Cohort Study of Non-melanoma Skin Cancer and the Risk of Exfoliation Glaucoma

Jae H. Kang, Trang Vopham, Francine Laden, Bernard A. Rosner, Barbara Wirostko, Robert Ritch, Janey L. Wiggs, Abrar Qureshi, Hongmei Nan, Louis R. Pasquale

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Precis: In a cohort study of 120,307 participants with 25+ years of follow-up, a history of non-melanoma skin cancer was associated with a 40% higher exfoliation glaucoma risk. Purpose: To evaluate the relationship between non-melanoma skin cancer (a marker of ultraviolet radiation exposure) and exfoliation glaucoma (XFG). Methods: We performed a cohort study of US women (n=79,102; 1980-2014) and men (n=41,205; 1986-2014), aged 40+ years and at risk for glaucoma who reported eye exams. From 1984 (women)/1988 (men), we asked about basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) history separately; in prior years, we asked about any non-melanoma skin cancer history in a single question. SCC was confirmed with histopathology reports while BCC and any early (<1984/<1988) non-melanoma skin cancer history was self-reported. Incident XFG cases (362 women and 83 men) were confirmed with medical records. Using pooled data, we estimated multivariable-adjusted relative risks (MVRR; 95% confidence intervals [CIs]) with Cox proportional hazards models that were stratified by age (in months), 2-year time period at risk and average lifetime residential latitude. Results: In multivariable-adjusted analyses, we observed a 40% higher XFG risk with any non-melanoma skin cancer history (MVRR=1.40; 95% CI=1.08,1.82); the association was observed even with 4 and 8 year lags in non-melanoma skin cancer history. Also, the non-melanoma skin cancer association was stronger in younger (<65▒y; MVRR=2.56; 95% CI=1.62,4.05) versus older participants (≥65▒y; MVRR=1.25; 95% CI=0.94,1.66; p for interaction=0.01) and those living in northern latitudes (≥42° north; MVRR=1.92; 95% CI=1.28,2.88) versus more southern latitudes (<42° north; MVRR=1.19; 95% CI=0.86,1.66; p for interaction=0.04). Conclusions: Non-melanoma skin cancer was associated with higher XFG risk, particularly among younger participants and those living in Northern US.

Original languageEnglish (US)
JournalJournal of glaucoma
StateAccepted/In press - 2020
Externally publishedYes


  • Epidemiology
  • Exfoliation syndrome
  • Glaucoma
  • Skin cancer
  • Ultraviolet light

ASJC Scopus subject areas

  • Ophthalmology

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  • Cite this

    Kang, J. H., Vopham, T., Laden, F., Rosner, B. A., Wirostko, B., Ritch, R., Wiggs, J. L., Qureshi, A., Nan, H., & Pasquale, L. R. (Accepted/In press). Cohort Study of Non-melanoma Skin Cancer and the Risk of Exfoliation Glaucoma. Journal of glaucoma.