Ultraviolet light and ocular diseases

A model of ocular ambient irradiance at any head orientation

Exposure to ambient ultraviolet radiation is associated with various ocular pathologies. Estimating the irradiance received by the eyes is therefore essential from a preventive perspective and to study the relationship between light exposure and eye diseases. However, measuring ambient irradiance on the ocular surface is challenging. Current methods are either approximations or rely on simplified setups. Additionally, factors like head rotation further complicate measurements for prolonged exposures. This study proposes a novel numerical approach to address this issue by developing an analytical model for calculating irradiance received by the eye and surrounding ocular area. The model takes into account local ambient irradiance, sun position, and head orientation. It offers a versatile and cost-effective means of calculating ocular irradiance, adaptable to diverse scenarios, and serves both as a predictive tool and as a way to compute correction factors, such as the fraction of diffuse irradiance received by the eyes. Furthermore, it can be tailored for prolonged durations, facilitating the calculation of radiant dose obtained during extended exposures.

Reduction of biofilm and pathogenic microorganisms using curcumin-mediated photodynamic inactivation to prolong food shelf-life

Pathogenic microbial contamination (bacteria and fungi) in food products during production poses a significant global health risk, leading to food waste, greenhouse gas emissions, and aesthetic and financial losses. Bacteria and fungi, by forming solid biofilms, enhance their resistance to antimicrobial agents, thereby increasing the potential for cross-contamination of food products. Curcumin molecule-mediated photodynamic inactivation (Cur-m-PDI) technology has shown promising results in sterilizing microbial contaminants and their biofilms, significantly contributing to food preservation without compromising quality. Photosensitizers (curcumin) absorb light, leading to a chemical reaction with oxygen and producing reactive oxygen species (ROS) that effectively reduce bacteria, fungi, and biofilms. The mechanism of microorganism inhibition is caused by exposure to ROS generated via the type 1 pathway involving electron transfer (such as O2•-, H2O2, -OH•, and other radicals), the type 2 pathway involving energy transfer (such as 1O2), secondary ROS, and weakening of antioxidant enzymes. The effectiveness of the inactivation of microorganisms is influenced by the concentration of curcumin, light (source type and energy density), oxygen availability, and duration of exposure. This article reviews the mechanism of reducing microbial food contamination and inhibiting their biofilms through Cur-m-PDI. It also highlights future directions, challenges, and considerations related to the effects of ROS in oxidizing food, the toxicity of PDI to living cells and tissues, conditions/types of food products, and the stability and degradation of curcumin.

Can high-resolution optical coherence tomography provide an optical biopsy for ocular surface lesions?

High-resolution optical coherence tomography (HR-OCT) has transformed the diagnosis and management of ocular surface lesions. Providing a detailed cross-sectional view of the cornea and conjunctiva, HR-OCT can be used to identify characteristic features of various benign and malignant ocular surface lesions, aiding in their diagnosis and guiding treatment. When incorporated into an ophthalmology clinic, HR-OCT provides morphological images of lesions in a noninvasive means, akin to an "optical biopsy". The characteristic HR-OCT features of several lesions have been well described in the literature, including for ocular surface squamous neoplasia, papilloma, melanoma, primary acquired melanosis, complexion associated melanosis, nevus, pterygium, pinguecula, lymphoma, and amyloidosis. HR-OCT can be used to differentiate between lesions with similar clinical features, lesions that co-exist on the same ocular surface, and atypically presenting lesions, such as pigmented ocular surface squamous neoplasia or amelanotic melanoma. The management of ocular surface lesions has been transformed by the implementation of HR-OCT, providing clinicians with the ability to monitor tumor response to topical chemotherapies, follow previously excised lesions for recurrence, and map out tumor borders intraoperatively. While there are some limitations to HR-OCT, including imaging of thick or deep lesions, it has become an essential tool for ocular oncologists in the management of ocular surface lesions.

Corneal Opacity in the United States: An American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) Study

PURPOSE

Vision loss associated with opacification of the cornea is one of the leading causes of blindness globally. However, the epidemiological data pertaining to the demographics, associated etiological causes and reduced vision in corneal opacity patients continue to be sparse. This study assesses the case frequencies, underlying etiologies, and vision outcomes in patients diagnosed with corneal opacity, in the United States.

DESIGN

Retrospective cohort study PARTICIPANTS: Patients in the IRIS® Registry (Intelligent Research in Sight) who were diagnosed with corneal opacity between January 1st, 2013, and November 30th, 2020.

METHODS

The IRIS Registry contains demographic and clinical data of 79,887,324 patients who presented to eye clinics during the study period. We identified patients with corneal opacity using International Classification of Disease (ICD) codes (ICD-9, and -10) of "371" (corneal scar) and "H17" (corneal opacity), respectively. The analyzed data included demographic parameters included age, sex, race, ethnicity, and geographical location. We evaluated clinical data including laterality, etiology, disease descriptors, and best-corrected visual acuity (VA) up to 1 year before the onset (± 30 days), at the time of diagnosis, and at one year following diagnosis (± 30 days).

MAIN OUTCOME MEASURES

Case frequencies, etiology, and vision outcomes in patients diagnosed with corneal opacity.

RESULTS

We identified 5,220,382 patients who were diagnosed with corneal opacity and scars using H17 (ICD-10) and 371.0 (ICD-9) codes over seven years. The case frequency of corneal opacity during the study period was 6,535 cases per 100,000 patients (6.5%). The mean age of the patients was 63.36±18.14 years and the majority were female (57.6%). In the cohort, 38.39% and 30.00% of patients had bilateral and unilateral corneal opacity, respectively. Most of the patients were White (69.13%), followed by Black or African American (6.84%), Asian (2.45%), American Indian or Alaska Native(0.34%), Native Hawaii or other Pacific Islander(0.19%). Among the patients with corneal opacity, 7.34% had Hispanic or Latino ethnicity. The primary etiologies associated with corneal opacity included corneal dystrophies (64.66%) followed by edema (18.25%), ulcer (7.78%), keratoconjunctivitis (7.18%), degeneration (5.62%), neovascularization (6.27%), and trauma (5.28%). Visual acuity of the patients significantly worsened due to corneal opacity (0.46±0.74 logMAR; ∼20/58 in Snellen) and did not improve to the baseline (0.37±0.68 logMAR, ∼20/46 in Snellen) post-management (0.43±0.77 logMAR, ∼20/54 in Snellen). The multiple linear regression analysis showed worse vision outcomes in females (compared to males), and Asian, Black or African American, and American Indian or Alaska Native (compared to White) patients. Additionally, worse vision outcomes were observed in patients with opacity associated with corneal malformation, degenerative disorders, edema, injury, and ulcer compared to those with hereditary corneal dystrophy.

CONCLUSIONS

Our study shows that the corneal opacity was diagnosed in 6.5% of the patients in the IRIS Registry and it was primarily associated with corneal dystrophies. The final vision outcomes in corneal opacity patients were significantly worse compared to baseline. The worse vision outcomes were associated with sociodemographic differences that might be associated with disparities in access, utilization, and care patterns.

Risk factors for pterygium: Latest research progress on major pathogenesis

A pterygium is a wedge-shaped fibrovascular growth of the conjunctiva membrane that extends onto the cornea, which is the outer layer of the eye. It is also known as surfer's eye. Growth of a pterygium can also occur on the either side of the eye, attaching firmly to the sclera. Pterygia are one of the world's most common ocular diseases. However, the pathogenesis remains unsolved to date. As the pathogenesis of pterygium is closely related to finding the ideal treatment, a clear understanding of the pathogenesis will lead to better treatment and lower the recurrence rate, which is notably high and more difficult to treat than a primary pterygium. Massive studies have recently been conducted to determine the exact causes and mechanism of pterygia. We evaluated the pathogenetic factors ultraviolet radiation, viral infection, tumor suppressor genes p53, growth factors, oxidative stress, apoptosis and neuropeptides in the progression of the disease. The heightened expression of TRPV1 suggests its potential contribution in the occurrence of pterygium, promoting its inflammation and modulating sensory responses in ocular tissues. Subsequently, the developmental mechanism of pterygium, along with its correlation with dry eye disease is proposed to facilitate the identification of pathogenetic factors for pterygia, contributing to the advancement of understanding in this area and may lead to improved surgical outcomes.

