FINDING YOUR SHADES, PROTECTING YOUR VISION

FINDING YOUR SHADES, PROTECTING YOUR VISION

Introduction They fall under car seats. They’re left behind in parks and shopping malls. Or even worse, they’re misplaced at home, never even making it out the door to safeguard eyes from the sun’s harmful ultraviolet (UV) rays. More than 55 percent of adults in the United States lose or break sunglasses every year. There’s actually good news within this statistic: These are the people trying to protect their eyes by wearing sunglasses. The bad news is that 27 percent of Americans don’t wear sunglasses at all.1 Every day, they put their eyes at risk for serious vision disorders from exposure to ultraviolet radiation. When it comes to the human eye and the sun’s rays, it’s what we can’t see that matters most. The UV radiation that reaches the Earth’s surface—made up of two types of invisible rays, UVA and UVB—endangers an unprotected eye in ways that can lead to vision impairment. Short-term exposure can leave the eyes bloodshot, swollen or hyper-sensitive to light. The effects of longer-term exposure can include cataracts, macular degeneration, abnormal growths on the eye’s surface and even cancer of the eye. Children especially should be protected anytime they’re outside since the lens in their eye doesn’t block as much UV light as the lens in an adult’s mature eye. While everyone should shield their eyes from UV rays, certain risk factors like age and eye color increase an individual’s vulnerability to UV-related eye disorders. Where you live or travel can also make a big difference in the level of UV exposure. Since UV damage can’t be

From my years of professional experience, as well as from a painful episode of snow blindness I suffered as a teen-aged skier, I know all too well how much UV exposure can hurt the eye. Sometimes the injury is short-lived, but too often it’s not. And too often it’s because someone was unaware of the risks. The Vision Council wants to get the word out; we want to help adults and children alike protect their eyes from solar radiation. We hope that you find this report useful—and that you enjoy a lifetime of good vision. –Scott MacGuffie Chairperson, Sunglass and Reader Division of The Vision Council

reversed, prevention through protection is key. This report, sponsored by The Vision Council as part of its Bureau of Missing Sunglasses initiative, is intended to spread the message: Sunglasses are absolutely critical for keeping vision safe from UV damage. But they’re of little help if they’re missing in action. About The Vision Council: Serving as the global voice for vision care products and services, The Vision Council represents the manufacturers and suppliers of the optical industry through education, advocacy and consumer outreach. By sharing the latest in eyewear trends, advances in technology and advice from eyewear experts, The Vision Council serves as a resource to the public looking to learn more about options in eyeglasses and sunglasses.

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FINDING YOUR SHADES, PROTECTING YOUR VISION

What You Don’t See Can Hurt You The sun’s UV rays are invisible to the human eye but certainly not harmless. They can penetrate to the eye’s internal structures and cause both temporary and permanent damage. Injury can occur at any age, but UV’s greatest impact happens over time, with too much cumulative exposure leading to abnormal growths and disease that can seriously impair vision. The solution is to protect your eyes from exposure early in life and then to keep protecting them for the rest of your life. Sunglasses that specifically block both UVA and UVB rays are essential.

Short-Term Problems In the aftermath of a long, sunny day at the beach, people frequently notice how their eyes seem bloodshot, swollen or hyper-sensitive to light. Even just several hours of intense, unprotected exposure to UV radiation can cause a variety of short-term problems, ranging from irritating to painful. The most extreme of these problems is photokeratitis, which essentially is sunburn of the eye. It’s also known as “snow blindness,” although a ski slope in winter isn’t the only place that reflected UV rays can sharply increase the risk to unprotected eyes. The condition can be quite painful and can result in a loss of vision for 24 to 48 hours.2

Long-Term Problems The most common complications include: • Pterygium, or “surfer’s eye,” an abnormal but typically benign growth on the eye’s surface (most times originating in the corner of the eye near the nose). Pterygium is linked to excessive exposure to sun, wind and sand. It can cause irritation, swelling and itchiness as well as corneal problems that can affect vision. And while it can be removed surgically, it also can recur. • Cataract, a progressive clouding of the lens of the eye and a main cause globally of reversible blindness. Studies have shown that UV harms the lens and accelerates deterioration that leads to age-related cataract. Worldwide, 18 million people are blind because of cataracts, and the World Health Organization (WHO) cites UV exposure in as many as five percent of those cases.3 Nearly 3 million surgeries to remove cataracts are done in the United States annually.

