Cumulative UV on the Eye UV Eye Damage may Effects be invisible, but itof is there!
Chronic UV light exposure may contribute to aging processes in the eye An Australian group of researchers, led by Professor Minas Coroneo have developed a method to detect precursors of ocular sun damage, using ultraviolet fluorescence photography (UVFP). Presence of areas of increased fluorescence was detected by UVFP, or presence of pinguecula was detected by standard photography.
Percentage of subjects with ocular changes consistent with pinguecula
Pinguecula
Raised, yellow-white fibrous growth; usually found nasally. While changes visible to the naked eye are seen using UV fluorescence photography 1 Established on standard photography, as early as thepingueculae, mid-teens, early signs maywere be seen in children as3x young as nine 32 years % of age. More common in areas and activities with high UV seen in 10% of the children; on UVFP, all of these pinguecuexposure, and with environmental lae demonstrated fluorescence (Figure 1). elements In total, 32% (wind, dust). Symptoms include dryness and discomfort – ocular lubricants can help with these. have increased fluorescence detected on UVFP, including the 30% with pingueculae. Of the remaining 70%, the changes were only detectable using UVFP (Figures 2, 3).
0 – Normal
1 – Trace
Fluorescence on UVFP was seen in children aged 9 years and above, with prevalence increasing with age. The presence of fluorescence was 0% for children aged 3 to 8 years, 26% for those aged 9 to 11 years, and 81% of those aged 12 to 15 years.
10 %
2 – Mild
Standard (Control) Photography
4 – Severe
Ultraviolet Fluorescence Photography (UVFP)
UV Fluorescence photography reveals early sun damage not seen in standard photography*
Early Detection Technique – UV fluorescence photography Control photograph demonstrates an established pinguecula
13 year old – early signs of pinguecula visible Left nasal interpalpebral region of a 13-year-old boy with an established pinguecula. withFigure slit1:lamp
Corresponding UV-fluorescence photograph illustrates fluorescence at the side of the pinguecula
Same 13 year old – UV fluorescence photography
Corresponding UV-fluorescence photograph demonstrates an area of fluorescence in the right temporal interpalpebral region
Same 11 year old – UV fluorescence photography shows early signs
photograph 11 year old –Control no signs is apparently normal visible with slit lamp
courtesy of Prof. Minas Coroneo. Figure 2: Right temporal interpalpebral regionPictures of an 11-year-old girl without pinguecula.
Pterygium
3 – Moderate
Detection of early signs of pinguecula in children1 Age group (years)
White light image (visible signs)
UV Fluorescence image ( visible signs)
3-8 (n=27)
0%
0%
9-11 (n=23)
0%
29%
12-15 (n=21)
33%
81%
Corresponding UV-fluorescence photograph demonstrates an area of fluorescence in the left nasal interpalpebral region
Control photograph is apparently normal
Triangular-shaped, vascularised growth onto cornea; more common nasally. Seen from 20’s & 30’s in high UV-environments or activities (e.g. surfers, sailors, fishermen) and related to high UV exposure in youth and dry, windy climates.2 Ocular lubricants will help the symptoms of dryness and theregirlare also cosmetic concerns. Vision can be affected. Figure 3: Left nasal discomfort, interpalpebral region ofbut an 11-year-old without pinguecula.
0 – Normal
1 – Trace
2 – Mild
3 – Moderate
4 – Severe
Photos provided courtesy of: Professor Minas T. Coroneo Department of Ophthalmology, 2nd Floor, South Wing, Edmund Blacket Building, Prince of Wales Hospital, Randwick NSW 2031 AUSTRALIA. * Ooi J, Sharma N, Papalkar D, Sharma S, Oakey M, Dawes P, and Coroneo M. Ultraviolet Fluorescence Photography to Detect Early Sun Damage in the Eyes of School-Aged Children. American Journal of Ophthalmology, 2006 Feb; 141(2): 294 -298.
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Cortical cataract Spoke-shaped cloudiness of internal lens; begins in 40s’ – 50’s and highly related to UV exposure.3 Other key risk factors include age, smoking, diet, medication and general health. Symptoms include blurred vision, haloes and glare with night driving.
0 – Normal
1 – Trace
2 – Mild
3 – Moderate
4 – Severe
Macular Pigment Density A higher level of macular pigment appears to have a protective effect against age-related macular degeneration, a major cause of reduced vision for people over age 55. Chronic UV light exposure contributes to the aging processes in the eye, including macular changes.4 Young children are more at risk from ocular UV exposure when the crystalline lens has little ability to block UV light.5 Other key risk factors include age, hereditary, health, smoking and diet. Symptoms include blurred central vision and can lead to blindness.