Evidence for persistent UV-induced DNA damage and altered DNA damage response in xeroderma pigmentosa patient corneas

Xeroderma pigmentosum (XP) is a rare genetic disorder characterized by injury to the ocular surface due to exposure to ultraviolet (UV) radiation. UV-induced damage in the cells leads to the formation of cyclobutane pyrimidine dimers (CPDs) and 6-4 pyrimidine-pyrimidone photoproducts that are repaired by the NER (Nucleotide Excision Repair) pathway. Mutations in the genes coding for NER proteins, as reported in XP patients, would lead to sub-optimal damage repair resulting in clinical signs varying from photo-keratitis to cancerous lesions on the ocular surface. Here, we aimed to provide evidence for the accumulation of DNA damage and activation of DNA repair pathway proteins in the corneal cells of patients with XP. Corneal buttons of patients who underwent penetrating keratoplasty were stained to quantify DNA damage and the presence of activated DNA damage response proteins (DDR) using specific antibodies. Positive staining for pH2A.X and thymidine dimers confirmed the presence of DNA damage in the corneal cells. Positive cells were found in both control corneas and XP samples however, unlike normal tissues, positive cells were found in all cell layers of XP samples indicating that these cells were sensitive to very low levels of UV. pH2A.X-positive cells were significantly more in XP corneas (p < 0.05) indicating the presence of double strand breaks in these tissues. A positive expression of phosphorylated-forms of DDR proteins was noted in XP corneas (unlike controls) such as ataxia telangiectasia mutated/Rad-3 related proteins (ATM/ATR), breast cancer-1 and checkpoint kinases-1 and -2. Nuclear localization of XPA was noted in XP samples which co-localized (calculated using Pearson's correlation) with pATM (0.9 ± 0.007) and pATR (0.6 ± 0.053). The increased presence of these in the nucleus confirms that unresolved DNA damage was accumulating in these cells thereby leading to prolonged activation of the damage response proteins. An increase in pp53 and TUNEL positive cells in the XP corneas indicated cell death likely driven by the p53 pathway. For comparison, cultured normal corneal epithelial cells were exposed to UV-radiation and stained for DDR proteins at 3, 6 and 24 h after irradiation to quantify the time taken by cells with intact DDR pathway to repair damage. These cells, when exposed to UV showed nuclear translocation of DDR proteins at 3 and 6 h which reduced significantly by 24 h confirming that the damaged DNA was being actively repaired leading to cell survival. The persistent presence of the DDR proteins in XP corneas indicates that damage is being actively recognized and DNA replication is stalled, thereby causing accumulation of damaged DNA leading to cell death, which would explain the cancer incidence and cell loss reported in these patients.

A numerical model for quantifying exposure to natural and artificial light in human health research

Various skin and ocular pathologies can result from overexposure to ultraviolet radiation and blue light. Assessing the potential harm of exposure to these light sources requires quantifying the energy received to specific target tissue. Despite a well-established understanding of the light-disease relationship, the quantification of received energy in diverse lighting scenarios proves challenging due to the multitude of light sources and continuous variation in the orientation of receiving tissues (skin and eyes). This complexity makes the determination of health hazards associated with specific lighting conditions difficult. In this study, we present a solution to this challenge using a numerical approach. Through the implementation of algorithms applied to 3D geometries, we created and validated a numerical model that simulates skin and ocular exposure to both natural and artificial light sources. The resulting numerical model is a computational framework in which customizable exposure scenarios can be implemented. The ability to adapt simulations to different configurations for study makes this model a potential investigative method in human health research.

Ocular findings in a population of geriatric equids in the United Kingdom

BACKGROUND

There are a growing number of horses, ponies, and donkeys aged 15 years or older in the United Kingdom, yet there have been no studies utilising a complete ophthalmic examination to investigate the prevalence of ophthalmic pathology within this population.

OBJECTIVES

To investigate the prevalence of ophthalmic pathology and associations with signalment, in a convenience sample of geriatric equids in the United Kingdom.

STUDY DESIGN

Cross sectional.

METHODS

Horses, ponies, and donkeys aged 15 years or older based at The Horse Trust charity underwent a full ophthalmic examination including slit lamp biomicroscopy and indirect ophthalmoscopy. Relationships between signalment and pathology were assessed using Fisher's exact and Mann-Witney U tests.

RESULTS

Fifty animals were examined ranging from 15 to 33 years (median 24, interquartile range [IQR] 21, 27). The prevalence of ocular pathology was 84.0% (95% confidence interval [CI] 73.8, 94.2%; n = 42). Four animals (8.0%) had adnexal pathology, while 37 (74.0%) and 22 (44.0%) had at least one form of anterior or posterior segment pathology, respectively. Of those with anterior segment pathology, 26 animals (52.0%) had cataract in at least one eye, with the most common location being anterior cortical (65.0% of those animals with cataract). Animals with posterior segment pathology included 21 animals (42.0%) with fundic pathology, with senile retinopathy being the most common (42.9% of all animals with fundic pathology). Despite the high prevalence of ocular pathology, all eyes examined remained visual. The most common breeds were Irish Draught (24.0%, n = 12), Shetland (18.0%, n = 9) and Thoroughbred (10%, n = 5); the majority were geldings (74.0%, n = 37). There was a statistically significant relationship between the presence of anterior segment pathology and breed (p = 0.006), with all Cobs and Shetlands examined having anterior segment pathology. The presence of posterior segment pathology and senile retinopathy were associated with older median age (posterior segment pathology: 26.0 years [interquartile range {IQR} 24.0, 30.0 years] vs. 23.5 years [IRQ 19.5, 26.5 years], p = 0.03; senile retinopathy: 27.0 years [IQR 26.0, 30 years] vs. 24.0 years [IQR 20.0, 27.0], p = 0.04). None of the pathologies investigated were more prone to affect one versus both eyes (p > 0.05; 71.4% of ocular pathologies were bilateral while 28.6% were unilateral).

MAIN LIMITATIONS

Data were obtained from a relatively small sample size of a single cohort of animals that lacked a control group.

CONCLUSIONS

There was a high prevalence and wide range of ocular lesions in this subset of geriatric equids.

Use of multiple correspondence analysis to explore associations between caregivers and sun protective habits during summer vacations

BACKGROUND

Childhood exposure to ultraviolet radiation (UVR) plays an important role in the development of keratinocyte carcinomas and melanomas. Therefore, sun protective measures ought to be implemented during early childhood. Young children are largely dependent upon adult care providers in order to achieve proper sun protection.

OBJECTIVES

To develop effective photoprotection in children, it is necessary to understand caregivers' attitudes and knowledge about UVR exposure. This study aimed to explore the variables associated with sun protective behaviour in parents and grandparents during summer vacations.

METHODS

A multinational, cross-sectional study was conducted using a web-based online survey with a representative sample of parents and grandparents of children aged ≤ 12 years, who cared for their children/grandchildren for at least 2 weeks during the summer of 2021, in five countries (France, Germany, Spain, Italy and the USA). Multiple correspondence analysis (MCA) was used to explore in an unbiased way the possible relationships among all the variables and to identify specific profiles.

RESULTS

A total of 6190 adult participants responded to the questionnaire: 5104 parents (average age 42.0 years, 54.3% women) and 1086 grandparents (average age 64.2 years, 55.5% women). MCA allowed discrimination of two groups of respondents based on their answers: a profile with 'unprotected sun exposure habits' vs. those with 'protective sun exposure habits'. Parents fell in closer proximity to the 'unprotected sun exposure habits', and 'sunburn reported in youngest child'. Grandparents adopted more cautious behaviours than parents. Nevertheless, grandparents fell in proximity to 'having exposed the grandchild to the sun between 11 h and 17.00 h', 'not using an umbrella' and 'not using sunglasses'.

CONCLUSIONS

Although grandparents appear to adopt more cautious behaviours than parents, many gaps in proper sun protection behaviour were observed in both groups of caregivers.

