A systematic review of risks associated with environmental change on refractive and non-refractive ocular health: Special focus on Africa

Okenwa, Emmanuel Elochukwu -Vincent; Riel, Nathan; Pagani, Linda S

Home
→
Research Papers
→
SCHOOL OF HEALTH SCIENCES
→
View Item

dc.contributor.author	Okenwa, Emmanuel Elochukwu -Vincent
dc.contributor.author	Riel, Nathan
dc.contributor.author	Pagani, Linda S
dc.date.accessioned	2025-07-07T10:06:01Z
dc.date.available	2025-07-07T10:06:01Z
dc.date.issued	2025
dc.identifier.citation	Abera, A., Friberg, J., Isaxon, C., et al., 2021. Air quality in Africa: public health implications. Annu. Rev. Public Health 42, 193–210. Alves, M., Asbell, P., Dogru, M., et al., 2023. TFOS Lifestyle Report: impact of environmental conditions on the ocular surface. Ocul. Surf. 29, 1–52. Bai, Y.C., Wang, C.Y., Lin, C.L., Lai, J.N., Wei, JCC., 2021. Association between air pollution and the risk of uveitis: a nationwide, population-based cohort study. Front. Immunol. 12, 613893. Buchan, J.C., Thiel, C.L., Steyn, A., et al., 2022. Addressing the environmental sustainability of eye health-care delivery: a scoping review. Lancet Planet. Health 6 (6), e524–e534. Burton, M.J., Ramke, J., Marques, A.P., et al., 2021. The Lancet global health Commission on global eye health: vision beyond 2020. Lancet Glob. Health 9 (4), e489–e551. Cairncross, E., Dalvie, A., Euripidou, R., Irlam, J., Naidoo, RN., 2018. Climate change, air pollution and health in South Africa. Clim. Change Air Pollut. Impact. Hum. Health Dev. Dev. Ctries. 327–347. Chen, C.S., Chen, C., Liu, TC., 2022. Dust storms increase the risk of age-related macular degeneration. Int. J. Environ. Res. Public Health 19 (12), 7403. Chen, G., Wu, Y., Qian, Z.M., et al., 2022. Associations between conjunctivitis and ambient PM2⋅5 and physical activity: a nationwide prospective cohort study. Sci. Total. Environ. 851 (1), 157979. Chen, Y., He, Y.S., Feng, Y.T., et al., 2022. The effect of air pollution exposure on risk of outpatient visits for Sjogren’s syndrome: a time-series study. Environ. Res. 214 (3), 114017. Chua, S.Y., Warwick, A., Peto, T., et al., 2022. Association of ambient air pollution with age-related macular degeneration and retinal thickness in UK Biobank. Br. J. Ophthalmol. 106 (5), 705–711. Dida, G.O., Lutta, P.O., Abuom, P.O., Mestrovic, T., Anyona, DN., 2022. Factors predisposing women and children to indoor air pollution in rural villages, Western Kenya. Arch. Public Health 80 (1), 46. Echevarría-Lucas, L., Senciales-Gonzalez, ´ J.M., Medialdea-Hurtado, M.E., RodrigoComino, J., 2021. Impact of climate change on eye diseases and associated economical costs. Int. J. Environ. Res. Public Health 18 (13), 7197. Egondi, T., Kyobutungi, C., Ng, N., et al., 2013. Community perceptions of air pollution and related health risks in Nairobi slums. Int. J. Environ. Res. Public Health 10 (10), 4851–4868. Fuller, R., Landrigan, P.J., Balakrishnan, K., et al., 2022. Pollution and health: a progress update. Lancet Planet. Health 6 (6), e535–e547. Grant, A., Leung, G., Freeman, EE., 2022. Ambient air pollution and age-related eye disease: a systematic review and meta-analysis. Invest. Ophthalmol. Vis. Sci. 63 (9), 17. –17. Huang, L., Schmid, K.L., Yin, X.N., et al., 2021. Combination effect of outdoor activity and screen exposure on risk of preschool myopia: findings from Longhua Child Cohort Study. Front. Public Health 9, 607911. IAPB Climate Action Working Group, 2019. Guide for environmentally sustainable practices in the eye health sector. Int. Agency Prevent. Blindness 2, 2022. Jaggernath, J., Haslam, D., Naidoo, KS., 2013. Climate change: impact of increased ultraviolet radiation and water changes on eye health. Health 5 (5), 921–930. Jiying, W., Beraud, J.J.D., Xicang, Z., 2023. Investigating the impact