title: Solar exposure and residential geographic history in relation to exfoliation syndrome in the United States and Israel.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  METHODS
  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
  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.
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts2Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston.
authors.forename: Louis R
authors.initials: LR
authors.lastname: Pasquale
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston.
authors.forename: Aliya Z
authors.initials: AZ
authors.lastname: Jiwani
authors.affiliation: Goldschleger Eye Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel.
authors.forename: Tzukit
authors.initials: T
authors.lastname: Zehavi-Dorin
authors.affiliation: Goldschleger Eye Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel.
authors.forename: Arow
authors.initials: A
authors.lastname: Majd
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston4Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Rhee
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston.
authors.forename: Teresa
authors.initials: T
authors.lastname: Chen
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston.
authors.forename: Angela
authors.initials: A
authors.lastname: Turalba
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston.
authors.forename: Lucy
authors.initials: L
authors.lastname: Shen
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston.
authors.forename: Stacey
authors.initials: S
authors.lastname: Brauner
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston5currently withNovartis Institute for BioMedical Research, Cambridge, Massachusetts.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Grosskreutz
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston.
authors.forename: Matthew
authors.initials: M
authors.lastname: Gardiner
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston.
authors.forename: Sherleen
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston.
authors.forename: Sheila
authors.initials: S
authors.lastname: Borboli-Gerogiannis
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston.
authors.forename: Scott H
authors.initials: SH
authors.lastname: Greenstein
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Chang
authors.affiliation: Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York.
authors.forename: Robert
authors.initials: R
authors.lastname: Ritch
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Loomis
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Jae H
authors.initials: JH
authors.lastname: Kang
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston.
authors.forename: Janey L
authors.initials: JL
authors.lastname: Wiggs
authors.affiliation: Goldschleger Eye Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel.
authors.forename: Hani
authors.initials: H
authors.lastname: Levkovitch-Verbin
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D004781:Environmental Exposure / Q000706:statistics & numerical data*; D017889:Exfoliation Syndrome / Q000453:epidemiology*; D005260:Female; D062306:Geography, Medical; D006801:Humans; D007557:Israel / Q000453:epidemiology; D007899:Leisure Activities; D008297:Male; D008875:Middle Aged; D009790:Occupations; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012307:Risk Factors; D013472:Sunlight; D011795:Surveys and Questionnaires; D014466:Ultraviolet Rays; D014481:United States / Q000453:epidemiology