Too much fun in the sun can cause eye damage

By Ray Segebrecht

McClatchy Newspapers

(MCT)

KANSAS CITY, Mo. — At 5 p.m., as Jose Vega uncaps a tiny, $100 tube of ointment, he thinks of work. As a chef at Jabinero's, he should already be spreading ingredients — onions, peppers, meats — across the restaurant stovetop. But instead, he spreading ointment over two rows of stitches in his eyes, and he can't come close to that, or any, stove for five more weeks.

That means for another five weeks, his wife Tanya Vega will have to keep the family of five afloat with nonstop nightly shifts at St. Luke's Hospital on top of nursing school classes. Vega, who had his third pterygium — a layer of tissue that grows over the eye, starting at the inside corner — removed last week, has to stay clear from sun and heat that long to recover.

The pterygiums, which Vega got subjecting his eyes to too much sunlight, are just one of many problems the sun can cause in human eyes, said Vega's surgeon Carl Stout, of Discover Vision. Others, he said, vary from a keratitis — a sun burn on the eye — to both a higher risk, and a faster onset, of more serious conditions like cataracts and macular degeneration.

The danger for all eye damage from the sun is significantly greater in the summertime. In summer, people are closer to the sun, and its light is more intense, like when people visit the equator. A number of season activities, such as water sports and games on concrete, only raise that risk by exposing people to reflected light, too.

But unfortunately, a lack of awareness on the harm of sunlight to eyes, and what people need for full protection, is also great, Strout said. As a result, doctors are trying to educate their patients in each exam, and nationally, the American Academy of Ophthalmology has recognized July as UV Safety Awareness Month.

"It's just one more thing that we can protect ourselves from, if we're a little aware of the problem," said Lee Duffner, AAO correspondent and Hollywood, Fla., ophthalmologist. "If we're totally unaware of the problem, nobody's going to do anything."

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For Vega, the principal problem was a lack of education on personal eye care. As a boy, he played soccer daily with friends in his hometown of Guanaguanto, Mexico, without sunglasses. Later, as a young man, he picked broccoli all day on a sunny farm in Soledad, Calif., with his eyes equally unprotected.

All these years, he never knew the potential long-term effects of exposing his eyes to the sun. Eventually, his first pterygium at age 23 was simply his eyes' natural way of saying "enough" and trying to block out any future harmful light on their own.

Before a pterygium, Vega likely had a cinguecula, or an "unsightly thickening" of the membrane, that often effects outdoor workers, like farmers and lifeguards. Then, with more exposure, that thickening worsened into the growths that Stout had to remove. Both pterygiums and cingueculas are more unique in that they are caused by UVA light that that affects the conjunctiva membrane, covering the white part of the eye, Duffner said.

Of the sunlight's three kinds of ultraviolet, or UV, light — UVA, UVB and UVC — only the last two types, common for sunglass labels, enter the atmosphere to be of concern. Most eye problems occur due to UVB light, which has a shorter wavelength that can penetrate the cornea.

Some of these conditions, like keratitis, can develop in a day or afternoon, especially at a pool or lake where water reflects the light. But he risk for most of them, and especially the more serious ones like cataracts, macular degeneration or pterygiums, rises more gradually with light exposure. Like with pterygiums, the damage is cumulative over the course of years.

"The interesting thing about a lot of UV damage that occurs as adults is you don't really see it until adulthood," said optometrist Jason Rogers, of Drs. Hawks, Besler & Rogers in Overland Park, Kan.

Rogers said he always recommends people exercise caution and always wear sunglasses because they often can't properly perceive the level of harm they are doing. The cornea of the eye has more nerve endings than any other part of the body, but the damage often needs to reach the point of a keratitis for people to feel pain.

Even with a keratitis, or sunburned eye, people often can't pinpoint the pain they do feel, Rogers said, because they've been swimming and assume the discomfort is due to chlorine. And if they could, he added, the study of UV damage to eyes hasn't reached a place where they can look back and count their exposure to their current level of risk, like with sunburns, anyway.

"They just don't know the relationship between how much exposure causes retinal damage," Rogers said. "They know it happens, but they don't know how much at this point will do it."

