Abstract
PurposeWe aimed to determine the prevalence of corneal arcus and to identify associated factors in the general population of Germany.MethodsThe Gutenberg Health Study (GHS) is a population-based cohort study in Germany, which includes an ophthalmological assessment. Refraction, distance-corrected visual acuity, non-contact tonometry and anterior segment imaging were performed for the five-year follow-up examination. Anterior segment photographs were graded for the presence of corneal arcus. Prevalence estimates were computed, and multivariable logistic regression analysis was applied to determine associated factors for corneal arcus including sex, age, spherical equivalent, central corneal thickness, intraocular pressure (IOP), socio-economic status, smoking, BMI, systolic and diastolic arterial blood pressure, HbA1c, HDL-C, LDL-C, triglyceride, and lipid modifying agents.ResultsA total of 9,850 right and 9,745 left eyes of 9,858 subjects (59.2±10.8 years), 49.0% females were included in this cross-sectional analysis. 21.1% of men (95%-CI: 20.0%– 22.3%) had a corneal arcus in at least one eye, and 16.9% (95%-CI: 15.9%– 18.0%) of women. In multivariable analyses, the presence of corneal arcus was associated with male gender (OR = 0.54 for female, p<0.0001), higher age (OR = 2.54 per decade, p<0.0001), smoking (OR = 1.59, p<0.0001), hyperopia (OR = 1.05 per diopter, p<0.0001), thinner cornea (OR = 0.994 per μm, p<0.0001), higher IOP (OR = 1.02, p = 0.039), higher HDL-C-level (OR = 2.13, p<0.0001), higher LDL-C-level (OR = 1.21, p<0.0001), and intake of lipid modifying agents (OR = 1.26, p = 0.0001). Arcus was not associated with socio-economic status, BMI, arterial blood pressure, and HbA1c.ConclusionsCorneal arcus is a frequent alteration of the cornea in Germany and is associated with ocular parameters and systemic parameters of dyslipidemia.
Highlights
Corneal arcus is a common ophthalmological finding, which may be associated with dyslipidemia or may occur independently with normal ageing processes
A total of 9,850 right and 9,745 left eyes of 9,858 subjects (59.2±10.8 years), 49.0% females were included in this cross-sectional analysis. 21.1% of men (95%-CI: 20.0%– 22.3%) had a corneal arcus in at least one eye, and 16.9% (95%-CI: 15.9%– 18.0%) of women
The presence of corneal arcus was associated with male gender
Summary
Corneal arcus is a common ophthalmological finding, which may be associated with dyslipidemia or may occur independently with normal ageing processes. This mostly bilateral greywhite-yellowish opacity appears in the corneal periphery, separated from the limbus by a clear corneal zone (lucid interval of Vogt) with a sharp edge on its limbal margin and a less welldefined edge on its central margin (Fig 1) [1]. The pathophysiology of arcus stems from increased permeability of vessels of the conjunctiva and episclera which are adjacent to the anterior cornea and the ciliary vessels adjacent to the posterior cornea These are involved in transport, delivery and removal of lipids and lipoproteins from the corneal tissue [2]. Hyperlipoproteinemia is the most common systemic risk factor predisposing to this ocular lipid deposition
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