Last month, we were privileged to have optometrist Dr. Tammy Wittmann join us for a webinar about protecting our kids' eyes. If you missed it, check out this article by Dr. Wittmann, or AMP members can watch the recorded webinar today! You'll learn:
- What is UV exposure?
- How does it cause damage in and around the eye?
- How does it affect our students in marching band?
- What can we do about it?
- How can we make it "cool" for students to protect their eyes?
This is a subject that is really close to my heart. It combines 2 of my passions: the performing arts and ocular health. Many of you already know I grew up in the performance arts. I started twirling baton when I was 7 and was member of the national championship twirling team, "The Linda Thomas All Stars." When I reached high school, not only did I twirl in marching band, but I also started spinning flags, rifles and sabers with my high school winter guard. The summers before and after my senior year I marched in drum corps: first with Florida Vanguard (who later became Florida Wave) and then with Spirit of Atlanta. Just a few short years later I also was a member of Pride of Cincinnati Winter Guard. Needless to say, these activities plus growing up in Florida exposed me to the sun quite often for long hours at a time.
In this article, I am going to explain what UV exposure is and how it causes damage in and around the eye. I want to bring it to your world and tell you specifically how it affects our students in marching band. I want you to know there are things we can do about it. And because image is HUGE at their age, I want to show you how we can make it cool for our students to protect their eyes.
I want tell you about a patient of mine. For our purposes tonight we will call him "Jimmy." Jimmy is 32 years old. He spent all of his high school years performing in marching band. He was a trumpet player and really enjoyed the performing arts. He went off to college and was in the marching band there as well. In addition to his marching band experience, he loved outdoor activities. He was not a consistent sunglass wearer.
Fast forward to April 2013. Remember, he is only 32 years old. He comes to me for a comprehensive eye exam. He is not having any vision problems and only came in because his wife is a patient of mine and thought maybe he should have his eyes checked because he had never had an eye exam. He'd had screenings in school and at his doctor's office, but that was it.
The exam went very smoothly. His vision was 20/15 in each eye uncorrected and he had no near vision strain. Upon looking inside his eyes with digital retinal photography, it was very apparent that there was a problem. In his macula, which is where your central vision occurs, there were white deposits. These deposits are signs of macular degeneration. This is a disease that breaks down the macula, which is your central vision. We used to call this disease age-rlated macular degeneration, because we never saw this disease in younger patients. WE DO NOW. Unfortunately, he is not alone.
I have another patient who we shall call Sarah. Sarah is 53 years old. She came in to see me for her routine eye examination. She wears glasses but had not had an exam for about 5 years. Her exam was pretty routine...until I dilated her eyes. In her right eye I saw a large mass in her peripheral retina. It turned out to be malignant melanoma. If you don't know, malignant melanoma is the deadly form of skin cancer. I sent her to a specialist and last I heard she was in Methodist Hospital having radiation on her eye hoping to save her eye.
Before we go any further, you need to understand that both of these conditions can be, and in these patients cases most likely were, caused by a lifetime of UV exposure. I have found that most patients are aware of what UV radiation can do to the skin but very few are aware of what UV radiation can and does do to the eye...not just externally but internally as well.
Another thing is I have found that kids either don't think that sunwear is cool or they feel that it will impede their performance, so they don't wear it.
As parents, we need to take control of this just like we would insist our kids wear seatbelts. I know, you're thinking, "Come on...not wearing sunglasses isn't putting their lives in danger!" However, it can because remember that ultraviolet radiation (UVR) from sun exposure is linked to deadly melanoma in the eye.
Also, imagine a life without vision.
A few statistics:
- Almost 50% of parents report that their children "seldom" or "never" wear sunglasses with 100% UV protection.
- Although 82% of parents feel it's important for children to wear sunglasses and 91% feel sunscreen should be worn, children are two times more likely to wear sunscreen than they are sunglasses.
- The lens in a child's eye does not block as much UV radiation as in an adult's eye, putting them at increased risk for sun damage to the eyes.
- Certain medications such as antidepressants, tetracyclines, sulfa drugs, NSAIDs and birth control pills are just some of the medications that increase your risk to eye disease.
WHAT IS UV RADIATION?
There are 3 types of UV Radiation...most of us have heard of UVA and UVB but there is also UVC.
Let's start with UVB. It's easy to remember UVB because it is associated with Burn, as in sunburn.
