Sliney David H
US Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving Ground, Md., USA.
Dev Ophthalmol. 2002;35:40-59. doi: 10.1159/000060809.
The geographical variations in the incidence of age-related ocular changes such as presbyopia and cataracts and diseases such as pterygium and droplet keratopathies have led to theories pointing to sunlight, ultraviolet radiation (UVR) exposure and ambient temperature as potential etiological factors. Some epidemiological evidence also points to an association of age-related macular degeneration to sunlight exposure. The actual distribution of sunlight exposure and the determination of temperature variations of different tissues within the anterior segment of the eye are difficult to assess. Of greatest importance are the geometrical factors that influence selective UVR exposures to different segments of the lens, cornea and retina. Studies show that the temperature of the lens and cornea varies by several degrees depending upon climate, and that the incidence of nuclear cataract incidence is greater in areas of higher ambient temperature (i.e., in the tropics). Likewise, sunlight exposure to local areas of the cornea, lens and retina varies greatly in different environments. However, epidemiological studies of the influence of environmental UVR in the development of cataract, pterygium, droplet keratopathies and age-related macular degeneration have produced surprisingly inconsistent findings. The lack of consistent results is seen to be due largely to either incomplete or erroneous estimates of outdoor UV exposure dose. Geometrical factors dominate the determination of UVR exposure of the eye. The degree of lid opening limits ocular exposure to rays entering at angles near the horizon. Clouds redistribute overhead UVR to the horizon sky. Mountains, trees and building shield the eye from direct sky exposure. Most ground surfaces reflect little UVR. The result is that highest UVR exposure occurs during light overcast where the horizon is visible and ground surface reflection is high. By contrast, exposure in a high mountain valley (lower ambient temperature) with green foliage results in a much lower ocular dose. Other findings of these studies show that retinal exposure to light and UVR in daylight occurs largely in the superior retina.
与年龄相关的眼部变化(如老花眼和白内障)以及疾病(如翼状胬肉和点状角膜病变)的发病率存在地理差异,这导致了一些理论认为阳光、紫外线辐射(UVR)暴露和环境温度是潜在的病因。一些流行病学证据也表明年龄相关性黄斑变性与阳光暴露有关。眼部前段不同组织的阳光暴露实际分布情况以及温度变化的测定很难评估。最重要的是那些影响晶状体、角膜和视网膜不同部位选择性UVR暴露的几何因素。研究表明,晶状体和角膜的温度会因气候不同而有几度的变化,并且在环境温度较高的地区(即热带地区)核性白内障的发病率更高。同样,在不同环境中,角膜、晶状体和视网膜局部区域的阳光暴露差异很大。然而,关于环境UVR对白内障、翼状胬肉、点状角膜病变和年龄相关性黄斑变性发展影响的流行病学研究结果却惊人地不一致。结果缺乏一致性在很大程度上被认为是由于对户外UV暴露剂量的估计不完整或错误。几何因素在眼睛UVR暴露的测定中起主导作用。眼睑张开程度限制了眼睛对接近地平线角度入射光线的暴露。云层将头顶的UVR重新分布到地平线天空。山脉、树木和建筑物使眼睛免受直接的天空照射。大多数地面反射的UVR很少。结果是,在能看见地平线且地面反射率高的轻度阴天时UVR暴露最高。相比之下,在有绿色树叶的高山山谷(环境温度较低)中,眼睛接受的剂量要低得多。这些研究的其他发现表明,白天视网膜对光线和UVR的暴露主要发生在视网膜上部。