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Top 10 de instrumentos de diagnóstico 2012

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Title: Top 10 de instrumentos de diagnóstico 2012
Author: Infolentes
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<span style="font-family: Verdana, sans-serif; font-size: small;">Los registros médicos electrónicos, cámaras digitales y los PTU son las tecnologías más populares de este año, de acuerdo a nuestra encuesta anual. Están cambiando la forma de practicar.</span></h5>
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<span style="background-color: #fefefd; color: #333333; font-family: Arial;">An electronic medical records system may be helpful if used correctly, but can be disastrous if something goes wrong. Meanwhile, an optical coherence tomographer is quickly becoming a tool that optometrists simply cannot do without. </span><br />
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<span style="font-family: Arial;">These are just a couple of the findings from our Annual Diagnostic Technology Survey, based on responses from 260 optometrists to an email questionnaire. </span></div>
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<span style="font-family: Arial;">Among our questions, we asked our readers which instruments or equipment they currently want to buy or have purchased in the past three years. <br style="font-family: Tahoma, Arial, Helvetica, sans-serif;" />The top 10 most bought or most wished-for items are:</span></div>
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<span style="font-family: Arial;"><strong style="font-family: Tahoma, Arial, Helvetica, sans-serif;"><span style="color: #c7020c; font-size: small;">1. EMR</span></strong> <br style="font-family: Tahoma, Arial, Helvetica, sans-serif;" />EMR systems are not diagnostic equipment, of course. Still, they elbowed out the other technology-related products on our survey by a wide margin—41% of our respondents say they’ve recently bought or are looking to buy an EMR system and/or software that integrates equipment and practice management programs. </span></div>
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<span style="font-family: Arial;">“EMR has without a doubt been the most significant improvement in the practice,” says optometrist James Budd, of Monroeville, Pa. “There are some growing pains, but it’s infinitely better than paper.”</span></div>
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<span style="font-family: Arial;">Indeed, as many as 64% of respondents now use an EMR system. Compare that to just 39% in 2009—which was the year that Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act to promote the adoption and “meaningful use” of health information technology. </span></div>
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<span style="font-family: Arial;">As you know by now, the HITECH Act provides financial incentives for those who use a certified EMR system. On the other hand, the act will reduce Medicare and Medicaid reimbursements for those who cannot document “meaningful use” of such a system by 2015. </span></div>
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<span style="font-family: Arial;">The HITECH Act is worthy in spirit; but in practical terms, reaction to the requirement that doctors embrace this technology has been hit or miss. </span></div>
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<span style="font-family: Arial;">“Eight new computers and [a leading EMR/practice management system] were purchased in the last quarter of 2011 to take advantage of certain Federal tax deductions and tax credits,” says Ira J. Cohen, O.D., of his Lake Worth, Fla., practice. “So far, it has created a lot of stress in the office and dissension among the staff members.”</span></div>
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<span style="font-family: Arial;">Many doctors complain of losing days of data if the system goes down. Optometrist Larry Gunnell of Wichita Falls, Texas, voices another common complaint: “Sometimes I feel more like a proofreader than a clinician. Autofill is a real problem when it comes to lens prescriptions.”</span></div>
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<span style="font-family: Arial;">Fortunately for many practitioners, the technology actually does what it’s supposed to do. </span></div>
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<span style="font-family: Arial;">“I wanted to be more organized, with better capability to recall charts and data,” says William Jackson, O.D., of Lake Jackson, Texas. “This purchase has done just that. It has also allowed the office to be more organized and more consistent in billing and coding.”</span></div>
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<span style="font-family: Arial;"><strong style="font-family: Tahoma, Arial, Helvetica, sans-serif;"><span style="color: #c7020c; font-size: small;">2. Digital Fundus Camera</span></strong> <br style="font-family: Tahoma, Arial, Helvetica, sans-serif;" />About one-third (34%) of O.D.s who responded to our survey now own or are considering a digital fundus camera. </span></div>
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<span style="font-family: Arial;">Robert Buonfiglio, O.D., of Saugus, Mass., recently bought one. “While I’m hoping it enhances revenue, it also allows me to show patients the insides of their eyes,” he says. “For patients with diabetes, I now send photos with any changes labeled to their primary care doctors. It’s my hope that doing this will produce more referrals, not only for diabetic evaluations but for red eyes, foreign bodies, etc.”</span></div>
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<span style="font-family: Arial;">Lamont P. Freeman, O.D., sees a large number of patients with diabetes at his clinic in Brooklyn. “The adage, ‘A picture is worth a thousand words,’ is not just a saying. It’s very real,” he says of his digital fundus camera. “All [of our] recommendations are accepted by patients after they view their fundus.” Additional benefits include increased income, better patient flow, increased number of patients and increased utilization of services, he says. </span></div>