Multifunctional transition and temperature-responsive contact lenses

Smart contact lenses have recently gained traction due to their functionalization as noninvasive diagnostic and therapeutic wearables that can address several ocular diseases. Herein, multifunctional contact lenses exhibiting UV-transition and temperature-responsive capabilities were developed utilizing chromogenic materials that were integrated simultaneously into poly(2-hydroxyethyl methacrylate) (pHEMA) contact lenses. The functionalities of the contact lenses were optically evaluated in both their activated and non-activated states. Transition contact lenses offered excellent UV and blue light blocking capabilities (~45%) at their inactive states. When activated via UV exposure, the transparent lenses darkened instantaneously and absorbed portions of the visible light spectrum. The absorption intensity and transient discoloration of the transition lenses relied primarily on the utilized photochromic material. Likewise, the temperature-responsive contact lenses exhibited distinct colorimetric variations in response to temperature changes within the physiological range (33-38 °C). The maximum sensitivity of the thermochromic lens was 8% transmitted light per Celsius degree shift. Physiochemical and morphological analysis indicated the adequacy of the contact lenses. Hence, the multifunctional contact lenses can be deployed as smart wearables to manage ophthalmic deficiencies that are deterred by UV radiations and variations in ocular surface temperature.

TFOS Lifestyle Report: Impact of environmental conditions on the ocular surface

Environmental risk factors that have an impact on the ocular surface were reviewed and associations with age and sex, race/ethnicity, geographical area, seasonality, prevalence and possible interactions between risk factors are reviewed. Environmental factors can be (a) climate-related: temperature, humidity, wind speed, altitude, dew point, ultraviolet light, and allergen or (b) outdoor and indoor pollution: gases, particulate matter, and other sources of airborne pollutants. Temperature affects ocular surface homeostasis directly and indirectly, precipitating ocular surface diseases and/or symptoms, including trachoma. Humidity is negatively associated with dry eye disease. There is little data on wind speed and dewpoint. High altitude and ultraviolet light exposure are associated with pterygium, ocular surface degenerations and neoplastic disease. Pollution is associated with dry eye disease and conjunctivitis. Primary Sjögren syndrome is associated with exposure to chemical solvents. Living within a potential zone of active volcanic eruption is associated with eye irritation. Indoor pollution, "sick" building or house can also be associated with eye irritation. Most ocular surface conditions are multifactorial, and several environmental factors may contribute to specific diseases. A systematic review was conducted to answer the following research question: "What are the associations between outdoor environment pollution and signs or symptoms of dry eye disease in humans?" Dry eye disease is associated with air pollution (from NO2) and soil pollution (from chromium), but not from air pollution from CO or PM10. Future research should adequately account for confounders, follow up over time, and report results separately for ocular surface findings, including signs and symptoms.

miR-1273h-5p protects the human corneal epithelium against UVR-induced oxidative stress and apoptosis: Role of miR-1273h-5p in climatic droplet keratopathy

Climatic droplet keratopathy (CDK) is characterized by an increased number of oil-like deposits on the most anterior corneal layers, which affect vision and can cause blindness. Environmental ultraviolet radiation (UVR) exposure is a major risk factor, but the underlying mechanism of CDK pathogenesis is unclear. Increasing evidence has demonstrated that miRNAs participate in the cross-talk with oxidative stress. We aimed to explore whether certain miRNAs are involved in the pathogenesis of CDK. We performed miRNA sequencing of tears from patients with CDK and healthy individuals from Tacheng region of Xinjiang and conducted bioinformatic analysis of key miRNAs. We also evaluated viability, migration, and apoptosis of human corneal epithelial cells (HCECs) subjected to UVR treatment. miR-1273h-5p expression was abnormally downregulated in the tears of patients with CDK. miR-1273h-5p promoted cell proliferation and migration and inhibited UVR-induced mitochondrial apoptosis. miR-1273h-5p protected HCECs against UVR-induced oxidative damage by reducing the accumulation of reactive oxygen species and inhibiting mitochondrial apoptosis via the activation of the Nrf2 pathway. Thus, our results suggest that miR-1273h-5p protects the corneal epithelium against UVR-induced oxidative stress damage.

Association of sunlight exposure with visual impairment in an Indian fishing community

Purpose

Indian fishermen belong to a marginalized population and are continuously exposed to extreme occupational hazards and sunlight. A high prevalence of visual impairment (VI) is reported in the coastal fishing community. We aimed to investigate the association between VI and sunlight exposure measurement (SEM).

Methods

In this cross-sectional observational study, 270 eyes of 135 participants were enrolled from a coastal fishing village. Participants underwent a comprehensive ophthalmic examination, which included best-corrected visual acuity (BCVA), and anterior and posterior segment examination. Ocular Surface Disease Index (OSDI) and SEM questionnaire were administered to estimate the level of dry eye and ultraviolet-B (UV-B) exposure, respectively. VI was defined as presenting visual acuity worse than 6/12 (logarithm of the minimum angle of resolution [logMAR] > 0.3).

Results

The mean age and spherical equivalent were 50.56 ± 11.72 years (range: 18-80 years) and 0.36 ± 1.68 diopters (D) (range: -7.0 to +3.0 D), respectively. Age, SEM, OSDI, fishing as an occupation, and cataract were significantly associated with higher odds of VI in univariate analysis. Refraction, gender, education level, smoking status, amblyopia, systematic, and other ocular diseases were not significantly associated with VI. In the multivariate analysis, age, SEM, and presence of cataract remained significantly associated with a higher risk for VI. The area under the receiver operating characteristic curve values for age and SEM scores demonstrate a fair index of discrimination for the detection of VI.

Conclusion

SEM level is directly associated with a higher risk of VI among fishermen. The fishing community might benefit from regular eye examinations and awareness about the harmful effects of sunlight exposure and preventive measures.

Blue Light Exposure: Ocular Hazards and Prevention-A Narrative Review

INTRODUCTION

Exposure to blue light has seriously increased in our environment since the arrival of light emitting diodes (LEDs) and, in recent years, the proliferation of digital devices rich in blue light. This raises some questions about its potential deleterious effects on eye health. The aim of this narrative review is to provide an update on the ocular effects of blue light and to discuss the efficiency of methods of protection and prevention against potential blue light-induced ocular injury.

METHODS

The search of relevant English articles was conducted in PubMed, Medline, and Google Scholar databases until December 2022.

RESULTS

Blue light exposure provokes photochemical reactions in most eye tissues, in particular the cornea, the lens, and the retina. In vitro and in vivo studies have shown that certain exposures to blue light (depending on the wavelength or intensity) can cause temporary or permanent damage to some structures of the eye, especially the retina. However, currently, there is no evidence that screen use and LEDs in normal use are deleterious to the human retina. Regarding protection, there is currently no evidence of a beneficial effect of blue blocking lenses for the prevention of eye diseases, in particular age-related macular degeneration (AMD). In humans, macular pigments (composed of lutein and zeaxanthin) represent a natural protection by filtering blue light, and can be increased through increased intake from foods or food supplements. These nutrients are associated with lower risk for AMD and cataract. Antioxidants such as vitamins C, E, or zinc might also contribute to the prevention of photochemical ocular damage by preventing oxidative stress.

CONCLUSION

Currently, there is no evidence that LEDs in normal use at domestic intensity levels or in screen devices are retinotoxic to the human eye. However, the potential toxicity of long-term cumulative exposure and the dose-response effect are currently unknown.

Objectively-Assessed Ultraviolet Radiation Exposure and Sunburn Occurrence

Ultraviolet radiation (UVR) exposure is the primary modifiable risk factor for melanoma. Wearable UVR sensors provide a means of quantifying UVR exposure objectively and with a lower burden than self-report measures used in most research. The purpose of this study was to evaluate the relationship between detected UVR exposure and reported sunburn occurrence. In this study, a UVR monitoring device was worn by 97 parent-child dyads during waking hours for 14 days to measure instantaneous and accumulated UVR exposure. The results showed that the participants' total UVR exposure was associated with reported sunburn after adjusting for Fitzpatrick skin type and geographic location. It was observed that one standard erythemal dose (SED) increase in the participants' daily total UVR exposure was associated with reported sunburn (an odds ratio (OR) of 1.26 with a 95% CI of 1.13 and 1.41, and p < 0.001 for parents and an OR of 1.28 with a 95% CI of 1.12 and 1.47, and p < 0.001 for children). A one-SED increase in the participants' UVR exposure from 10 am to 4 pm was also associated with reported sunburn (an OR of 1.31 with a 95% CI of 1.15 and 1.49, and p < 0.001 for parents and an OR of 1.33 with a 95% CI of 1.12 and 1.59, and p = 0.001 for children). We found that elevated UVR exposure recordings measured by the UVR sensor were associated with reported sunburn occurrence. Future directions for wearable UVR sensors may include their use as an intervention tool to support in-the-moment sunburn prevention.

