Position statement - Eye protection

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Position statement - Eye protection


RANZCO

This position statement is endorsed by The Royal Australian and New Zealand College of Ophthalmologists


Recommendations

As part of a comprehensive SunSmart lifestyle, Cancer Council Australia recommends wearing close-fitting wraparound sunglasses and a broad-brimmed hat to protect the eyes from ultraviolet (UV) radiation.

UV radiation exposure to the eyes is dependent on a number of factors and is not closely correlated to ambient UV levels and the UV index. Cancer Council Australia recommends protecting the eyes from UV at all times when outdoors during daylight hours.

Cancer Council Australia recommends:

  • reducing exposure of the eye to UV radiation as much as possible;
  • wearing close-fitting, wraparound style sunglasses that meet the Australian/New Zealand Standard for sunglasses (categories 2, 3 and 4) or the Australian/New Zealand Standard for eye protectors for industrial applications as appropriate; and
  • further protection of the eyes by wearing a broad-brimmed, bucket or legionnaire style hat.

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Health effects of UV radiation on the eyes

Repeated exposure of the eyes to UV radiation causes both short-term eye complaints and permanent eye damage. The most common short-term impact of UV exposure to the eye is acute photo keratopathy, akin to sunburn of the cornea, which can cause inflammation[1].

Exposure to UV radiation over long periods can result in more serious damage to the eyes including squamous cell cancers on the surface of the eye[2][3][4] and skin cancer around the eyes[5]. The link between UV and some types of eye cancer is clear, however the evidence that UV radiation is a risk factor for ocular melanoma is weaker[6][7]. While one Australian study suggested that cumulative UV radiation is not associated with ocular melanoma and sunglass wearing does not protect against it[8], another study found a strong link between artificial UV radiation exposure (from solariums and welding) and some ocular melanomas[9]. Although UV radiation is strongly associated with skin cancer, including on the eyelids[2][10], UV does not appear to be a risk factor for sebaceous carcinoma of the eyelid[11].

Other long-term eye problems associated with UV radiation include:

  • cataracts – cloudiness of the lens[1];
  • macular degeneration – damage to the retina[1][12];
  • pterygium – an overgrowth of the conjunctiva on to the cornea[13]; and
  • climatic droplet keratopathy – cloudiness of the cornea[14].

It has been estimated that 20% of cataracts are potentially due to UV radiation exposure to the eye[15]. In 2004, the direct cost of cataract in Australia was estimated at $326.6 million. In 2000 and 2001 it was estimated that almost half of the 8600 cases of pterygium treated annually in Australia are caused by sun exposure[16][17]. The cost of pterygium in Australia was estimated at $8.3 million in 2001[17].

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Exposure of the eyes to UV radiation

UV radiation exposure to the eyes is dependent on a number of factors and can differ dramatically from the pattern of ambient UV radiation. The level of UV exposure to the eyes is highly dependent on the angle of sunlight reaching the eyes, which is influenced by time of day and time of year. The eye receives direct UV radiation when facing the sun with the sun low in the sky, however reflected and scattered light also have a strong impact in contributing to the total UV exposure to the eyes[18]. Exposure also depends on facial geometry, with the brows and nose blocking some UV radiation at certain times of day.

Ambient UV levels, the UV index and time of day do not correlate well with the risk of ocular UV damage, due mainly to the geometry of the eye. UV index is not deemed an appropriate indicator of whether eye protection is required[18].

Non-wraparound sunglasses are not effective in blocking peripheral UV[19]. Wraparound, close fitting, large-lens sunglasses provide the best protection through reducing direct and reflected UV radiation and glare reaching the eyes[20][21][22]. UV-blocking contact lenses effectively reduce UV exposure to the eyes, blocking around 90% of UVA transmittance[19].

Alternatively, a broad-brimmed hat can reduce UV radiation to the eyes by 50%[23].

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Australian standards

Sunglasses

The Australian/New Zealand Standard AS/NZS 1067:2003 Sunglasses and Fashion Spectacles regulates all sunglasses and fashion spectacles available in Australia, and their classification and labelling[24]. The Standard defines five categories of lenses, according to the amount of UV radiation that is able to pass through the lens (see Table 1). The Standard also specifies lens dimensions (width and height) and safety requirements.


Table 1. Classifications of sunglasses and fashion spectacles according to the Australian/New Zealand Standard AS/NZS 1067:2003

Lens category Description
Lens category 0: Fashion spectacles These are not sunglasses, as they have a very low ability to reduce sun glare; they provide limited UV protection
Lens category 1: Fashion spectacles These are not sunglasses, however, they do provide limited sun glare reduction and UV protection; they are not suitable for driving at night
Lens category 2: Sunglasses These sunglasses provide a medium level of sun glare reduction and good UV protection
Lens category 3: Sunglasses These sunglasses provide a good level of UV protection and a high level of sun glare reduction
Lens category 4: Sunglasses These are special purpose sunglasses that provide a very high level of sun glare reduction and good UV protection, they must not be used when driving
Source: Australian/New Zealand Standard AS/NZS 1067:2003[24]


Sunglasses and fashion spectacles meeting the Australian/New Zealand Standard must be labelled to specify that they comply with AS/NZS 1067:2003, and which lens category they comply with. Fashion spectacles (lens categories 0 and 1) are not sunglasses and do not provide adequate protection against UV radiation[24].

