Solar UV exposure at eye is different from environmental UV: diurnal monitoring at different rotation angles using a manikin

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.

UV Index Does Not Predict Ocular Ultraviolet Exposure

Purpose

The ultraviolet index (UVI), available online, is an international linear scale of levels from 0 to 13+ that warns about the risk of sunburn; however, it does not address the risk to eyes. Our purpose was to develop a useful instrument to warn the public against ocular ultraviolet (OUV) exposure and to serve as a tool for researching UV-induced ocular diseases.

Methods

A rotating model head that included ultraviolet B (UVB) sensors documented UV irradiance at the crown and at the eyes spanning eight azimuths from sunrise to sunset under different climatic conditions in each season. The dose intensities obtained were compared with their respective UVI levels. Doses to the eyes were mathematically transformed to develop an OUV index with linear levels from 0 to 13+, similar to the UVI. Then, readings from both instruments were compared.

Results

UV exposure at the crown increases with solar culmination, whereas that to the eye is greater under low rather than maximum solar altitude. The OUV index levels were higher than recorded UVI levels in the summer under low solar altitude in the early morning and mid- to late afternoon and were markedly higher all day in winter when solar altitude remains low.

Conclusions

The UVI does not provide sufficient warning about the risks of ocular UV damage. The proposed OUV index is a useful instrument to warn the public against OUV exposure and to serve as a tool for researching UV-induced ocular diseases.

Translational Relevance

The OUV index is useful to prevent ocular UV-related diseases.

Cohort Study of Nonmelanoma Skin Cancer and the Risk of Exfoliation Glaucoma

PRECIS

In a cohort study of 120,307 participants with 25+ years of follow-up, a history of nonmelanoma skin cancer (NMSC) was associated with a 40% higher exfoliation glaucoma (XFG) risk.

PURPOSE

The purpose of this study was to evaluate the relationship between NMSC (a marker of ultraviolet radiation exposure) and XFG.

METHODS

We performed a cohort study of US women (n=79,102; 1980-2014) and men (n=41,205; 1986-2014), aged 40+ years and at risk for glaucoma who reported eye examinations. From 1984 (women)/1988 (men), we asked about basal cell carcinoma or squamous cell carcinoma history separately; in prior years, we asked about any NMSC history in a single question. Squamous cell carcinoma was confirmed with histopathology reports while basal cell carcinoma and any early (<1984/<1988) NMSC history was self-reported. Incident XFG cases (362 women and 83 men) were confirmed with medical records. Using pooled data, we estimated multivariable-adjusted relative risks [MVRRs; 95% confidence intervals (CIs)] with Cox proportional hazards models that were stratified by age (in mo), 2-year time period at risk and average lifetime residential latitude.

RESULTS

In multivariable-adjusted analyses, we observed a 40% higher XFG risk with any NMSC history (MVRR=1.40; 95% CI=1.08-1.82); the association was observed even with 4 and 8-year lags in NMSC history. Also, the NMSC association was stronger in younger (below 65 y; MVRR=2.56; 95% CI=1.62-4.05) versus older participants (65 y and above; MVRR=1.25; 95% CI=0.94-1.66; P for interaction=0.01) and those living in the northern latitudes (≥42°N; MVRR=1.92; 95% CI=1.28-2.88) versus more southern latitudes (<42°N; MVRR=1.19; 95% CI=0.86-1.66; P for interaction=0.04).

CONCLUSION

NMSC was associated with higher XFG risk, particularly among younger participants and those living in the Northern US.

Sun exposure to the eyes: predicted UV protection effectiveness of various sunglasses

The aim of this study was to assess solar ultraviolet radiation (UVR) doses received by the eyes in different exposure situations, and to predict the sun protection effectiveness provided by various styles of sunglasses at facial, periorbital, and ocular skin zones including the cornea and accounting for different head positions. A 3D numeric model was optimized to predict direct, diffuse and reflected erythemally weighted UVR doses received at various skin zones. Precisely defined facial, periorbital, and ocular skin zones, sunglasses (goggles, medium-, and large-sized sunglasses) and three head positions were modeled to simulate daily (08:00-17:00) and midday (12:00-14:00) UVR doses. The shading from sunglasses' frame and lenses' UVR transmission were used to calculate a predictive protection factor (PPF [%]). Highest ocular daily UVR doses were estimated at the uncovered cornea (1718.4 J/m²). Least sun protection was provided by middle-sized sunglasses with highest midday dose at the white lateral (290.8 J/m²) and lateral periorbital zones (390.9 J/m²). Goggles reached almost 100% protection at all skin zones. Large-sized sunglasses were highly effective in winter; however, their effectiveness depended on diffuse UVR doses received. In "looking-up" head positions highest midday UVR doses were received at the unprotected cornea (908.1 J/m²), totally protected when large-sized sunglasses are used. All tested sunglass lenses fully blocked UVR. Sunglasses' protection effectiveness is strongly influenced by geometry, wearing position, head positions, and exposure conditions. Sunglasses do not totally block UVR and should be combined with additional protection means. 3D modeling allows estimating UVR exposure of highly sensitive small skin zones, chronically exposed and rarely assessed.