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<span style="font-family: Arial;">Kenneth R. Mueller, O.D., of Hannibal, Mo., appreciates the usefulness of the Pictor (Volk Optical), a new handheld, portable anterior and posterior camera. “It offers nice photographic capabilities for mobility-challenged patients in an ergonomic and affordable device,” he says. </span></div>
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<span style="font-family: Arial;"><span style="color: #c7020c; font-family: Tahoma, Arial, Helvetica, sans-serif; font-size: small;"><strong>3. & 4. SD-OCT and TD-OCT</strong></span> <br style="font-family: Tahoma, Arial, Helvetica, sans-serif;" />Optical coherence tomography is not officially part of the standard operating equipment for optometric practices—yet. But once optometrists get an OCT, they wonder how they got along without it. </span></div>
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<span style="font-family: Arial;">Specifically, 28% of our respondents own or want to own a time-domain (TD) OCT, and 29% voiced the same interest in a spectral-domain (SD) OCT. (Respondents were allowed to choose more than one option in the survey.) </span><br />
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<span style="font-family: Arial;">Paul Heersink, O.D., of Monte Vista, Colo., says the SD-OCT is the single best instrument purchase he’s ever made. “It gives me unparalleled confidence in managing retinal conditions. It improves my ability to educate my patients on their retinal condition [by] showing the problem in a way that they can more easily understand,” he says. </span></div>
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<span style="font-family: Arial;">Furthermore, Dr. Heersink adds, “as a rural practitioner in solo practice, it has been invaluable to me because I often have to make the call to send someone three to four hours away for a referral. Now I know whether it’s necessary or not because I’ve already sent it to the retina specialist for his opinion.”</span></div>
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<span style="font-family: Arial;">Unfortunately, the billing for an OCT changed in 2011 from a single-eye test to a bilateral one, effectively cutting the reimbursement fee in half. “With the cut in reimbursement, the instrument is not paying for itself,” says optometrist Bob Day, of Garland, Texas. “But I am able to better care for my patients.” </span></div>
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<span style="font-family: Arial;">Expanded indications for OCT can help to defray the cost while continuing to improve care. Although OCT traditionally had been reserved for retinal disease diagnosis, it has lately made inroads in the management of other conditions. For instance, newer software modules can analyze retinal nerve fiber layer dropout and ganglion cell loss in glaucoma, as well as corneal thickness and the anterior segment angle.</span></div>
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<span style="font-family: Arial;">“The OCT that we bought last year has increased referrals and has improved patient care dramatically,” says Todd Cohan, O.D., of Long Grove, Ill. “We have been diagnosing glaucoma suspects way ahead of time and are able to provide more preventative eye care. The patients have been more than impressed. As a result, our medical billing has increased with more medical follow-up exams.”</span></div>
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<span style="font-family: Arial;"><span style="color: #c7020c; font-family: Tahoma, Arial, Helvetica, sans-serif; font-size: small;"><strong>5. Corneal Topographer</strong></span> <br style="font-family: Tahoma, Arial, Helvetica, sans-serif;" />Some 26% of our respondents recently have purchased or are considering a corneal topographer. Optometrist Michael Raff of Brockport, N.Y., got one last year. “We increased contact lens fit/refit fees by $5, which offset the cost for the instrument while upgrading the technology,” he says. </span></div>
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<span style="font-family: Arial;">Jared Hadlock of Montrose, Colo., bought a three-in-one topographer/autorefractor/keratometer. “We needed a new AR and wanted a topo, so it was a great way to knock out two birds with one stone for not much more in price than just an AR,” he says. “We’ve been able to find more keratoconus patients than we originally thought we had. It has definitely added a ‘wow’ factor for patients as well. It’s easy and does all the measurements at one time, so it’s quick, too.”</span></div>
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<span style="font-family: Arial;"><strong style="font-family: Tahoma, Arial, Helvetica, sans-serif;"><span style="color: #c7020c; font-size: small;">6. Automated Refraction System</span></strong> <br style="font-family: Tahoma, Arial, Helvetica, sans-serif;" />Twenty-five percent of optometrists have bought or want to buy an automated refraction system. Matthew Stanley, O.D., recently added it to two exam lanes in his Manhattan, Kan., office. “I save nearly five minutes per patient on refraction,” he says. “The patients are wowed by the technology and love seeing the difference between their old and new Rx.” This effect has boosted his optical sales, he adds. </span></div>
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<span style="font-family: Arial;">Carlton Chan, O.D., of Solana Beach, Calif., realized a dramatically different benefit: “The Marco TRS saved my career. It solved all my back problems.”</span></div>