Early Detection Techniques Patient Symptoms Low Contrast Visual Acuity
Slit Lamp Examination Retinal Imaging
UV Fluorescence Photography Macular Pigment Optical Density
This is offered as an educational tool that you may choose to use as part of your patiients’ evaluations. These materials are not intended as, and do not constitute medical or optometric advice.
Help your patients protect their eyes Eyes are exposed to harmful UV radiation and, as for skin, the UV effect on the eyes is cumulative6 All year round, all day protection is needed
Solar angle – affected by time of day and location7
Environment – influenced by weather and surface reflectance
Angle of sun above horizon
<35°
35 - 45°
Eye exposure
Partially exposed
Fully illuminated
Fully shadowed
Sources of UV
Diffuse UV from surface reflections and scattered light
Direct UV, reflected and scattered light
Indirect UV from surface reflections and scattered light
Summer
• Early morning, late afternoon in all latitudes
• Mid morning, afternoon in low mid latitudes
• Midday in low mid latitudes
Exposure – at unlikely times and in unlikely locations7 • O cular UV exposure can be a significant risk all year round
• Midday in extreme latitudes
• N ot only can UV rays pierce cloud cover, they reflect off all surfaces at different – and often surprisingly high degrees
Winter
Peripheral Light-Focussing Effect – sunglasses only provide partial protection8 Corneal optics focus and intensify rays entering from temporal periphery onto lens and nasal limbus. This is the Peripheral Light-Focussing Effect (PLF). Non wrap-around UV-absorbing sunglasses are not fully protective as light ‘leaks’ around the lenses.
>45°
• Near sunrise and sunset in all latitudes
• Most of day in all but near equatorial latitudes
Sunglasses alone may not be enough UV-blocking spectacle lens
Exposure to UV from peripheral sources is still possible even when wearing UV-blocking spectacle lenses.
• Will not occur in extreme latitudes • Midday only in near equatorial latitudes
Sunglasses plus UV-blocking contact lenses UV-blocking spectacle lens
UV-blocking contact lens
The use of a UV-blocking contact lens provides additional protection.
Management options • Ask patients questions about their lifestyle, hobbies and occupation • Look for early, pre-clinical signs with a range of techniques • Advise all patients about the risks of UV radiation
Who is vulnerable?
• Recommend comprehensive ocular UV protection
Young patients are especially vulnerable • They have larger pupils • They have clearer lenses • They spend more time outdoors • Few wear sunglasses or hats9 All those doing outdoor occupations or hobbies
Make UV protection part of your everyday professional eye health communication
UV absorbing contact lenses are not substitutes for devices like UV-blocking sunglasses as they do not completely cover the eye or surrounding area. 1. Ooi J-L et al. Ultraviolet fluorescence photography to detect early sun damage in the eyes of school-aged children. Amer J Ophthalmol 2006; 14(2): 294-298. McCarty et al. Epidemiology of pterygium in Victoria, Australia. Brit J Ophthalmol 2000; 84(3): 289-292. 3. McCarty et al. Attributable Risk Estimates for Cataract to Prioritize Medical and Public Health Action. Invest. Ophthalmol. Vis. Sci.2000; 41(12): 3720-3725. 4. Chalam KV, Khetpal V, Rusovici R et al. A review: role of ultraviolet radiation in age-related macular degeneration. Eye & Contact Lens 2011; 37(4): 225-232. 5. Wagner R S. Why children must wear sunglasses. Contemp Pediatr, 1995, 12: 27-31. 6. A Special Issue: Ultraviolet Radiation and Its Effects on the Eye. Eye & Contact Lens 2011; 37(4): 167-272. 7. Sasaki H, Sakamoto Y, Schnider C et al. UV-B exposure to the eye depending on solar altitude. Eye & Contact Lens 2011; 37(4): 191-195. 8. Kwok LS, Daszynski DC, Kuznetsov VA, Pham T, Ho A, Coroneo MT. Peripheral light-focussing as a potential mechanism for phakic dysphotopsia and lens phototoxicity. Opthalmic Physiol Opt 2004;24(2):119-29. 9. Maddock J et al. Use of Sunglasses in Public Outdoor Recreation Settings in Honolulu, Hawaii. Optom Vis Sci, 2009, 86 (2): 165–166. THE VISION CARE INSTITUTE® is a registered trademark of Johnson & Johnson Medical Ltd. ©Johnson & Johnson Medical Ltd 2012. 12MAYPOS10