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Fifteen-year incidence rate and risk factors of pterygium in the Southern Indian state of Andhra Pradesh
  1. Rohit C Khanna1,2,3,4,
  2. Srinivas Marmamula1,2,3,5,
  3. Maria Vittoria Cicinelli6,
  4. Asha Latha Mettla1,2,
  5. Pyda Giridhar1,2,
  6. Seema Banerjee1,2,
  7. Konegari Shekhar1,2,
  8. Subhabrata Chakrabarti2,
  9. Gudlavalleti V S Murthy7,8,
  10. Clare E Gilbert7,
  11. Gullapalli Nageswara Rao1,2
  12. and Andhra Pradesh Eye Disease Study Group
    1. 1 Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
    2. 2 Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
    3. 3 School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
    4. 4 University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
    5. 5 Wellcome Trust/Department of Biotechnology India Alliance Research Fellow, LV Prasad Eye Institute, Hyderabad, India
    6. 6 Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, via Olgettina 60, 20132, Milan, Italy
    7. 7 International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
    8. 8 Indian Institute of Public Health, Hyderabad, India
    1. Correspondence to Rohit C Khanna, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Road # 2, Banjara Hills, Hyderabad, India; rohit{at}


    Purpose To report 15-year incidence rate and associated risk factors of pterygium among people aged 30 years and above at baseline in the rural clusters of longitudinal Andhra Pradesh Eye Disease Study (APEDS III).

    Methods The baseline APEDS I included 7771 participants of which 6447 (83%) were traced and 5395 (83.7%) were re-examined in APEDS III. To estimate the incidence of pterygium, we selected participants who were 30 years and above at baseline (4188), of which 2976 were traced and 2627 (88.3%) were examined, and based on inclusion criteria, 2290 participants were included in the study. The incidence rate of pterygium was defined as the proportion of people free of pterygium at baseline who had developed the condition at 15-year follow-up (range 13–17 years). Univariate and multivariable analyses for risk factors were undertaken.

    Results The sex-adjusted incidence rate of pterygium was 25.2 per 100 person-years (95% CI 24.8 to 25.7) which was significantly higher for men than women (26.3 per 100 person-years (95% CI 25.6 to 27.0) and 24.7 (95% CI 24.1 to 25.3) respectively). At the multivariable analysis, male gender (RR: 1.35, 95% CI 1.0 to 1.83), no formal education (RR: 2.46, 95% CI 1.22 to 4.93), outdoor occupation (RR: 1.47, 95% CI 1.14 to 1.9) and lower body mass index (BMI) (<18.5) (RR: 1.25, 95% CI 1.02 to 1.55) were associated with increased risk of pterygium.

    Conclusions The overall incidence rate of pterygium was high in this rural population, especially in men and those engaged in outdoor activities, lack of formal education and with lower BMI. It is likely that greater exposure to ultraviolet light is a major contributing factor, thus warranting preventive strategies.

    • Child health (paediatrics)
    • Epidemiology
    • Clinical Trial
    • Diagnostic tests/Investigation
    • Optics and Refraction
    • Public health
    • Glaucoma
    • Vision
    • Retina
    • Treatment Medical
    • Medical Education
    • Anatomy
    • Macula
    • Intraocular pressure
    • Optic Nerve
    • Eye (Tissue) Banking

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    • Collaborators Andhra Pradesh Eye Disease Study Group, Maneck Nicholson, Raghava J V, Sahitya T, Lavanya E Y, Hira B Pant, Ritu Dixit, Goutham Pyatla, Syed Hameed, Samir Bera, Sneha Kumari, Inderjeet Kaur, Byagari Raghavender.

    • Contributors RCK, SM, MVC, ALM, PG, SB, KS, SC, GVSM, CEG, GNR: Contributions to the conception and design of the work, acquisition, analysis and interpretation of data; drafting the work and revising it critically and final approval of the version published.

    • Funding Financial Support for this study is provided by Hyderabad Eye Research Foundation, India, Lions Clubs International Foundation, SightFirst Research grant, USA and Dept. of Biotechnology, Centre of Excellence (CoE) grant, India.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data are available upon reasonable request.

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