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<span style="font-family: Arial;"><span style="color: #c7020c; font-family: Tahoma, Arial, Helvetica, sans-serif; font-size: small;"><strong>7. Perimeter/Visual Field Analyzer</strong></span> <br style="font-family: Tahoma, Arial, Helvetica, sans-serif;" />If you want to diagnose and treat glaucoma, you need a perimeter. And 23% of our respondents are “scouting the field” for one. Some doctors, such as Michael Lange, O.D., of Ocala, Fla., went for the added investment of a visual field analyzer. “It’s highly sensitive for detecting early glaucoma field loss,” he says. “Patients love it and I trust it. It can perform a billable full-threshold test on a new patient in around four minutes, get better dependability indices for many patients, and give me better decision-making data on those ‘iffy’ early suspects.”</span></div>
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<span style="font-family: Arial;"><span style="color: #c7020c; font-family: Tahoma, Arial, Helvetica, sans-serif; font-size: small;"><strong>8. Digital Anterior Seg Camera</strong></span> <br style="font-family: Tahoma, Arial, Helvetica, sans-serif;" />“We have done posterior segment photos for many years, and anterior seg photography is a logical and practical extension of posterior seg documentation,” says Larry Cusma, O.D., of Scotia, N.Y. Other optometrists appear to think the same—about one in five (21%) have recently bought an anterior seg camera or are looking to buy one. “It’s a great device for showing patients their ocular pathology of the anterior seg, and reinforcing the need for regular exams and follow-up monitoring,” Dr. Cusma says. </span></div>
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<span style="font-family: Arial;"><strong style="font-family: Tahoma, Arial, Helvetica, sans-serif;"><span style="color: #c7020c; font-size: small;">9. Pachymeter</span></strong> <br style="font-family: Tahoma, Arial, Helvetica, sans-serif;" />Three out of four optometrists (75%) say they now have a pachymeter (or other instrument that measures corneal thickness). That’s up from about two-thirds (68%) who reported they had one in our 2010 survey. About 21% of our respondents are in the market for one. </span></div>
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<span style="font-family: Arial;">“It’s amazing how the pachymeter affects how I view whether or not someone is a glaucoma suspect,” says Lorelei Zeiler, O.D., of Caledonia, Ontario. “If the patient has large discs, large cupping or higher IOPs (20mm Hg to 24mm Hg) but thick corneas—no worries. Thin corneas? Yes, worry!”</span></div>
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<span style="font-family: Arial;"><span style="color: #c7020c; font-family: Tahoma, Arial, Helvetica, sans-serif; font-size: small;"><strong>10. Patient Callback/Reminder System</strong></span> <br style="font-family: Tahoma, Arial, Helvetica, sans-serif;" />About one in five (21%) respondents recently obtained or are shopping for one of these patient retention systems. The connectivity with EMR systems and the high-tech advancements—such as sending a text message to a patient’s smartphone—has led to renewed interest and savings in this practice management technology. </span></div>
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<span style="font-family: Arial;">Ten percent of our respondents say that increasing revenue is their most important reason for buying new equipment. While adding revenue is always an important consideration, this statistic takes a distant second place compared to improving patient care—77% of O.D.s say this is their primary reason for investing in new technology.</span></div>
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<tr><td style="padding: 3px;"><span style="font-family: Arial; font-size: small;">• <strong style="font-family: Tahoma, Arial, Helvetica, sans-serif;">Wide-field scanning laser ophthalmoscope. </strong>“The Optomap (Optos) has greatly impacted my practice,” says Marcia Leverett, O.D., of Virginia Beach, Va. “It has increased my revenues, helped in diagnosing retinal disease and helped me to start thinking in an even more medically-oriented way for my whole practice. I would not want to practice without it now.”</span><br />
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<span style="font-family: Arial; font-size: small;">• <strong style="font-family: Tahoma, Arial, Helvetica, sans-serif;">Specular microscope. </strong>“The utilization and reimbursement make this technology a financial ‘home run,’” Dr. Gunnell says.</span></div>
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<span style="font-family: Arial; font-size: small;">• <strong style="font-family: Tahoma, Arial, Helvetica, sans-serif;">Handheld tonometer.</strong> “We bought the Icare tonometer to replace the non-contact tonometer (NCT) as a screening device used by the technician. Patients love it,” says Suzanne Corbitt of St. Johnsbury, Vt. “It is so much easier to get an IOP reading on children (and adults alike) who are very apprehensive about the NCT or even the Goldmann tonometer. It gets the technician more involved with the exam and it has made the overall exam that much more efficient for the doctors.”</span></div>
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<span style="font-family: Arial; font-size: small;">• <strong style="font-family: Tahoma, Arial, Helvetica, sans-serif;">Patient education system.</strong> “I can create or upload practice or product info into these displays, and people love to watch them—no one can resist a TV screen [in the waiting room],” Dr. Lange says. “Now I get asked about new products or services by an open-minded patient instead of having to ‘pitch’ a product or treatment…[and] I don’t have to waste chair time doing it.”</span></div>
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Top 10 de instrumentos de diagnóstico 2012

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Estudian una nueva especie de semilla amazónica que tiene 66% de omega 3

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Title: Estudian una nueva especie de semilla amazónica que tiene 66% de omega 3
Author: Infolentes
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Visualizacion optima 1600x900 pixel Comenta.esta.publicación Su reciente hallazgo lo denomina ‘el alimento promisorio de Amazonas p...

