title: Relation between time spent outdoors and exfoliation glaucoma or exfoliation glaucoma suspect.
abstract: OBJECTIVE
  To evaluate the relation between time spent outdoors at various life periods and risk of exfoliation glaucoma or exfoliation glaucoma suspect.
  
  
  METHODS
  Retrospective cohort study in the United States.
  
  
  METHODS
  Participants (49 033 women in the Nurses Health Study and 20 066 men in the Health Professionals Follow-up Study) were 60+ years old, were free of glaucoma and cataract, reported eye examinations, and completed questions about time spent outdoors in direct sunlight at midday at 3 life periods: high school to age 24 years, age 25-35 years, and age 36-59 years (asked in 2006 in women and 2008 in men). Participants were followed biennially with mailed questionnaires from 1980 women/1986 men to 2010. Incident cases (223 women and 38 men) were confirmed with medical records. Cohort-specific multivariable-adjusted rate ratios from Cox proportional hazards models were estimated and pooled with meta-analysis.
  
  
  RESULTS
  Although no association was observed with greater time spent outdoors in the ages of 25-35 or ages 36-59 years, the pooled multivariable-adjusted rate ratios for ≥11 hours per week spent outdoors in high school to age 24 years compared with ≤5 hours per week was 2.00 (95% confidence interval = 1.30, 3.08; P for linear trend = .001). In women, this association was stronger in those who resided in the southern geographic tier in young adulthood (P for interaction = .07).
  
  
  CONCLUSIONS
  Greater time spent outdoors in young adulthood was associated with risk of exfoliation glaucoma or exfoliation glaucoma suspect, supporting an etiologic role of early exposures to climatic factors.
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Harvard Medical School and Brigham & Women's Hospital, Boston, Massachusetts. Electronic address: nhjhk@channing.harvard.edu.
authors.forename: Jae H
authors.initials: JH
authors.lastname: Kang
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts.
authors.forename: Janey L
authors.initials: JL
authors.lastname: Wiggs
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Harvard Medical School and Brigham & Women's Hospital, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts.
authors.forename: Louis R
authors.initials: LR
authors.lastname: Pasquale
mesh_terms: D000328:Adult; D000368:Aged; D004777:Environment; D017889:Exfoliation Syndrome / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007429:Intraocular Pressure / Q000502:physiology*; D007899:Leisure Activities; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult