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

PurposeTo compare the burden of age-related eye diseases among adults exposed to higher versus lower levels of ambient air pollutants.MethodsMEDLINE, 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 [O₃], particulate matter [PM] less than 2.5 µm in diameter [PM_2.5], and PM less than 10 µm in diameter [PM₁₀]) 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.ResultsA 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/m³ increase of PM_2.5 on glaucoma was 1.18 (95% CI, 0.95–1.47). Consistent evidence was also found for O₃ 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 PM₁₀ and cataract. One of one studies reported a positive relationship between CO and AMD. Other relationships were less consistent between studies.ConclusionsCurrent evidence suggests there may be an association between some air pollutants and cataract, AMD, and glaucoma.     

Use of Single-Item Self-Rated Health Measure to Identify Frailty and Geriatric Assessment-Identified Impairments Among Older Adults with Cancer

BackgroundPoor self-rated health (SRH) is a known predictor of frailty and mortality in the general population; however, its role among older adults with cancer is unknown. We evaluated the role of SRH as a potential screening tool to identify frailty and geriatric assessment (GA)-identified impairments.Materials and MethodsAdults ≥60 years diagnosed with cancer in the UAB Cancer & Aging Resilience Evaluation (CARE) registry underwent a GA at the time of initial consultation. We measured SRH using a single-item from the Patient-Reported Outcomes Measurement Information System global health scale and dichotomized responses as poor (poor, fair) and good (good, very good, and excellent). We evaluated the diagnostic performance of SRH in measuring frailty, and GA impairment (≥2 deficits among a set of seven GA domains). We examined the impact of SRH with survival using a Cox model adjusting for confounders, exploring the mediating role of frailty.ResultsSix hundred and three older adults with cancer were included, with a median age of 69 years. Overall, 45% (n = 274) reported poor SRH. Poor SRH demonstrated high sensitivity and specificity for identifying frailty (85% and 78%, respectively) and GA impairment (75% and 78%, respectively). In a Cox regression model, poor SRH was associated with inferior survival (HR = 2.26; 95% CI 1.60-3.18) after adjusting for confounders; frailty mediated 69% of this observed relationship.ConclusionSelf-rated health may be used as a screening tool to identify older adults with cancer with frailty and GA impairments. Poor SRH is associated with inferior survival, which is mediated by frailty.