Vega didn't know the sun was to blame for his growths until six years after the first one began to form. As the growth grew inward, he assumed it came from too much television. In Mexico, where his home was smaller, he would always watch TV up-close, and he had seen the eyes of his friends redden with too much time in front of the screen.

But unlike his friends, Vega found his eyes didn't improve when he would leave the TV set. Instead, they began to worsen because, in trying to self-treat by watching TV less, he actually spent more time outdoors. Not until an exam with Dr. Stout in 2005, Vega's first year in Kansas, did he learn that the sun — rather than TV — was the cause.

Now, of course, Vega wishes he could go back and wear sunglasses. He has a big pair that covers the entire area around his eyes, and he wears the lenses every time he leaves the house. Twenty years ago, they could have saved him two costly surgeries, years of eye pain and the current financial hardship for his family. But by now, for Vega, that knowledge came too late.

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Doctors recommend people consider three main factors when buying sunglasses: the lenses, their intended use and the frame. So far, most of the country isn't paying attention.

According to an Eye-Q survey released last month by the American Optometric Association, the majority of Americans prioritize style, comfort or price ahead of protection.

Todd Fletcher, Eye Care Council communications director, said organizations such as his, the American Optometric Association and the American Academy of Ophthalmology have tried to fight this trend. Periodically, he said, they try to raise awareness by releasing information, particularly online.

But he also added, "the doctors actually do most of it through their office when they're talking to patients."

For lenses, Stout said he advises that most important element to have is UV 400 protective coating or, in percentages, lenses that provide 99 to 100 percent UVA and UVB protection. Rogers said that with eyes, all people are at equal risk, so he always gives the same message: unlike with skin cancer, everyone needs the same level of UV protection, regardless of ethnicity or eye color.

"You can look at different ethnic backgrounds and which one has a higher risk for a certain type of skin cancer," Rogers said. "But for eye stuff, it's across the board."

As for lenses with full protection, Stout said people still have a pretty wide range of flexibility. Some who spend a significant amount of their time by water often prefer polarized lenses because they reduce glare off of the water. Others, who need precise vision far away like for driving, pick amber ones because they seem to enhance details at a distance. Stout said he usually suggests a lens that is dark grey — the color of the visors pilots use — because it allows a person to see things as they naturally appear.

Optometrist Melissa Hahn, of Olathe (Kan.) Family Vision, said that, to ensure full protection, people should also be careful that whatever lenses they pick are a large enough size. To be safe, she said they should select both a frame that wraps around the face and lenses that cover the eyes and the surrounding skin and eyelids completely.

If they don't, Rogers said people can actually develop skin cancers around their eyes and on their eyelids. On the eyelid, he said, a skin cancer can be much worse that it would be elsewhere because the skin is so thin. Often, removing the cancer requires major reconstructive surgery.

"We're seeing a lot of skin cancers called basil cell carcinomas," he said. "It's pretty common."

In terms of cost, Rogers warned that price stickers can often be misleading. Frequently, he said, people will pick out an expensive designer pair they like and assume their paying for the best lenses for their eyes. But really they're often just paying for the frame and good optics, or clarity, in the lenses. The harmful UVA and UVB rays still pass through to the eyes.

"We have a UV meter in our office, and we'll have patients bring in their lenses," Rogers said. "A lot of them don't have full coverage at all."

On the contrary, Stout said people can pick up a perfectly adequate pair of sunglasses pretty cheaply. Most Wal-Mart, CVS Pharmacy, Costco and Sam's Club stores, he said, have inexpensive pairs with ample UV protection.

"Any optometric or ophthalmologic facility that sells glasses," he also added, "will have it for sure."

Next, Hahn said, people just need to be equally careful in wearing their sunglasses as in shopping for them.

"They should be worn year round," she said, "because the snow often reflects just as bad as water in the summer."

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In summer, doctors say kids are usually the ones who go outside most often without sunglasses.

"This time of year, they tend to be outside a fair amount more than adults," Rogers said, of all children. "And most of that time is by pools, where 50 percent of light comes from reflective surfaces."