UVA is associated with Aging of tissues and enhances the affects of UVB. Most of UVC is absorbed by the atmosphere.
It's probably pretty obvious how direct sunlight can be damaging, however most people don't think about reflected light. Surfaces like snow, sand, water and pavement reflect much of the UV that reaches them. Because of this, reflection and UV intensity can be deceptively high even in shaded areas.
HOW DOES UV RADIATION DAMAGE THE EYE?
To begin with the external structures of the eye, we all know UV increases wrinkles on and around the eyelids. It also contributes to the sagging of the upper and lower lid skin. But it is also important to note that 5-10% of skin cancers occur on and around the lids. We are certainly seeing more incidence of malignant melanoma on the lids. There is another condition called pterygium, which is basically a fleshy callous type tissue that develops on the white part of the eye. It is trying to protect the eye from the damage of UVR.
Internally, we see cataracts, macular degeneration and malignant melanoma as well. Cataracts and macular degeneration, like that of my patient Jimmy, are occurring at younger ages. And I have yet to tell a patient of any age of the risk of developing malignant melanoma in the eye that already knew this could occur.
Now, about 80% of the damage from UVR that occurs in and around the eye occurs by the age of 18. There are a few reasons for this.
- The pupil size in children is generally much larger than adults, therefor letting more UVR inside the eye.
- The natural filters that occur in the eye aren't developed until that time.
- Kids tend to spend more time outside without eye UV protection than adults.
It has also been shown that the light entering the eye from an angle gets intensified inside the eye and causes more damage in the tissues opposing the entry point of the eye than direct light.
HOW DOES UVR AFFECT OUR STUDENTS IN MARCHING BAND?
Now we are all a little better educated on how UV damages our eyes. I think we all know that our kids are at great risk for early eye disease if they are not protecting their eyes from UVR.
There are a few things to consider. Our kids are out in the sun for many hours on end. This is the obvious exposure, right? We all know that when we are out in the sun we are getting sun exposure. We have also all heard that the worst time to be out in the sun is at the hottest time of day...the hours between 10 and 2 right?
Well, think about reflected light. We get much more reflected light during the other hours. Studies have shown that we actually get more damage from the reflected light between 8 and 10 am and 2 to 4 pm. About 40% of exposure occurs during these non-peak hours. We also get the reflected light when in the shade. And to further complicate things, for those of us who wear glasses and/or sunglasses, we actually get a lot of reflected light off the back side of our glasses, yes even sunglasses as well, especially during these off-peak hours.
So, our children are outside working on their show for hours on end. Many of these hours are during these off-peak times. They may or may not be wearing a hat. The guard probably is not wearing a hat because it inhibits their ability to see tosses. They are still getting reflections from the black top or ground where they are practicing. Not to mention the reflection off of their own and other's instruments. If they are wearing glasses they are getting exposure from the UV radiation bouncing off the back of their glasses and into their eyes.
WHAT CAN WE DO ABOUT IT?
The main objective is to protect our eyes from the damage from UV radiation. Here's what you need to know in a nutshell.
- Your child needs to be wearing sun protection for their eyes.
- The sun wear must have 100% UVA and UVB protection.
- The sun wear must have anti-reflective coating. NOTE: anti-reflective coating INCREASES UV exposure. So if you have sunglasses with AR coating WITHOUT 100% UVA/UVB protection you are INCREASING the damage to the eye.
- Polarized sunglasses are a must for those practicing on a black top. The black top throws off a lot of glare. Polarized lenses cut that glare as well.
- All UV protection is not the same: Inexpensive sunglasses have a sprayed on UV coating. The tag may say 100% UV but because it's sprayed on every time you clean the lenses you are wiping away part of the UV coating.
- Sunglasses without quality 100% UV protections actually causes more harm than not wearing sunglasses at all. The tinted lenses open up the pupils and more harmful rays enter the eye.
- There are really great companies who make quality sport frames and quality lenses that will protect your child's eyes as well as perform great in high humidity conditions. Look for frames that have grippers on the temples and nose pieces so that when the child gets sweaty the glasses won't fall off.
HOW CAN WE MAKE IT COOL FOR OUR KIDS?
Having kids protect their eyes from the sun is not easy. I hear it all the time. "My kid loses his sunglasses." "I don't want raccoon eyes!" "None of the other kids are wearing them."
What can we do? We can get them the right frames that fit their face and will not slide down their noses and fly off their heads. This needs to be view like any other protective sports gear. These are protecting their eyes.