₁₀], ozone [O₃], nitrogen dioxide [NOâ‚‚], and sulfur dioxide levels [SOâ‚‚]) for 2 years preceding the ocular examinations were acquired. Associations of multiple air pollutants with pterygium or pterygium recurrence after surgery were examined using multivariate logistic models, after adjusting for several covariates. Distributed lag models were additionally used for estimating cumulative effects of air pollution on pterygium. None of air pollution factors was significantly associated with pterygium or pterygium recurrence (each P > 0.05). Distributed lag models also showed that air pollution factors were not associated with pterygium or pterygium recurrence in 0-to-2 year lags (each P > 0.05). However, primary pterygium showed a weak association with PM₁₀ after adjusting for covariates (odds ratio [OR] 1.23; [per 5 μg/m³ PM₁₀ increase]; P = 0.023). Aging, male sex, and greater sun exposure were associated with pterygium, while higher education level and myopia were negatively associated with pterygium (each P ≤ 0.001). Male sex and myopia were negatively associated with pterygium recurrence (each P < 0.05). In conclusion, exposure to higher PM10 levels was associated with primary pterygium, although this study observed no significant association between air pollution and overall pterygium or pterygium recurrence in Korean adults.

Keyword

Air Pollution; Pterygium; Association; Recurrence; PM₁₀

MeSH Terms

Adult
Aging
Air Pollutants
Air Pollution*
Education
Humans
Korea*
Logistic Models
Male
Myopia
Nitrogen Dioxide
Nutrition Surveys
Ozone
Particulate Matter
Pterygium*
Recurrence
Slit Lamp
Solar System
Sulfur Dioxide
Air Pollutants
Nitrogen Dioxide
Ozone
Particulate Matter
Sulfur Dioxide

Figure

• 

  Fig. 1 Flow diagram presenting the selection of study participants. KNHANES = Korea National Health and Nutrition Examination Survey.

• 

  Fig. 2 Distributed lag models between outdoor air pollutants (humidity, PM, O3, NO2, and SO2) and pterygium. (A) Model 1, (B) Model 2. Model 1: sociodemographic factors were included as covariates; Model 2: sociodemographic factors, sun exposure, and myopia were included as covariates. PM10 = particulate matter with aerodynamic diameter less than 10 µm, O3 = ozone, NO2 = nitrogen dioxide, SO2 = sulfur dioxide, OR = odds ratio, CI = confidence interval.

• 

  Fig. 3 Distributed lag models between PM and primary pterygium. (A) Model 1, (B) Model 2. Model 1: sociodemographic factors were included as covariates; Model 2: sociodemographic factors, sun exposure, and myopia were included as covariates. PM10 = particulate matter with aerodynamic diameter less than 10 µm, OR = odds ratio, CI = confidence interval. *Associated with primary pterygium in multivariate logistic regression.

Reference

1. World Health Organization. WHO Air Quality Guidelines for Particulate Matter, Ozone, Nitrogen Dioxide and Sulfur Dioxide: Global Update 2005. Geneva: World Health Organization;2006.

2. Kampa M, Castanas E. Human health effects of air pollution. Environ Pollut. 2008; 151:362–367.

3. Hwang SH, Choi YH, Paik HJ, Wee WR, Kim MK, Kim DH. Potential importance of ozone in the association between outdoor air pollution and dry eye disease in South Korea. JAMA Ophthalmol. 2016; 134:503–510.

4. Livingston PM, McCarty CA, Taylor HR. Visual impairment and socioeconomic factors. Br J Ophthalmol. 1997; 81:574–577.

5. Hill JC, Maske R. Pathogenesis of pterygium. Eye (Lond). 1989; 3:218–226.

6. Marmamula S, Khanna RC, Rao GN. Population-based assessment of prevalence and risk factors for pterygium in the South Indian state of Andhra Pradesh: the Andhra Pradesh eye disease study. Invest Ophthalmol Vis Sci. 2013; 54:5359–5366.

