{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:19:33Z","timestamp":1791389973685,"version":"4.3.3"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>Understanding the association between social determinants of health (SDoHs) and microbial keratitis (MK) can inform underlying risk for patients and identify risk factors associated with worse disease, such as presenting visual acuity (VA) and time to initial presentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This was a cross-sectional study was conducted with patients presenting with MK to the cornea clinic at a tertiary care hospital in Madurai, India. Patient demographics, SDoH survey responses, geographic pollution, and clinical features at presentation were collected. Descriptive statistics, univariate analysis, multi-variable linear regression models, and Poisson regression models were utilized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      There were 51 patients evaluated. The mean age was 51.2 years (SD = 13.3); 33.3% were female and 55% did not visit a vision center (VC) prior to presenting to the clinic. The median presenting logarithm of the minimum angle of resolution (logMAR) VA was 1.1 [Snellen 20\/240, inter-quartile range (IQR) = 20\/80 to 20\/4000]. The median time to presentation was 7 days (IQR = 4.5 to 10). The average particulate matter 2.5 (PM2.5) concentration, a measure of air pollution, for the districts from which the patients traveled was 24.3 mg\/m\n                      <jats:sup>3<\/jats:sup>\n                      (SD = 1.6). Age- and sex-adjusted linear regression and Poisson regression results showed that higher levels of PM2.5 were associated with 0.28 worse presenting logMAR VA (Snellen 2.8 lines,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.002). Patients who did not visit a VC had a 100% longer time to presentation compared to those who did (incidence rate ratio = 2.0, 95% confidence interval = 1.3\u20133.0,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Patient SDoH and environmental exposures can impact MK presentation. Understanding SDoH is important for public health and policy implications to mitigate eye health disparities in India.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijo.ijo_331_23","type":"journal-article","created":{"date-parts":[[2023,6,14]],"date-time":"2023-06-14T09:06:18Z","timestamp":1686733578000},"page":"2448-2454","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["The effect of social determinants of health on severity of microbial keratitis presentation at a tertiary eye care hospital in Southern India"],"prefix":"10.4103","volume":"71","author":[{"given":"Anvesh","family":"Annadanam","sequence":"first","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrice M","family":"Hicks","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Chen","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mercy","family":"Pawar","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prabhleen","family":"Kochar","sequence":"additional","affiliation":[{"name":"Department of Cornea & Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suvitha","family":"Selvaraj","sequence":"additional","affiliation":[{"name":"Department of Cornea & Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhanya","family":"Kuppuraj","sequence":"additional","affiliation":[{"name":"Department of Cornea & Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chetan","family":"Rathod","sequence":"additional","affiliation":[{"name":"Department of Cornea & Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rekha Sravya","family":"Muppala","sequence":"additional","affiliation":[{"name":"Department of Cornea & Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Smriti","family":"Gaur","sequence":"additional","affiliation":[{"name":"Department of Cornea & Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abinaya","family":"Krishnan","sequence":"additional","affiliation":[{"name":"Department of Cornea & Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SR","family":"Sumithra","sequence":"additional","affiliation":[{"name":"Department of Cornea & Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria A","family":"Woodward","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA"},{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N Venkatesh","family":"Prajna","sequence":"additional","affiliation":[{"name":"Department of Cornea & Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,6,14]]},"reference":[{"key":"R1-20251006","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1038\/s41433-020-01339-3","article-title":"Infectious keratitis:An