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Conjunctival ultraviolet autofluorescence area decreases with age and sunglasses use
  1. Gareth Lingham1,
  2. Jason Kugelman2,
  3. Jason Charng1,
  4. Samantha SY Lee1,
  5. Seyhan Yazar1,3,
  6. Charlotte M McKnight4,
  7. Minas T Coroneo5,
  8. Robyn M Lucas6,
  9. Holly Brown1,
  10. Louis J Stevenson1,
  11. David A Mackey1,
  12. David Alonso-Caneiro2
  1. 1Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia
  2. 2School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
  3. 3Garvan-Weizmann Centre for Cellular Genomics, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
  4. 4Ophthalmology, St John of God Health Care, West Perth, Western Australia, Australia
  5. 5Department of Ophthalmology, University of New South Wales, Sydney, New South Wales, Australia
  6. 6National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
  1. Correspondence to Dr Gareth Lingham, University of Western Australia Centre for Ophthalmology and Visual Science, Perth, WA 6009, Australia; garethlingham{at}


Background Conjunctival ultraviolet autofluorescence (CUVAF) is a method of detecting conjunctival damage related to ultraviolet radiation exposure. In cross-sectional studies, CUVAF area is positively associated with self-reported time spent outdoors and pterygium and negatively associated with myopia; however, longitudinal studies are scarce.

Aims To use a novel deep learning-based tool to assess 8-year change in CUVAF area in young adults, investigate factors associated with this change and identify the number of new onset pterygia.

Methods A deep learning-based CUVAF tool was developed to measure CUVAF area. CUVAF area and pterygium status were assessed at three study visits: baseline (participants were approximately 20 years old) and at 7-year and 8-year follow-ups. Participants self-reported sun protection behaviours and ocular history.

Results CUVAF data were available for 1497 participants from at least one study visit; 633 (43%) participants had complete CUVAF data. Mean CUVAF areas at baseline and the 7-year and 8-year follow-ups were 48.4, 39.3 and 37.7 mm2, respectively. There was a decrease in mean CUVAF area over time (change in total CUVAF area=−0.96 mm2 per year (95% CI: −1.07 to –0.86)). For participants who wore sunglasses ≥1/2 of the time, CUVAF area decreased by an additional −0.42 mm2 per year (95% CI: −0.72 to –0.12) on average. Fourteen (1.5%) participants developed a pterygium.

Conclusions In this young adult cohort, CUVAF area declined over an 8-year period. Wearing sunglasses was associated with a faster reduction in CUVAF area. Deep learning-based models can assist in accurate and efficient measurement of CUVAF area.

  • conjunctiva
  • imaging

Data availability statement

Data may be obtained from a third party and are not publicly available. Not applicable.

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Data availability statement

Data may be obtained from a third party and are not publicly available. Not applicable.

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  • GL and JK are joint first authors.

  • DAM and DA-C are joint senior authors.

  • Contributors GL and JK performed the statistical analysis and drafted the manuscript. SY, JC, DAM, MTC, RL, DA-C and SSYL were involved in the conceptualisation and design of the study. GL, JK, HB, LJS, SY, JC, CMM and SSYL were involved in conduct of the study and data collection, extraction or analysis. All authors were involved in the interpretation of the study results and critical revision of the manuscript. GL is guarantor and responsible for the overall article content.

  • Funding The core management of the Raine Study is funded by the University of Western Australia, Curtin University, Telethon Kids Institute, Women and Infants Research Foundation, Edith Cowan University, Murdoch University, the University of Notre Dame Australia and the Raine Medical Research Foundation. The eye data collected at the 20-year, 27-year and 28-year follow-ups (described as baseline, 7-year and 8-year follow ups in this manuscript) of the Generation 2 cohort of the Raine Study were funded by grants from the National Health and Medical Research Council (NHMRC) Project Grants (1021105, 1102106, 1109057, 1121979). The 20-year follow-up study (described as baseline in this manuscript) was additionally funded by the Lions Eye Institute, the Australian Foundation for the Prevention of Blindness, Alcon Research Institute, Ophthalmic Research Institute of Australia (ORIA) and Telethon (no corresponding grant numbers). DAM is funded as an NHMRC Practitioner Fellow.

  • Disclaimer The funders had no involvement in the conduct of this study.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.