The range of energy that makes up visible light is just a portion of the electromagnetic spectrum. UV radiation falls within an equally narrow band on the lower part of that spectrum. Two types of UV rays reach the Earth’s surface, and it is now generally accepted that ultraviolet A (UVA) and ultraviolet B (UVB) can burn the skin, cause skin cancer and damage the eyes. Eye protection and sunscreen should be capable of blocking both.

• Age-related macular degeneration (AMD), a major cause of vision loss in older people that may result from prolonged UV exposure. The macula sits at the back of the eye, in the middle of the retina, where it focuses sharp, clear central vision. Damage to nerve cells there blurs fine detail and dulls colors in the center field of vision. Smoking, obesity, genetics and other factors also are risks associated with AMD.4 The disease is progressive and often irreversible. • Cancer of the eye, eyelid and surrounding skin. Although cancer of the eye is relatively rare, skin cancers of the area surrounding the eye is not. According to The Skin Cancer Foundation, a tenth of all skin cancers are found on the eyelid. Most are diagnosed as basal cell carcinoma, which can spread to the eye and adjacent tissue.5 missingsunglasses.com

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FINDING YOUR SHADES, PROTECTING YOUR VISION

Assessing Your Own UV Risk Age, eye color and skin complexion. Geography, the season and time of day. All these are details that factor into a person’s potential UV exposure—and risk of eye damage. •

Age can play a part in the UV risk for young and old alike. oo Children receive three times the annual sun exposure of adults6, and research has shown that their young eyes are especially susceptible to UV-related harm. Unlike the mature lens of an adult eye, a child’s lens cannot filter out UV rays and so more radiation reaches the retina.7 oo Decades of sun exposure make older eyes much more prone to visual problems and disease from the cumulative damage of UV radiation. Decreased concentrations of protective molecules in the eye, also related to age, may be implicated, too.8

•

•

•

Eye color appears to be important, with studies suggesting that blue eyes are at more risk for UV damage than brown eyes. The protective pigment melanin may be the key reason—blue irises have less of it. Research has shown a higher incidence of agerelated macular degeneration may be one consequence.9 Skin complexion may reduce some people’s risk of sunburn but has no effect on eye damage. According to the WHO, darker skin affords no greater defense to eyes against UV harm. Geography influences UV levels in sometimes complicated ways. oo In the United States, southern communities tend to receive more intense solar rays than northern ones. But elevation can make a difference, since the thinner atmosphere at higher altitudes can’t absorb as much radiation. (See page 6 for a look at UV intensity in specific locations across the country.) oo Surroundings affect exposure, too. At the beach, sand or water can reflect up to 25 percent of UV; on a snow-covered surface, as much as 80 percent of UV may be reflected, adding to the initial exposure.10

•

The season and time of day affect UV intensity in virtually any area. In the United States, UV levels are highest during summer months, especially between 10 a.m. and 4 p.m.

A Mother’s View Who’s the fairest of them all? As a kid, I was. It seemed like all it took was five minutes outdoors, and I’d be nursing blistering skin and puffy, burnt eyes for a week. Now that I’m a mom, I am much more careful to protect my daughter’s eyes—and my own—to set a good example for what I hope is a lifelong habit. Eighteen-month-old Charlotte already has several pairs of sunglasses. Her favorite pair is covered with flowers that match a rufflebrimmed hat. I joke that she’s trying to give the paparazzi the slip. No autographs, please! The reality is no joke. The same way that I buckle Charlotte into her car seat for safety, I put on her sunglasses to keep her eyes safe when we’re outside. Given her age, I admit that I often have to put them on again and again and again. But they’ve been non-negotiable ever since I learned that the younger the eyes are, the more vulnerable they are to the sun’s harmful effects. More pediatricians should talk to parents about UV exposure and vision during routine check-ups. More parents need to know the dangers. They have to understand that sunglasses and hats are as essential as sunscreen for children. To paraphrase the 1980s rock band Timbuck3, the future’s so bright, they’ve gotta wear shades! Bryanna MacAdams Bensalem, Pennsylvania