update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance","volume":"35","author":"Ting","year":"2021","journal-title":"Eye"},{"key":"R2-20251006","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.survophthal.2018.12.003","article-title":"The persistent dilemma of microbial keratitis:Global burden, diagnosis, and antimicrobial resistance","volume":"64","author":"Ung","year":"2019","journal-title":"Surv Ophthalmol"},{"key":"R5-20251006","doi-asserted-by":"crossref","first-page":"618597","DOI":"10.3389\/fimmu.2021.618597","article-title":"Polluted air exposure compromises corneal immunity and exacerbates inflammation in acute herpes simplex keratitis","volume":"12","author":"Sendra","year":"2021","journal-title":"Front Immunol"},{"key":"R6-20251006","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1016\/S0140-6736(14)60617-6","article-title":"Outdoor air pollution and asthma","volume":"383","author":"Guarnieri","year":"2014","journal-title":"Lancet"},{"key":"R7-20251006","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1038\/s41569-020-0371-2","article-title":"Environmental determinants of cardiovascular disease:Lessons learned from air pollution","volume":"17","author":"Al-Kindi","year":"2020","journal-title":"Nat Rev Cardiol"},{"key":"R8-20251006","first-page":"460","article-title":"Outdoor air pollution and cancer:An overview of the current evidence and public health recommendations","volume":"70","author":"Turner","year":"2020","journal-title":"CA Cancer J Clin"},{"key":"R9-20251006","doi-asserted-by":"crossref","first-page":"3740","DOI":"10.3390\/jcm9113740","article-title":"Impact of air pollution and weather on dry eye","volume":"9","author":"Mandell","year":"2020","journal-title":"J Clin Med"},{"key":"R10-20251006","doi-asserted-by":"crossref","first-page":"4915","DOI":"10.1167\/iovs.19-28346","article-title":"The relationship between ambient atmospheric fine particulate matter (PM 2.5) and glaucoma in a large community cohort","volume":"60","author":"Chua","year":"2019","journal-title":"Investig Opthalmol Vis Sci"},{"key":"R11-20251006","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s40557-018-0252-x","article-title":"Spatial analysis between particulate matter and emergency room visits for conjunctivitis and keratitis","volume":"30","author":"Lee","year":"2018","journal-title":"Ann Occup Environ Med"},{"key":"R12-20251006","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1111\/1468-0009.12390","article-title":"Meanings and misunderstandings:A social determinants of health lexicon for health care systems","volume":"97","author":"Alderwick","year":"2019","journal-title":"Milbank Q"},{"key":"R13-20251006","doi-asserted-by":"crossref","first-page":"273","DOI":"10.4103\/0301-4738.53051","article-title":"Review of epidemiological features, microbiological diagnosis and treatment outcome of microbial keratitis:Experience of over a decade","volume":"57","author":"Gopinathan","year":"2009","journal-title":"Indian J Ophthalmol"},{"key":"R14-20251006","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1080\/09286580601001347","article-title":"Microbial keratitis in South India:Influence of risk factors, climate, and geographical variation","volume":"14","author":"Bharathi","year":"2007","journal-title":"Ophthalmic Epidemiol"},{"key":"R16-20251006","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1016\/j.oret.2021.01.005","article-title":"Detection of posterior segment eye disease in rural eye camps in South India:A nonrandomized cluster trial","volume":"5","author":"Schehlein","year":"2021","journal-title":"Ophthalmol Retin"},{"key":"R17-20251006","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1097\/ICO.0000000000002784","article-title":"Effectiveness of a tele-ophthalmology vision center in treating corneal disorders and its associated economic benefits","volume":"41","author":"Komal","year":"2022","journal-title":"Cornea"},{"key":"R18-20251006","doi-asserted-by":"crossref","first-page":"125","DOI":"10.2471\/BLT.19.245704","article-title":"Air quality standards for the concentration of particulate matter 2.5, global descriptive analysis","volume":"99","author":"Nazarenko","year":"2021","journal-title":"Bull World Health Organ"},{"key":"R22-20251006","doi-asserted-by":"crossref","first-page":"388","DOI":"10.3928\/1081-597X-19970701-16","article-title":"Proper method for calculating average visual acuity","volume":"13","author":"Holladay","year":"1997","journal-title":"J Refract Surg"},{"key":"R25-20251006","doi-asserted-by":"crossref","first-page":"e144","DOI":"10.1016\/S2214-109X(20)30489-7","article-title":"Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020:The right to sight:An analysis for the Global Burden of Disease