Smog And Sight: An Epidemiological Evidence On The Link Between Air Pollution And Ocular Aging: A Comprehensive Systematic Review And Meta-Analysis
Published 2026 - 44th Congress of the ESCRS
Reference: PP21.06 | Type: Free paper | DOI: 10.82333/s4aq-ff64
Authors: Dr Ahmed Alnabihi* 1 , Dr Anas Alamoudi 2 , Dr Sultan Al-Qahtani 3 , Dr Naif Almufarriji 4 , Dr Waleed K. Alsarhani 5 , Dr Iqbal Ike K. Ahmed 6
1Department of Ophthalmology,King Khaled Eye Specialist Hospital and Research Center,Riyadh,Saudi Arabia, 2Department of Ophthalmology,Jeddah Eye Hospital,Jeddah,Saudi Arabia, 3Department of Ophthalmology and Vision Sciences,University of Toronto,Toronto,Canada, 4Department of Ophthalmology,King Fahad Medical City,Riyadh,Saudi Arabia, 5Department of Ophthalmology and Vision Sciences,University of Toronto,Toronto,Canada;Department of Ophthalmology,King Faisal Specialist Hospital & Research Centre,Riyadh,Saudi Arabia, 6John A. Moran Eye Center,University of Utah,Salt Lake,United States;Prism Eye Institute,Mississauga,Canada;Department of Ophthalmology and Vision Sciences,University of Toronto,Toronto,Canada
Purpose
To assess associations between major ambient air pollutants and age-related ocular diseases.
Setting
A systematic review and meta-analysis.
Methods
We systematically searched MEDLINE, Embase, Scopus, and Web of Science up to 15 May 2025. Eligible studies were observational, included adults, and reported quantitative estimates for glaucoma, cataract, or age-related macular degeneration (AMD) in relation to particulate matter (PM₂.₅, PM₁₀), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), ozone (O₃), or carbon monoxide (CO). Two reviewers independently screened and extracted data. Risk of bias was assessed, and random-effects meta-analyses pooled odds ratios (ORs) or hazard ratios (HRs). Certainty of evidence was graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. The review was prospectively registered in PROSPERO (CRD420251051872).
Results
Forty-one studies met eligibility criteria. PM₂.₅ showed the strongest and most consistent associations. The pooled OR for glaucoma per interquartile range (IQR; standardized to 10 µg/m³ where applicable) increase in PM₂.₅ was 1.08 (95% CI, 1.04–1.12; I² = 19%), with high-certainty evidence. PM₂.₅ was also associated with cataract (HR = 1.04; 95% CI, 1.02–1.05; I² = 25%). Glaucoma risk was higher in the highest vs lowest exposure quartiles (OR = 1.70; 95% CI, 1.22–2.37; I² = 0%). O₃ exposure increased AMD risk (HR = 1.14; 95% CI, 1.06–1.23), supported by high-certainty evidence. Associations for PM₁₀, NO₂, and SO₂ were not statistically significant.
Conclusions
Ambient PM₂.₅ exposure is consistently linked with elevated glaucoma and cataract risk, while evidence for AMD remains less consistent. These findings highlight the potential ocular benefits of reducing fine particulate air pollution.