They are also the most vulnerable to damage from the sun. Under the age of 10, Rogers said, kids can have eyes that allow as much as 75 percent of UV light to pass through to the back of their eye. By age 25, the eyes become less translucent, letting only 10 percent of light penetrate.

"The natural lens that's inside the eye," Rogers said, "in kids, it's super clear, so clear they don't seem to be bothered as much by light and glare." But early on when their lens is clear is when they especially need to keep their eyes protected, he added. "Because their lens is so clear," he said, "they get more exposure."

To protect themselves, children should always wear sunglasses, Stout said, and even consider using UV protective goggles while in the water. Hahn said parents should get them started as soon as possible.

"We actually recommend that they start wearing sunglasses even as a child, an infant," Hahn said.

For Jose Vega, the time when he was young and spent what he calls la mayoria del tiempo afuera in Mexico has long passed. He was just a normal boy then who loved to play soccer, a normal kid like thousands of others — in Mexico and here — who love spending summertime outdoors.

But now, in the form of surgeries, Jose Vega paying a steep price for never learning to cover his eyes. The cost of each of the three he has undergone since 1999 has varied from $600 to $900. With each one, he has also had to sacrifice more unpaid work time than most patients like him because cooking requires him to be by a burner and heat that his eyes can't yet handle.

Still, after both eyes and already one repeat because the tissue cut from the top of his right eye didn't take to the side surface as planned, he could someday need more. But by now, Vega isn't sure he would accept that, despite that meaning he could live his whole life with a ball of scar tissue that hurts like debris.

"He's always been the main income. And then, to lose that main income, it's been tough," said Tanya, who now often works 7 p.m. to 7 a.m. and then attends her nursing school classes from 8 a.m. to 1 p.m. before another night shift.

Vega is supposed to spend two full months off work, but he has decided to only take six weeks to relieve his wife, Tanya, sooner. Two weeks before he starts, he says, his kids will return home from their summer in Mexico to three new pairs of 100 percent UV protective sunglasses, waiting for them to wear.

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WHEN BUYING SUNGLASSES, KEEP IN MIND ...

UV protection: Wear only sunglasses that offer UV 400 — or 99 to 100 percent — protection against UVA and UVB rays.

Frames: Choose a pair that wraps around your eyes to block light from the sides. Pick one with lenses large enough to cover your eyelids and the skin around your eyes, too, to protect against skin cancer.

Function: Some people who spend a significant amount of their time by the water often prefer polarized lenses because they reduce glare off of the water. Others, who need precise vision far away, as for driving, pick amber ones because they seem to enhance details at a distance. Lens that are dark gray — the color of the visors pilots use — allow a person to see things as they naturally appear.

Brand: Don't pick out an expensive designer pair and assume you are paying for the best lenses for your eyes. Often, you're just paying for the frame and good optics, or clarity, in the lenses. Harmful UVA and UVB rays can still pass through to the eyes. Any optometric or ophthalmologic facility and most stores such as Walmart, CVS Pharmacy, Costco and Sam's Club offer sunglasses with full UV protection.

Lens color: A darker lens does not necessarily mean a more protective lens. Read the UV protection label.

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UV-WHAT?

The different kinds of ultraviolet — or UV — light rays:

UVA: Long wavelength

—Harm the membrane covering the white part of the eye.

—Can cause a cinguecula, or a thickening of the membrane, and eventually pterygiums, or growths.

UVB: Shorter wavelength

—Penetrate the cornea, or middle, of the eye.

—Can cause short-term problems like a keratitis, or sunburn, on the eye.

—Can lead to a higher risk, and faster onset, for long-term conditions such as cataracts and macular degeneration.

UVC: Shortest wavelength

—Don't penetrate the atmosphere and aren't a concern.

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Sources: Carl Stout, ophthalmologist of Discover Vision Centers, Dr. Jason Rogers, optometrist of Drs. Hawks, Besler & Rogers in Overland Park, Kan.; Lee Duffner, ophthalmologist and correspondent for the American Academy of Ophthalmology, and Carl Stout, ophthalmologist of Discover Vision Centers.

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