We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Solar Exposure and Residential Geographic History in Relation to Exfoliation Syndrome in the United States and Israel

Louis R. Pasquale, MD1,2; Aliya Z. Jiwani, MD2; Tzukit Zehavi-Dorin, MD3; Arow Majd, MD3; Douglas J. Rhee, MD2,4; Teresa Chen, MD2; Angela Turalba, MD2; Lucy Shen, MD2; Stacey Brauner, MD2; Cynthia Grosskreutz, MD, PhD2,5; Matthew Gardiner, MD2; Sherleen Chen, MD2; Sheila Borboli-Gerogiannis, MD2; Scott H. Greenstein, MD2; Kenneth Chang, MD2; Robert Ritch, MD6; Stephanie Loomis, MPH1; Jae H. Kang, ScD1; Janey L. Wiggs, MD, PhD2; Hani Levkovitch-Verbin, MD, MPA3
[+] Author Affiliations
1Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts
2Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston
3Goldschleger Eye Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel
4Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio
5currently withNovartis Institute for BioMedical Research, Cambridge, Massachusetts
6Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York
JAMA Ophthalmol. 2014;132(12):1439-1445. doi:10.1001/jamaophthalmol.2014.3326.
Text Size: A A A
Published online

Importance  Residential (geographic) history and extent of solar exposure may be important risk factors for exfoliation syndrome (XFS) but, to our knowledge, detailed lifetime solar exposure has not been previously evaluated in XFS.

Objective  To assess the relation between residential history, solar exposure, and XFS.

Design, Setting, and Participants  This clinic-based case-control study was conducted in the United States and Israel. It involved XFS cases and control individuals (all ≥60-year-old white individuals) enrolled from 2010 to 2012 (United States: 118 cases and 106 control participants; Israel: 67 cases and 72 control participants).

Main Outcomes and Measures  Weighted lifetime average latitude of residence and average number of hours per week spent outdoors as determined by validated questionnaires.

Results  In multivariable analyses, each degree of weighted lifetime average residential latitude away from the equator was associated with 11% increased odds of XFS (pooled odds ratio [OR], 1.11; 95% CI, 1.05-1.17; P < .001). Furthermore, every hour per week spent outdoors during the summer, averaged over a lifetime, was associated with 4% increased odds of XFS (pooled OR, 1.04; 95% CI, 1.00-1.07; P = .03). For every 1% of average lifetime summer time between 10 am and 4 pm that sunglasses were worn, the odds of XFS decreased by 2% (OR, 0.98; 95% CI, 0.97-0.99; P < .001) in the United States but not in Israel (OR, 1.00; 95% CI, 0.99-1.01; P = .92; P for heterogeneity = .005). In the United States, after controlling for important environmental covariates, history of work over water or snow was associated with increased odds of XFS (OR, 3.86; 95% CI, 1.36-10.9); in Israel, there were too few people with such history for analysis. We did not identify an association between brimmed hat wear and XFS (P > .57).

Conclusions and Relevance  Lifetime outdoor activities may contribute to XFS. The association with work over snow or water and the lack of association with brimmed hat wear suggests that ocular exposure to light from reflective surfaces may be an important type of exposure in XFS etiology.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?






You need to register in order to view this quiz.


Some tools below are only available to our subscribers or users with an online account.

2 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections