Australian Researchers Lead World in Pterygium Science

The studies mapped the intellectual landscape of pterygium research, drawing on data from the Web of Science Core Collection, with notable consistency in their conclusions.  

Pterygium affects an estimated 12% of the global population, with prevalence considerably higher in sun-exposed regions – making it a condition of particular relevance to Australian clinical practice. Despite decades of research, its pathogenesis remains incompletely understood and its only proven curative treatment remains surgical excision, with recurrence rates that, without adjunctive therapy, can exceed 80% following bare sclera excision. 

What the Research Found 

A study, published in the International Journal of Ophthalmology by Wang and colleagues, analysed 1,516 publications on pterygium between 2000 and 2019.1 Using software to construct detailed knowledge domain maps, the authors traced the evolution of research themes, collaboration networks, and citation patterns across 83 contributing countries. 

A second, more expansive investigation – published in Annals of Medicine and Surgery last year – extended the search window from 1945 to 2024, retrieving 2,633 studies and identifying the 100 most influential publications by citation count.2 The top cited article had accumulated 536 citations; the 100th, still a notable 69. 

Both studies converged on several key findings. The United States ranked first for overall publication volume, but Australia emerged as the second most influential country in terms of impactful research, contributing to 22% of the top 100 most cited articles – a significant result. Singapore rounded out the top three. 

The Singapore National Eye Centre held the highest institutional total link strength in the collaboration network analysis, reflecting its central role in connecting researchers across borders. Yet it was an Australian researcher who dominated the author-level analysis most comprehensively. 

The Coroneo Effect 

Prof Coroneo was identified in both studies as the single most prolific and influential author in the pterygium literature. In the latter analysis, he was named the author with the highest total link strength across the entire global collaboration network – ahead of all other contributors. He also held the greatest number of authorships among the top 100 most cited articles, with nine publications in the list. 

His work on ultraviolet radiation and pterygium pathogenesis – including the hypothesis linking limbal UV exposure to pterygium formation, now widely referred to in the literature – appeared as a cornerstone reference in the co-citation analysis conducted by Wang and colleagues, clustering within the foundational knowledge structure of the field. 

For Prof Coroneo, the recognition carries particular meaning. 

“What I am particularly proud of is the recognition as one of the most influential and highly cited researchers in modern pterygium science and also that my publications were central not only to international collaboration networks, but also to the foundational knowledge structure underpinning current understanding of ultraviolet-related pathogenesis and ocular surface disease,” he told mivision. 

“The ‘Coroneo effect’ is widely cited and while questioned by some, we have repeated and updated our original studies – being prepared for publication – which confirm our earlier findings.” 

Prof Coroneo said he was equally proud of what the data revealed about Australian ophthalmology more broadly. 

“There are few fields in ophthalmology where Australia has done as well as this,” he said. 

Research Themes and Future Directions 

Both analyses identified three dominant research clusters that have shaped the field: surgical techniques and adjuvant therapies for pterygium (particularly the ongoing debate over conjunctival autograft versus amniotic membrane transplantation, and the role of mitomycin-C); the pathogenesis of pterygium, including the molecular mechanisms linking UV exposure, limbal stem cell dysfunction, and angiogenesis; and epidemiology, particularly the global prevalence data and risk factor identification. 

The second study added a forward-looking dimension, using time-visualised co-occurrence analysis to identify emerging hotspots. Since 2010, three themes have risen with increasing prominence: fibrin glue as an alternative to suturing in pterygium surgery, mitomycin-C dosing strategies, and amniotic membrane transplantation techniques – all of which the authors flagged as likely focal points for future research. 

Both studies also sounded a consistent note of caution about the evidence base underpinning current practice. Retrospective studies accounted for 34% of the top 100 cited articles in the 2025 analysis, and the authors noted that high-quality prospective trials and randomised controlled trials remain underrepresented in the literature. Greater inter-institutional collaboration was also identified as a priority, with network maps in both studies revealing relatively sparse connections between research groups. 

The hope, as both studies note, is that a deeper understanding of the molecular biology of pterygium formation will ultimately yield pharmacological alternatives to surgery – a goal that the field’s most influential researchers, led in no small measure by Australia’s own Prof Coroneo, continue to pursue.