of air pollution in selected African developing countries. Environ. Sci. Pollut. Res. 30 (23), 64460–64471. Ju, M.J., Kim, J., Park, S.K., Kim, D.H., Choi, YH., 2022. Long-term exposure to ambient air pollutants and age-related macular degeneration in middle-aged and older adults. Environ. Res. 204, 111953. Kemper, K., Chaudhuri, S., 2025 Feb 16. Air pollution: A silent Killer in Lagos [Internet]. World Bank Blogs [cited]Available from. https://blogs.worldbank.org/en/afri cacan/air-pollution-silent-killer-lagos. Kim, Y., Choi, Y.H., Kim, M.K., Paik, H.J., Kim, DH., 2020. Different adverse effects of air pollutants on dry eye disease: ozone, PM2. 5, and PM10. Environ. Pollut. 265, 115039. Li, L., Song, M., Zhou, J., Sun, X., Lei, Y., 2022. Ambient particulate matter exposure causes visual dysfunction and retinal neuronal degeneration. Ecotoxicol. Environ. Saf. 247, 114231. Li, L., Xing, C., Zhou, J., et al., 2021. Airborne particulate matter (PM2. 5) triggers ocular hypertension and glaucoma through pyroptosis. Part Fibre Toxicol. 18 (1), 1–13. Li, L., Zhu, Y., Han, B., et al., 2022. Acute exposure to air pollutants increase the risk of acute glaucoma. BMC. Public Health 22 (1), 1782. Li, X., Guo, Y., Liu, T., et al., 2021. The association of cooking fuels with cataract among adults aged 50 years and older in low-and middle-income countries: results from the WHO Study on global AGEing and adult health (SAGE). Sci. Total. Environ. 790, 148093. Liang, C.L., Wang, C.M., Jung, C.R., et al., 2022. Fine particulate matter measured by satellites predicts the risk of age-related macular degeneration in a longitudinal cohort study. Environ. Sci. Pollut. Res. Int. 29 (34), 51942–51950. Liu, L., Li, C., Yu, H., Yang, X., 2022. A critical review on air pollutant exposure and agerelated macular degeneration. Sci. Total. Environ. 840, 156717. Lo, CK-L, Mertz, D., Loeb, M., 2014. Newcastle-Ottawa scale: comparing reviewers’ to authors’ assessments. BMC. Med. Res. Methodol. 14, 45. https://doi.org/10.1186/ 1471-2288-14-45. Long, H.A., French, D.P., Brooks, JM., 2020. Optimising the value of the critical appraisal skills programme (CASP) tool for quality appraisal in qualitative evidence synthesis. Res. Methods Med. Health Sci. 1, 31–42. https://doi.org/10.1177/ 2632084320947559. Lu, P., Zhang, Y., Xia, G., Zhang, W., Li, S., Guo, Y., 2019. Short-term exposure to air pollution and conjunctivitis outpatient visits: a multi-city study in China. A multicity study in China. Environ. Pollut. 254, 113030. Lucas, R.M., Norval, M., Wright, CY., 2016. Solar ultraviolet radiation in Africa: a systematic review and critical evaluation of the health risks and use of photoprotection. Photochem. Photobiol. Sci. 15, 10–23. Luo, C.W., Chiang, Y.W., Sun, H.Y., et al., 2022. Fine particulate matter exposure levels in patients with normal-tension glaucoma and primary open-angle glaucoma: a population-based study from Taiwan. Int. J. Environ. Res. Public Health 19 (7), 4224. Lv, X., Gao, X., Hu, K., Yao, Y., Zeng, Y., Chen, H., 2022. Associations of humidity and temperature with cataracts among older adults in China. Front. Public Health 10, 872030. Maeda, Y., Caskurlu, S., Kozan, K., Kenney, RH., 2023. Development of a critical appraisal tool for assessing the reporting quality of qualitative studies: a worked example. Qual. Quant. 57, 1011–1031. https://doi.org/10.1007/s11135-022-01403- y. Majdi, M., Milani, B.Y., Movahedan, A., Wasielewski, L., Djalilian, AR., 2014. The role of ultraviolet radiation in the ocular system of mammals. Photonics. 