The Australian Radiation Protection and Nuclear Safety Authority developed an eye protection factor (EPF) rating system for glasses complying with the Standard. The EPF rating ranges from 1 to 10, with EPF values of 9 and 10 transmitting almost no UV radiation. Some sunglasses may be labelled with an EPF value.

Sunglasses may also be labelled UV 400 (blocking 100% of UV), or state the amount of UV radiation blocked as a percentage.

It is important that the price of sunglasses not be used to gauge the quality of protection from UV radiation. Sunglasses providing excellent protection need not be expensive. Darker-tinted or polarised lenses may be required to reduce glare, however the darkness or colour of the lens does not indicate the level of UV protection.

Check the label to determine the level of UV protection provided. Cancer Council Australia recommends wearing close-fitting, wraparound style sunglasses that meet the Australian/New Zealand Standard for sunglasses (categories 2, 3 and 4).

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Sunglasses and children

Children are particularly sensitive to UV radiation skin and eye damage[25]. As such it is important to protect children’s eyes.

Exposure of very young children to UV radiation should be limited. It is important that children wear a sun protective hat to provide some protection to the eyes.

Once children are old enough to manage wearing sunglasses, they should be encouraged to do so when exposed to UV radiation. These glasses should meet the Australian/New Zealand Standard for sunglasses (not fashion spectacles)[24]. Sunglasses labelled as toys are not covered by the Standard and therefore should not be used to provide sun protection.

For more information on sun protection for infants (0–12 months), see our position statement.

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Eye protection at work

The Australian/New Zealand Standard AS/NZS 1338.1:1992 Filters for eye protectors - Filters for protection against radiation generated in welding and allied operations regulates eye protection in the workplace for occupations both indoors and outdoors where UV radiation may reach potentially hazardous levels[26]. Tinted eye protectors that comply with Australian Standard AS/NZS 1338:1992 are recommended as these provide at least the same amount of protection against UV radiation as sunglasses, as well as impact protection. Untinted eye protectors marked ‘O’ (for outdoor) also have sufficient UV protection for outdoor use[26].

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Prescription glasses

The Australian/New Zealand Standard for sunglasses and fashion spectacles does not cover either tinted or clear prescription glasses. However, some tinted or clear prescription lenses may provide protection from UV radiation. Lenses can also be coated with a UV protective layer. Lenses that darken when exposed to sunlight provide additional comfort by reducing glare, but do not necessarily filter out more UV radiation. Prescription glasses used for sun protection should be close-fitting and wraparound to provide maximum protection.

If you wear prescription glasses, ask your optometrist about the level of UV protection they provide.

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Recommendations

As part of a comprehensive SunSmart lifestyle, Cancer Council Australia recommends wearing close-fitting wraparound sunglasses and a broad-brimmed hat to protect the eyes from UV radiation.

UV radiation exposure to the eyes is dependent on a number of factors and is not closely correlated to ambient UV levels and the UV index. Cancer Council Australia recommends protecting the eyes from UV at all times when outdoors during daylight hours.

Cancer Council Australia recommends:

  • reducing exposure of the eye to UV radiation as much as possible;
  • wearing close-fitting, wraparound style sunglasses that meet the Australian/New Zealand Standard for sunglasses (categories 2, 3 and 4) or the Australian/New Zealand Standard for eye protectors for industrial applications as appropriate; and
  • further protection of the eyes by wearing a broad-brimmed, bucket or legionnaire style hat.

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Position statement details

This position statement was developed by Cancer Council Australia's National Skin Cancer Committee and reviewed by The Royal Australian and New Zealand College of Ophthalmologists. It was endorsed by Cancer Council Australia's principal Public Health Committee and published in July 2013.