The Emotional Effects of Gain-Loss Frames in Persuasive Messages about Sun Protection on Health Promotional Outcomes: Evidence from an Experimental Study

Although the importance of emotions for the effects of gain-loss framed messages has been supported, the emotional effects of mixed frames have not been sufficiently investigated. To fill this gap, this experimental study exposed participants (N = 154) to single gain- or loss-framed vs. mixed frame messages about sun-protection outcomes. Integrating the idea of mixed frames with the concept of emotional flow, data were analyzed using a serial mediation model with emotional experience (as indexed by valence and arousal) and intention as factors mediating the effect of shifts on actual behavior, measured two weeks after message exposure. Results demonstrate that mixed messages and their impact on emotional experiences are not generally more effective than pure gain or pure loss messages. However, the application of mixed frame or purely loss-framed messages offers a higher potential to increase behavioral health intentions (resulting in respective behaviors) than messages simply focusing on gain frames.

Eye Care Behaviors among Adults in Poland: A Nationwide Cross-Sectional Survey

Implementation of eye care behaviors may reduce the risk of eye symptoms and diseases. This study aimed to assess eye care behaviors and identify factors associated with eye care practices among adults in Poland. This cross-sectional survey was carried out between 9 and 12 December 2022 on a nationwide random quota sample of adults in Poland. The study questionnaire included a set of questions on 10 different eye care behaviors. The study population included 1076 participants with a mean age of 45.7 ± 16.2 years, and 54.2% of participants were females. The most common (30.2%) eye care behavior was the use of good lighting indoors, and 27.3% used sunglasses with a UV filter. More than one-fifth of participants declared taking regular screen breaks and limiting screen time. Less than one-tenth of participants used dietary supplements with lutein, beta-carotene, or zinc. Out of 12 factors assessed in this study, self-reported knowledge of eye diseases was the most important factor associated (p < 0.05) with eye care behaviors. There were no economic or educational gaps (p > 0.05) in the implementation of most of the eye care behaviors among adults in Poland. This study revealed a low level of implementation of eye care behaviors among adults in Poland.

The Relationship between Pinguecula and Diabetes Mellitus: A Comparative Cross-Sectional Study

Purpose

To assess the relationship between diabetes mellitus (DM) and the presence of pinguecula and to identify other risk factors associated with pinguecula in patients attending the eye clinic at two tertiary university hospitals in Jordan.

Methods

This was a comparative cross-sectional hospital-based study of 241 consecutive patients (122 patients with DM and 119 patients with no diabetes). All patients underwent complete ophthalmic examination, and data were collected regarding age, sex, occupational activity, presence and grade of pinguecula, glycosylated hemoglobin (HbA1c), and presence of diabetic retinopathy.

Results

The mean (standard deviation, SD) ages of the DM and non-DM groups were 59.5 (10.8) years and 59.0 (11.6) years (p-value = 0.729), respectively. There was no significant difference in the prevalence of pinguecula between the diabetic and nondiabetic groups (66.4% vs. 66.5%, p = 0.998). Multivariate logistic regression analysis revealed that only outdoor occupational activity (OR = 5.16, 95% CI: 1.98-13.44, p = 0.001) was associated with increased prevalence of pinguecula. DM was not significantly associated with pinguecula (OR = 0.96, 95% confidence interval (CI): 0.55-1.67, p = 0.873). Neither age nor sex were significantly associated with pinguecula (p-value = 0.808, p-value = 0.390), respectively.

Conclusion

DM was not significantly associated with the development of pinguecula in this Jordanian population. The prevalence of pinguecula was significantly associated with an outdoor occupational activity.

Ocular and Facial Far-UVC Doses from Ceiling-Mounted 222 nm Far-UVC Fixtures

Far-UVC radiation, defined in this paper as ultraviolet (UV) radiation with wavelengths from 200 to 235 nm, is a promising tool to help prevent the spread of disease. The unique advantage of far-UVC technology over traditional UV germicidal irradiation lies in the potential for direct application of far-UVC into occupied spaces since antimicrobial doses of far-UVC are significantly below the recommended daily safe exposure limits. This study used a ceiling-mounted far-UVC fixture emitting at 222 nm to directly irradiate an indoor space and then evaluated the doses received upon a manikin. Radiation-sensitive film was affixed to the head, nose, lip and eyes of the manikin, and the 8-h equivalent exposure dose was determined. Variables examined included manikin height (sitting or standing position), manikin offset from directly below the fixture, tilt of the manikin, the addition of glasses, the addition of hair and different anatomical feature sizes. Importantly, at the manikin position with the highest dose to eyes, the average eye dose was only 5.8% of the maximum directly measured dose. These results provide the first experimental analysis of possible exposure doses a human would experience from an indoor far-UVC installation.

A cross-sectional study investigating the effects of argon laser retinal photocoagulation on lens clarity and corneal endothelial cells

Background

The mechanism of argon laser retinal photocoagulation (ALRP) treatment is to apply thermal-induced retinal pigment epithelium damage. Light passes through the anterior optical segments of the eye to reach the retina. Lens densitometry is a noninvasive and quantitative measurement providing information about corneal and lens clarity.

Objectives

This study aimed to investigate whether laser light affects lens clarity and corneal endothelial cells.

Design

This was a prospective, cross-sectional study.

Methods

Lens densitometric (LD) analysis and specular microscopy were performed before, after, and 1 month after ALRP treatment, by an expert ophthalmologist, blinded to the medical status of the patients. LD analysis was performed using a Pentacam HR (Oculus, Wetzlar, Germany) and a Specular Microscope CEM-530 (Nidek, Japan) was used for endothelial cell analysis.

Results

The evaluation was made on 81 eyes of 41 patients, with a mean age of 54.46 ± 6.7 years. LD, after ALRP, was significantly more than before ALRP (p < 0.001). There was no statistically significant difference in LD, before ALRP, and 1 month after ALRP (p = 0.262). There was a statistically significant increase in LD after ALRP compared to before ALRP, but it decreased after 1 month. There was an increase in the coefficient of variance (CV) after ALRP compared to before ALRP but it was not statistically significant (p = 0.188). There was no statistically significant difference in CV between before ALRP and 1 month after ALRP (p = 1.000). There was no statistically significant difference in the cell density, the hexagonality percentage between before ALRP, after ALRP, and 1 month after ALRP (p = 0.993, and 0.863, respectively).

Conclusion

ALRP may affect the lens densitometry temporarily during the procedure. Thermal damage may be the reason for increased lens densitometry.

UVA induces retinal photoreceptor cell death via receptor interacting protein 3 kinase mediated necroptosis

Ultraviolet light A (UVA) is the only UV light that reaches the retina and can cause indirect damage to DNA via absorption of photons by non-DNA chromophores. Previous studies demonstrate that UVA generates reactive oxygen species (ROS) and leads to programmed cell death. Programmed cell death (PCD) has been implicated in numerous ophthalmologic diseases. Here, we investigated receptor interacting protein 1 and 3 (RIPK1 and RIPK3) kinases, key signaling molecules of PCD, in UVA-induced photoreceptor injury using in vitro and ex vivo models. UVA irradiation activated RIPK3 but not RIPK1 and mediated necroptosis through MLKL that lie downstream of RIPK3 and induced apoptosis through increased oxidative stress. Moreover, RIPK3 but not RIPK1 inhibition suppresses UVA-induced cell death along with the downregulation of MLKL and attenuates the levels of oxidative stress and DNA fragmentation. In conclusion, these results identify RIPK3, not RIPK1, as a critical regulator of UVA-induced necroptosis cell death in photoreceptors and highlight RIPK3 potential as a neuroprotective target.