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Any UV risk profile should also consider personal behavior, and that may be as particular as the age of the individual. For example: Children tend to spend significant time outside, whether playing during school recess, for fun on weekends or as part of organized sports teams. Given the greater vulnerability of their eyes, sunglasses should be as much a part of their outdoor gear as balls and bikes. Teenagers often increase their UV exposure through sports, tanning or, as part of that enduring rite of passage, driving. While they might not be hip to wearing sunglasses for their protective qualities, trendy styles can help make the case. Adults may forget to be vigilant as weekend sports warriors, thinking that such intermittent exposure doesn’t amount to much, or may purposefully avoid sunglasses out of vanity. While most adults reported in a recent survey from The Vision Council that they wear sunglasses, only 17 percent do so while playing sports.11 Less than half of those surveyed recognized the health benefits of sunglasses in helping to prevent sunburned eyes, cataracts and age-related macular degeneration.

So, Why Risk It? What reasons, if any, prevent you from protecting your eyes and the skin around your eyes from the sun’s ultraviolet (UV) rays?

16.4% More than 20% of respondants do not believe that they are at risk from sun exposure. More than 10% don’t think it’s important enough to even bother wearing sunglasses.

It’s inconvenient

48.8%

13.9%

Forget to wear sunglasses

I lose or break sunglasses easily

20.2%

I am not at risk from sun exposure

5.8% It’s too costly

10.8%

It’s not important to me

The Vision Council 2012 Consumer Sunglass Study

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FINDING YOUR SHADES, PROTECTING YOUR VISION

Sunny, With An Increasing Chance Of UV Given the role that geography plays in ultraviolet intensity, the Environmental Protection Agency and National Weather Service offer UV projections for nearly five dozen cities across the United States and Puerto Rico. Their UV Index represents the amount of eye- and skin-damaging radiation expected to reach the Earth’s surface at the time when the sun is highest in the sky. The calculation takes into account seasons, climatic conditions and the concentration of stratospheric ozone, all of which can make a difference in ultraviolet exposure. The higher the index, the greater the dose rate of damaging UV radiation.12 At missingsunglasses.com, ZIP code-specific forecasts are available daily. The map here shows the “top 25” among the monitored cities—those that in 2011 saw the most days of very high or extreme risk from unprotected sun. Every community except one had an increase in risk from the previous year.