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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWxeAI11Ws80Ar0T9fLg2XWEncJvsiJ5jPCuvm7v6we5b-XFzVjDKgXlNjpf0b9bKpxogrsmJTXb6Bxq7vSHF71TfPTARC7hgZ3BxdhWLimZVsOVvWZbEneUrBjBED92pWxpOHIN8vJg8/s1600/STON0087.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWxeAI11Ws80Ar0T9fLg2XWEncJvsiJ5jPCuvm7v6we5b-XFzVjDKgXlNjpf0b9bKpxogrsmJTXb6Bxq7vSHF71TfPTARC7hgZ3BxdhWLimZVsOVvWZbEneUrBjBED92pWxpOHIN8vJg8/s400/STON0087.jpg" width="400" /></a></div>
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<span style="background-color: white; color: #333333; font-family: arial; text-align: start;">Su reciente hallazgo lo denomina ‘el alimento promisorio de Amazonas para el mundo’. Se trata de la huayllabambana, un fruto que posee el mayor contenido de aceites omega 3 conocido hasta el momento en un producto vegetal. Su concentración llega al 66%, y aunque su apariencia en los arbustos es similar a la del sacha inchi –en forma de estrella–, se trata de un producto distinto. “Es como si habláramos del tomate y la papa, que no son iguales, pero ambos son solanáceas. En este caso, esta nueva semilla y el sacha inchi también pertenecen a una familia, pero son diferentes especies”, explica el ingeniero Edy Barnett, director encargado de la Escuela Profesional de Ingeniería de Industrias Alimentarias de la Universidad San Martín de Porres. </span><strong style="background-color: white; border: 0px; color: #333333; font-family: arial; margin: 0px; outline: 0px; padding: 0px; text-align: start;">Si quieres saber más sobre este interesante tema, sigue leyendo este informe desarrollado por Pamela Montes.</strong></div>
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<strong style="background-color: white; border: 0px; color: #333333; font-family: arial; margin: 0px; outline: 0px; padding: 0px; text-align: start;">El ingeniero Barnett lidera una investigación para ampliar los conocimientos de caracterización fitoquímica y valor nutricional de la huayllabambana.</strong></div>
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<strong style="background-color: white; border: 0px; color: #333333; font-family: arial; margin: 0px; outline: 0px; padding: 0px; text-align: start;">“En la selva la comercializaban como sacha inchi, pero ahora ya se sabe que es otra semilla y de mejor valor por los omega 3. Mientras que el sacha inchi tiene un 44% de omega 3, la huayllabambana tiene concentraciones entre 60% y 66%”.</strong></div>
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<strong style="background-color: white; border: 0px; color: #333333; font-family: arial; margin: 0px; outline: 0px; padding: 0px; text-align: start;">Asimismo, tiene gran fortaleza frente al ataque de nematodos, una plaga que suele dañar raíces del sacha inchi, comprometiendo su producción.</strong></div>
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<strong style="background-color: white; border: 0px; color: #333333; font-family: arial; margin: 0px; outline: 0px; padding: 0px; text-align: start;">Los estudios en el laboratorio del ingeniero Bernett han corroborado el potencial que se menciona en el estudio científico que dio cuenta de su hallazgo, en abril del año pasado.</strong></div>
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<strong style="background-color: white; border: 0px; color: #333333; font-family: arial; margin: 0px; outline: 0px; padding: 0px; text-align: start;">El “Nordic Journal of Botany” publicó por primera vez la descripción de una nueva especie peruana, la ‘Plukenetia huallabambana’, bajo autoría de los científicos Rainer Bussmann, Carolina Téllez y Ashley Glenn.</strong></div>
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<strong style="background-color: white; border: 0px; color: #333333; font-family: arial; margin: 0px; outline: 0px; padding: 0px; text-align: start;">Ellos establecieron que se trataba de una especie distinta al sacha inchi (‘Plukenetia volubilis’) y detallaron que, además de su valioso aporte nutricional, esta semilla se perfila como una opción importante de cultivo alternativo a la coca en la región amazónica.</strong></div>
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<strong style="background-color: white; border: 0px; color: #333333; font-family: arial; margin: 0px; outline: 0px; padding: 0px; text-align: start;">Aunque la forma en estrella del fruto en el arbusto se asemeje a la del sacha inchi, su gran tamaño lo diferencia a simple vista. Las semillas se desprenden de su cáscara con facilidad, la almendra es redonda y de color claro; y su consumo está recomendado en forma de aceite.</strong></div>
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<strong style="background-color: white; border: 0px; color: #333333; font-family: arial; margin: 0px; outline: 0px; padding: 0px; text-align: start;">Luego del prensado de las almendras se obtiene un aceite altamente viscoso y de sabor muy agradable. “Su consumo no sería en almendra sino en aceite, tal como el sacha inchi. Se sabe que cuando el fruto se somete al calor en el tostado, se alteran sus propiedades. Estamos ampliando estudios para determinar con exactitud estos cambios”, finaliza el ingeniero Barnett.</strong></div>
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<strong style="background-color: white; border: 0px; color: #333333; font-family: arial; margin: 0px; outline: 0px; padding: 0px; text-align: start;"><strong style="border: 0px; margin: 0px; outline: 0px; padding: 0px;">Valor nutricional</strong></strong></div>
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<li style="border: 0px; margin: 0px; outline: 0px; padding: 0px;"><strong style="background-color: white; border: 0px; color: #333333; font-family: arial; margin: 0px; outline: 0px; padding: 0px; text-align: start;">Muchas personas suelen evitar alimentos como las pecanas, maní o palta porque contienen grasas. Sin embargo, se trata de grasas beneficiosas para el organismo.</strong></li>
