Associations between Ambient Air Pollution and Five Common Vision-threatening Ocular Diseases in Middle-aged and Older Adults: A Large Prospective Cohort Study

Ambient air pollution may exacerbate ocular conditions; however, comprehensive research on the effects of various pollutants remains limited. 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 METHODS: 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 (NOx), nitrogen dioxide (NO2), and particulate matter (PM) with diameters < 2.5 (PM2.5) 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 NOx was significantly associated with a higher risk of diabetic retinopathy among participants with myopia, with hazard ratios (HRs) of 1.11 (95% confidence interval [CI]: 1.01-1.23) and 1.22 (95% CI: 1.02-1.45), respectively. PM10 was linked to 9% increase in retinal detachment incidence in the myopic population and PM2.5 was linked to 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.