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      Risk Factors for Pterygium in Korea: The Korean National Health and Nutrition Examination Survey V, 2010–2012

      , PhD, , MD, , MD, PhD, , MD, , MD, PhD


      Wolters Kluwer Health

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          The aim of this study is to report general and age-specific risk factors for pterygium prevalence in the Korean population.

          This in an observational case series study.

          Data from total 24,812 participants (age 40 years or older) from the Korean National Health and Nutrition Examination Surveys conducted from 2010 to 2012 were retrieved. After applying exclusion criteria, data from 13,204 participants (821 with pterygium and 12,383 without) were used for univariate and multivariate analyses. General risk factors were identified and participants were grouped by decade: 40 s, 50 s, 60 s, 70 s, and 80+. Age-specific risk factors were investigated for each group.

          After univariate analysis, 2 multiple regression models were constructed. Model 1: age + sex + spherical equivalent (SE) + sun exposure hours + occupation (indoor vs outdoor) + residency area (rural vs urban) + education level; model 2: age + sex + SE + sun exposure hours. In model 1, older age (odds ratio [OR]: 1.05 95% confidence interval [CI]: 1.05–1.06), male gender (OR: 1.28, 95% CI: 1.01–1.61), and longer sun exposure hours (OR: 1.47, 95% CI: 1.11–1.94) were significant risk factors for pterygium prevalence whereas higher level of education (elementary school vs college, OR: 3.98, 95% CI: 2.24–7.06) and urban residency (vs rural residency, OR: 0.56, 95% CI: 0.45–0.70) were protective factors. Higher SE (OR 1.11, 95% CI: 1.03–1.19) refractive error was considered a risk factor when using model 2 for the analysis. Age-specific risk factors were different in each age group. Male gender was associated with higher pterygium prevalence in younger age groups while longer sun exposure (5+ hours/day) increased pterygium prevalence in older age groups.

          Previously characterized risk factors were also found in this large population study. However, we found that risk factors may vary according to the age group. Myopic eyes were found to have lower prevalence than hyperopic eyes.

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          Most cited references 29

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          Risk analysis in the development of pterygia.

          No detailed analysis of risk factors in the development of pterygia has been previously performed. In this report, the authors identify and quantify these risk factors. In a case-control study, 278 patients treated in a Brisbane hospital for primary pterygium between 1973 and 1978 were compared with a similar number of people without pterygium who were matched for age, race, and sex, using information from a standard questionnaire completed during a personal interview. Risk of pterygium was increased among patients who, in their third decade of life, worked outdoors in an environment with high surface reflectance of ultraviolet light compared with those who worked indoors. The elevation of risk was raised several hundred-fold among those subjects who worked mainly on sand compared with those who worked indoors when results were adjusted for associated risk factors. When risk was measured among subjects who worked in an environment that was mainly concrete, risk was increased almost 20-fold. Those subjects who spent their first 5 years of life at latitudes less than 30 degrees had almost 40 times the risk of pterygium than those living at latitudes greater than 40 degrees; spending the majority of times outdoors in these earliest years was associated with a 20-fold increase in risk of developing pterygium. There was a strong protective element in the wearing of regular glasses, sunglasses, or a hat. There is a strong suggestion of a causal relationship between ultraviolet light exposure and the development of pterygia during the early years of life and the cumulative exposure over the next 2 to 3 decades in occupations in which there is a high component of reflected ultraviolet light.
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            Histological changes of high axial myopia.

             J Jonas,  L. Xu (2014)
            To describe pathological changes in the anatomy of highly myopic (axially elongated) eyes, enucleated globes were examined by light microscopy and ocular structures were measured histomorphometrically. These studies revealed that highly axially myopic eyes show continuous thinning of the sclera starting at or behind the equator with a maximal thinning at the posterior pole; a profound thinning of the choroid decreasing from ∼ 250 to <10 μm in extreme axial myopia, secondary macular defects in the Bruch's membrane associated with a complete loss of retinal pigment epithelium and choriocapillaris, and retinal photoreceptors; a Bruch's membrane of normal thickness in contrast to the profound thinning of the choroid and the sclera; an up to 10-fold elongation and thinning of the peripapillary scleral flange as anterior roof of the orbital cerebrospinal fluid space, and subsequently a retrobulbar extension of the cerebrospinal fluid space; an increased distance of the peripapillary arterial circle of Zinn-Haller to the optic disc border; an elongation and thinning of the lamina cribrosa with a subsequently decreased distance between the intraocular pressure compartment and the retrobulbar orbital cerebrospinal fluid pressure compartment; an increasing exposure of the peripheral posterior lamina cribrosa surface to the cerebrospinal fluid space, no longer buffered by the solid optic nerve tissue; and the development and enlargement of parapapillary gamma zone, in contrast to a myopia-independent parapapillary beta zone. These anatomical changes may be associated with high axial myopia-related complications such as an increased susceptibility of glaucomatous optic neuropathy and myopic retinopathy.
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              Prevalence and risk factors of pterygium in a southwestern island of Japan: the Kumejima Study.

              To determine the prevalence and risk factors for pterygium in a Japanese population aged 40 years or older on Kumejima Island, Japan. Cross-sectional, population-based study. All residents of Kumejima Island, Japan, located in Southwestern Japan (Eastern longitude 126 degrees, 48 feet and Northern latitude 26 degrees, 20 feet), aged 40 years and older were asked to undergo a comprehensive questionnaire and ocular examination. Of the 4,632 residents, 3,762 (81.2%) underwent the examination. The presence of pterygium could not be determined in 15 subjects. Of the 3,747 eligible subjects, 1,154 (30.8%; 95% confidence interval [CI], 29.3% to 32.3%) had pterygium in at least 1 eye and 491 subjects (13.1%; 95% CI, 12.1% to 14.3%) had pterygium in both eyes. In the logistic regression analysis, older age (P < .001), male gender (P = .024), hyperopic refraction (P = .001), lower intraocular pressure (P = .002), and outdoor job experience (P < .001) were independently associated with a higher risk of pterygium. The prevalence of pterygium is 30.8% among adult Japanese aged 40 years and older in Kumejima. Older age, male gender, hyperopic refraction, lower intraocular pressure, and outdoor job history were independently associated with a higher risk of pterygium.

                Author and article information

                Medicine (Baltimore)
                Medicine (Baltimore)
                Wolters Kluwer Health
                August 2015
                14 August 2015
                : 94
                : 32
                From the Department of Biostatistics, Dongguk University Ilsan Hospital (C-YL); Department of Ophthalmology, Dongguk University, Ilsan Hospital, Goyang, Kyunggido, South Korea (S-HK, CYP); and Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA (RSC, JKL).
                Author notes
                Correspondence: Choul Y. Park, Department of Ophthalmology, Dongguk University, Ilsan Hospital, 814, Siksadong, Ilsan-dong-gu, Goyang, Kyunggido 410-773, South Korea (e-mail: oph0112@ ).
                Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

                This is an open access article distributed under the Creative Commons Attribution-NoDerivatives License 4.0, which allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author.

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                Observational Study
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