25

24

23

18

20

15 9

11

10

17 22

21

19

16

13

8

6

14

12

5 4

7

2

Rank

City

3

Total Days of Extreme and Very High Risk

% Annually

Rank

City

1

Total Days of Extreme and Very High Risk

% Annually

1

San Juan, PR

287

78.63%

14

Atlanta, GA

151

41.37%

2

Honolulu, HI

251

68.77%

15

Las Vegas, NV

140

38.36%

3

Miami, FL

223

61.10%

16

Dallas, TX

133

36.44%

4

Tampa Bay, FL

202

55.34%

17

Raleigh, NC

122

33.42%

5

Mobile, AL

183

50.14%

18

Denver, CO

120

32.88%

6

New Orleans, LA

182

49.86%

19

Memphis, TN

118

32.33%

7

Jacksonville, FL

179

49.04%

20

Norfolk, VA

118

32.33%

8

Houston, TX

171

46.85%

21

Little Rock, AR

117

32.05%

9

Albuquerque, NM

171

46.85%

22

Oklahoma City, OK

116

31.78%

10

Phoenix, AZ

164

44.93%

23

San Francisco, CA

114

31.23%

11

Los Angeles, CA

160

43.84%

24

Salt Lake City, UT

109

29.86%

12

Charleston, SC

158

43.29%

25

Cheyenne, WY

107

29.32%

13

Jackson, MS

157

43.01%

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FINDING YOUR SHADES, PROTECTING YOUR VISION

A Doctor’s View

Findings From Our 2012 Sunglasses Survey

Patients have given me many and varied excuses over the years as to why they don’t wear sunglasses, but I’ve yet to hear any that outweighed the benefit of protecting their eyes. Quite simply, sunglasses are the best defense we have against UV damage to vision. Just be sure the lenses block both UVA and UVB rays.

As part of its Bureau of Missing Sunglasses initiative, The Vision Council polled 10,000 adults from across the United States about their knowledge and use of sunglasses. Their answers signaled growing recognition of UV risks and eye safety as well as some distressingly persistent gaps in awareness.

As an ophthalmologist in southern California, I’ve seen firsthand the painful and sometimes devastating consequences of unprotected UV eye exposure. In my practice especially, I have seen many teenagers and young adults affected by the irritation and pain associated with pterygium, also known as “surfer’s eye.” I tell them how this noncancerous growth can be removed surgically—but can also grow back, especially if they neglect to use adequate UV protection in the future. It’s hard for people to grasp the true impact of UV exposure since we’re talking primarily about its cumulative effect. Conditions like cataracts don’t follow a single unprotected day at the pool. Add on the ski trip when you left your goggles behind at home, the quick trips to the store on those cloudy days when sunglasses didn’t seem necessary, and certainly all the summers spent playing outside as a kid. I’d like to think I lead by example because I always wear my sunglasses. I take care of them and keep them close because I need them to take care of my eyes. Because here’s the bottom line: For all the advances we’ve made in correcting and saving vision, we’re still challenged when dealing with the problems caused by UV. So with a bit of apology to Ben Franklin, I stress, “An ounce of UV prevention is worth a pound of an uncertain cure.” Paul E. Michelson, MD La Jolla, California Chairperson, Better Vision Institute

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For example, barely one in six respondents cited health dangers as the reason for wearing sunglasses (compared to nearly two-thirds who listed glare). Twenty percent of respondents believe they’re not at risk from sun exposure. Among the survey’s other findings: To protect eyes and the skin around eyes from the sun’s ultraviolet rays, respondents: • • • • •

Use sunscreen (38.6%) Wear a hat (33.0%) Use sunglasses (73.1%) Stay in the shade (23.6%) Don’t use any protection (12.3%)

To protect their children’s eyes and adjacent skin, respondents have their children: • • • • •

Use sunscreen (66.6%) Wear a hat (48.1%) Use sunglasses (58.2%) Stay in the shade (33.4%) Don’t use any protection (11.0%)

When asked about the health effects of unprotected UV exposure, respondents answered: • • • • • •

Sunburned skin (63.6%) Sunburned eyes (45.8%) Skin cancer (72.9%) Cataracts (40.1%) Age-related macular degeneration (43.9%) No health impact (11.0%)

While the car ranked as the top spot where lost sunglasses have turned up in the past, the range of locations was impressive. In other answers from the home front, respondents confessed to finding their sunglasses buried between sofa cushions, cooling in refrigerators, hidden in diaper bags, left behind in bathrooms, and even dumped in … the garbage.

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The Best Sunglasses for You The Bureau of Missing Sunglasses checked with leading authorities to highlight the details you should keep in mind when picking shades. For maximum performance, remember that use should be every bit as important as cosmetic appeal. The options described here are available in non-prescription and prescription lenses. Want more information? Visit The Vision Council’s Bureau of Missing Sunglasses website at missingsunglasses.com. For information on eyewear trends or styles that would best fit your face shape, visit eyecessorize.com.