Efficiency of ocular UV protection by clear lenses

Ocular UV doses accumulate all-day, not only during periods of direct sun exposure. The UV protection efficiency of three clear lenses was evaluated experimentally, validated by simulation, and compared to non-UV protection: a first spectacle lens with a tailored UV absorber, a second spectacle lens, minimizing UV back reflections, as well as a third spectacle lens, combining both. A tailored UV-absorber efficiently reduced overall UV irradiance to 7 %, whereas reduction of back-reflections still left UV irradiance at 42 %. Thus, clear lenses with a tailored UV absorber efficiently protect the eye from UV, supplementing sun glasses wear to an all-day protection scenario.

Seasonal Effect on Ocular Sun Exposure and Conjunctival UV Autofluorescence

PURPOSE

To evaluate feasibility and repeatability of measures for ocular sun exposure and conjunctival ultraviolet autofluorescence (UVAF), and to test for relationships between the outcomes.

METHODS

Fifty volunteers were seen for two visits 14 ± 2 days apart. Ocular sun exposure was estimated over a 2-week time period using questionnaires that quantified time outdoors and ocular protection habits. Conjunctival UVAF was imaged using a Nikon D7000 camera system equipped with appropriate flash and filter system; image analysis was done using ImageJ software. Repeatability estimates were made using Bland-Altman plots with mean differences and 95% limits of agreement calculated. Non-normally distributed data was transformed by either log10 or square root methods. Linear regression was conducted to evaluate relationships between measures.

RESULTS

Mean (±SD) values for ocular sun exposure and conjunctival UVAF were 8.86 (±11.97) hours and 9.15 (±9.47) mm, respectively. Repeatability was found to be acceptable for both ocular sun exposure and conjunctival UVAF. Univariate linear regression showed outdoor occupation to be a predictor of higher ocular sun exposure; outdoor occupation and winter season of collection both predicted higher total UVAF. Furthermore, increased portion of day spent outdoors while working was associated with increased total conjunctival UVAF.

CONCLUSIONS

We demonstrate feasibility and repeatability of estimating ocular sun exposure using a previously unreported method and for conjunctival UVAF in a group of subjects residing in Ohio. Seasonal temperature variation may have influenced time outdoors and ultimately calculation of ocular sun exposure. As winter season of collection and outdoor occupation both predicted higher total UVAF, our data suggests that ocular sun exposure is associated with conjunctival UVAF and, possibly, that UVAF remains for at least several months after sun exposure.

Distributions of Direct, Reflected, and Diffuse Irradiance for Ocular UV Exposure at Different Solar Elevation Angles

To analyze intensities of ocular exposure to direct (E_o,dir), reflected (E_o,refl), and diffuse (E_o,diff) ultraviolet (UV) irradiance at different solar elevation angles (SEAs), a rotating manikin and dual-detector spectrometer were used to monitor the intensity of ocular exposure to UV irradiation (E_o) and ambient UV radiation (UVR) under clear skies in Sanya, China. E_o,dir was derived as the difference between maximum and minimum measured E_o values. E_o,refl was converted from the value measured at a height of 160 cm. E_o,diff was calculated as the minimum measured E_o value minus E_o,refl. Regression curves were fitted to determine distributions of intensities and growth rates at different wavelengths and SEAs. E_o,dir differed from ambient UVR exposure. Linear, quadratic, and linear E_o,dir distributions were obtained in SEA ranges of 14°–30°, 30°–50°, and 50°–90°, respectively, with maximum E_o,dir at 32°–38° SEA. Growth rates of E_o,dir with increasing wavelength were fitted with quadratic functions in all SEA ranges. Distributions and growth rate of E_o,refl values were fitted with quadratic functions. Maximum E_o,diff was achieved at the same SEA for all fitted quadratic functions. Growth rate of E_o,diff with increasing wavelength was fitted with a linear function. E_o,dir distributions were fitted with linear or quadratic functions in different SEA ranges. All E_o,refl and E_o,diff distributions were fitted with quadratic functions. As SEA increased, the E_o,dir portion of E_o increased and then decreased; the E_o,refl portion increased from an initial minimum; and the E_o,diff portion first decreased and then increased. The findings may provide data supporting on construction of a mathematical model of ocular UV exposure.