Study","volume":"9","author":"Steinmetz","year":"2021","journal-title":"Lancet Glob Heal"},{"key":"R26-20251006","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.envpol.2018.11.109","article-title":"Impacts of air pollution on dry eye disease among residents in Hangzhou, China:A case-crossover study","volume":"246","author":"Mo","year":"2019","journal-title":"Environ Pollut"},{"key":"R27-20251006","doi-asserted-by":"crossref","first-page":"9231","DOI":"10.3390\/ijerph17249231","article-title":"Association between exposure to ambient air pollution and age-related cataract:A nationwide population-based retrospective cohort study","volume":"17","author":"Shin","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"R28-20251006","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1016\/j.envpol.2017.08.109","article-title":"Air pollution and outpatient visits for conjunctivitis:A case-crossover study in Hangzhou, China","volume":"231","author":"Fu","year":"2017","journal-title":"Environ Pollut"},{"key":"R30-20251006","doi-asserted-by":"crossref","first-page":"30802","DOI":"10.1007\/s11356-022-19591-3","article-title":"Proposed city-specific interim targets for India based on WHO air quality guidelines 2021","volume":"29","author":"Kesavachandran","year":"2022","journal-title":"Environ Sci Pollut Res"},{"key":"R31-20251006","doi-asserted-by":"crossref","first-page":"102382","DOI":"10.1016\/j.scs.2020.102382","article-title":"Temporary reduction in fine particulate matter due to 'anthropogenic emissions switch-off'during COVID-19 lockdown in Indian cities","volume":"62","author":"Kumar","year":"2020","journal-title":"Sustain Cities Soc"},{"key":"R32-20251006","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.ophtha.2021.09.010","article-title":"The economic burden of vision loss and blindness in the United States","volume":"129","author":"Rein","year":"2022","journal-title":"Ophthalmology"},{"key":"R33-20251006","doi-asserted-by":"crossref","first-page":"100852","DOI":"10.1016\/j.eclinm.2021.100852","article-title":"Global economic productivity losses from vision impairment and blindness","volume":"35","author":"Marques","year":"2021","journal-title":"EClinicalMedicine"},{"key":"R34-20251006","doi-asserted-by":"crossref","first-page":"2141","DOI":"10.4103\/ijo.IJO_2804_21","article-title":"Current estimates of the economic burden of blindness and visual impairment in India:A cost of illness study","volume":"70","author":"Mannava","year":"2022","journal-title":"Indian J Ophthalmol"},{"key":"R35-20251006","doi-asserted-by":"crossref","first-page":"28640","DOI":"10.1073\/pnas.2007236117","article-title":"Outdoor air pollution in India is not only an urban problem","volume":"117","author":"Ravishankara","year":"2020","journal-title":"Proc Natl Acad Sci"},{"key":"R36-20251006","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.envint.2016.03.004","article-title":"Cause-specific premature death from ambient PM2.5 exposure in India:Estimate adjusted for baseline mortality","volume":"91","author":"Chowdhury","year":"2016","journal-title":"Environ Int"},{"key":"R37-20251006","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1029\/2018GH000169","article-title":"Premature mortality due to PM 2.5 over India:Effect of atmospheric transport and anthropogenic emissions","volume":"3","author":"David","year":"2019","journal-title":"GeoHealth"},{"key":"R38-20251006","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1080\/09603123.2019.1612042","article-title":"Short and long term exposure to ambient air pollution and impact on health in India:A systematic review","volume":"30","author":"Rajak","year":"2020","journal-title":"Int J Environ Health Res"},{"key":"R39-20251006","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.puhe.2010.11.009","article-title":"Monetary burden of health impacts of air pollution in Mumbai, India:Implications for public health policy","volume":"125","author":"Patankar","year":"2011","journal-title":"Public Health"}],"container-title":["Indian Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_331_23","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:57:31Z","timestamp":1786647451000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_331_23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6]]},"references-count":30,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.4103\/ijo.ijo_331_23","relation":{},"ISSN":["0301-4738","1998-3689"],"issn-type":[{"value":"0301-4738","type":"print"},{"value":"1998-3689","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6]]},"assertion":[{"value":"2023-02-03","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-03-20","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}