Atopic disease and astigmatism: a population-based study

Objectives: To assess the relationship between atopic disease and astigmatism in adolescence and young adulthood. Methods: In this population-based cross-sectional study 897,811 medical records of Israeli adolescents and young adults without keratoconus were reviewed. The prevalence of low-to-moderate (3.00 > D >= 0.75) and high ( >= 3.00 D) astigmatism were calculated in cases with and without atopic disease, including ocular atopic disease (OAD), asthma, allergic rhinitis, atopic dermatitis, angioedema/urticaria, and history of anaphylaxis. Relationships were analysed using multinominal logistic regression, with adjustments for relevant sociodemographic factors. Results: A total of 897,811 adolescents were included in the analysis (mean age 17.2 +/- 0.8 years, 57.8% men). OAD was found in 4702 individuals, with a prevalence of 0.5%. Adolescents with OAD demonstrated a gradual increase in odds ratio (OR) for low-to-moderate and for high astigmatism (OR 1.16, 95% CI 1.07-1.27 and OR 2.10, 95% CI 1.63-2.70, respectively). This group also showed increased OR for with-the-rule astigmatism (OR 1.34, 95% CI 1.21-1.48). Other atopic diseases were associated with more modest ORs for low-to-moderate (OR 1.09, 95% CI 1.07-1.11) and for high astigmatism (OR 1.10, 95% CI 1.02-1.19), persisting across all axis orientations. Sensitivity analysis revealed a dose-response relationship between OAD severity and astigmatism, and consistent point estimates in a group of 1331 adolescents diagnosed with OAD during military service. Conclusions: This study establishes an association between OAD and astigmatism, highlighting the importance of effective OAD management. Further research into tailored therapeutic interventions that address both conditions concurrently is needed.