Ambient Air Pollution and Age-Related Eye Disease: A Systematic Review and Meta-Analysis

PURPOSE: To compare the burden of age-related eye diseases among adults exposed to higher versus lower levels of ambient air pollutants. METHODS: MEDLINE, EMBASE, and Scopus were searched for relevant articles until September 30, 2021. Inclusion criteria included studies of adults, aged 40+ years, that provided measures of association between the air pollutants (nitrogen dioxide, carbon monoxide [CO], sulfur dioxide, ozone [O(3)], particulate matter [PM] less than 2.5 µm in diameter [PM(2.5)], and PM less than 10 µm in diameter [PM(10)]) and the age-related eye disease outcomes of glaucoma, age-related macular degeneration (AMD), or cataract. Pooled odds ratio (OR) estimates and 95% confidence intervals (CIs) were calculated using a random-effects meta-analysis model. PROSPERO registration ID: CRD42021250078. RESULTS: A total of eight studies were included in the review. Consistent evidence for an association was found between PM(2.5) and glaucoma, with four of four studies reporting a positive association. The pooled OR for each 10-µg/m(3) increase of PM(2.5) on glaucoma was 1.18 (95% CI, 0.95–1.47). Consistent evidence was also found for O(3) and cataract, with three of three studies reporting an inverse association. Two of two studies reported a null association between PM(2.5) and cataract, while one of one studies reported a positive association between PM(10) and cataract. One of one studies reported a positive relationship between CO and AMD. Other relationships were less consistent between studies. CONCLUSIONS: Current evidence suggests there may be an association between some air pollutants and cataract, AMD, and glaucoma.