Prevalence of corneal arcus and associated factors in a German population-Results from the Gutenberg Health Study

PLoS One. 2021 Sep 21;16(9):e0255893. doi: 10.1371/journal.pone.0255893. eCollection 2021.


Purpose: We aimed to determine the prevalence of corneal arcus and to identify associated factors in the general population of Germany.

Methods: The Gutenberg Health Study (GHS) is a population-based cohort study in Germany, which includes an ophthalmological assessment. Refraction, distance-corrected visual acuity, non-contact tonometry and anterior segment imaging were performed for the five-year follow-up examination. Anterior segment photographs were graded for the presence of corneal arcus. Prevalence estimates were computed, and multivariable logistic regression analysis was applied to determine associated factors for corneal arcus including sex, age, spherical equivalent, central corneal thickness, intraocular pressure (IOP), socio-economic status, smoking, BMI, systolic and diastolic arterial blood pressure, HbA1c, HDL-C, LDL-C, triglyceride, and lipid modifying agents.

Results: A total of 9,850 right and 9,745 left eyes of 9,858 subjects (59.2±10.8 years), 49.0% females were included in this cross-sectional analysis. 21.1% of men (95%-CI: 20.0%- 22.3%) had a corneal arcus in at least one eye, and 16.9% (95%-CI: 15.9%- 18.0%) of women. In multivariable analyses, the presence of corneal arcus was associated with male gender (OR = 0.54 for female, p<0.0001), higher age (OR = 2.54 per decade, p<0.0001), smoking (OR = 1.59, p<0.0001), hyperopia (OR = 1.05 per diopter, p<0.0001), thinner cornea (OR = 0.994 per μm, p<0.0001), higher IOP (OR = 1.02, p = 0.039), higher HDL-C-level (OR = 2.13, p<0.0001), higher LDL-C-level (OR = 1.21, p<0.0001), and intake of lipid modifying agents (OR = 1.26, p = 0.0001). Arcus was not associated with socio-economic status, BMI, arterial blood pressure, and HbA1c.

Conclusions: Corneal arcus is a frequent alteration of the cornea in Germany and is associated with ocular parameters and systemic parameters of dyslipidemia.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Arcus Senilis / epidemiology*
  • Cornea / physiopathology*
  • Cross-Sectional Studies
  • Female
  • Germany / epidemiology
  • Humans
  • Intraocular Pressure*
  • Male
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Visual Acuity*

Grants and funding

The Gutenberg Health Study is funded through the government of Rhineland-Palatinate (“Stiftung Rheinland-Pfalz für Innovation”, contract AZ 961-386261/733), the research programs “Wissen schafft Zukunft” and “Center for Translational Vascular Biology (CTVB)” of the Johannes Gutenberg-University of Mainz, and its contract with Boehringer Ingelheim and PHILIPS Medical Systems, including an unrestricted grant for the Gutenberg Health Study. Schuster AK holds the professorship for ophthalmic healthcare research endowed by “Stiftung Auge” and endowed by “Deutsche Ophthalmologische Gesellschaft” and “Berufsverband der Augenärzte Deutschlands e.V.” He received research funding from Allergan, Bayer Vital, Novartis, PlusOptix, and Heidelberg Engineering. The topics for the funding are: Allergan: “News in health service research in glaucoma” Bayer: “Adherence and persistence in age-related macular degeneration” Novartis: “Epidemiology in age-related macular degeneration” PlusOptix: “Refractive error in children” Philipp S. Wild is funded by the Federal Ministry of Education and Research (BMBF 01EO1503) and he is PI of the German Center for Cardiovascular Research (DZHK). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.