Ambient PM2.5 and O3 and their combined effects on prevalence of presbyopia among the elderly: A cross-sectional study in six low- and middle-income countries

Hualiang Lin, Yanfei Guo, Zengliang Ruan, Yin Yang, Yanbing Chen, Yang Zheng, Lenise A. Cummings-Vaughn, Steven E. Rigdon, Michael G. Vaughn, Shengzhi Sun, Lingli Zhang, Xiaojie Wang, Zhengmin (Min) Qian, Fan Wu

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18 Citations (Scopus)


Background: Ambient air pollutant directly contacts with the eyes, however, the effect of ambient fine particulate matter (PM2.5) and ozone (O3) on vision impairment, such as presbyopia, has been kept largely unknown. Methods: We surveyed a total of 36,620 participants aged 50 years and above in six low- and middle-income countries. Ambient annual concentrations of PM2.5 and O3 for the residential community were estimated using satellite data and chemical transport model. A mixed effects model was utilized to assess the effects of ambient PM2.5 and O3 on presbyopia, as well as their combined effects. Results: A total of 13,841 presbyopia cases were identified among the participants with a prevalence rate of 41.17%. For both PM2.5 and O3, we found a J-shaped exposure-response relationship with the threshold being identified at 15 μg/m3 for PM2.5 and 55 μg/m3 for O3. The odds ratio (OR) of presbyopia was 1.15 (95% CI: 1.09, 1.21) for each 10 μg/m3 increase in PM2.5 above 15 μg/m3 and 1.37 (95% CI: 1.23, 1.54) for O3 above 55 μg/m3 after adjusting for various potential confounding factors. There appeared to be a synergistic interaction between ambient PM2.5 and O3 on presbyopia in the additive model, the combined effect was significantly larger than the sum of their individual effects, with a synergistic index of 2.39. Conclusion: This study supports that exposures to ambient PM2.5 and O3 might be important risk factors of presbyopia among old adults, and simultaneously exposure to high level of the two pollutants could intensify their individual effects.

Original languageEnglish
Pages (from-to)168-173
Number of pages6
JournalScience of the Total Environment
Publication statusPublished - 2019 Mar 10

Bibliographical note

Funding Information:
This work was supported by the National Key R&D Program of China ( 2018YFA0606201 ). We thank the respondents and survey teams from the six SAGE countries.

Publisher Copyright:
© 2018

All Science Journal Classification (ASJC) codes

  • Environmental Engineering
  • Environmental Chemistry
  • Waste Management and Disposal
  • Pollution


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