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Hua et al. BMC Ophthalmology (2021) 21:316 https://doi.org/10.1186/s12886-021-02065-4 RESEARCH ARTICLE Open Access Prevalence and associated factors for climatic droplet keratopathy in Kazakhs adults: a cross-sectional study in Tacheng, Xinjiang, China Zhixiang Hua1,2,3, Xiaoyan Han1,2,3, Guoqing Li4,LiLv5, Xiaolan He4, Laman Gu4, Jianfeng Luo6,7,8*† and Jin Yang1,2,3*† Abstract Background: Investigation of the prevalence of climatic droplet keratopathy (CDK) in Tacheng, Xinjiang, China. Methods: A total of 1030 participants, in their 40s or older, from the Kazakh ethnic group in Tacheng, were randomly sampled by stratification method. Ophthalmic examinations and surveys were carried out on these participants. Factors associated with CDK were analyzed with logistic regression models. Results: CDK was found in 66 (6.4%; 95% confidence interval [CI]: 4.9–7.9%) Kazakh individuals. After multiple regression model analysis, it demonstrated that age (< 0.001), exposure time (< 0.001), exposure protection (< 0.001), and vegetable intake (< 0.001) were of correlation with CDK, of which age (OR = 1.21[CI]: 1.16– 1.27) and long-term outdoor exposure (OR = 2.42[CI]: 1.26–4.67) were the risk factors, and that vegetable intake (OR = 0.29[CI]: 0.14–0.59) and wearing a hat (OR = 0.24[CI]: 0.10–0.56) were protective factors. Conclusions: This study has revealed the risk and protective factors of CDK, providing a new insight on related research. Keywords: Climatic droplet keratopathy, Prevalence, Risk factors Background of CDK varies widely in different regions and ethnic Climatic droplet keratopathy (CDK) is also known as the groups, with rates as low as 2.7% [5] and as high as spheroidal keratopathy, Labrador keratopathy, or Bietti’s 100% [6]. Zhang et al. (1991) reported that in Inner keratopathy [1–3]. CDK is characterized by corneal opa- Mongolia, CDK mainly occurs in middle-aged and eld- city which results from a increment of oil-like deposits erly Mongolians with the prevalence being 8.1% in adults on the anterior elastic lamina and anterior stromal layer over the age of 30 [7]. Currently, high-quality research [4]. Previous studies have indicated that the prevalence in the field of CDK is absent. Generally, CDK is considered to be a degenerative cor- * Correspondence: [email protected]; [email protected] neal disease associated with chronic corneal damage. †Jianfeng Luo and Jin Yang contributed equally to this work. The exact pathogenesis of CDK is still not clear, but 6 Department of Biostatistics, School of Public Health, Fudan University, 130 there are many risk factors for CDK including: exposure Dongan Rd., Shanghai 200032, China 1Department of Ophthalmology and the Eye Institute, Eye and Ear, Nose, and to ultraviolet radiation, aging, dietary habits, and occu- Throat Hospital, Fudan University, 83 Fenyang Rd., Shanghai, People’s pational hazards. Among them, ultraviolet radiation is Republic of China the most widely established factor [1, 8]. Studies have Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Hua et al. BMC Ophthalmology (2021) 21:316 Page 2 of 10 reported that the intensity and time of exposure to ultra- cities (Tacheng and Usu), four counties (Emin County, Sha- violet radiation correlates significantly to the prevalence wan County, Toli County, and Yumin County), and an au- of CDK [1]. tonomous county (Hoboksar Mongol Autonomous Currently, there are no specific pharmacological treat- County). ments for CDK, but superficial keratectomy along with am- Sample size was calculated with the cross-sectional z2 a pð1−pÞ niotic membrane transplant or corneal transplantation are 1− = N ¼ 2 available for advanced CDK cases [9]. However, the proced- study formula d2 , where Z1-α/2 = 1.96. As ure is not able to be practiced in several impoverished re- α = 0.05, p stands for the prevalence of CDK (which was gions. The epidemiology and pathogenesis of CDK gain 5.0% in our pretest), and d is admissible error (which is little attention because only a few patients seek medical as- 2%). According to the formula, the theoretical sample sistance due to its mild symptoms in the early stage [1]. size was 502, which includes an extra 10% for subject’s In our clinical work in Tacheng, CDK can only be loss. found among middle-aged and elderly Kazakhs, especially We have randomly selected 7 different townships in those who have been farming or herding outdoors for different cities and