Awareness and Knowledge of the Effect of Ultraviolet (UV) Radiation on the Eyes and the Relevant Protective Practices: A Cross-Sectional Study from Jordan

Background: Overexposure to ultraviolet (UV) radiation is linked to serious adverse health effects that are cumulative in nature and affect children more than adults. UV radiation has also been reported to have serious complications for the eye, particularly in areas with a high UV radiation index. Increasing public awareness about the harmful effects of UV radiation on the eye and promoting awareness about protection against UV radiation may prevent eye disease related to UV radiation damage and help in the improvement of public health in general. This study aims to assess public awareness and knowledge of UV radiation and practices toward UV protection in Jordan, which is a country recognized as having a relatively high UV index throughout the year. Methods: A cross-sectional study was performed using an online questionnaire using Google Forms^® to assess people's awareness, knowledge, practices toward eye protection from UV radiation, and the reasons for not wearing UV-protective eyeglasses in Jordan. Sociodemographic information of participants including age, gender, education level, and employment status was also acquired. People's knowledge on UV protection and harmfulness was measured via rewarding their correctly answered knowledge questions with one mark and zero for incorrectly answered questions based on key answers defined from the literature. Results: A total of 1331 participants (77% females and 23% males) with an average age of 26(±10) years completed the online questionnaire. Participants showed generally high levels of knowledge and awareness about UV radiation and its harmful effects. Nevertheless, participants showed a low level of knowledge about the link between UV radiation and some of the ocular diseases in the questionnaire. Practices toward UV radiation protection where inadequate, with 59% of the respondents reporting that they do not use any protective eyewear from natural UV radiation. The main reported reason for not wearing UV-protective sunglasses was uncertainty in the efficiency of UV protection in sunglasses, as reported by 47% of the participants who do not wear UV-protective sunglasses. Conclusions: The awareness of UV radiation and its harmful effects is high in the studied population. Participant knowledge is also relatively high in relation to nature of solar UV radiation, other synthetic sources of UV radiation, and the most dangerous UV exposure time. However, low participant knowledge was measured on the association between UV radiation with ocular disease and the role of UV-protective eyeglasses. Participant practice toward UV radiation protection was found to be insufficient. Thus, it is important to further increase the knowledge of damaging effects of solar and synthetic UV radiation and emphasize the benefits of eye protection from UV radiation. Eye care practitioners should target youth by different strategies including health campaigns, media, and clinics.

One-Year Ocular Safety Observation of Workers and Estimations of Microorganism Inactivation Efficacy in the Room Irradiated with 222-Nm far Ultraviolet-C Lamps

Two krypton-chloride germicidal excimer lamp units (Care222 TRT-104C11-UI-U3, USHIO Inc.) were installed in the examination room of an ophthalmology department. The irradiation dose was set not to exceed the former (i.e., before 2022) threshold limit value (TLV) (22 mJ/cm² /8 hours) recommended by the ACGIH. Section 1: The eyes and lids of the 6 ophthalmologists (5 wore glasses for myopic correction) who worked in the room for a mean stay of 6.7 hours/week were prospectively observed for 12 months. Slitlamp examinations revealed neither acute adverse events such as corneal erosion, conjunctival hyperemia, lid skin erythema nor chronic adverse events such as pterygium, cataract, or lid tumor. The visual acuity, refractive error, corneal endothelial cell density remained unchanged during the study. Section 2: The irradiation of samples placed on the table or floor using the same fixtures in the room (5-7.5 mJ/cm² ) was associated with >99% inhibition of φX174 phage and >90% inhibition of S. aureus. In conclusion, no acute or chronic health effects in human participants was observed in a clinical setting of full-room ultraviolet germicidal irradiation by 222-nm lamp units and high efficacy in deactivation of microorganisms was determined in the same setting.

Solar UV Measured under Built-Shade in Public Parks: Findings from a Randomized Trial in Denver and Melbourne

Reducing exposure to ultraviolet radiation (UV) is crucial for preventing UV-induced diseases of the skin and eyes. Shade may offer significant protection from UV. More empirical research to quantify the UV protection offered from built shade is needed to guide disease prevention practices and confidence in investment in shade. This study quantified UV levels under built-shade relative to unshaded passive recreation areas (PRAs) over summer months in parks in two cities. In a randomized controlled trial, n = 1144 UV measurements were conducted at the center and periphery of PRAs in a total sample of 144 public parks as part of pretest and posttest measures of use of the PRAs by park visitors for three recruitment waves per city during 2010 to 2014. Following pretest, 36 PRAs received built-shade and 108 did not. Regression analyses modelled pre-post change in UV (Standard Erythemal Dose (SED) per 30 min) at PRAs; and environmental predictors. Mean UV at the center of built-shade PRAs decreased from pretest to posttest (x¯ = 3.39, x¯ = 0.93 SED), a change of x¯ = -3.47 SED relative to control PRAs (p < 0.001) adjusting for the covariates of ambient SED, (cosine) solar elevation and cloud cover. Clouds decreased and solar elevation increased UV levels under shade. No significant differences in UV by shade design occurred. A substantial reduction in exposure to UV can be achieved using built-shade with shade cloth designs, offering considerable protection for shade users. Supplementary sun protection is recommended for extended periods of shade use during clear sky days.

Emphasis on heat strain to the ocular surface: A functional and clinical study of a modified goggle

Purpose

The limitations of conventional goggles have caused immense inconvenience, and even damage, to the physical and mental health of healthcare workers. Hence, this study aimed to build a modified goggle (MG) with better physical performance. The temperature-humidity index (THI) was used as an indicator to investigate the impact of goggle-related heat strain on the ocular surface.

Methods

The basic functions of antifog, anti-ultraviolet (UV), and anti-blue-light radiation capabilities were evaluated. Furthermore, the clinical impact on noninvasive keratography tear film break-up time (NIKBUT), intraocular pressure, central corneal thickness, Schirmer test I, and the Dry Eye-related Quality of life Score (DEQS) were assessed in 40 healthcare workers by comparing MG with standard goggles (SG). The relationships between THI and the above parameters were explored.

Results

MG had a significantly longer antifog time than SG (212.75 ± 23.95 vs. 138.35 ± 5.54 min, p < 0.05), stronger antiultraviolet ability at 400 nm (99.99 vs. 45.55%), and optimal anti-blue-light performance at 440 nm (33.32 vs. 13.31%). Tear film stability after wearing the goggle was significantly worse than that before wearing them (p < 0.05). Both goggles achieved moderate to strong heat strain, with a THI of >80 at all timepoints. The MG group showed lower THI and DEQS and higher NIKBUT than the SG group (p < 0.05). THI was significantly correlated with DEQS, NIKBUT, and real fogging time (r = 0.876, −0.532, −0.406; all p < 0.05).

Conclusion

Wearing goggles for a long time may cause heat strain to the eyes, thereby leading to eye discomfort and changes in the microenvironment of the ocular surface. Our MG exhibited better antifog, antiultraviolet, and optimal anti-blue-light performance and lower heat strain than SG, thus making it ideally suited for healthcare workers.

Weather-Related Human Outdoor Behavior with Respect to Solar Ultraviolet Radiation Exposure in a Changing Climate

Climate-related changes in human sun exposure behavior can be an important influence on future ultraviolet radiation (UVR) related disease risks. In particular, active leisure mobility and leisure activities are more dependent on weather conditions than routine activities. However, the direction and extent of the effects vary. For temperate and cold climates, the available studies provide indications that a possible increase in UVR exposure would primarily result from a reduction in clothing and only secondarily from changes in the time spent outdoors. Existing studies suggest a nonlinear, bell-shaped relationship with threshold value effects for the relationship between outdoor time and thermal conditions. If the local climate is already very warm and there are only minor seasonal differences, there is no statistically significant evidence of changes in behavior. If there is significant warm discomfort, there is a tendency to avoid being outdoors or in the sun. It is not justified to simply transfer and generalize results and conclusions to different climates and seasons and between different leisure activities and forms of active mobility. The geographical context must be considered also in terms of cultures and habits, adaptations, traffic and land use (urban, rural). In addition, changes in behavior can develop differently depending on individual characteristics of people such as heat affinity, leisure type, age and gender. Differentiated analyses are required that take into account and balance opposing effects.

Assessing Human Eye Exposure to UV Light: A Narrative Review

Exposure to ultraviolet light is associated with several ocular pathologies. Understanding exposure levels and factors is therefore important from a medical and prevention perspective. A review of the current literature on ocular exposure to ultraviolet light is conducted in this study. It has been shown that ambient irradiance is not a good indicator of effective exposure and current tools for estimating dermal exposure have limitations for the ocular region. To address this, three methods have been developed: the use of anthropomorphic manikins, measurements through wearable sensors and numerical simulations. The specific objective, limitations, and results obtained for the three different methods are discussed.

The Chemical Composition and Biological Activities of Essential Oil from Korean Native Thyme Bak-Ri-Hyang (Thymus quinquecostatus Celak.)