<li style="border: 0px; margin: 0px; outline: 0px; padding: 0px;"><strong style="background-color: white; border: 0px; color: #333333; font-family: arial; margin: 0px; outline: 0px; padding: 0px; text-align: start;">Es el caso de los ácidos grasos omega 3, un grupo de grasas esenciales que el cuerpo humano no los puede fabricar y que deben ser consumidas mediante alimentos como los pescados azules y semillas como el sacha inchi.</strong></li>
<li style="border: 0px; margin: 0px; outline: 0px; padding: 0px;"><strong style="background-color: white; border: 0px; color: #333333; font-family: arial; margin: 0px; outline: 0px; padding: 0px; text-align: start;">Estos ácidos ayudan a la formación de estructuras neuronales, mejoran la circulación sanguínea y el sistema inmunológico, y reducen los niveles de triglicéridos y el colesterol.</strong></li>
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<strong style="background-color: white; border: 0px; color: #333333; font-family: arial; margin: 0px; outline: 0px; padding: 0px; text-align: start;"><strong style="border: 0px; margin: 0px; outline: 0px; padding: 0px;">Producción incipiente</strong> En la provincia de Rodríguez de Mendoza, en el departamento de Amazonas, ya existen cerca de 1.000 hectáreas de cultivo de este fruto.</strong></div>
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<strong style="background-color: white; border: 0px; color: #333333; font-family: arial; margin: 0px; outline: 0px; padding: 0px; text-align: start;"><strong style="border: 0px; margin: 0px; outline: 0px; padding: 0px;">Similares pero distintos</strong> El sacha inchi crece en la selva baja, mientras que la huayllabambana ha sido encontrada en la selva alta, en alturas superiores a los 1.200 metros sobre el nivel del mar.</strong></div>
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<strong style="background-color: white; border: 0px; color: #333333; font-family: arial; margin: 0px; outline: 0px; padding: 0px; text-align: start;"><strong style="border: 0px; margin: 0px; outline: 0px; padding: 0px;">Buen futuro</strong> Los investigadores piensan que el potencial de esta semilla es amplio en la industria aceitera y beneficioso como cultivo alternativo para familias que viven entre los 1.300 y 2.200 m.s.n.m.</strong></div>
<div style="border: 0px; font-weight: normal; line-height: 16px; margin-bottom: 15px; outline: 0px; padding: 0px;">
<strong style="background-color: white; border: 0px; color: #333333; font-family: arial; margin: 0px; outline: 0px; padding: 0px; text-align: start;"><strong style="border: 0px; margin: 0px; outline: 0px; padding: 0px;">Alta rentabilidad</strong> Su rendimiento es de 3.000 kg. por hectárea y su precio de venta promedio por kilogramo es de S/. 5,50.</strong></div>
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Estudian una nueva especie de semilla amazónica que tiene 66% de omega 3

Visualizacion optima 1600x900 pixel Comenta.esta.publicación Su reciente hallazgo lo denomina ‘el alimento promisorio de Amazonas p...

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Enfoque de los colores en la miopía e hipermetropía

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Title: Enfoque de los colores en la miopía e hipermetropía
Author: Infolentes
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Visualizacion optima 1600x900 pixel Comenta.esta.publicación La aberración cromática El ojo consta de un sistema de lentes convergent...

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<strong style="border: 0px; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">La aberración cromática</strong></div>
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El ojo consta de un sistema de lentes convergentes que enfocan la imagen en el fondo del ojo, en la retina. Lo característico de una lente es que cambia la dirección de los rayos de luz, en esta característica concreta se parece a otro sistema óptico llamado <em style="border: 0px; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">prisma</em>. Ahora no vamos a especificar todas las características de las lentes y los prismas, pero si que nos vamos a detener en el fenómeno que permite cambiar de dirección la luz, que se llama <a href="http://es.wikipedia.org/wiki/Refracci%C3%B3n" style="border: 0px; color: #cc0000; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;">refracción</a>. La refracción tiene una característica muy interesante, y es que el ángulo de desviación de la luz depende (entre otras cosas) de la <a href="http://es.wikipedia.org/wiki/Longitud_de_onda" style="border: 0px; color: #cc0000; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;">longitud de onda</a>. En el espectro de la luz visible, los colores se diferencian entre sí por la longitud de onda. La luz blanca contiene todos los colores, es el ejemplo de <em style="border: 0px; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">luz policromática</em> (es decir, varios colores “contenidos” en el mismo haz de luz). Si un haz de luz blanca es sometido a refracción, debido a que cada color sale con un ángulo diferente, inevitablemente se separan entre sí los rayos de cada color, originando lo que se llama <em style="border: 0px; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">dispersión de la luz</em>.<br />Veamos un ejemplo:</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkAm6fYIbIRQnFFPjCrE86FrDFU3WCIHtP3G1F6aUrYX_Zvs7utnEAcFWmnBWQ0CkOXFIgY-tuwwsgCM185-aksQimWJO4xoYvtqxkNTeXPb5nUYjnPEkAuIkIDSd1nj4cXSM2-mYeUfo/s1600/1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkAm6fYIbIRQnFFPjCrE86FrDFU3WCIHtP3G1F6aUrYX_Zvs7utnEAcFWmnBWQ0CkOXFIgY-tuwwsgCM185-aksQimWJO4xoYvtqxkNTeXPb5nUYjnPEkAuIkIDSd1nj4cXSM2-mYeUfo/s1600/1.jpg" /></a></div>