The angular distributions of ultraviolet spectral irradiance at different solar elevation angles under clear sky conditions

To investigate the angular distributions of UVA, UVB, and effective UV for erythema and vitamin D (vitD) synthesis, the UV spectral irradiances were measured at ten inclined angles (from 0° to 90°) and seven azimuths (from 0° to 180°) at solar elevation angle (SEA) that ranged from 18.8° to 80° in Shanghai (31.22° N, 121.55° E) under clear sky and the albedo of ground was 0.1. The results demonstrated that in the mean azimuths and with the back to the sun, the UVA, UVB, and erythemally and vitD-weighted irradiances increased with the inclined angles and an increase in SEA. When facing toward the sun at 0°-60° inclined angles, the UVA first increased and then decreased with an increase in SEA; at other inclined angles, the UVA increased with SEA. At 0°-40° inclined angles, the UVB and erythemally and vitD-weighted irradiances first increased and then decreased with an increase in SEA, and their maximums were achieved at SEA 68.7°; at other inclined angles, the above three irradiances increased with an increase in SEA. The maximum UVA, UVB, and erythemally and vitD-weighted irradiances were achieved at an 80° inclined angle at SEA 80° (the highest in our measurements); the cumulative exposure of the half day achieved the maximum at a 60° inclined angle, but not on the horizontal. This study provides support for the assessment of human skin sun exposure.

The consequences for human health of stratospheric ozone depletion in association with other environmental factors

Ozone depletion, climate and human health.

Conjunctival UV autofluorescence--prevalence and risk factors

PURPOSE

Autofluorescence of ultraviolet (UV) light has been shown to occur in localised areas of the bulbar conjunctiva, which map to active cellular changes due to UV and environmental exposure. This study examined the presence of conjunctival UV autofluorescence in eye care practitioners (ECPs) across Europe and the Middle East and its associated risk factors.

METHOD

Images were captured of 307 ECPs right eyes in the Czech Republic, Germany, Greece, Kuwait, Netherlands, Sweden, Switzerland, United Arab Emirates and the United Kingdom using a Nikon D100 camera and dual flash units through UV filters. UV autofluorescence was outlined using ImageJ software and the nasal and temporal area quantified. Subjects were required to complete a questionnaire on their demographics and lifestyle including general exposure to UV and refractive correction.

RESULTS

Average age of the subjects was 38.5±12.2 years (range 19-68) and 39.7% were male. Sixty-two percent of eyes had some conjunctival damage as indicated by UV autofluorescence. The average area of damage was higher (p=0.005) nasally (2.95±4.52mm(2)) than temporally (2.19±4.17mm(2)). The area of UV damage was not related to age (r=0.03, p=0.674), gender (p=0.194), self-reported sun exposure lifestyle (p>0.05), geographical location (p=0174), sunglasses use (p>0.05) or UV-blocking contact lens use (p>0.05), although it was higher in those wearing contact lenses with minimal UV-blocking and no spectacles (p=0.015). The area of UV damage was also less nasally in those who wore contact lenses and spectacles compared to those with no refractive correction use (p=0.011 nasal; p=0.958 temporal).

CONCLUSION

UV conjunctival damage is common even in Europe, Kuwait and UAE, and among ECPs. The area of damage appears to be linked with the use of refractive correction, with greater damage nasally than temporally which may be explained by the peripheral light focusing effect.

Risk of ocular exposure to biologically effective UV radiation in different geographical directions

To quantify ocular exposure to solar ultraviolet radiation (UVR) and to assess the risk of eye damage in different geographical directions due to UVR exposure, we used a spectrometer and a manikin to measure horizontal ambient and ocular exposure UVR in different geographical directions at four different locations at the Northern Hemisphere. Describing the relationship of exposure to risk of eye damage requires the availability of UV hazard weighting function. So, we used the UV hazard weighting function (ICNIRP) proposed by International Commission on Non-Ionizing Radiation Protection to determine the biologically effective UV irradiance (UVBEeye ) and then cumulative effective radiant exposure (Heye ) to shown the risk of eye. We found that in different geographical directions, distributions of ocular exposure to UVR were markedly different from those of horizontal ambient UVR. When the midday maximum SEA > 50°, eye received more UVR from the east and west directions during the morning and evening hours, respectively. However, when the midday maximum SEA < 50°, eye received more UVR from the south direction at noon. The results of this research indicate that the higher risk of eye caused by UVR varies according to the midday maximum SEA corresponding to different geographical direction.