Every morning, ophthalmologist Dr. Susan Sarangapani undoubtedly does two things: She applies SPF50 sunscreen to her face, arms and hands, then puts on a pair of sunglasses.
While the sunscreen isn’t too surprising, perhaps the glasses are.
Yet she wears it for the same reason: to protect herself, but here specifically her eyes, from the sun’s ultraviolet (UV) rays.
Plus, she says, she’ll wear them outdoors all year round, whether it’s sunny or cloudy.
‘What people don’t realize is that eyes are ten times more sensitive to the sun’s harmful UV rays than the skin,’ says Dr Sarangapani, consultant surgeon at Luton and Dunstable Hospital NHS Foundation Trust and the private OCL eye clinic in London . ‘And not protecting it can lead to problems – from excessive blinking due to light sensitivity to serious long-term conditions that can cause vision loss.’
‘What people don’t realize is that eyes are ten times more sensitive to the sun’s harmful UV rays than the skin,’ says Dr Sarangapani
These include age-related macular degeneration (AMD), where the cumulative effects of UV exposure contribute to the deterioration of the middle part of vision – and cataracts, where the lens of the eye becomes cloudy.
‘The rays can also increase the risk of cancer, both on the delicate skin of the eyelid and on the eyeball itself,’ adds Dr Sarangapani.
Even though we all know there’s a risk of skin cancer, “people are still shocked when I tell them to wear UV-blocking sunglasses whether it’s a warm, sunny day or not,” she says.
Much of what we know about this comes from Australia, which has spent years researching the effects of sun damage due to its high year-round UV levels, and is decades ahead of us when it comes to its impact on health of the eyes. .
In 2007, the Australian Cancer Council added the words ‘seek’ and ‘slide’ (seek shade and put on sunglasses) to its famous ‘Slip, Slop, Slap’ campaign, launched in the 1980s to address the unfortunate position of Australia to tackle the world’s highest rates of skin cancer. The decision was made following research by renowned Australian ophthalmologists, Professors Hugh Taylor and Paul Mitchell, in the 1990s.
“They collaborated with the Melbourne Visual Impairment project and the Blue Mountains Eye study – population-based studies into the prevalence, severity and progression of common eye conditions (such as cataract, glaucoma and AMD),” says David Mackey, professor of ophthalmology at the University of Western Australia.
Professor Taylor had also done research in Australia on sunlight and eye diseases, which showed that indigenous Australians who lived closer to the equator were more likely to have cataracts and pterygium, when lesions appear on the white of the eye, and that is also linked to an increased risk. of skin cancer.
Another study, published in 1989, which looked at the effect of sun exposure on fishermen in the US Chesapeake Bay over time, found a link between their exposure to UV radiation and the development of cataracts, pterygium and skin cancer.
This insight is especially important for children, whose eyes are at greater risk of UV damage. With larger pupils and clearer lenses, up to 70 percent more UV radiation reaches the retina than in an adult’s eye, thanks to younger and healthier eyes.
This has led to a situation in Australia where eye protection is considered as important as skin protection – the impact of which can be seen in a 2021 study published by Professor Mackey and his team on the effectiveness of the sun protection campaign since the introduction of sunglasses – from here showed that the number of operations for pterygium is declining, with a drop of 47 percent nationally, says Professor Mackey.
Every morning, ophthalmologist Dr. Susan Sarangapani undoubtedly does two things: She applies SPF50 sunscreen to her face, arms and hands – and then puts on a pair of sunglasses.
“I definitely practice what I preach and wear a hat and sunglasses for eight months of the year when the UV rays are strongest.”
However, in Britain we still seem worryingly ignorant about these risks, experts say.
Dr. Paramdeep Bilkhu, clinical advisor to the College of Optometrists, says: ‘Some people still think it needs to be warm for high UV levels – this isn’t entirely true as the levels you are exposed to also depend on altitude and reflective radiation. surfaces, such as water, against which the rays collide.
“The sky doesn’t have to be cloudless either,” he adds. ‘UV rays can penetrate clouds. The UV risk to eye health is real, even outside the summer months.’
The intensity of the sun is measured by the UV index, usually shown in weather broadcasts or available on the Met Office website based on your location. This index is rated from 1, ‘low’, to 11+, ‘very high’ – but anything above 3 (graded as ‘moderate’) can cause damage, so wear sunglasses.
‘While we protect our skin from these rays with clothing or sunscreen, our eyes are constantly exposed,’ says Dr Bilkhu.
‘Also, as with skin tones, lighter eye colors such as blue are more sensitive to UV damage than brown because they have less pigment to absorb the rays.’
There are two types of harmful rays: UVA and UVB.
‘UVA rays pass through the front of the eye to the lens, and there is a possible link between UVA exposure and macular degeneration and uveal (that is, eye) melanoma,’ says Dr Bilkhu.
‘UVB rays carry more energy and are absorbed by the cornea (the clear part at the front of the eye) and exposure can lead to sunburn in the eyes.
‘This often happens within hours of exposure and can be painful, cause red, light-sensitive and watery eyes and blur your vision,’ says Dr Bilkhu.
‘Luckily it’s usually temporary and anti-inflammatory eye drops can help.’
But long-term exposure to UVB can cause damage to cell DNA, increasing the risk of cancer, adds Dr. Sarangapani.
This can affect the eyelid, where the skin is thinnest and particularly vulnerable, or on the eyeball itself, although this is rare (around 851 cases are diagnosed in Britain each year).
Uveal melanoma is the most common form of eyeball cancer and affects the uvea – the middle layer that covers the iris – and can be fatal. Symptoms include a change in the size or shape of the pupil, blurred vision, or pain in the eye. “Unfortunately, this can result in removal of the eyeball,” says Dr. Sarangapani.
“A simple way to prevent this is to wear UV-blocking sunglasses,” she adds. ‘I wear them all year round, but advise patients to wear them at least from mid-March to mid-October.
‘Also protect children the most: babies under six months should be kept completely out of direct sunlight. From six months, babies can wear a type of glasses that sit on an elastic band so that they cannot take them off. From the age of five they can wear normal sunglasses.
When you wear them during the day is also important.
‘For skin protection, the advice is to avoid the sun from 11am to 3pm, when the UV intensity is strongest,’ says Dr Bilkhu.
‘But with sunglasses it is important to wear them early in the morning and late at night. This is when the sun is lower in the sky and your eyes can be blinded by the glare, meaning they are hit by UV rays.’
But you also need to wear the right sunglasses.
‘The easiest way to get this right is to see your optician for advice,’ says Dr Bilkhu, who wears sunglasses when UV levels are high or the sun is low in the sky, regardless the time of year.
Otherwise, there are simple rules to follow.
First look for the European standard CE or UKCA mark. This means that the lenses meet health and safety standards that ensure they protect against UV light.
Second, don’t assume that a darker lens (or even a higher price) will provide a higher level of UV protection.
‘The darkness of the lens has nothing to do with UV protection, the tint simply reduces the brightness of visible light reaching your eyes,’ says Dr Bilkhu.
If you wear prescription glasses, you can choose photochromic lenses with UV protection, or you can use clip-on or flip-up sunglass lenses. Contact lens wearers should choose products with UV filters. ‘However, these only protect the cornea and prevent UV from entering the eye through the pupil. They do not protect the exposed areas of the eyeball or surrounding skin, so an extra pair of sunglasses is important,” says Dr Bilkhu.
“Wearing sunglasses regularly is very simple and can prevent future avoidable vision loss,” says Dr. Sarangapani.
“If my colleagues in Australia, who have been researching this topic for decades, emphasize its importance, then we should do the same.”