Has the Sun Protection Campaign in Australia Reduced the Need for Pterygium Surgery Nationally?

ABSTRACT

Background

The Slip! Slop! Slap! Sunsmart safety campaign was an Australian initiative implemented in the 1980s. To assess this campaign’s effect on pterygium, we examined the rate of pterygium surgery across Australia and described the prevalence and associations of pterygium in Perth, Australia’s sunniest capital city.

Methods

The rate of pterygium surgery was examined using Australian Medicare data. A cross-sectional analysis of the Generation 1 (Gen1) cohort of the Raine Study was performed to investigate the prevalence of pterygium in Perth. We investigated the association between pterygium and conjunctival ultraviolet autofluorescence (CUVAF) area, an objective biomarker of sun exposure, and demographics and health variables derived from a detailed questionnaire.

Results

Between 1994 and 2017, the rate of Medicare funded pterygium surgery in Western Australia fell 11%, well below the national average decline of 47%. Of the 1049 Gen1 Raine Study participants, 994 (571 females; mean age 56.7 years, range = 40.9–81.7) were included in the analysis. The lifetime prevalence of pterygium was 8.4% (n = 83). A higher prevalence of pterygium was associated with outdoor occupation (p-trend = 0.007), male sex (p-trend 0.01) and increasing CUVAF area (p-value <0.001).

Conclusions

The effect of Australia’s Slip! Slop! Slap! Sunsmart safety campaign on pterygium been mixed. Since 1994, the rate of private pterygium surgery has declined significantly in all Australian states except Western Australia. Perth, Western Australia, has the highest pterygium prevalence of any mainland-Australian cohort. Higher CUVAF area, male sex, and outdoor occupation were associated with an increased risk of pterygium.

KEYWORDS:

• Epidemiology
• ultraviolet radiation
• Raine study
• pterygium

Acknowledgments

The authors would like to acknowledge the Raine Study participants and their families for their ongoing participation in the study; the Raine Study team for study co-ordination and data collection; and the Centre for Sleep Science, School of Anatomy, Physiology & Human Biology at the University of Western Australia, for utilisation of the facility and the sleep study technicians. 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 Gen1 26-year follow-up was funded by the NHMRC project grant 1084947. Funding was also provided by the Lions Eye Institute, University of Western Australia. SY was supported by an NHMRC Early Career Fellowship (GNT1111437).

Disclosure statement

The authors have no conflicts of interest to declare.

Data availability statement

Data are available upon reasonable request made to the corresponding author. The Human Research Ethics Committee at the Royal Victorian Eye and Ear Hospital will be consulted throughout this process to ensure that all legal and ethical obligations are met. Available data consist of deidentified participant data in addition to a record of the statistical analysis performed.

Publication state

This submission has not been published elsewhere previously and is not under simultaneous consideration by another publication.

Additional information

Funding

National Health and Medical Research Council project grant 1084947 and Lions Eye Institute.