Crucial Considerations Buy from a reputable retailer. They’ll meet frame and lens safety criteria set by the American National Standards Institute. Insist on protection from UVA and UVB rays since both can damage vision. Go for comfort. Sunglasses that don’t feel right are less likely to get worn. Think about your activities. Some lenses and frames are better suited to certain types of sports or work. Select a lens color that improves clarity and reduces glare. Different colors and tints work in different ways. Pick a design that works best for you. Wraparound glasses or glasses with larger temple pieces help block the sun from side angles.

Leading Lenses Photochromic lenses automatically darken and lighten when exposed to sunlight to provide the right level of protection and comfort over a wide range of light conditions. Anti-reflective lenses dramatically reduce distracting reflections, improving contrast, visual acuity and comfort in difficult lighting situations. Mirror-coated lenses reflect light across a wide spectrum, including infra red or heat rays. Polarized lenses work exceptionally well to filter out reflected glare from shiny surfaces like water, pavement and dashboards, improving contrast and visibility while reducing squinting. Impact-resistant lenses are a must for high-impact or competitive sport use. In addition to polycarbonate, new lens materials such as polyurethane and Trivex® bring new performance options. All sunglasses in the United States must meet federal impact requirements. Scratch-resistant lenses increase durability and minimize abrasions.

Top Tints Solid tinted lenses are evenly tinted across the entire lens to cut glare from all directions. Gradient-tinted lenses are darker at the top and lighter at the bottom to cut overhead glare and provide clearer vision when looking straight ahead or down. Double-gradient lenses are darker at the top and bottom and lighter in the center to cut overhead and reflected glare from the ground while providing clearer vision straight ahead. Brown/amber/copper lenses are tints that reduce glare and improve contrast and visibility for selectively filtering blue light—great for golfing, water and snow sports. Gray/green-gray lenses are general purpose tints that reduce glare while maintaining natural colors, making them the most popular for driving because the eyes won’t tire as much. Yellow/rose lenses enhance contrast and definition, especially in lower-light conditions such as fog and haze.

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FINDING YOUR SHADES, PROTECTING YOUR VISION

The Myths and Truths of Sunglasses MYTH: There’s so much conflicting information that it is hard to know what to believe about eye health. MYTH: The eye is no more vulnerable to solar UV than other parts of the body.

MYTH: Summer is the only season when UV rays are a real concern.

MYTH: Darker sunglasses block more UV.

MYTH: Sunglasses with UV protection cost more.

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TRUTH: Studies have shown conclusively that UV damages the eye and that wearing protective eyewear lessens the risk for lasting harm. TRUTH: More than any organ but skin, the eye can suffer significant injury from the sun. TRUTH: Although UV intensity varies according to the calendar—in this country, rising in the spring and peaking during the summer—solar radiation is present year-round. In the winter, UV rays reflecting off snow can double overall exposure.13

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TRUTH: UV protection has nothing to do with the darkness or color of a lens.14 Dark lenses without adequate UV protection can actually be worse than no sunglasses at all because they cause the eye’s pupil to dilate, which then increases retinal exposure to the unfiltered UV.

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TRUTH: UV protection doesn’t make a pair of sunglasses more expensive; rather, designer frames, specialized lenses and other features are what really affect the price tag.15 Look for sunglasses that offer UVA and UVB protection.

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Conclusion Sunglasses that aren’t worn can’t protect eyes. The Vision Council is bringing this message to cities and towns nationwide this summer through its Bureau of Missing Sunglasses. Nearly 30 million Americans misplace or break their sunglasses each year. Sadly, many of these specs are never found, or the damage is irreparable. The Bureau is an effort to raise awareness and ensure that more adults and children protect their eyes from the sun’s harmful UV rays. The Bureau has tools to remind you to keep eyes shielded from the sun. The smartphone Packlist app helps you plan for travel with a customizable packing list of clothes and items you’ll need to take with you on business trips or vacations to anywhere in the world. A UV indicator widget can be placed on any website or blog to make for easy checking, no matter what a person’s location. The best shades will always look good, feel right and block UV from putting your eyes at risk in the short and long term. So keep yours in a safe, accessible location and then be sure to put them on when you head outside. Let those sunglasses do their job, and you’re that much closer to a lifetime of healthy vision. Go to missingsunglasses.com to check out the Bureau of Missing Sunglasses events in 2012 and tips and tools for keeping your eyes sun safe.

