Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec 9:11:1492180.
doi: 10.3389/fmed.2024.1492180. eCollection 2024.

Conjunctival ultraviolet autofluorescence as a biomarker of outdoor time in myopic children

Miriam de la Puente  1   2 , Valentina Bilbao-Malavé  2   3 , Jorge González-Zamora  1   2 , Aura Ortega Claici  2   4 , Jaione Bezunartea  1   5   6 , Leire Gomez-Arteta  4 , Elena Alonso  1   2   5   6 , María Hernández  1   2   5   6 , Patricia Fernández-Robredo  1   2   5   6 , Manuel Sáenz de Viteri  1   2   5   6 , Nerea Martín Calvo  5   7   8 , Alfredo García-Layana  1   2   5   6 , Jesús Barrio-Barrio  1   2   5   6 , Sergio Recalde  1   2   5   6
Affiliations

Conjunctival ultraviolet autofluorescence as a biomarker of outdoor time in myopic children

Miriam de la Puente et al. Front Med (Lausanne). .

Abstract

Introduction: The prevalence of myopia has increased significantly in recent years including an earlier onset of myopia development on the pediatric population. The main objective of the study is to compare CUVAF (Conjunctival Ultraviolet Autofluorescence) in children with and without myopia to validate its usefulness as an outdoor protective biomarker.

Methods: A case-control observational study was conducted in a child cohort from subjects that attended to the Ophthalmology Department of Clínica Universidad de Navarra for an ophthalmological examination. The general exclusion criteria were (among others): amblyopia, congenital myopia, general ophthalmic disease, and any conjunctival alteration that might difficult the measurement of the CUVAF area. All participants underwent an automatic objective refraction under cycloplegic effect, biometry to measure axial length (AL) and central corneal radius (CCR), and completed a questionnaire about their lifestyle habits. A total of 4 images of the bulbar conjunctiva were taken with blue light in order to quantify the CUVAF area.

Results: A total of 263 subjects (6 to 17 years old) were analyzed with no significant differences in demographic data between case group and control group. There were 50 non-myopic subjects (19%) and 213 myopic subjects (81%). In relation to the outdoor activities (OA), myopic subjects spent significantly fewer hours per week outdoors than the control-group (p = 0.03). About the CUVAF area, the differences between groups were statistically significant, showing that the myopic group has a significantly smaller CUVAF area than the control-group (0.33 ± 0.72 mm2 vs. 0.78 ± 1.22 mm2; p = 0.0023), likewise, the frequency of CUVAF area absence between both groups showed an odds ratio (OR) of 2.52 (CI95% 1.33-4.74). A Pearson correlation test was done, obtaining a strong significant inverse correlation between myopia degree-CUVAF area (r = 0.1877; IC95% 0.068-0.302), and also ratio (AL/CCR)-CUVAF area (p = 0.002 and p = 0.04) respectively.

Conclusion: CUVAF is a useful biomarker for OA and it has an inverse relationship with myopia degree also in pediatric age, especially after the age of 12, so it could be useful to differentiate the risk of developing myopia. Having a CUVAF area greater than that corresponding to age, protect to myopia 2.5 times, being almost 5 times the protection in case of high myopia.

Keywords: CUVAF; biomarker; light exposure; myopia; outdoor activities for children.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Analysis of the differences between the control and each myopic group (Controls vs. M1, M2 and HM). (A) Time spent doing near vision activities (hours/week). (B) Time spent doing outdoor activities (hours/week). (C) Differences in CUVAF-area (mm2). Values shown are the mean and standard error of the mean (SEM).*p < 0.05, **p < 0.01, ****p < 0.0001.
Figure 2
Figure 2
Graphical representation of differences in CUVAF-area (mm2) in groups according to age. (A) Under 12 years of age vs. over 12 years of age. (B) In individuals younger than 12 years, controls vs. M1, M2 and HM. (C) In individuals younger than 12 years, controls vs. M1, M2 and HM. Values shown are the mean and standard error of the mean (SEM). **p < 0.01, ****p < 0.0001.
Figure 3
Figure 3
Pearson correlation analysis between CUVAF-area (mm2) and emmetropization-related ocular parameters. (A) Positive correlation between CUVAF and SE, with a statistically significant difference (p = 0.002). (B) No significant correlation was observed between CUVAF and AL (p = 0.894). (C) No significant correlation was proven between CUVAF-area and CCR (p = 0.372). (D) There is a positive correlation with statistically significant results between CUVAF and the obtained ratio from the AL and CCR (p = 0.040).
Figure 4
Figure 4
Percentage of participants with CUVAF-area (mm2) = 0. (A) Controls vs. myopes. (B) Controls vs. M1, M2 and HM. *p < 0,05; **p < 0,01.
Figure 5
Figure 5
CUVAF discriminative capacity (total mean, mm2). (A) AUC of control vs. case group. (B) AUC of control vs. Low miopes (M1). (C) AUC of control vs. Moderate miopes (M2). (D) AUC of control vs. high miopes (HM).
See this image and copyright information in PMC

References

    1. Flitcroft DI, He M, Jonas JB, Jong M, Naidoo K, Ohno-Matsui K, et al. . IMI–defining and classifying myopia: a proposed set of standards for clinical and epidemiologic studies. Invest Ophthalmol Vis Sci. (2019) 60:M20–30. doi: 10.1167/iovs.18-25957, PMID: - DOI - PMC - PubMed
    1. Rudnicka AR, Kapetanakis VV, Wathern AK, Logan NS, Gilmartin B, Whincup PH, et al. . Global variations and time trends in the prevalence of childhood myopia, a systematic review and quantitative meta-analysis: implications for aetiology and early prevention. Br J Ophthalmol. (2016) 100:882–90. doi: 10.1136/bjophthalmol-2015-307724, PMID: - DOI - PMC - PubMed
    1. Schiefer U, Kraus C, Baumbach P, Ungewiß J, Michels R. Refractive errors. Dtsch Arztebl Int. (2016) 113:693–702. doi: 10.3238/arztebl.2016.0693 - DOI - PMC - PubMed
    1. Davies LN, Biswas S, Bullimore M, Cruickshank F, Estevez JJ, Khanal S, et al. . BCLA CLEAR presbyopia: mechanism and optics. Cont Lens Anterior Eye. 47:102185. doi: 10.1016/j.clae.2024.102185 - DOI - PubMed
    1. Zhan GF, Du L, Hernández GP, Suárez RGP, Almaguer MG. Factores asociados a la prevalencia de la miopía mundial y su impacto social. Rev Cubana Oftalmol. (2021) 34:4.