7. Rim TH, Nam J, Kim EK, Kim TI. Risk factors associated with pterygium and its subtypes in Korea: the Korean National Health and Nutrition Examination Survey 2008-2010. Cornea. 2013; 32:962–970.

8. Tano T, Ono K, Hiratsuka Y, Otani K, Sekiguchi M, Konno S, Kikuchi S, Onishi Y, Takegami M, Yamada M, et al. Prevalence of pterygium in a population in Northern Japan: the locomotive syndrome and health outcome in Aizu cohort study. Acta Ophthalmol. 2013; 91:e232–6.

9. Zhao L, You QS, Xu L, Ma K, Wang YX, Yang H, Jonas JB. 10-year incidence and associations of pterygium in adult Chinese: the Beijing eye study. Invest Ophthalmol Vis Sci. 2013; 54:1509–1514.

10. Lim CY, Kim SH, Chuck RS, Lee JK, Park CY. Risk factors for pterygium in Korea: the Korean National Health and Nutrition Examination Survey V, 2010-2012. Medicine (Baltimore). 2015; 94:e1258.

11. Welty LJ, Peng RD, Zeger SL, Dominici F. Bayesian distributed lag models: estimating effects of particulate matter air pollution on daily mortality. Biometrics. 2009; 65:282–291.

12. Lim YH, Kim H, Kim JH, Bae S, Park HY, Hong YC. Air pollution and symptoms of depression in elderly adults. Environ Health Perspect. 2012; 120:1023–1028.

13. Dabass A, Talbott EO, Venkat A, Rager J, Marsh GM, Sharma RK, Holguin F. Association of exposure to particulate matter (PM2.5) air pollution and biomarkers of cardiovascular disease risk in adult NHANES participants (2001-2008). Int J Hyg Environ Health. 2016; 219:301–310.

14. Liu T, Liu Y, Xie L, He X, Bai J. Progress in the pathogenesis of pterygium. Curr Eye Res. 2013; 38:1191–1197.

15. Bradley JC, Yang W, Bradley RH, Reid TW, Schwab IR. The science of pterygia. Br J Ophthalmol. 2010; 94:815–820.

16. Chui J, Di Girolamo N, Wakefield D, Coroneo MT. The pathogenesis of pterygium: current concepts and their therapeutic implications. Ocul Surf. 2008; 6:24–43.

17. Coroneo MT. Pterygium as an early indicator of ultraviolet insolation: a hypothesis. Br J Ophthalmol. 1993; 77:734–739.

18. Poljšak B, Fink R. The protective role of antioxidants in the defence against ROS/RNS-mediated environmental pollution. Oxid Med Cell Longev. 2014; 2014:671539.

19. Ozsutcu M, Arslan B, Erdur SK, Gulkilik G, Kocabora SM, Muftuoglu O. Tear osmolarity and tear film parameters in patients with unilateral pterygium. Cornea. 2014; 33:1174–1178.

20. Ishioka M, Shimmura S, Yagi Y, Tsubota K. Pterygium and dry eye. Ophthalmologica. 2001; 215:209–211.

21. Rajiv MS, Mithal S, Sood AK. Pterygium and dry eye--a clinical correlation. Indian J Ophthalmol. 1991; 39:15–16.

22. Kaufman SC, Jacobs DS, Lee WB, Deng SX, Rosenblatt MI, Shtein RM. Options and adjuvants in surgery for pterygium: a report by the American Academy of Ophthalmology. Ophthalmology. 2013; 120:201–208.

23. Han SB, Jeon HS, Kim M, Lee SJ, Yang HK, Hwang JM, Kim KG, Hyon JY, Wee WR. Risk factors for recurrence after pterygium surgery: an image analysis study. Cornea. 2016; 35:1097–1103.

24. Sul S, Korkmaz Ş, Novruzlu Ş. Seasonal effects on pterygium surgery outcome: implications for the role of sunlight exposure. Cornea. 2014; 33:504–506.

25. Cutolo M, Wilder RL. Different roles for androgens and estrogens in the susceptibility to autoimmune rheumatic diseases. Rheum Dis Clin North Am. 2000; 26:825–839.