UV and Kids

The effects of UV on children, and the role photochromic lenses can play

The vital role that good vision plays in children's development is well documented. We know about the importance of vision screening for young people as a means of detecting vision problems before they become part of a learning issue.

But there is another factor affecting the ocular health of children—ultraviolet radiation (UVR) exposure from the sun—that often gets overlooked by parents, educators, and even ECPs.

The fact that UV exposure can cause a variety of serious eye diseases and blindness later in life goes largely unrecognized, even though simple and inexpensive measures can be taken to protect the eye.

Children's eyes are particularly at risk of UVR damage, yet few people seem to be aware of the danger.

THE EFFECTS OF EXPOSURE

There are several factors that make children especially vulnerable to the damaging effects of UVR. First, they generally spend more time outdoors in the sun than adults. Also, the immature nature of the crystalline lens (which transmits more than 75 percent of UVR in children under 10, versus 10 percent in those older than 25) leaves them vulnerable to long-term damage.

In 2003, a roundtable discussion challenged some of the current thinking on UVR and glare's influence on eye health. Among other things, the panel discussed long-term damage to the eyelids, conjunctiva, cornea, lens, and retina.

EYELIDS. Both UVA and UVB (the latter being the more harmful range of UV radiation) will cause sunburn of the eyelids.

The lids are also susceptible to the development of skin cancers as a result of overexposure.

CONJUNCTIVA. UVB damage leads to the formation of pinguecula (a triangular patch of mucous membrane involving the conjunctiva at the inner canthus of the eye) and pterygium (a similar entity found on the cornea) of the conjunctiva.

CORNEA. The cornea can develop photokeratitis—essentially a corneal sunburn—as a result of exposure to UVB. The highly regenerative capacity of the cornea usually repairs this condition rapidly. Other degenerative changes, such as climactic droplet keratopathy or speroidal degeneration, result from chronic, cumulative UV exposure.

LENS AND RETINA. Simply put, chronic exposure to UVR increases the risk of developing agerelated cataracts. People with diabetes also may be particularly susceptible to UV damage.

Even a low level of UVA reaching the retina will result in damage over time.

THE BEST PROTECTION

When children are outside, they should be advised to wear shatter-resistant, UVR-protective lenses with sturdy frames. The use of a wide-brimmed hat (extending at least three inches from the head) that shields the face can offer additional protection.

But what kind of protective lens is best? The American Academy of Ophthalmology recommends that protective lenses should block 99 percent of all UVR.

When discussing the use of protective eyewear for children, consider what is practical and, most of all, convenient. Proper protection from UVR must often extend from the early morning hours until dusk, so impact-resistant polycarbonate and Trivex® photochromic lenses can provide a good option for many active children.

For the ametropic child who must wear corrective lenses, for example, poly or Trivex photochromic lenses allow him to use one pair of eyeglasses for many purposes. And, photochromic lenses carry no risk of creating photo-phobia or photosensitivity.

The full-time UVR and impact protection these lenses provide also accommodates the indoors-to-outdoors life of many active children.

THE ROLE OF PHOTOCHROMICS

Countless studies in the eye health field have shown the ravages of the eye's exposure to the sun. The best defense, short of living a life entirely indoors, is to protect the eyes with lenses that block 100 percent of UV radiation, both UVA and UVB.

Some photochromic lenses, in addition to providing visual comfort as a spectacle lens, provide that total blockage of UVR.

In addition to complete UVR blockage, there are several reasons why photochromic lenses may be recommended as a high-quality defense against UVR. They can:

■ Provide excellent indoor visual acuity

■ Darken quickly in sunlight

■ Reduce discomforting glare and improve contrast

■ Reduce blue light

■ Provide visual comfort and convenience and improved vision quality

■ Help reduce the age-related onset of eye disease if used as eye protection from an early age

But what's the use of prescribing sunlenses if your young patient doesn't wear them?

That's another area in which photochromics can be a plus. Studies show the photochromic lens options are well-accepted by children, parents, and teachers

In a study conducted by Madeline L. Romeu, OD, and Susan Stenson, MD, of children between 10 and 17 years old, 90 percent of participants preferred wearing photochromics over clear lenses. The major difference the children experienced was in their ability to see better in bright sunlight with the photochromic lenses versus the clear lenses.

In the past, some parents may have hesitated to put their children in photochromics, saying their children's school or camp had policies against wearing tinted lenses. As the technology of photochromic lenses improved (i.e., returning to a clear state when indoors), so did the acceptance and understanding of the lenses' other positive factors.

What Parents Can Do

Parents can help protect their children from UV radiation in several ways. Talk to them about making sure their children: ■ Wear hats with a wide brim extending at least three inches away from the head ■ Wear fixed tint or photochromic lenses; make sure they block 100 percent of UV radiation (some do not) ■ Reduce outdoor exposure during the peak hours of UVR, generally 10 a.m. to 2 p.m. ■ Become educated about UV and the eye; talk to an ECP

THE BOTTOM LINE: WHAT YOU CAN DO

Special attention must be given to raising the awareness of ECPs—and through them, parents—of the long-term risks of UV radiation and the special vulnerability of young eyes to its damaging rays.

New approaches to eyecare must emphasize total quality-of-life issues, including UV protection, elimination of glare that compromises vision, improved visual quality, and the comfort and convenience that will increase compliance with UV-protective eyewear guidelines.

Some of the specific things ECPs can do to increase patients' awareness of the dangers of UVR include:

■ Discuss why children are at high risk for UV exposure

■ Provide clinical reasons as to why ocular protection is crucial to children's eye health

■ Recommend optimal vision solutions to provide optimal eye protection for children

As eyecare professionals, use your dispensing conversations to talk about the technologies that exist today to help protect against UVR—including quality sunlenses and the particular benefits of photochromic lenses for children. EB