UV-Absorbing Contact Lenses: A Concept Gaining Momentum

APR. 1997

UV protection in spectacles has become the status quo. Will contact lenses follow suit? Yes, say these practitioners.

Consumers have become more and more knowledgeable about the damaging effects of the sun on their skin, thanks in part to a strong educational effort by organizations such as the American Cancer Society. This increased awareness has spawned a new category in the health and beauty aids department -- sun blockers, as opposed to tanning lotions -- and has even prompted the U.S. National Weather Service to develop an Ultraviolet Index to help predict potential damage based on weather conditions and ozone levels.

Eyecare practitioners have long been aware of the effects of UV radiation on ocular tissue and can now offer numerous options, including contact lenses with UV blockers, to help patients avoid sun-related damage to their eyes.

Contact Lens Spectrum: Do you think heightened public awareness about the damage caused by sun exposure has increased patients' interest in contact lenses that can protect their eyes from ultraviolet radiation?

Dr. Eric White: More people are becoming interested in the concept of UV-absorption in contact lenses, especially among my disposable lens patients. In southern California, people are very interested in health products and in keeping their skin and their bodies healthy. UV protection in contact lenses is part of that movement toward maintaining health and healthy lifestyles.

Dr. Hankin: Even though people are more aware of the dangers of UV radiation in general, there's still some misunderstanding. Many patients believe that contact lenses, by their very nature, block UV radiation. We need to educate patients that there's even more light getting into their eyes while they're wearing contact lenses than while they're wearing spectacles.

Dr. Yager: People are very health conscious nowadays. And based on the growing body of clinical evidence, the media have widely reported the suspected link between UV radiation and cataracts and retinal damage. So, when Precision UV, the first UV-absorbing disposable lens, became available, it was a natural addition to our contact lens practice.

Dr. Becherer: Eventually, it will be just assumed that all contact lenses will offer UV-absorption.

Contact Lens Spectrum: As more UV-absorbing lenses become available at competitive prices, do you expect UV protection to become the standard of care in contact lenses?

Dr. Ossip: In our office, we talk regularly about UV protection, whether the patient wants spectacles or contact lenses. Not until all lenses have UV-absorbing capabilities, however, will we be able to provide this protection for all contact lens patients.

Dr. Hankin: There are patients who are wearing traditional daily wear lenses who don't want to go into a frequent replacement plan. There are also those who don't want to switch to a significantly different lens. But for those where the fitting characteristics are good, it may be a good fit. The push in UV-absorbing contact lenses initially needs to be manufacturer-driven. When there are more choices, then it will become consumer-driven. At present, however, the patient identification factor is still minimal.

Dr. Yager: After UV-absorbing lenses were advertised to the public in our area, interest in the lens jumped significantly. I anticipate that national advertising will result in a dramatic increase in requests for UV protection in contact lenses.

PATIENT EDUCATION

Contact Lens Spectrum: How do you introduce the concept of contact lenses with UV protection to patients?

Dr. Yager: If we hear during a case history that the patient is an outdoors enthusiast -- an angler or a beachgoer or a golfer -- we suggest UV-absorbing contact lenses. We also recommend them to patients who spend a lot of time in front of a computer screen, which also emits UV rays.

Dr. Hankin: I target patients with a family history of macular degeneration or cataracts or patients with mild cataract formation. UV protection would be required if these patients were wearing spectacles, so the same thought process should apply to contact lenses. Any patient at risk for dermatological problems due to UV exposure should seek UV protection in all eyewear.

Dr. Ossip: The key to patient education about UV protection is to begin by asking lifestyle questions, and then follow up with a discussion with the doctor, the contact lens technician or the optician. Staff and patients need to know why UV protection is important. At some point, patients stop asking 'why' and say 'why not.' Indeed, why not get the extra protection?

One other element of patient education is that UV protection is invisible. You can't look at the lens and say, "Gee, there it is."

Dr. Hankin: It makes a lot of sense to patients when you explain that we should be trying to protect their eyes, not just when they're wearing sunglasses, but also when they're wearing eyeglasses or contact lenses.

Dr. Bergmanson: Practitioners should also educate patients that some medications are UV photosensitizing, including oral contraceptives, tetracyclines, antifungals, NSAIDs, psoralens, tranquilizers, certain blood pressure medications and sulfa drugs.

There are even some foods that are photosensitizing, such as citrus fruits, carrots, celery, mustards, parsley and parsnips. We need to communicate this information to patients as well.

