UV AND YOU

What you need to know about the effects of long-term UV exposure, and how you can best protect your patients

By Susan P. Tarrant

Thanks to consumer awareness and health initiatives about skin cancer, most folks know the importance of wearing hats and sunscreen when in the sun. But, if they are like the majority of their fellow Americans, many of your patients may be under-aware of the danger that exposure to UV rays presents to their eyes.

A Global Healthy Sight Survey by Transitions found that while the majority of Americans understand the danger to their skin from long-term UV exposure and are aware of the need for skin protection, just 13 percent were aware that UV exposure can damage their eyes, inside and out. Other studies have shown that one in four Americans believe that UV eye protection is only important during the spring and summer (hint: it's not true).

UV BASICS

There are two types of UV rays that reach the earth's surface: UVA and UVB. UVB is the stronger of the two (causing sunburn), but UVA travels deeper into human tissue (causing premature aging, wrinkling, and suppression of the body's immune system). Both are recognized as causing skin cancer and other diseases, so it's imperative that all protective measures—including eyewear—block as much of both as possible.

ALL DAY, EVERY DAY. UV rays are strongest between 10 a.m. and 4 p.m. Because of glare, the greatest risk to the eyes occurs between 8 and 10 a.m., and 2 and 4 p.m. On overcast days, 31 percent of solar radiation still reaches the earth's surface. Unfortunately, that's also when patients are least likely to be wearing sunglasses.

LOCATION, LOCATION. Where your practice is located can have an impact on the urgency with which you speak to your patients about the subject, as states in the mountain, desert, and sunbelt regions have higher average UV indices.

FREE CE

The American Optometric Association (AOA) and the Opticians Association of America (OAA) have joined together, with support from Luxottica and The Vision Council, to form the SUN Alliance to support eyecare practices with information and education on UV and eye health.

At the core of this industry alliance is a comprehensive educational program. The COPE and ABO-approved CE is offered in three modules, titled “Protect,” “Prescribe,” and “Present.” The educational series provides ECPs with information they need to educate patients on the dangers of UV exposure and prescribe the proper sun protection.
The courses can be accessed at aoa.org/eyelearn, oaa.org, or sunpresent.com.

EVERY SEASON. A common myth is that UV rays are only an issue in the spring and summer. While they are strongest in those seasons, the danger persists year-round. UV reflecting off surfaces, such as snow, sand, or water, may double overall exposure.

CUMULATIVE EFFECTS

The eye is just as—if not more—vulnerable to long-term exposure to the sun's harmful rays as your skin. Though only a small amount of UV light reaches the inner eye, it is still considered significant, as the ocular tissues are very susceptible to its damaging effects.

Long-term exposure to UV has been found to play a role in the development of the following:

CATARACTS. An estimated 20 percent of the 20 million cataract cases are caused by extended UV exposure.

MACULAR DEGENERATION. Extended exposure to UV as well as High Energy Visible (HEV) light are known risk factors in AMD, and can make symptoms worse for those already diagnosed.

PTERYGIUM. Because it's caused by UV exposure and windy conditions, it's extremely preventable.

PHOTOKERATITIS. Consider it sunburn of the cornea.

PINGUECULAE. Though the precise cause is unknown, chronic sunlight exposure has been suggested to be a factor, and is often associated with outdoor work.

SKIN CANCERS AND TUMORS OF THE EYELID. Long-term exposure to sunlight is the single-most important risk factor associated with skin cancers on the eyelids.

It should be noted that studies have also shown HEV rays, or “blue light,” to play a causal role in ARMD. Some sunlenses offer some level of HEV protection. However, to completely block HEV rays is dangerous—it would impair the wearer's ability to discern certain colors accurately.

EYEWEAR AND PROTECTION

Given the research suggesting the large role that prolonged UV exposure can play in eye disease, it makes sense for ECPs to talk to patients about the importance of UV-protective lenses. Fixed tint lenses that are specifically rated to block 100 percent of UV rays, as well as light-adaptive lenses, will offer the best UV protection while also protecting the eye from the discomfort of bright light and glare.

Clear spectacle lenses can also provide protection, which is important to note considering we are exposed to UV even in non-sunny circumstances. Polycarbonate and Trivex materials offer 100 percent blockage, and most high-index lens material offer close to 100 percent blockage. Other lens materials will necessitate a simple UV coating.

Contact lenses also play an important role here. Some contact lens brands have been certified as offering 100 percent blockage of UV rays. Others offer less protection. While the UV-filtering lenses can offer important protection, it is important patients also wear sunwear outdoors to get full coverage of the entire eye area.

Sunglasses, appropriately sized to cover the entire area surrounding the eye, provide protection against the discomfort of bright light. But unless they block 100 percent of both UVA and UVB rays, they are leaving wearers at risk of UV exposure.

Prescribing the correct combination of UV-blocking sunwear, photochromic lenses, contact lenses, and even clear lenses provides patients with the best UV protection. EB

Sources: American Optometric Association; “The Effects of Ultraviolet and Visible Light on the Eye,” white paper sponsored by Transitions Optical; Essilor of America; “Hidden Dangers of UV: Keeping Your Eyes Safe,” The Vision Council; Johnson & Johnson Vision Care; “UV and Our Nation's Vision: Insights From Congressional Briefing,” Prevent Blindness America and Transitions Optical; and Vision-Ease Lens.