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Esta imagen la puse en <span style="border: 0px; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration: underline; vertical-align: baseline;">este artículo</span>, donde hablaba de las aberraciones visuales. Ahí explicaba que este mismo fenómeno origina, por ejemplo, el arco iris. Pero ahora volvamos a nuestro ojo: el fenómeno de dispersión de los colores dentro del ojo se conoce como <strong style="border: 0px; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">aberración cromática</strong>. Esta aberración ocurre siempre y lo podemos utilizar como método diagnóstico. Veremos que la luz con más energía tienen más frecuencia, por tanto menos longitud de onda, y se refractan más (es decir, su ángulo de desviación es mayor). De hecho, en la imagen se ve muy bien. Los colores rojos y amarillos quedan menos desviados, su trayectoria es más parecida a la que hubiera seguido la luz blanca si no si hubiera refractado. Y los colores azules y verdes están más desviados, más inclinados con respecto a la luz blanca.<br />Alto, un momento: si cada color sigue una dirección distinta, sería imposible que todos los colores se enfocaran en la retina. No pueden converger los rayos en el mismo punto, porque unos colores se quedarían por delante de otros. ¿Esto es así?. Pues sí. Y sin embargo, nosotros vemos toda la imagen enfocada, tengan los colores que tengan.<br />Esto ocurre porque para la potencia de las lentes del ojo y la distancia en la que los rayos se pueden dispersar, el efecto es muy escaso. La imagen queda de tal forma que el punto focal (donde queda enfocado) de unos colores queda por delante y otros por detrás, y la distancia es tan pequeña que el desenfoque de los que quedan más alejados de la retina es muy poca. No se notaría el desenfoque.<br />Pongamos ejemplos concretos. La luz verde es de mayor frecuencia (más energética), y por tanto, de menor longitud de onda, que la luz roja. Por tanto la luz verde se refracta más, tiene un ángulo de desviación mayor. La lente convergente del ojo tiene más efecto en la luz verde, por lo que se enfoca en un punto más cercano a la lente que la roja. Así que, estudiando solamente esos dos colores, el enfoque del rojo queda <em style="border: 0px; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">siempre</em> por detrás que el verde. Esto es importante: sea el paciente miope o hipermétrope, esté híper o hipocorregido en sus gafas, el color rojo siempre estará enfocado por detrás del verde.</div>
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<strong style="border: 0px; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">El test rojo-verde</strong></div>
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Se llama test bicromático o test duocromo, y precisamente evalúa la respuesta ante estos dos colores, rojo y verde. Es una prueba subjetiva, enseñamos al paciente unos optotipos sobre fondo rojo y otros sobre fondo verde, el paciente verá mejor los que estén mejor enfocados, es decir, cuyo foco esté más cerca de la retina.<br />Aquí tenéis un ejemplo:</div>
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Pero volvamos al interior del ojo, a ver qué pasa con en enfoque en las diferentes situaciones. En una situación en donde el ojo no tiene ningún defecto de refracción (emetropía), el enfoque general queda más o menos entre el verde y el rojo, en un punto intermedio, por lo que en pequeño “desenfoque” de ambos colores es similar y muy pequeño. No hay diferencia. En el caso de una persona miope o hipermétrope pero que está bien corregida con gafas, pasaría lo mismo. El test no demuestra que se vea mejor la parte verde o la roja.<br />Supongamos que una persona es miope y no lleva gafas. En la miopía, el punto focal queda por delante de la retina, más próxima. En este caso, los dos puntos focales, rojo y verde, quedan por delante de la retina. Pero hemos dicho que, entre ellos, el verde queda por delante del rojo. Como la retina está por detrás de ambos, el enfoque rojo queda más cerca de la retina que el verde. Es decir, el miope ve mejor el color rojo. Ahora ponemos gafas al miope. Si corregimos su miopía totalmente (funcionalmente ya no es miope), ya no ve mejor el rojo. Si nos quedamos cortos, el paciente sigue siendo funcionalmente miope, sigue viendo mejor los optotipos sobre fondo rojo.<br />¿Y si nos pasamos de graduación?. Podemos poner en las gafas más graduación de la necesaria, y el punto de enfoque no sólo lo vamos llevando hacia atrás hasta llegar a la retina, sino que nos pasamos y lo llevamos por detrás de ella. Digamos que en este caso el paciente es “hipermétrope”. Están ambos focos, rojo y verde, por detrás de la retina. Pero hemos dicho el el punto rojo siempre está por detrás del verde, por lo que siempre estará más lejos. Por tanto, el paciente, ve mejor el verde.<br />Bien, ya hemos visto el miope y las tres situaciones posibles de corrección (poco corregido, bien corregido o demasiado corregido). Vamos al hipermétrope. Recordamos que en este caso el enfoque se sitúa detrás de la retina. Por lo que, estando el verde por delante del rojo, quedará éste más cerca de la retina y los optotipos sobre fondo verde se verán mejor. Al hipermétrope hipocorregido le pasará lo mismo, todavía queda hipermetropía. Si la graduación está corregida, como ya hemos dicho antes, los optotipos verde y rojo se verán igual de bien. Y si nos pasamos de graduación, quiere decir que los enfoques pasan a estar delante de la retina. Sería “como si fuera miope”, entonces el rojo queda más cerca de la retina y se vería el rojo.</div>
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En resumen:<br />- Si el paciente ve igual de bien los optotipos sobre fondo rojo o verde: O no tiene graduación, o la lleva bien corregida.<br />- Si ve mejor los optotipos sobre fondo rojo: es un miope no corregido o hipocorregido. O bien es un hipermétrope hipercorregido.<br />- Si ve mejor los optotipos sobre fondo verde: es un hipermétrope no corregido o hipocorregido. O bien es un miope hipercorregido.</div>
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Enfoque de los colores en la miopía e hipermetropía

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Lentes de contacto con vitamina E podrían ser claves en el tratamiento del glaucoma

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Title: Lentes de contacto con vitamina E podrían ser claves en el tratamiento del glaucoma
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Visualizacion optima 1600x900 pixel Comenta.esta.publicación La vitamina E incluida en lentes de contacto terapéuticas especiales ...

