Conjunctival Ultraviolet Autofluorescence as a Biomarker of Outdoor Exposure in Myopia: A Systematic Review and Meta-analysis.

Abstract

Abstract Outdoor activity (OA) is considered the main modifiable risk factor for myopia development. Quantifying the association between Conjunctival Ultraviolet Autofluorescence (CUVAF) area and OA can be useful as a biomarker for myopia control. The purpose of this study is to quantify the association between CUVAF area and myopia. The articles included populations from different geographic areas (Europe/Asia/Australia) and ages. The bibliographic research was accomplished between June-August of 2022 with the following databases: MEDLINE/SCIENCE DIRECT/GOOGLE SCHOLAR/WEB OF SCIENCE/SCOPUS with all the terms related of "conjunctival ultraviolet autofluorescence” (2006-2022). Cross-sectional and case-control studies were included. The differences between CUVAF area and the hours of OA performed by myopic and non-myopic patients and the correlation of OA with the size of the CUVAF area were analyzed. The meta-analysis of the CUVAF area between myopic and non-myopic patients showed statistically smaller areas (-3.30 mm²-CI95%[-5.5;-1.06]). Stratified sub-analysis by different geographic areas showed that Australia-Asia patients showed a greater difference in CUVAF area (-4.92 mm²-CI95%[-9.5;-0.29]) compared to Europe patients (-1.97 mm²;CI95%;-2.8;-1.14, p= 0.007). Myopic reported less OA vs non-myopic (-3.38 hours/week-CI95%[-4.6;-2.09]), and the correlation between CUVAF area and OA was 0.14 (CI95%[0.09;0.19]). A strong relationship was observed between CUVAF, myopia and OA in different studies and geographic locations. The importance of this validation is that CUVAF is a simple, fast and non-invasive quantitative method to evaluate the control of myopia.