Thymus quinquecostatus Celak. (Korean name: bak-ri-hyang) is an important medicinal and aromatic herb in Korea, which is named for the spread of its fragrance over a distance of approximately 40 km. In traditional Korean systems of medicine, T. quinquecostatus has been used to treat cancer, constipation, hepatic disease, arteriosclerosis, poor circulation in women, constipation, and menstrual irregularities. At present, T. quinquecostatus is used only for ornamental and ground cover purposes. A literature search was conducted to retrieve information regarding the essential oil composition and biological properties of T. quinquecostatus from PubMed, Science Direct, Wiley, Springer, Taylor and Francis, Wiley, and other literature databases. T. quinquecostatus can be divided into different chemotypes, such as γ-terpinene, thymol, phenol, carvacrol, and geraniol, according to the presence of major components in its essential oil. Further, the essential oil from T. quinquecostatus has been reported to possess various therapeutic properties such as antioxidant, antimicrobial, anticancer, anti-inflammatory, analgesic, sleep prolonging, soothing, skin protection and whitening, anti-aging, anti-obesity, and anti-acne properties. In conclusion, this review will be helpful for utilizing the T. quinquecostatus plant in different industries including food, pharmaceuticals, pesticides, perfumery, and cosmetics.

Nerve Growth Factor (NGF) as Partaker in the Modulation of UV-Response in Cultured Human Conjunctival Fibroblasts

Corroborating data sustain the pleiotropic effect of nerve growth factor (NGF) in the protection of the visual system from dangerous stimuli, including ultraviolet (UV). Since UV exposure might promote ocular surface changes (conjunctival inflammation and matrix rearrangement), as previously reported from in vivo studies sustaining some protective NGF effects, in vitro cultures of human conjunctival fibroblasts (FBs) were developed and exposed to a single UV exposure over 15 min (0.277 W/m²), either alone or supplemented with NGF (1–10–100 ng/mL). Conditioned media and cell monolayers were collected and analyzed for protein release (ELISA, ELLA microfluidic) and transcript expression (real-time PCR). A specific “inflammatory to remodeling” pattern (IL8, VEGF, IL33, OPN, and CYR61) as well as a few epigenetic transcripts (known as modulator of cell differentiation and matrix-remodeling (DNMT3a, HDAC1, NRF2 and KEAP1)) were investigated in parallel. UV-exposed FBs (i), showed no proliferation or significant cytoskeleton rearrangement; (ii), displayed a trkA^NGFR/p75^NTR phenotype; and (iii), synthesized/released IL8, VEGF-A, IL33, OPN, and CYR61, as compared to unexposed ones. NGF addition counteracted IL8, IL33, OPN, and CYR61 protein release merely at lower NGF concentrations but not VEGF. NGF supplementation did not affect DNMT3a or HDAC1 transcripts, while it significantly upregulated NRF2 at lowest NGF doses and did not change KEAP1 expression. Taken together, a single UV exposure activated conjunctival FBs to release pro-inflammatory/fibrogenic factors in association with epigenetic changes. The effects were selectively counteracted by NGF supplementation in a dose-dependent fashion, most probably accountable to the trkA^NGFR/p75^NTR phenotype. Further in vitro studies are underway to better understand this additional NGF pleiotropic effect. Since UV-shield impairments represent a worldwide alert and UV radiation can slowly affect ocular surface homeostasis (photo-ageing, cataract) or might exacerbate ocular diseases with a preexisting fibrosis (pterygium, VKC), these findings on NGF modulation of UV-exposed FBs might provide additional information for protecting the ocular surface (homeostasis) from low-grade long-lasting UV insults.

Sun Protection Policies and Practices in Preschool and Elementary Schools in Andalusia (Spain)

Sun exposure in childhood is a major risk factor for the development of skin cancer as an adult. School children spend much of their time outdoors exposed to ultraviolet radiation during recreational and sports activities. Skin cancer incidence tripled from 1978 to 2002 in Spain. Andalusia, the largest and sunniest region of Spain, lacks data on the sun protection measures taken in schools. To address this deficit, the aim of this study was to determine photoprotection practices and policies in preschools and primary schools in Andalusia. This descriptive study involved the administration of an online questionnaire completed by principals regarding school sun protection policies and practices. Preschool and primary schools were selected from the database of the Ministry of Education of the Andalusian Regional Government. Information of interest included photoprotection policies, students' sun protection knowledge, sun protection measures, relevant curricular content, and availability of shade at the school. A total of 2425 schools were contacted. Of them, 420 schools responded (17.31%), with the highest number of responses received from Malaga (23.8%) and Seville (19.5%) provinces. Of those responding, 67.1% of the schools did not have written sun protection policies. The photoprotection measures reported included mandatory use of a cap or hat (3.3%), use of sunglasses in outdoor areas (30%), and active encouragement of students to use sunscreen (50.7%). Roughly 24% of schools evaluated their shaded areas, with 52.9% reporting insufficient protection for most activities. The study results showed that photoprotection policies and practices in Andalusian schools were mostly insufficient. Given that skin cancer incidence has increased considerably over the last decade, it is important to concentrate on improving primary prevention practices. Additionally, photoprotection programs in schools have been shown to improve children's knowledge, attitudes, and habits regarding photoprotection. Thus, it is essential for Andalusian preschools and primary schools to develop policies and strategies to help reduce children's sun exposure while at school.

The clinical features and the factors affecting visual prognosis in pediatric open-globe ınjuries

PURPOSE

To investigate clinical features and factors affecting visual prognosis after pediatric open-globe injuries.

METHODS

Retrospective study of 223 children with open-globe injury was conducted. Children with final logMAR visual acuity (LVA) > 0.70 were determined as poor-vision group (group 1, n = 108) and those with final LVA ≤ 0.70 as good-vision group (group 2, n = 115). Demographic characteristics (age, gender, and damaged eye), time between trauma and surgery, ocular trauma score (OTS), follow-up time, injury size, initial and final visual acuity levels, injury type (penetrating injury, globe rupture, perforating injury, and intraocular foreign body injury), injury localization (zone 1 = within the corneal and/or limbal area, zone 2 = within the scleral area extending 5 mm back from the limbus, and zone 3 = within the area posterior to zone 2), injury cause [metal objects (fork, knife, needle), broken glass, blunt objects (ball, punch), pen-pencil, and unidentified objects], and accompanying ocular findings of the groups were detected, and comparisons were done. Additionally, effects of age, time between trauma and surgery, OTS, injury size, follow-up time, initial LVA, injury type, and injury zone on final LVA were analyzed in both groups.

RESULTS

Mean age was 9.1 ± 2.0 years. There were 151 males and 72 females. Compared to group 1, group 2 had better initial and final visions (1.21 ± 0.26 vs 0.60 ± 0.28, p < 0.001 for initial LVA; 1.00 ± 0.32 vs 0.30 ± 0.13, p < 0.001 for final LVA), greater OTS (1.72 ± 0.53 vs 3.73 ± 0.61, p = 0.025), and smaller injury size (10.4 ± 3.5 vs 5.8 ± 2.4 mm, p = 0.002). Globe rupture (p = 0.015) and relative afferent pupillary defect (RAPD) (p = 0.037) were higher in group 1, while penetrating injury (p = 0.044), zone 1 involvement (p = 0.038), and metal object injury (p = 0.041) were higher in group 2. Based on multivariate analysis, the presences of globe rupture (p = 0.024) and RAPD (p = 0.035), the involvement without zone 1 (p = 0.042), and the injury without metal object (fork, knife, needle) (p = 0.046) were associated with poor final vision. Final LVA (for group 1 and group 2) was negatively correlated with OTS (r =  - 0.398, p = 0.037; r =  - 0.369, p = 0.040), while positively correlated with injury size (r = 0.412, p = 0.031; r = 0.318, p = 0.046) and initial LVA (r = 0.335, p = 0.043; r = 0.402, p = 0.034).

CONCLUSION

In our study, poor prognostic factors affecting final vision were low OTS, poor initial vision, the presences of globe rupture and RAPD, the large injury size, the involvement without zone 1, and the injury without metal object (fork, knife, needle).

Clinical profile of melanocytic lesions of the ocular surface in a Hispanic population

PURPOSE

To determine the prevalence, clinical characteristics, and demographic factors of melanocytic lesions of the ocular surface, such as racial melanosis, primarily acquired melanosis, conjunctival nevus, and conjunctival melanoma in a Hispanic population.

MATERIALS AND METHODS

A cross-sectional and observational study was undertaken in a tertiary referral ophthalmological center in northern Mexico from December 2020 to April 2021. All patients attending an ophthalmology specialty clinic were screened during their first visit in order to detect melanocytic lesions of the ocular surface. Demographic factors, clinical characteristics, and diagnosis and treatment were recorded.

