Q: Of course my patients wear their sunglasses in the summer. How do I remind them that adequate UV protection is a year-round necessity—and that sometimes, sunglasses aren’t enough?
A: Eye care practitioners don’t talk to patients as much as necessary about ultraviolet radiation, says Stephen Cohen, O.D.1 But, research findings may provide openings for a discussion:
• The “peripheral light focusing effect.” Minas Coroneo, M.D., coined this term when he noted that temporal light intensifies while passing through the ocular surfaces from the temporal cornea moving nasally. His conclusion? The light is 22 times stronger at the nasal limbus and eight times stronger at the nasal lens cortex—the most common locations for pterygium and cortical cataracts, both of which are associated with chronic UV radiation exposure.1
• Age. Dr. Coroneo has also found ocular changes due to UV damage in children as young as age nine. In another study, 80% of patients under the age of 15 demonstrated signs of UV-related eye damage.1 Remind parents that children are never too young for sun protection. Indeed, 71% of patients don’t ensure that their children wear sunglasses outdoors, according to the 2009 American Optometric Association’s Eye-Q Survey.2
• Time of day. In off-peak times (e.g., morning, fall, etc.), eyes are at risk for UV damage simply because patients don’t take the same precautions as they do during times of more obvious risk (e.g., summer).1
“Overexposure to UV rays can lead to cataracts, macular degeneration, or, in some cases, skin cancer around the eyelids,” says Sarah Hinkley, O.D., of the American Optometric Association’s Health Promotion Committee. “Other disorders that can occur are abnormal growths on the eye’s surface and even sunburn of the eyes. These conditions can cause blurred vision, irritation, redness, tearing, temporary vision loss, and in some instances, blindness.”2 Look carefully during each exam at every patient’s face—especially the periocular areas—for suspicious skin lesions.
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How to Suggest Sunglasses:
• Remind patients that UV radiation doesn’t occur only in the summer.
• Tell them about the damage that UV radiation can cause.
• Recommend sunglasses with UV radiation blockage rates of at least 99% and visible light reduction of at least 75%.
• Advise patients that wide-brimmed hats block most of the UV rays that sunglasses don’t.
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A Takeaway Message
The problem in talking to patients about UV damage, Dr. Cohen believes, is that the message can be overly complex. But, when simplified into a few main points, patients are more likely to take action.1
Remind patients to verify sunglasses’ UV protection before they purchase them. Quality sunglasses should block 99% to 100% of UV-A and UV-B radiation and screen 75% to 90% of visible light.2
Likewise, make sure patients understand that there’s more to the color of the lens than an aesthetic choice. Gray reduces light intensity and least alters the patient’s color vision, while brown or amber improves contrast in addition to blocking light intensity.2
Also, sunglasses alone aren’t enough. A wide-brimmed hat in conjunction with sunglasses blocks eight times the UV rays.1 The best combination: UV-blocking contact lenses, sunglasses, and a wide-brimmed hat.1,3
A Careful Balance
But, too little sunlight is harmful as well. The possibility of vitamin D deficiency is very real.4 Vitamin D helps prevent diabetes and AMD, and the easiest way to get the required amount is a few minutes of sunlight daily.4
Bottom line: Make sure that patients understand how to protect their eyes from UV radiation with sensible precautions year-round.
1. Cohen S. SOS: ultraviolet radiation and the eye. Rev Cornea Contact Lenses. 2007 Oct;28-35.
2. American Optometric Association. An Eye Opener: Overexposure to UV Rays Can Lead to Eye Diseases. Available at: http://aoa.org/x15026.xml (Accessed June 2010).
3. Kwok LS, Kuznetsov VA, Ho A, Coroneo MT. Prevention of the adverse photic effects of peripheral light-focusing using UV-blocking contact lenses. Invest Ophthalmol Vis Sci. 2003 Apr;44(4):1501-7.
4. Richer S. Nutraceuticals and the ocular surface. Rev Cornea Contact Lenses. 2009 Mar;28-33.