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Solar insolation at 6 months before glaucoma diagnosis was estimated from residential data using Quantum Geographic Information System. Genotyping was performed and polygenic risk scores (PRS; PGS004766) were calculated. Optical coherence tomography and standard automated perimetry were performed; retinal nerve fibre layer (RNFL) and mean deviation slopes were estimated. Logistic regression and linear mixed models assessed the effects of sunlight exposure and genetic susceptibility on the risk and progression rate of POAG. Mediation analysis assessed whether intraocular pressure (IOP) mediated the effect of sunlight exposure on POAG.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 745 participants (mean age 52.0 \u00b114.2 years; 49% male). After adjusting for age, sex, IOP, comorbidities, urbanisation level and PRS, sunlight exposure significantly associated with greater POAG risk (adjusted OR: 1.20; 95%\u2009CI 1.05 to 1.38, p=0.009). Among high-sunlight exposure individuals, POAG proportion increased from 17% to 36% across PRS quartiles (p&lt;0.001); in contrast, no trend was seen in the low-sunlight exposure group. Greater sunlight exposure correlated with faster RNFL thinning (\u03b2=\u22120.09, 95%\u2009CI \u22120.17 to \u22120.01; p=0.026). Mediation analysis showed that the association between sunlight exposure and POAG was not mediated by IOP (p=0.728).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Greater sunlight exposure was modestly associated with higher POAG risk and faster progression independent of IOP, particularly among genetically susceptible individuals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjo-2026-330421","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T17:20:12Z","timestamp":1787764812000},"page":"bjo-2026-330421","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Interaction of genetic susceptibility and sunlight exposure on primary open-angle glaucoma risk and progression"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6972-7732","authenticated-orcid":false,"given":"Yun","family":"Hsia","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan"},{"name":"College of Medicine, National Taiwan University, Taipei, Taiwan"},{"name":"Department of Ophthalmology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan"},{"name":"Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I-Chieh","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui-Wen","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Medical Research, 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