Elsevier

Environmental Research

Volume 157, August 2017, Pages 103-109
Environmental Research

Climate and the eye: Case-crossover analysis of retinal detachment after exposure to ambient heat

https://doi.org/10.1016/j.envres.2017.05.017Get rights and content

Highlights

  • We studied the association between high outdoor temperature and retinal detachment.

  • Elevated temperature was associated with a higher risk of traction retinal detachment.

  • The association was consistent across age and sex.

  • Elevated temperature and heat waves may be important to consider for prevention of retinal detachment.

Abstract

Background

Retinal detachment is an important cause of visual loss, but the association with outdoor heat exposure has not been studied. Our objective was to determine the relationship between acute exposure to high outdoor temperature and risk of retinal detachment.

Materials and methods

We analysed 14,302 individuals with inpatient procedures for retinal detachment from April through September between 2006 and 2013 in the province of Quebec, Canada. Using a time-stratified case-crossover study design, we examined the association of retinal detachment with outdoor summer temperature the preceding week. We estimated odds ratios (OR) and 95% confidence intervals (CI) for mean weekly temperature according to subtypes of retinal detachment (traction, serous, rhegmatogenous, breaks), and assessed associations by age and sex.

Results

Exposure to elevated temperature the preceding week was associated with a higher likelihood of traction detachment, but not other forms of retinal detachment. Associations were stronger at <75 years of age in both men and women. Relative to 15 °C, a mean weekly temperature of 25 °C was associated with an OR for traction detachment of 2.71 (95% CI 1.56–4.71) before 55 years, 2.73 (95% CI 1.61–4.64) at 55–64 years, and 1.98 (95% CI 1.30–3.02) at 64–75 years.

Discussion

Elevated outdoor temperatures may be associated with an increased risk of traction retinal detachment. In light of climate change, a better understanding of the impact of heat waves on the eye and other sensory organs is needed.

Introduction

Few studies have addressed weather as a potential risk factor for ophthalmological disorders, including retinal detachment. Retinal detachment is a common ophthalmic emergency and a major cause of visual loss (Feltgen and Walter, 2014). The estimated annual incidence of retinal detachment is around 12.6 cases per 100,000 persons (D’Amico, 2008), with 90 eyes blinded by detachments every hour around the world (Shah, 2009). Prevention of retinal detachment is challenging because its causes are not fully understood, and known risk factors such as myopia, cataract surgery, and trauma explain only a fraction of cases (Feltgen and Walter, 2014). The role of environmental triggers is not well characterized, including the contribution of elevated outdoor temperature. Retinal detachment is an acute event, and sudden environmental stressors such as heat have the potential to contribute to their occurrence.

Ambient temperature may affect the risk of retinal detachment given an increased incidence in warm compared with cold seasons (Ghisolfi et al., 1986, Jensen, 1957, Laatikainen et al., 1985, Lin et al., 2011, Mansour et al., 2009, Paavola et al., 1983, Prabhu and Raju, 2016). The vitreous, a clear gel contained between the lens and back of the eye that holds the retina in place, is sensitive to variation in temperature (Deman and Bruyneel, 1977, Katsimpris et al., 2003). Animal studies have highlighted that cold temperatures increase adhesive forces in the eye which potentially prevent collapse of the vitreous gel, while hot temperature liquefies the vitreous, predisposing to detachment (Deman and Bruyneel, 1977, Katsimpris et al., 2003, Mansour et al., 2009). However, the few population studies relating average monthly or seasonal temperature to retinal detachment in humans produce conflicting results (Lin et al., 2011, Mansour et al., 2009, Prabhu and Raju, 2016). Furthermore, evidence that daily variation in temperature is associated with retinal detachment is sparse. As global warming is predicted to increase (Snyder, 2016), the potential for an increased risk of retinal detachment during high temperature has public health implications. We therefore studied the relationship of daily and weekly temperature during the warmest time of the year with risk of retinal detachment using medical records for the province of Quebec, Canada.

Section snippets

Materials and methods

We carried out a multicenter case-crossover study. We used data from the Maintenance and Use of Data for the Study of Hospital Clientele registry which contains all hospital discharge summaries in Quebec from 2006 to 2013. In Quebec, discharge summaries are coded by trained hospital personnel, and compiled by the Health Ministry which validates the data for all centers using rigorous algorithms (Ministère de la Santé et des Services sociaux, 2016). We selected individuals with retinal

Results

In this study, there were 14,302 individuals with inpatient procedures for retinal detachment, including 9.8% traction, 19.5% serous, 32.4% rhegmatogenous, 6.1% breaks, and 34.6% unspecified detachments (Table 1). Mean temperature the week before retinal detachment was greater than 20 °C for 20.2% of individuals with retinal detachment. The proportion was higher for individuals with traction retinal detachment (23.6%, P=0.004). Around 3.4% of retinal detachments occurred after 3 or more days of

Discussion

In this case-crossover study of more than 14,000 patients with retinal detachment in a large North American region, we documented a higher likelihood of procedures for traction detachment after exposure to elevated outdoor temperatures during warm months. Associations were present predominantly before 75 years of age regardless of sex. In addition, associations were more pronounced three to six days before the retinal procedure, reflecting the possible delay between initial detachment, clinical

Conclusions

This case-crossover study documented a higher likelihood of traction retinal detachment after acute exposure to elevated temperatures, with associations most prominent before the age of 75 years. Associations were present in both men and women, but not with other forms of retinal detachment. Traction retinal detachment is a rare occurrence, but is nonetheless an ophthalmologic emergency associated with significant loss of visual acuity or blindness. The possibility of an association with acute

Declaration of interest

None declared.

Funding

This work was supported by the Canadian Institutes of Health Research (grant number MOP-142277); and the Fonds de recherche du Québec-Santé (career award 25128). The sponsor(s) were not involved in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

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