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La vitamina E incluida en lentes de contacto terapéuticas especiales podrían permitir mantener los fármacos utilizados para el glaucoma en el ojo durante 100 veces más tiempo que las actuales lentillas, según un estudio de la Universidad de Florida en Gainesville (EEUU). El estudio se ha hecho público en la reunión nacional de la Sociedad Química Americana que se celebró en San Francisco (EEUU).</div>
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Los autores del estudio han utilizado la vitamina E para desarrollar lentes de contacto que podrían administrar una mayor cantidad de medicación para el glaucoma y quizás otras enfermedades oculares. El glaucoma después de las cataratas es la principal causa de pérdida de visión y ceguera en el mundo y afecta a más de 67 millones de personas.</div>
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Las gotas oftálmicas que controlan la presión intraocular son el principal tratamiento, según explica Anuj Chauhan director del estudio, “el problema es que en alrededor de dos a cinco minutos tras poner las gotas en el ojo las lágrimas eliminan una parte del fármaco que no alcanza el tejido al que se dirige. Gran parte del medicamento es absorbido por el flujo sanguíneo pudiendo provocar efectos secundarios. Solo entre el 1 y el 5% de los fármacos oftálmicos alcanza la córnea”.</div>
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Los científicos han desarrollado un nuevo método de liberación ampliada de medicamentos que incorpora la vitamina E a las lentes de contacto. Los cúmulos invisibles, o agregados, de moléculas de vitamina E forman lo que Chuhan describe como “barreras de transporte” que ralentizan la liberación del medicamento desde las lentes al ojo.</div>
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La liberación del fármaco de las lentes al ojo se mantiene en la lágrima mucho más tiempo que las gotas, lo que lleva a una terapia más eficaz. En estudios experimentales, las lentes que contenían la vitamina E administraron fármacos durante 100 veces más tiempo que la mayoría de la lentes terapéuticas actuales, estas lentillas pueden diseñarse para llevarlas durante un mes de forma continua.</div>
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Según concluye el director del estudio, la presencia de vitamina E en las lentes de contacto bloquea la radiación ultravioleta y puede incluirse en las lentes sin reducir su transparencia. Los ensayos clínicos de estas nuevas lentillas comenzarán dentro de un plazo de dos años.</div>
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Lentes de contacto con vitamina E podrían ser claves en el tratamiento del glaucoma

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El papel de los rayos UV en la enfermedad ocular

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Title: El papel de los rayos UV en la enfermedad ocular
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<span style="background-color: #fefefd; color: #333333; font-family: Tahoma, Arial, Helvetica, sans-serif; font-size: 13px; font-style: italic; font-weight: bold;">or Paul Karpecki, OD, FAAO</span>
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<span style="font-family: Tahoma, Arial, Helvetica, sans-serif;">OBJETIVO DECLARACIÓN:</span></h2>
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<span style="font-family: Tahoma, Arial, Helvetica, sans-serif;">Optometristas han sabido por mucho tiempo el impacto de la radiación ultravioleta (UV) la luz que puede resultar en el desarrollo de catarata relacionada con la edad degeneración macular e incluso pterigión o pinguecula.</span> <span style="font-family: Tahoma, Arial, Helvetica, sans-serif;">Este curso se ve en la última comprensión de la exposición UV y algunos de los más comunes, así como las enfermedades raras que optometristas enfrentan cuando se trata a los rayos UV.</span></div>
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FACULTY/EDITORIAL BOARD:</h2>
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<strong style="font-family: Tahoma, Arial, Helvetica, sans-serif;"></strong>Paul Karpecki, OD, FAAO</div>
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CREDIT STATEMENT:</h2>
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This course is COPE approved for 2 hours of CE credit. COPE ID 35694-SD. Check with your local state licensing board to see if this counts toward your CE requirements for relicensure.</div>
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JOINT-SPONSORSHIP STATEMENT:</h2>
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This continuing education course is joint-sponsored by the University of Alabama School of Optometry and Essilor.</div>
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DISCLOSURE STATEMENT:</h2>
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The author is a consultant for AMO, Alcon, Bausch + Lomb, Focus Labs and OcuSoft and is a stock shareholder of TearLab.</div>
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Dr. Karpecki is also on the Essilor Advisory Board, but has no financial interest in any products.</div>
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Optometrists have long known the impact of ultraviolet (UV) light radiation that can result in cataract development, age-related macular degeneration and even pterygia or pingueculae.</div>
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But these conditions continue to increase in prevalence even though many contact lenses, IOLs and spectacles have UV protection coatings. This paper looks at the latest understanding of UV exposure and some of the more common as well as rare diseases that optometrists face when it comes to UV damage.</div>
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UV EXPOSURE AND OCULAR HEALTH</h2>
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There are three forms of ultraviolet light—UVA, UVB and UVC.</div>
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UVA has a wavelength of 315nm to 380nm and penetrates deeply into the skin. This is often associated with tanning, but also is linked to skin aging.</div>
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UVB has a wavelength that is even smaller, between 280nm to 315nm. UVB does not penetrate into the skin as deeply as UVA because the epidermis mostly absorbs it. Thus, it can be a more damaging form of ultraviolet light that can cause erythema or sunburn, blistering of the skin, and potentially various skin cancers.</div>
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UVC ranges from 100nm to 280nm in wavelength and is the most harmful to the skin, also resulting in skin cancer. Fortunately, most of it is absorbed by the ozone layer and does not reach the Earth's surface.</div>
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<strong class="references" style="font-size: 8pt; text-align: left;">Figure 1: A patient diagnosed with a conjunctival malignant melanoma.</strong>
