Potential Importance of Ozone in the Association Between Outdoor Air Pollution and Dry Eye Disease in South Korea

Abstract

IMPORTANCE Air pollution is an important public health concern and the ocular surface is continuously exposed to pollutants in outdoor air. Ocular surface abnormalities related to air pollution are thought to be a subtype of dry eye disease (DED). However, to date, there is no large-scale study evaluating an association between air pollution and DED that includes multiple air pollutants. OBJECTIVE To investigate associations between outdoor air pollution and DED in a Korean population. DESIGN, SETTING, AND PARTICIPANTS A population-based cross-sectional study using data on 16 824 participants in the fifth Korea National Health and Nutrition Examination Survey was conducted from January 1, 2010, to December 31, 2012. Data analysis was conducted from September 1 to 30, 2015. Dry eye disease was defined as previously diagnosed by an ophthalmologist or the presence of frequent ocular pain and discomfort. Outdoor air pollution measurements (mean annual humidity, particulate matter with aerodynamic diameter <10 μm [PM 10 ], ozone, and nitrogen dioxide levels) were collected from 283 national monitoring stations in South Korea. MAIN OUTCOMES AND MEASURES Associations of multiple air pollutants with DED were assessed from multivariable logistic regression analyses. Sociodemographic factors and previously known factors associated with DED were applied as covariates (model 1 controlled for sociodemographic factors and model 2 controlled for sociodemographic, behavioral, and clinical factors). RESULTS Among 16 824 participants (7104 men and 9720 women), higher ozone levels and lower humidity levels were significantly associated with symptoms and diagnosis of DED. In model 1, an increase in ozone levels of 0.003 ppm was significantly associated with symptoms and diagnosis of DED

Outdoor Air Pollution and Pterygium in Korea

“…Air pollution factors of ambient PM 10 (PM with an aerodynamic diameter less than 10 μm), O 3 , NO 2 , and SO 2 concentrations and relative humidity were considered in this study. Outdoor relative humidity was considered together as an air pollution factor because PM 10 and NO 2 were significantly correlated with humidity in the previous study (3). We calculated annual average concentration to each air pollutant prior to the ocular examinations (present, 1 year ago, and 2 years ago) for the total 16 administrative divisions of South Korea, and additionally calculated average concentration of each air pollutant for 2 years.…”

“…We calculated annual average concentration to each air pollutant prior to the ocular examinations (present, 1 year ago, and 2 years ago) for the total 16 administrative divisions of South Korea, and additionally calculated average concentration of each air pollutant for 2 years. The detailed monitoring methods were specified in the previous study (3). …”

“…Multivariate logistic models were performed to determine whether each air pollution factors were associated with a pterygium (n = 23,276). Because each air pollutants have high correlation (3), we also applied multi-pollutant models in the analysis; Model 1 controlled sociodemographic factors, and Model 2 controlled sociodemographic, clinical factors as covariates. Moreover, we analyzed associations between air pollution factors and the presence of pterygium with two different ways: 1) a model using average concentrations for previous 2 years before the ocular examination; and 2) distributed lag models using annual average concentrations by up to lagged 2 years before the ocular examination (year lag 0 through year lag 2), to account for the cumulative and/or delayed effects of environmental exposures (111213).…”

“…Although ocular surface is exposed to multiple air pollutants all of time, effects of outdoor air pollutants on ocular surface diseases have not been well-investigated. Recently, we revealed that higher tropospheric O 3 levels were associated with dry eye disease in the Korean adult population (3), and suggested a potential mechanism that air pollution-induced oxidative stress and subclinical inflammation may be related with dry eye disease.…”

Punicalagin and (–)-Epigallocatechin-3-Gallate Rescue Cell Viability and Attenuate Inflammatory Responses of Human Epidermal Keratinocytes Exposed to Airborne Particulate Matter PM10

“…It infiltrates blood vessels and circulates throughout the body, causing cardiovascular and cerebrovascular diseases [5]. Moreover, PM10 causes eye irritation leading to allergic conjunctivitis and dry eye syndrome [6]. It penetrates the skin and causes inflammatory skin diseases, such as atopic dermatitis, acne, and psoriasis [7].…”