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FINDING YOUR SHADES, PROTECTING YOUR VISION

QUIZ Know Your UV Score Take the quiz to check your UV risk. 1. When outside, do you: (count 1 for always, 2 for sometimes, 3 for never) Wear sunglasses:  always  sometimes  never Put on a hat:  always  sometimes  never Use sunscreen:  always  sometimes  never Seek shade from an umbrella:  always  sometimes  never Reapply sunscreen after swimming:  always  sometimes  never Use your hands to block the sun:  always  sometimes  never 2. Do you live in one of the following states? (add 2 points if you live or have lived in any of the states below) Hawaii

Texas

Florida

Alabama

Louisiana

California

3. Do you live in the following states? (subtract 2 points if you live or have lived in the states below) Washington

Montana

Missouri

Idaho

Kansas

Virginia

Answer the following questions (count 1 point for each correct answer, 2 for each incorrect answer) 4. If you wear UV protection contacts, you still need sunglasses. A. True

B. False

Answer: A Because the eyelid is a frequent site of skin cancer (10 percent of all skin cancers), sunglasses are vital to sun safety.16 5. Window glass does not protect your eyes from both harmful UVA and UVB rays. A. True

B. False

Answer: A UVB rays can’t penetrate glass, but UVA rays can. 6. The sun is weaker on cloudy and overcast days, so your eyes are safe from UV radiation. A. True

B. False

Answer: B Overcast skies still allow 31 percent of solar radiation to reach the Earth. Eyes need protecting on cloudy as well as sunny days.17

Score: 23 or above High Risk: Unprotected exposure to UVA and UVB radiation can lead to serious eye damage and skin cancers. Make sure to practice sun-safe behaviors such as wearing sunglasses and sunscreen year round. Whenever you’re outside, wear sunglasses! 13 to 22 Moderate Risk: Remember that UV damage is cumulative and can’t be repaired, so prevention is crucial. Keep in mind that protecting eyes takes little more than the right pair of sunglasses. Whenever you’re outside, wear sunglasses! 0 to 12 Low Risk: Good job! You practice sun safety and know the facts about UV exposure. But keep it up. Whenever you’re outside, wear sunglasses!

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Endnotes 1 The Vision Council. 2012 Consumer Sunglass Study. 2 U.S. Food and Drug Administration. The Risks of Tanning (accessed online). 3 World Health Organization. Ultraviolet radiation and human health fact sheet, December 2009 (accessed online). 4 American Academy of Ophthalmology. Are You at Risk for Age-Related Macular Degeneration? March 2010. 5 Skin Cancer Foundation. The Eyelids: Highly Susceptible to Skin Cancer (accessed online). 6 Truhan AP. Sun protection in childhood. Clinical Pediatrics® 30(12):676-681, 1991. 7 Prevent Blindness America. Children’s Eyes More Susceptible to Long-Term Damage from UV Rays, April 2010. 8 Miller D. Light Damage to the Eye. In: Yanoff M, Duker AS, eds. Ophthalmology. London: Mosby; 1999: 2.4.1-2.4.5. 9 Ibid. 10 World Health Organization. Global solar UV index fact sheet, August 2002 (accessed online). 11 The Vision Council. 2012 Consumer Sunglass Study. 12 U.S. Environmental Protection Agency. SunWise UV Index (accessed online). 13 World Health Organization. Global solar UV index fact sheet, August 2002 (accessed online). 14 EyeCare America. Sunglasses (accessed online). 15 Glaucoma Research Foundation. A Guide to Sunglasses (accessed online). 16 Skin Cancer Foundation. The Eyelids: Highly Susceptible to Skin Cancer (accessed online). 17 U.S. Environmental Protection Agency. Ozone Layer Depletion, How UV Index is Calculated (accessed online).

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