1, 347–368. https://doi.org/10.3390/photonics1040347. Martin, R., Research Group, E.M.O., 2023. Symptoms of dry eye related to the relative humidity of living places. Contact. Lens Anterior Eye 46 (4), 101865. Miyazaki, D., Fukagawa, K., Fukushima, A., et al., 2019. Air pollution significantly associated with severe ocular allergic inflammatory diseases. Sci. Rep. 9 (1), 18205. Mo, Z., Fu, Q., Lyu, D., et al., 2019. Impacts of air pollution on dry eye disease among residents in Hangzhou, China: a case-crossover study. Environ. Pollut. 246, 183–189. Morgan, IG., 2018. Myopia prevention and outdoor light intensity in a school-based cluster randomized trial. Ophthalmology. 125 (8), 1251–1252. E.E. Okenwa-Vincent et al. Hygiene and Environmental Health Advances 14 (2025) 100128 7Mu, J., Zeng, D., Fan, J., et al., 2021. Associations between air pollution exposure and daily pediatric outpatient visits for dry eye disease: a time-series study in shenzhen, China. Int. J. Public Health 66, 1604235. Mudu, P., 2021. Ambient Air Pollution and Health in Accra, Ghana. World Health Organization, Geneva, Switzerland. Nkosi, V., Mathee, A., Blesic, S., Kapwata, T., Kunene, Z., du Preez, D.J., Garland, R., Wright, CY., 2022. Exploring meteorological conditions and human health impacts during two dust storm events in Northern cape province, South Africa: findings and lessons learnt. Atmosphere (Basel) 13, 424. Page, M.J., McKenzie, J.E., Bossuyt, P.M., et al., 2021. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int. J. Surg. 88, 105906. Patel, M., Shrestha, M.K., Manandhar, A., et al., 2022. Effect of exposure to biomass smoke from cooking fuel types and eye disorders in women from hilly and plain regions of Nepal. Br. J. Ophthalmol. 106 (1), 141–148. Patel, S., Kaplan, C., Galor, A., Kumar, N., 2021. The role of temperature change, ambient temperature, and relative humidity in allergic conjunctivitis in a US veteran population. Am. J. Ophthalmol. 230, 243–255. Rauchman, S.H., Locke, B., Albert, J., De Leon, J., Peltier, M.R., Reiss, AB., 2023. Toxic external exposure leading to ocular surface injury. Vision 7 (2), 32. Rose, K.A., French, A.N., Morgan, IG., 2016. Environmental factors and myopia: paradoxes and prospects for prevention. Asia Pac. J. Ophthalmol. (Phila) 5 (6), 403–410. Roth, M., Herrmann, M.E., Geerling, G., Guthoff, R., 2022. Current and future effects of climate change on ophthalmology. Ophthalmologie 119 (6), 552–560. Ruan, Z., Qian, Z.M., Guo, Y., et al., 2019. Ambient fine particulate matter and ozone higher than certain thresholds associated with myopia in the elderly aged 50 years and above. Environ. Res. 177, 108581. Sepadi, M.M., Nkosi, V., 2023. Personal PM2.5 exposure monitoring of informal cooking vendors at Indoor and outdoor markets in Johannesburg, South Africa. Int. J. Environ. Res. Public Health 20, 2465. Shin, J., Lee, H., Kim, H., 2020 Dec 10. Association between exposure to ambient air pollution and age-related cataract: a nationwide population-based retrospective cohort study. Int. J. Environ. Res. Public Health 17 (24), 9231. Stang, A., 2010. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur. J. Epidemiol. 25, 603–605. https://doi.org/10.1007/s10654-010-9491-z. Tan, H., Pan, S., Zhong, Z., Shi, J., Liao, W., Su, G., et al., 2022. Association between temperature changes and uveitis onset in mainland China. Br. J. Ophthalmol. 106 (1), 91–96. Wang, X., Du, Y., Sun, W., et al., 2021. The effects of air pollution and precipitation on outpatient visits for primary glaucoma: a multi-model time series analysis. Air Qual. Atmosphere Health 1–15. Wei, C.C., Lin, H.J., Lim, Y.P., et al., 2019. PM2. 5 and NOx exposure promote myopia: clinical evidence and experimental proof. Environ. Pollut. 254, 113031. Wright, C.Y., Norval, M., 2021. Health risks associated with excessive exposure to solar ultraviolet radiation among outdoor workers in South Africa: an overview. Front. Public Health 9, 678680. Wu, D., Lim, B.X., Seah, I., et al., 2023. Impact of microplastics on the ocular surface. Int. J. Mol. Sci. 24 (4), 3928. Wu, P.C., Chen, C.T., Lin, K.K., et al., 2018. Myopia prevention and outdoor light intensity in a school-based cluster randomized trial. Ophthalmology. 