RESULTS

227 patients were screened for melanocytic lesions. Melanocytic lesions were identified in 114 patients (50.2%). The prevalence of the different melanocytic lesions in the screened population was racial melanosis, 45.3%; primary acquired melanosis, 3.5%, and conjunctival nevus 1.3%. No conjunctival melanoma was identified in the screened population. Primary acquired melanosis was more common in the fifth to sixth decade of life and in females. Racial melanosis showed no gender predilection and was also more common in the fifth to sixth decade of life. Only 1 melanocytic lesion (a primary acquired melanosis) required medical treatment with excisional biopsy and cryotherapy.

CONCLUSION

The prevalence of racial melanosis is remarkably high in the Hispanic population. While less prevalent, primary acquired melanosis is also present in a considerable percentage of Hispanic patients. Both melanocytic lesions exhibit demographic characteristics that match those previously reported in the medical literature.

[The UV Protection Alliance in Germany-Purpose and goals]

Despite the serious health consequences of UV radiation, protection against UV radiation is even now still not a matter of course. The population has a largely realistic view of UV radiation-related health risks but this does not seem to instigate a change in personal risk assessments and towards an adequate UV protection behavior. This is not least due to the partly contradictory statements and recommendations regarding the positive and negative health effects, also from the scientific community. A harmonization as well as a collation of the statements and activities of individual players in UV protection related to the prevention of UV-related diseases gives the key messages the necessary strength to make UV protection a matter of course in society. To this end, the UV Protection Alliance was initiated by the Federal Office for Radiation Protection (BfS). This article reports on the UV Protection Alliance, presents the partners in the Alliance, the goals of the UV Protection Alliance, previous results of work by the Alliance and actions and interventions of the Alliance partners. The public impact of the UV Protection Alliance is explained and an outlook is given on future tasks of the Alliance.

Surgical Techniques and Adjuvants for the Management of Pterygium

OBJECTIVE

To provide an updated review of surgical techniques and adjuvants for the management of pterygium.

METHODS

A literature search was conducted in PubMed for studies published since January 2011. "Pterygium surgery" and the MeSH term "Pterygium/surgery" was used. The results were filtered for randomized controlled trials in English, yielding 60 citations.

RESULTS

One study compared topical anesthetic agents. One study compared methods of corneal polishing of the corneoscleral bed after pterygium excision. Numerous studies evaluated the use of conjunctival autograft versus amniotic membrane, superior versus inferior conjunctival autograft, and conjunctival versus limbal-conjunctival autograft. Many studies evaluated graft fixation methods. Several studies evaluated the adjuvant use of mitomycin C, 5-fluorouracil, and bevacizumab. A few studies evaluated the adjuvant use of steroids. Eleven studies evaluated various methods of postoperative management.

CONCLUSIONS

Current evidence supports pterygium excision with conjunctival autograft fixation using fibrin glue, followed by patching until the first postoperative visit. Surgical adjuvants and postoperative use of artificial tears and topical cyclosporine 0.05% may further reduce recurrence. Postoperative use of topical steroids is highly variable because there is no consensus regarding the optimal dose, frequency, and duration of treatment.

[Alterations of the anterior segment of the eye caused by exposure to UV radiation]

BACKGROUND

By identifying diseases of the anterior segment of the eye associated with exposure to UV light, recommendations for action can be derived.

AIM

After reading this review, the reader should be familiar with UV light-associated diseases of the anterior segment of the eye.

METHOD

Using a selective literature search, UV light-associated diseases of the anterior segment of the eye were identified and protective mechanisms are described.

RESULTS

The UV light-associated lesions of the anterior segment of the eye include basal cell and squamous cell carcinomas, malignant melanoma of the eyelids and conjunctiva, pterygium, keratoconjunctivitis photoelectrica and climatic droplet keratopathy as well as cortical cataract.

CONCLUSION

Eyeglasses for filtering UV light, sunglasses and special safety glasses, such as welding helmets and wearing headgear protect against UV light exposure to the anterior segment of the eye and the associated diseases.

Ultraviolet and Visible Transmittance of Soft Contact Lenses with and without Ultraviolet Blockers

SIGNIFICANCE

Ultraviolet (UV) and visible light transmittance of soft contact lenses (SCLs) was measured. A significant difference in UV transmittance has been found between SCLs with a positive and negative back vertex power (BVP). It can be shown that thicker SCLs absorb more UV radiation.

PURPOSE

This study aimed to determine UV and visible light transmittance of different SCLs with and without UV protection filters.

METHODS

Twenty-one lens brands were investigated in the BVP range of -12.00 to +6.00 D. Three SCLs were measured per BVP 25 times. Three hundred thirty-nine SCLs with UV filter (stenfilcon A, somofilcon A, narafilcon A, senofilcon A, senofilcon C, etafilcon A, nesofilcon A) and 489 SCLs without UV filter (delefilcon A, lotrafilcon A, lotrafilcon B, comfilcon A, balafilcon A, samfilcon A, asmofilcon A, nelfilcon A, omafilcon A, hilafilcon B, ocufilcon D, hioxifilcon A, omafilcon B) have been examined. The measurement setup was created according to ISO 18369-3.

RESULTS

All UV-absorbing labeled test SCLs meet UV protection class 2. senofilcon A, senofilcon C, and narafilcon A meet the higher UV protection class 1 level. A statistically significant difference in UV transmittance (280 to 380 nm) has been found between SCLs with a positive BVP (+1.00 to +6.00 D) and SCLs with a negative BVP (-1.00 to -12.00 D), both without (P = .04) and with UV filters (P = .02).

CONCLUSIONS

With the ISO-conforming, diopter-independent measurement setup, the UV-absorbing test contact lenses that meet the current international standards, regardless of their BVP, were identified. Lenses with increased center thickness absorb more UV radiation. Further studies may use a modified measurement setup with a larger aperture than 10 mm. It would also be worthwhile to examine the UV absorption of the contact lens over the complete corneal area and limbal area because UV radiation may damage inner ocular tissues like the crystalline lens as well as limbal stem cells.

Ionic Hydrogels Based Wearable Sensors to Monitor the Solar Radiation Dose for Vitamin D Production and Sunburn Prevention

Wearable solar radiation sensors based on ionic hydrogels are facilely prepared to simultaneously monitor the radiation dose for the production of vitamin D and the prevention of sunburn. Tetramethylethylenediamine (TEMED) is neutralized with acrylic acid (AA) to obtain tetramethylethylenediamine acrylate (TEMEDA), which is further polymerized with acrylamide by a free radical reaction. By simply adding MB or NR during the polymerization, the final obtained ionic hydrogels can indicate solar radiation. Due to the extent of discoloration, the discoloration speed of MB and NR is correlated to the radiation dose. This wearable sensor can indicate the solar radiation dose required by the human body to synthesize vitamin D through the discoloration of the ionized hydrogel of MB, whereas those with NR are able to illustrate the threshold of radiation dose that causes potential skin hurt. Therefore, the benefit and drawback of solar radiation can be well balanced by optimizing the exposure time to solar irradiation. In addition, polyurethane cross-linked with a thermoresponsive coating is used as band for this wearable sensor. Due to the hydrophilicity below its transition temperature, the cross-linked band possesses the easy cleaning capability of stains after the daily wear. Such type of wearable sensor can be broadly used for monitoring the solar radiation, especially in outdoor activities.

Accelerated CXL Versus Accelerated Contact Lens-Assisted CXL for Progressive Keratoconus in Adults

PURPOSE

To compare the clinical and tomographic properties of adult patients with keratoconus treated with accelerated corneal cross-linking (A-CXL) versus accelerated contact lens-assisted corneal cross-linking (A-CACXL).

METHODS

Patients who underwent A-CXL and A-CACXL due to progressive keratoconus were enrolled from January 2015 to January 2018 in this retrospective case-control study. The treatment group (minimum corneal thickness of less than 400 µm after epithelium removal; 30 patients, 30 eyes) was treated with A-CACXL; the control group (minimum corneal thickness of 400 µm or greater, 32 patients, 32 eyes) was treated with A-CXL. Assessments occurred before treatment and 12 months postoperatively. Demographic, clinical, and tomographic data were obtained from outpatient clinic reports.

