{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:59:58Z","timestamp":1790830798248,"version":"4.1.0"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Background<\/jats:title>\n Air pollution is increasingly recognized as a potentially modifiable environmental determinant of age-related ocular disease, but its association with cataract remains incompletely characterized. Epidemiological evidence remains heterogeneous across pollutants and study methods, although emerging experimental findings support biological plausibility for pollution-related lens injury.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To systematically evaluate the epidemiologic evidence linking air-pollution exposure with cataract-related outcomes and to quantitatively synthesize pollutant-specific associations where sufficiently comparable data were available.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n PubMed, Embase, Scopus, Web of Science, and Google Scholar were searched through August 10, 2026 for observational studies reporting cataract-specific associations with specific air pollutants. Risk of bias was assessed using ROBINS-E for longitudinal follow-up studies and the WHO air-quality epidemiology instrument for cross-sectional and aggregate studies. Comparable hazard ratios (HRs) were synthesized using restricted maximum-likelihood random-effects models in Stata 18, with Knapp\u2013Hartung sensitivity analyses.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Fifteen studies were included in the systematic review, of which seven contributed to at least one meta-analysis. The pooled HR was 1.036 (95% CI, 0.988\u20131.086) per 1\u2005\u00b5g\/m\n 3<\/jats:sup>\n increase in PM\u2082.\u2085, 1.041 (95% CI, 1.013\u20131.070) per 10\u2005\u00b5g\/m\n 3<\/jats:sup>\n increase in NO\u2082, and 1.010 (95% CI, 0.983\u20131.038) per study-specific interquartile-range increase in black carbon. Heterogeneity was substantial for PM\u2082.\u2085 (I\n 2<\/jats:sup>\n \u2009=\u200999.68%) and NO\u2082 (I\n 2<\/jats:sup>\n \u2009=\u200986.04%) but lower for black carbon (I\n 2<\/jats:sup>\n \u2009=\u200933.41%). The highest-versus-lowest quartile analysis also showed a positive association for NO\u2082 (HR, 1.094; 95% CI, 1.057\u20131.133; I\n 2<\/jats:sup>\n \u2009=\u20090.11%), whereas corresponding PM\u2082.\u2085 and PM\u2081\u2080 estimates were not statistically significant. Knapp\u2013Hartung adjustment widened the NO\u2082 confidence intervals, indicating sensitivity to the small number of contributing studies.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n NO\u2082 showed the most consistent association with cataract outcomes, whereas evidence for PM\u2082.\u2085 remained heterogeneous and that for black carbon was limited. Although these findings support further investigation of traffic-related and other ambient pollution mixtures in cataract epidemiology, the sensitivity of NO\u2082 estimates to small-study inference precludes firm causal conclusions. Independent prospective studies with improved exposure assessment and standardized cataract phenotyping are needed.<\/jats:p>\n <\/jats:sec>\n \n Systematic Review Registration<\/jats:title>\n \n https:\/\/www.crd.york.ac.uk\/PROSPERO\/recorddashboard#<\/jats:ext-link>\n , identifier CRD420261509514.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2026.1969759","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:44:13Z","timestamp":1790829853000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Air pollution exposure and cataract outcomes: a systematic review and pollutant-specific meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Bin","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Cataract, Lanzhou Aier Eye Hospital","place":["Lanzhou, 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