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References

  1. 1.0 1.1 1.2 Roberts JE. Ultraviolet radiation as a risk factor for cataract and macular degeneration. Eye Contact Lens 2011 Jul;37(4):246-9 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21617534].
  2. 2.0 2.1 Sun EC, Fears TR, Goedert JJ. Epidemiology of squamous cell conjunctival cancer. Cancer Epidemiol Biomarkers Prev 1997 Feb;6(2):73-7 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/9037556].
  3. Ng J, Coroneo MT, Wakefield D, Di Girolamo N. Ultraviolet radiation and the role of matrix metalloproteinases in the pathogenesis of ocular surface squamous neoplasia. Invest Ophthalmol Vis Sci 2008 Dec;49(12):5295-306 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18641285].
  4. Tucker MA, Shields JA, Hartge P, Augsburger J, Hoover RN, Fraumeni JF Jr. Sunlight exposure as risk factor for intraocular malignant melanoma. N Engl J Med 1985 Sep 26;313(13):789-92 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/4033707].
  5. Armstrong B. How sun exposure causes skin cancer: An epidemiological perspective. In: Hill D, Elwood JM, English DR. Prevention of Skin Cancer. Dordrecht, Netherlands: Kluwer Academic Publishers; 2004. p. 89-116.
  6. Lucas RM. An epidemiological perspective of ultraviolet exposure--public health concerns. Eye Contact Lens 2011 Jul;37(4):168-75 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21670693].
  7. Gallagher RP, Lee TK. Adverse effects of ultraviolet radiation: a brief review. Prog Biophys Mol Biol 2006 Sep;92(1):119-31 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16580054].
  8. Pane AR, Hirst LW. Ultraviolet light exposure as a risk factor for ocular melanoma in Queensland, Australia. Ophthalmic Epidemiol 2000 Sep;7(3):159-67 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11035552].
  9. Vajdic CM, Kricker A, Giblin M, McKenzie J, Aitken JF, Giles GG, et al. Artificial ultraviolet radiation and ocular melanoma in Australia. Int J Cancer 2004 Dec 10;112(5):896-900 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15386378].
  10. Lindgren G, Diffey BL, Larkö O. Basal cell carcinoma of the eyelids and solar ultraviolet radiation exposure. Br J Ophthalmol 1998 Dec;82(12):1412-5 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/9930273].
  11. Kiyosaki K, Nakada C, Hijiya N, Tsukamoto Y, Matsuura K, Nakatsuka K, et al. Analysis of p53 mutations and the expression of p53 and p21WAF1/CIP1 protein in 15 cases of sebaceous carcinoma of the eyelid. Invest Ophthalmol Vis Sci 2010 Jan;51(1):7-11 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19628749].
  12. Chalam KV, Khetpal V, Rusovici R, Balaiya S. A review: role of ultraviolet radiation in age-related macular degeneration. Eye Contact Lens 2011 Jul;37(4):225-32 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21646979].
  13. Moran DJ, Hollows FC. Pterygium and ultraviolet radiation: a positive correlation. Br J Ophthalmol 1984 May;68(5):343-6 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/6712914].
  14. Gray RH, Johnson GJ, Freedman A. Climatic droplet keratopathy. Surv Ophthalmol 1992 Jan;36(4):241-53 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/1549808].
  15. World Health Organization, World Meteorological Organization, United Nations Environment Programme, International Commission on Non-Ionizing Radiation Protection. Global solar UV index: a practical guide. Geneva, Switzerland: WHO; 2002 Available from: http://www.unep.org/pdf/Solar_Index_Guide.pdf.
  16. Hayes S, Cafaro TA, Boguslawska PJ, Kamma-Lorger CS, Boote C, Harris J, et al. The effect of vitamin C deficiency and chronic ultraviolet-B exposure on corneal ultrastructure: a preliminary investigation. Mol Vis 2011;17:3107-15 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22171156].
  17. 17.0 17.1 Wlodarczyk J, Whyte P, Cockrum P, Taylor H. Pterygium in Australia: a cost of illness study. Clin Experiment Ophthalmol 2001 Dec;29(6):370-5 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11778806].
  18. 18.0 18.1 Sasaki H, Sakamoto Y, Schnider C, Fujita N, Hatsusaka N, Sliney DH, et al. UV-B exposure to the eye depending on solar altitude. Eye Contact Lens 2011 Jul;37(4):191-5 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21670696].
  19. 19.0 19.1 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 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12657585].
  20. Sliney DH. Exposure geometry and spectral environment determine photobiological effects on the human eye. Photochem Photobiol 2005 May;81(3):483-9 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15755194].
  21. Coroneo MT. Albedo concentration in the anterior eye: a phenomenon that locates some solar diseases. Ophthalmic Surg 1990 Jan;21(1):60-6 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/2325997].
  22. Merriam JC. The concentration of light in the human lens. Trans Am Ophthalmol Soc 1996;94:803-918 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/8981716].
  23. Taylor HR. The biological effects of UV-B on the eye. Photochem Photobiol 1989 Oct;50(4):489-92 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/2687903].
  24. 24.0 24.1 24.2 24.3 Joint Standards Australia/Standards New Zealand technical committee CS-053, Sunglasses. Australian Standard Sunglasses and Fashion Spectacles. Sydney, Wellington: Standards Australia, Standards New Zealand; 2003 Apr 10. Report No.: AS/NZS 1067:2003. Available from: http://www.saiglobal.com/pdftemp/previews/osh/as/as1000/1000/1067.pdf.
  25. Whiteman DC, Whiteman CA, Green AC. Childhood sun exposure as a risk factor for melanoma: a systematic review of epidemiologic studies. Cancer Causes Control 2001 Jan;12(1):69-82 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11227927].
  26. 26.0 26.1 Standards Australia committee SF/6, Eye protection. Australian Standard Filters for eye protectors - Filters for protection against radiation generated in welding and allied operations. Sydney, Wellington: Standards Australia, Standards New Zealand; 1992 Nov 16. Report No.: AS/NZS 1338.1:1992.

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