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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.
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