VALUE-ADDED SERVICE

Contact Lens Spectrum: Do you think cost is an issue for patients who may be thinking about UV protection in contact lenses?

Dr. Ossip: I believe patients would be willing to pay a nominal extra charge for the protection.

Dr. Bergmanson: Cost may always be an issue for some patients, but our first job is education. For example, most parents don't realize that 50 percent of one's exposure to ultraviolet radiation occurs during the first 18 years. Therefore, it's especially important to protect adolescents and teen-agers.

Dr. Becherer: For years, we've added UV protection to every pair of eyeglasses that go through our office. But the idea itself isn't something you can charge for. It's an added value. All things being equal, if I have two types of contact lenses, one with a UV blocker and one without, I'll use the one with the blocker.

Dr. Kenneth White: I've been prescribing UV-absorbing contact lenses since they first became available. I use them as often as I practically can for patients who wear disposable lenses. Even here in the Pacific northwest, many people spend time on the water and the protection from UV on the water is a benefit to them.

When a UV-absorbing lens is priced competitively, it's a win-win situation for patients from a medical and an economic point of view. It's one more thing we can do to protect a patient's eyes over a lifetime.

Dr. Eric White: The best way to convince patients of the value of UV-absorbing lenses is to have them try the lenses. It's difficult to tell in the first five minutes of wear in my office if the lenses fit correctly, so we always let patients try them for a week. When they return, we again emphasize that the lenses are protecting their eyes. This reinforces that our concern is for their overall health and not just our pocketbooks.

Dr. Hankin: It's our job as eyecare professionals to educate patients about the risks associated with exposure to ultraviolet radiation and to provide preventive modalities, especially when there's no price barrier. CLS

This roundtable was sponsored by Wesley Jessen VisionCare, Inc., Des Plaines, Ill.

The practitioners who participated in this roundtable are members of Wesley Jessen's professional advisory panel. They are: P. Douglas Becherer, O.D., Belleville, Ill.; Jan Bergmanson, O.D., Ph.D.; Bruce R. Hankin, O.D., Penfield, N.Y.; Gregg L. Ossip, O.D., Indianapolis; Eric M. White, O.D., San Diego; Kenneth L. White, O.D., Mount Vernon, Wash.; and Joseph Yager, O.D., Orlando, Fla.

Thinning Ozone may Lead to Increase in Chronic UV-related Diseases

Chronic exposure to ultraviolet radiation may play a significant contributory role in the development of eye diseases, such as cataracts and macular degeneration of the retina, which is the leading cause of blindness in adults over age 55 in the United States. Other sunlight-related eye diseases are pterygium, cancer of the eyelids and photokeratitis.

Although there is documentation showing a connection between UV radiation and some ocular conditions, this correlation isn't easy to quantify. For example, UV exposure cannot be calculated solely by where someone lives. A lifeguard and an accountant can have dramatically different UV exposures - even if they're neighbors.

With the thinning of the earth's protective ozone layer, the indication is that UV-related ocular conditions will increase. One finding indicates that for every one percent decrease in the ozone, there will be an increase of 0.6 percent to 0.8 percent in cataracts annually. That's approximately 100,000 to 150,000 additional cases of cataract-induced blindness worldwide. We're also noticing that in tropical areas with higher UVB radiation, people are developing cataracts at younger ages.

Aside from conditions directly affecting the eye, the sun's damage to the skin is well known. There is evidence that cancer of the eyelid is light-induced.

The irony in UV radiation protection is that improper protection can be worse than none at all. Not all sunglasses effectively screen harmful UV rays. So wearing dark spectacles, which will cause a patient's eyes to dilate, will actually allow more of the damaging rays to reach the eye.

While discussions about preventing damage from the sun's rays are applicable to all patients, the following patients particularly need UV protection:

• Aphakes and pseudo-aphakes to prevent retinal damage.
• Cataract patients to try to decrease progressive changes.
• Patients on photosensitizing medication - chlorothiazides, antibiotics and oral contraceptives are a minimal list of examples.
• Workers in vocations rich in UV radiation: welders, electronics workers, people involved in the graphic arts and researchers.
• People who spend excessive hours in the sun.
• Patients with pinguecula, pterygia and macular degeneration.
• People who use sunlamps or solariums.
• Children who play outside or are exposed to excessive UV radiation to delay photochemical responses in the eye.

- By Penny Asbell, M.D.