125 (8), 1239–1250. Yu, D., Deng, Q., Wang, J., et al., 2019. Air pollutants are associated with dry eye disease in urban ophthalmic outpatients: a prevalence study in China. J. Transl. Med. 17 (1), 1–9. Yuan, T., Zou, H., 2022. Effects of air pollution on myopia: an update on clinical evidence and biological mechanisms. Environ. Sci. Pollut. Res. 29 (47), 70674–70685. Zhang, A., Wang, Q., Yang, X., et al., 2023. Impacts of heatwaves and cold spells on glaucoma in rural China: a national cross-sectional study. Environ. Sci. Pollut. Res. 30 (16), 47248–47261. Zhang, Ramke, J., Jan, C., et al., 2022. Advancing the sustainable development goals through improving eye health: a scoping review. Lancet Planet. Health 6 (3), e270–e280. Zhou, J., Fan, L., Lin, H., et al., 2023. Size-specific particulate matter and outpatient visits for allergic conjunctivitis in children: a time-stratified case-crossover study in Guangzhou, China. Environ. Sci. Pollut. Res. Int. 30 (12), 33949–33959.	en_US
dc.identifier.issn	100128
dc.identifier.uri	http://erepository.kafuco.ac.ke/123456789/277
dc.description.abstract	Background: Over the past two decades, the African continent has faced numerous environmental shifts that affect population health. Climate change, rapid urbanization, and air pollution contribute significant risks to human health. The impact of these shifts on refractive and non-refractive ocular health in Africa remains largely empirically undocumented. Objectives: A systematic review of the risks associated with environmental factors on refractive and non-refractive ocular health, with a specific emphasis on the African context. Methods: This systematic review over the recent decade, conforming to PRISMA guidelines, spanned two primary databases, PubMed, and Google Scholar. It included a combination of keywords related to ocular health, environmental change, air pollution, climate change, water quality, and other related concepts. In total, it captured 77 articles from 2013 to July 2023 that met review quality guidelines. Results: The review comprised varied study designs with a notable inclusion of cross-sectional (25⋅9%), cohort (14⋅3%), and review articles (36⋅4%). Findings indicated a significant correlation between air pollutants like PM2⋅5 and NOx with ocular diseases such as dry eye and ocular surface disorders (16⋅8%), conjunctival disorders (7⋅8%), and myopia (5⋅2%). Climate change exacerbated by rising temperatures and UV radiation was implicated in 39% of studies, with a specific focus on its relation to cataracts (5⋅2%) and retinal-related disorders (10⋅4%). Additionally, indoor air pollution disproportionately affected women and children in rural settings of Africa. Conclusions: The data indicate the need for urgent continental and regional policies against air pollution and Climate change to safeguard ocular health, especially among vulnerable African populations. The review underscores the need for interdisciplinary policy to address challenges. The documentation of the relationship between environmental factors and ocular health intersects with Sustainable Development Goals that emphasize the need for improved preventive eye care and intervention, particularly among vulnerable populations and rural inhabitants.	en_US
dc.language.iso	en_US	en_US
dc.publisher	Hygiene and Environmental Health Advances	en_US
dc.subject	Environmental change Ocular health Africa Air pollution Climate change Myopia Age-related macular degeneration Cataracts	en_US
dc.title	A systematic review of risks associated with environmental change on refractive and non-refractive ocular health: Special focus on Africa	en_US
dc.type	Preprint	en_US