RESULTS

Significant improvement in visual acuity was evident at 12-month follow-up for the control group in uncorrected distance visual acuity (0.62 ± 0.42 vs 0.43 ± 0.31 logMAR, P = .01) and the treatment group in corrected distance visual acuity (0.51 ± 0.30 vs 0.40 ± 0.49 logMAR, P = .03). Progression of keratoconus was halted at similar rates for both groups (76.7% treatment, 84.4% control, P = .21). Mean minimum corneal thickness showed minor but significant thinning at the 12-month follow-up visit compared to baseline (control group = 463 ± 31 vs 450 ± 35 µm, P > .01; treatment group = 398 ± 32 vs 388 ± 41 µm, P = .02).

CONCLUSIONS

A-CACXL halted keratoconus progression in 76.7% of eyes and achieved regression in 33.3% of eyes, with rates comparable to A-CXL. Visual outcomes improved for both groups, with similar keratometry changes. A-CACXL is an effective and safe option for patients with keratoconus and thin corneas, with results similar to A-CXL treatment in patients with a minimum corneal thickness of 400 µm or greater. [J Refract Surg. 2021;37(9):623-630.].

Evaluation of bactericidal effects of ultraviolet light C irradiation on cariogenic bacteria: An in vitro study

Backgrounds

Ultraviolet light C (UVL-C) irradiation has demonstrated an antimicrobial action against various pathogens. This study aimed to evaluate the bactericidal effect of UVL-C irradiation against cariogenic oral bacteria (Streptococcus mutans) in single layers and colonies grown on solid surfaces.

Methods

Two different experiments were performed. In the first experiment, a single layer of Streptococcus mutans bacteria on agar plates was exposed to UVL-C irradiation at energies from 0 to 21 mWs/cm². The second experiment was conducted to inhibit viability of bacterial colonies on solid surfaces. The samples were derived from saliva from a patient where bacteria were grown on plastic strips and then exposed to UVL-C. The highest energy was 1050 mWs/cm².

Results

Exposure to 21 mWs/cm² was bactericidal in single layers of Streptococcus mutans. The result for bacterial colonies on solid surfaces indicated only a bacteriostatic effect, even at energies of 1050 mWs/cm².

Conclusions

Ultraviolet light C exhibits bactericidal effects on single layers of Streptococcus mutans but has a limited effect on bacterial colonies in a biofilm. It is a matter of debate whether these in vitro results would have the same effect in clinical setting.

Relationship between practices of eye protection against solar ultraviolet radiation and cataract in a rural area

BACKGROUND

Cataract is a public health concern worldwide that differentially affects rural residents of outlying islands where ultraviolet radiation (UVR) may have greater penetration because of less shading.

OBJECTIVES

To assess the relationships between attitudes and practices of eye protection and eye diseases for residents of an offshore island of Taiwan.

METHODS

Questionnaire survey was administered to local residents (age > 50 years) regarding socio-demographic information, attitudes/practices of eye protection under sun exposure and eye diseases.

RESULTS

A total of 816 participants (response rate 90.7%, 816/900) completed the questionnaires. Mean age was 63.7 (+ 10.8) years. Among these participants, 44.4%, 15.1% and 8.3% had cataract, dry eye and glaucoma, respectively. Although 86.3% and 88.2% of participants agreed that they should avoid outdoor activities and wear glasses/broad-brimmed hats in harsh daylight, 69.4% and 48.3% of participants never/rarely used glasses or hats/umbrellas in harsh daylight, respectively. Predictors of less practices of eye protection against solar UVR included residents who were male, with lower education level, with longer residence and lack of commercial health insurance. Multivariate logistic regression revealed that practices of eye protection under sun exposure were significantly associated with less cataract, but not glaucoma or dry eye. Participants who did not wear glasses, broad-brimmed hats/use umbrellas or both in harsh sunlight (almost) every time were respectively associated with a 57% (P = 0.028), 45% (P = 0.027) or 70% (P = 0.026) increase of cataract than those who did in harsh sunlight (almost) every time.

CONCLUSIONS

Practices of eye protection under sun exposure is associated with lower risk of cataract.

Sunlight exposure and eye disorders in an economically active population: data from the KNHANES 2008-2012

BACKGROUND

Sunlight exposure is a major risk factor for eye disorders. Most outdoor workers cannot avoid sunlight exposure. This study aimed to analyze the relationship between outdoor sunlight exposure and eye disorders in an economically active population.

METHODS

This study analyzed the 2008-2012 Korea National Health and Nutritional Examination Survey data. Sunlight exposure was categorized as < 5 hours and > 5 hours. We also analyzed the dose-dependent relationship between exposure to sunlight and eye disorders (cataracts, pterygium, and age-related macular degeneration [AMD]) using data from 2010 to 2012 by subdividing the exposure groups into < 2 hours, 2-5 hours, and ≥ 5 hours. Eye disorders were diagnosed by an ophthalmologist. The study participants were stratified by sex, and the results were analyzed using the χ2 test and multiple logistic regression analysis.

RESULTS

In the female group, the odds ratio of pterygium in the high-level sunlight exposure group was 1.47 (95% confidence interval [CI]: 1.15-1.89). Regarding AMD, the odds ratios were 1.42 (95% CI: 1.16-1.73), 1.33 (95% CI: 1.03-1.73), and 1.58 (95% CI: 1.15-2.16) in the total, male, and female groups, respectively. Analysis of the dose-response relationship revealed that the odds ratios of pterygium in the high-level sunlight exposure subgroups of the total and female groups were 1.62 (95% CI: 1.25-2.08) and 2.00 (95% CI: 1.39-2.88), respectively.

CONCLUSIONS

This study demonstrated a relationship between sunlight exposure and eye disorders in an economically active population. Women were found to be especially vulnerable to pterygium. However, additional prospective studies to clarify the pathophysiology of pterygium are needed.

Impact of Climate Change on Eye Diseases and Associated Economical Costs

Climate change generates negative impacts on human health. However, little is known about specific impacts on eye diseases, especially in arid and semi-arid areas where increases in air temperatures are expected. Therefore, the main goals of this research are: (i) to highlight the association between common eye diseases and environmental factors; and (ii) to analyze, through the available literature, the health expenditure involved in combating these diseases and the savings from mitigating the environmental factors that aggravate them. Mixed methods were used to assess the cross-variables (environmental factors, eye diseases, health costs). Considering Southern Spain as an example, our results showed that areas with similar climatic conditions could increase eye diseases due to a sustained increase in temperatures and torrential rains, among other factors. We highlight that an increase in eye diseases in Southern Spain is conditioned by the effects of climate change by up to 36.5%; the economic burden of the main eye diseases, extrapolated to the rest of the country, would represent an annual burden of 0.7% of Spain's Gross Domestic Product. In conclusion, the increase in eye diseases has a strong economic and social impact that could be reduced with proper management of the effects of climate change. We propose a new concept: disease sink, defined as any climate change mitigation action which reduces the incidence or morbidity of disease.

Free-Radical Scavenger NSP-116 Protects the Corneal Epithelium against UV-A and Blue LED Light Exposure

The corneal epithelium is continuously exposed to oxygen, light, and environmental substances. Excessive exposure to those stresses is thought to be a risk factor for eye diseases. Photokeratitis is damage to the corneal epithelium resulting in a painful eye condition caused by unprotected exposure to UV rays, usually from sunlight, and is often found in people who spend a long time outdoors. In modern life, human eyes are exposed to artificial light from light-emitting diode (LED) displays of computers and smartphones, and it has been shown that short-wavelength (blue) LED light can damage eyes, especially photoreceptors. However, the effect of blue LED light on the cornea is less understood. In addition, it is important to develop new treatments for preserving human eyesight and eye health from light stress. Here, we used human corneal epithelial cells-transformed (HCE-T) cells as an in-vitro model to investigate the protective effect of NSP-116, an imidazolyl aniline derivative, against the oxidative stress induced by light in the corneal epithelium. Treatment with 10 µM NSP-116 significantly increased the cell viability and reduced the death ratio following UV or blue LED light exposure. Furthermore, NSP-116 treatment decreased light-induced reactive oxygen species production and preserved the mitochondrial membrane potential. Immunoblotting data showed that NSP-116 suppressed the stress response pathway. Finally, NSP-116 treatment prevented corneal epithelial apoptosis induced by blue LED light in an in-vivo mouse model. In conclusion, NSP-116 has a protective effect against oxidative stress and corneal cell death from both UV and blue LED light exposure.