counties. The final selection was many years. The main focus of this study was to identify made by assigning each township with a number and the most important factors influencing CDK, thus boost- use a random number generator from WinPepi to select ing early detection and intervention. To the best of our numbers within the range of the township list. A public knowledge, no study has been conducted to investigate hospital was chosen in each township for participants the prevalence of CDK among the Kazakh ethnic group in examination. Xinjiang. This study reports the prevalence of CDK and The study included only Kazakh residents who had its associated risk factors in the Kazakh ethnic group in lived in the area for more than 5 years and aged 40 years Tacheng, Xinjiang, and reviews existing literature on the or above. Monocular patients were excluded. In addition, prevalence of CDK. the study also excluded patients with a history of ocular surgery or ocular trauma and other diseases such as Methods mental illness which could potentially affect the evalu- Sampling ation of CDK. The study was based on the principles of Tacheng prefecture (longitude 82° 16′- 87° 21′, east; lati- the Declaration of Helsinki. Ethical approval was granted tude 43 25′-47°15′, north) (Fig. 1)isintheNorthwestern by the bioethical committee of the Ninth Division Hos- part of Xinjiang Uyghur Autonomous Region, China. It has pital of Xinjiang Production and Construction Corps. an area of 98824km2, and is divided into two county-level Fig. 1 The map of China highlighting site of this work (Tacheng prefecture) (Artificial drawing created by author ZXH) Hua et al. BMC Ophthalmology (2021) 21:316 Page 3 of 10 Data collection was based on the clinical symptoms and slit-lamp exami- Data was collected from September 2019 to December nations, and the degeneration was divided into three 2019 by a team of ophthalmologists and other medical stages (Table 1)[1, 2]. staff from The Ninth Division Hospital of Xinjiang Pro- duction and Construction Corps. During the data collec- Statistical analysis tion process, each participant underwent a comprehensive All statistical analyses were performed using the SPSS interview by trained interviewers. software program (Statistical Package for Social Sciences The questionnaire comprised basic personal informa- Inc., Chicago, IL, USA, Version 21.0.0.0). The data was tion, lifestyle habits, and medical history. Basic personal presented as figures using GraphPad Prism 7.0. The information included name, age, gender, ethnicity, occu- prevalence of CDK and the age-adjusted prevalence was pation (farmer, herder, worker, housework, and others), calculated with references from the 2010 China Popula- dietary habits (vegetables, fruits, meat, and milk tea), tion Census. For independent samples, t-test and chi- lifestyle (smoking and alcohol consumption), and disease square test were used to analyze the demographic char- history (e.g., hypertension, hyperlipidemia, diabetes, acteristics and the grades of CDK. In addition, univariate arthritis, and emphysema). Vegetables refer only to leafy analysis between the presence of CDK and prevalent fac- green vegetables. We listed several types of local vegeta- tors was performed. The factors showing statistical or bles in the questionnaire. (see supplementary question- clinical significance were included in multiple logistic re- naire)Agricultural and animal husbandry work were gression models. A P value of < 0.05 was considered to identified as outdoor occupations, while the others were be statistically significant. considered as indoor occupations. Height and weight were measured in centimeters and kilograms respect- Result ively. Body mass index (BMI) was calculated using the Out of 1197 eligible Kazakh residents, 1095 underwent universally recognized formula: weight (kg) / height ophthalmo-logical examinations, with an overall re- (m2). Systolic and diastolic blood pressures were mea- sponse rate of 91.48%. We finally included 1030 people sured with a digital automatic blood pressure monitor. who were 40 or older (as seen in the flow chart (Fig. 2)). The average of the three measurements was recorded. The mean age of the participants in the study was The questionnaire was written in Chinese, and each 54.59 ± 9.58 years old with their ages ranging from 40 to Kazakhs participant had undergone a comprehensive 93 years, and 46.9% (n = 483) of them were women.
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