Taylor H R, Muñoz B, West S, Bressler N M, Bressler S B, Rosenthal F S
Dana Center for Preventive Ophthalmology, Wilmer Institute, Johns Hopkins University, Baltimore, Maryland.
Trans Am Ophthalmol Soc. 1990;88:163-73; discussion 173-8.
Sunlight exposure has been suggested as a cause of AMD. To examine this, we collected detailed histories of ocular sun exposure in 838 watermen who work on the Chesapeake Bay. The presence and severity of AMD was assessed in stereo macular photographs. Macular changes were classified into four grades of increasing severity ranging from the presence of 5 or more drusen (AMD-1) to extensive geographic atrophy or disciform scars (AMD-4). Previously, we found no association between AMD and ocular exposure to either UV-B (290 to 320 nm) or two bands of UV-A (320 to 340 nm and 340 to 400 nm). We have undertaken further analysis to determine whether ocular exposure to violet light (400 to 450 nm), blue light (400 to 500 nm), or all visible light (400 to 700 nm) was associated with AMD. Ocular exposure was estimated using model computations of ambient irradiance and estimates of the ratio of ocular to ambient exposure. Compared to age-matched controls, established cases (AMD-4), but not milder cases, had significantly higher exposure to both blue and visible light over the preceding 20 years (Wilcoxon sign rank test, P = 0.027). There was no difference in exposure at younger ages. These data suggest that high levels of exposure to blue and visible light late in life may be important in causing AMD.
阳光照射被认为是年龄相关性黄斑变性（AMD）的一个病因。为了对此进行研究，我们收集了838名在切萨皮克湾工作的渔民详细的眼部阳光照射史。通过立体黄斑照片评估AMD的存在及严重程度。黄斑变化被分为四个严重程度递增的等级，从存在5个或更多的玻璃膜疣（AMD-1）到广泛的地图状萎缩或盘状瘢痕（AMD-4）。此前，我们发现AMD与眼部暴露于紫外线B（290至320纳米）或两个紫外线A波段（320至340纳米和340至400纳米）之间没有关联。我们进一步进行了分析，以确定眼部暴露于紫光（400至450纳米）、蓝光（400至500纳米）或所有可见光（400至700纳米）是否与AMD有关。眼部暴露量通过环境辐照度的模型计算以及眼部与环境暴露比率的估计值来估算。与年龄匹配的对照组相比，确诊病例（AMD-4），而非病情较轻的病例，在过去20年中蓝光和可见光的暴露量显著更高（Wilcoxon符号秩检验，P = 0.027）。年轻时的暴露量没有差异。这些数据表明，晚年高水平暴露于蓝光和可见光可能在AMD的发病中起重要作用。
