Ultraviolet radiation-blocking characteristics of contact lenses: relevance to eye protection for psoralen-sensitised patients

Ultraviolet Keratitis: From the Pathophysiological Basis to Prevention and Clinical Management

Ultraviolet keratitis is caused by the toxic effects of acute high-dose ultraviolet radiation (UVR) reflecting the sensitivity of the ocular surface to photochemical injury. The clinical syndrome presents with ocular pain, tearing, conjunctival chemosis, blepharospasm, and deterioration of vision typically several hours after exposure, lasting up to 3 days. Mountaineers, skiers, and beach recreationalists are particularly at risk to suffer from ultraviolet (UV) keratitis as the reflectivity of UVR in these environments is extremely high. The aim of this review is to raise awareness about the potential of UV damage on the eye with an emphasis on UV keratitis, to highlight the pathophysiological basis of corneal phototoxicity, and to provide practical guidance for the prevention and clinical management of UV keratitis commonly known as snow blindness.

Oxidative photodegradation of ocular tissues: beneficial effects of filtering and exogenous antioxidants

The fact that light is necessary for life is generally accepted as an axiom. The extent to which light interacts and influences human biology, however, is often not fully appreciated. Exposure to sunlight, for instance, can both promote and degrade human health. There is now general scientific consensus that, although the eye evolved to respond to light, it is also damaged by excessive exposure. Light-mediated ocular damage is involved in the pathophysiology of many common forms of blindness. The type of ocular tissue damage induced by light exposure depends on the extent of exposure and wavelength. The tissues of the lens, cornea, and retina contain specific chemical moieties that have been proven to exhibit light-mediated oxidative degradation. Proteins and lipids present in the cornea, lens, and retina, meet all of the physical requirements known to initiate the process of oxidative photodegradation upon exposure to solar radiation. As such, different mechanisms have evolved in the lens, cornea, and retina to ameliorate such light-mediated oxidative damage. It appears, however, that such mechanisms are ill-matched to handle modern conditions: namely, poor diet and longer life-spans (and the degenerative diseases that accompany them). Hence, steps must be taken to protect the eye from the damaging effects of light. Preventative measures include minimizing actinic light exposure, providing exogenous filtering (e.g., through the use of protective lenses), and enhancing antioxidant defenses (e.g., through increased dietary intake of antioxidants). These strategies may yield long-term benefits in terms of reducing oxidative photodegradation of the ocular tissues.

Photoprotection

Many agents affect the transmission of ultraviolet light to human skin. These include naturally occurring photoprotective agents (ozone, pollutants, clouds, and fog), naturally occurring biologic agents (epidermal chromophores), physical photoprotective agents (clothing, hats, make-ups, sunglasses, and window glass), and ultraviolet light filters (sunscreen ingredients and sunless tanning agents). In addition, there are agents that can modulate the effects of ultraviolet light on the skin (antioxidants and others). All of the above are reviewed in this article.

LEARNING OBJECTIVE

At the conclusion of this learning activity, participants should be able to provide an overview of all aspects of photoprotection.

Peripheral light focusing as a potential mechanism for phakic dysphotopsia and lens phototoxicity

Our aim was to examine secondary image formation in the anterior segment caused by peripheral light focusing (PLF) in the human cornea, and in particular the crystalline lens. Non-sequential ray-tracing (OptiCAD) was applied to an anatomically based human eye model, which incorporates a gradient index crystalline lens. For analysis of the limbal effect, we varied the incident angle from 100 to 122 degrees, while for the crystalline lens effect, the incident angle was varied from 60 to 90 degrees. The corneal shapes studied included central radii from 7.4 to 8.2 mm with a range of shape factors. In each case, we computed the peak and average intensities, and the area of exposure at the limbus or lens periphery. The computation was repeated with a previous model eye for comparison. For the limbal effect, a peak intensity gain of x22.5 was found at an incident angle of 104 degrees which compares well with previous results. The average intensity gain at this angle was x7.5 over an area of 0.23 mm2. Steeper corneal curvature produced a greater PLF effect. For the crystalline lens effect, maximum UVA (365 nm) intensity gain peaked at x8.6 at 84 degrees with average intensity gain of x2.3. The area of UVA exposure peaked at 4.7 mm2 at 70 degrees. A relatively wide range (30 degrees ) of incident angles produced peak PLF gains of x3 or more in the lens. Significant focusing of light is directed to the nasal limbus, and to a lesser extent to the crystalline lens over a broad range of incident angles. PLF in the nasal cornea is reduced by an order of magnitude when a UV-blocking soft contact lens is used. The concentration levels and intraocular sites of PLF action on UV and visible light suggest a new mechanism of phakic dysphotopsia and lens phototoxicity.

Photoprotection by clothing

Wearing of clothing, hats, and sunglasses to protect from exposure to sunlight should be part of a package of protection. Clothing specifically designed to avoid exposure is now available and recently standards have been published in several countries to measure the degree of protection. The ultraviolet protection factor (UPF) is likely to be as ubiquitous in clothing aisles as the sun protection factor (SPF) is now in the sunscreen aisle of your local department store.