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Alex W. Hewitt, Justin C. Sherwin, Lisa S. Kearns, Lyn R. Griffiths, David A. Mackey, Minas T. Coroneo; Refractive Error Is Associated With Degree Of Conjunctival UV Autofluorescence. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1190.
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Recent work has suggested that increased time spent outdoors is protective for the development of myopia. Outdoor exposure to UV light is associated with increased conjunctival UV autofluorescence (UVAF). We wished to determine whether there is an inverse association between myopia and degree of conjunctival UVAF.
All permanent residents of Norfolk Island aged ≥ 15 were invited to participate, and complete a standardized sun-exposure questionnaire. Examination included: autorefraction (Nidek, Gamagori, Japan); slit-lamp biomicroscopy; and conjunctival ultraviolet autofluorescence (UVAF) photography using a modified Nikon D100 (Nikon, Melville, New York, USA). The temporal and nasal size of conjunctival UVAF for each eye was measured digitally, with the total UVAF area being used for analysis. Emmetropia was defined as a spherical equivalence (SE) >-1.0D or <+1.0D, whilst myopia and hyperopia were defined as SE either <-1.0D or >+1.0, respectively.
Data were available from a total of 636 people and the mean age of participants was 54.1 years (SD: 16.24; range 15-89). The mean SE of participants was 0.56D (SD: 1.42; range -9D to +8D). Conjunctival UVAF was positively skewed, with the median total amount of conjunctival UVAF being 0.282cm2 (IQR:0.145-0.482). There was an inverse, linear relationship between UVAF and advancing age (p<0.001). Logistic regression demonstrated a significant association between refractive error and total conjunctival UVAF area (p=0.006). Multivariate analysis, adjusting for age, gender, height and weight, revealed that the OR (95% CI) for developing myopia for people in the lowest quartile of conjunctival UVAF was 3.14 (1.47 - 6.70).
We identified a strong association between increasing total area of conjunctival UVAF and refractive error. This study objectively supports the hypothesis that increased time outdoors is protective against myopia, although the alternative that glasses wear prevents conjunctival autofluorescence requires further investigation.
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