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<strong class="references" style="font-size: 8pt; text-align: left;">The sunlight that does reach the Earth is comprised of approximately 95% UVA light and 5% UVB/UVC.</strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;">UVB and especially UVC are directly absorbed by DNA molecules, so this is why experts believe that these have the greatest impact on altering skin tissue and are associated with skin cancers.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">1</sup></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;">UVC is also the form that plays a key role in cataract genesis, as well as macular degeneration.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">2</sup> UVC can actually form free radicals that directly affect the DNA. This has the ability to disrupt structures such as collagen, which are prevalent in the cornea and conjunctiva, as well as glycans such as hyaluronic acid.</strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;">On the other hand, some sun exposure is critically important to vitality, as it delivers vitamin D. In fact, many experts believe a vitamin D deficiency exists in the United States, which results in significant morbidity.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">3</sup></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;">Fortunately only 1% of all UV light from the atmosphere reaches the retina.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">4</sup> Most is absorbed at the cornea and the lens, which essentially work as filters to prevent its penetration.</strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;">Furthermore, transmission of UV light through the lens decreases greatly with age.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">5</sup> For example, a 10-year-old has a 75% or greater lens transmission rate. By age 25, the transmission drops to 10%. It is remarkable that this change happens within such a short span of years, and the amount of UV light transmission only decreases as age increases. Specifically, 80% of all the damage patients experience may well happen before age 18.</strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;">OCULAR DISEASES ASSOCIATED WITH UV EXPOSURE</strong></h2>
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<strong class="references" style="font-size: 8pt; text-align: left;"><i style="font-family: Tahoma, Arial, Helvetica, sans-serif;"><b>* Photokeratitis:</b></i> Photokeratitis— more commonly known as "snow blindness"—is essentially an inflammation of the cornea secondary to UV exposure. The condition is much more likely to be found by practitioners who live in ski resort areas (such as in Colorado or Utah), as well as those who live near beaches (such as in California and Florida).</strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;">Photokeratitis is directly attributed to environmental UV radiation exposure and generally occurs eight to 24 hours after being in the sun. It is more typical in individuals who have not used sun protection, such as sunglasses or hats, or were exposed to significant UV radiation for long periods.</strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Figure 2: Conjunctival intraepithelial neoplasm.</strong>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">The primary symptoms are similar to a welder's burn and include significant photophobia and pain. Patients may even have blepharospasm due to the level of photophobia. The cornea often shows signs of ocular surface disease damage, very similar to what you might see with an advanced dry eye disease patient. It is not uncommon to see filamentary keratitis, conjunctival injection and even significant superficial punctate keratopathy.</strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Patients are typically treated with a combination steroid/antibiotic agent, ample lubrication with preservative-free artificial tears, and are instructed to remain indoors with cool compresses.</strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><em style="font-family: Tahoma, Arial, Helvetica, sans-serif;"><strong>* Climatic Droplet Keratopathy:</strong></em> Another very rare corneal disease due directly to UV exposure is a condition called climatic droplet keratopathy. This degeneration affects the stromal layer of the cornea. Due to the significant UV effects, particularly from UVB and UVC, an accumulation of droplet-like deposits occurs in the cornea. Further research shows that these are actually altered proteins, but they have an appearance that mimic that of droplets.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">6</sup></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Similar to photokeratitis, climatic droplet keratopathy tends to be a binocular condition. Unfortunately, this can also be sight threatening, as it can lead to scarring and opaci-fication of the cornea.</strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Treatment is very similar to that of photokeratitis and involves a combination of corticosteroids, cool compresses and artificial tears. The patient should also be monitored for the potential of neovascularization and, in rare cases, eventual conjunctivalization (i.e., invasion of conjunctival epithelial cells onto the corneal surface).</strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><i style="font-family: Tahoma, Arial, Helvetica, sans-serif;"><b>* Pinguecula:</b></i> A more common condition due to UV exposure is pinguecula. This raised nodule appears on the conjunctiva, particularly around the limbal area, and is nasal or temporal in location. Pingueculae can become inflamed due to dryness or sun exposure. In fact, research shows that pingueculae are much more likely to be found in individuals who live in areas of greater sun exposure or dry air environments.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">7</sup></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">This combination suggests that this condition may be related to sun, but could also be related to dry eyes with irritation. Pingueculae are much more common in individuals who work or spend significant amounts of time outdoors.</strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Most commonly, patients with this condition have a cosmetic issue and at times may even get inflammation resulting in a pingue-culitis. Furthermore, patients with a pinguecula may have difficulty with contact lens wear, depending on the nodule's location.</strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><i style="font-family: Tahoma, Arial, Helvetica, sans-serif;"><b>* Pterygium: </b></i>Another similar condition is that of a pterygium. In this example, the patient has a raised, wedge-shaped area of growth over the temporal aspect of the cornea with a lipid line suggesting an aggressive condition. The pterygium is differentiated tissue that is migrating into the corneal space. However, very similar to a pinguecula, these tend to be found in arid conditions or where significant UV exposure is noted, such as near the equator.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">7</sup></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">The significance of a pterygium is that it continues to migrate into the visual axis of the cornea, resulting in topographical changes or even scarring of the visual axis if it progresses. For this reason, once the initial changes are noted or it appears to be progressing rapidly, a conjunctival resection is required.</strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Unfortunately, most resections have a high recurrence rate, and newer techniques—such as the use of a Gunderson flap, mitomycin C application or even amniotic membrane transfer—often have to be utilized to prevent recurrence and scarring.</strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgC2u4-ZTrD9f8qzGD5B2o60yfHanMqswq_rCOphst1FFM_YguGnqHvkQA_gFNjoyIxiwtANWOQRh-hOPiMMEV0gma82pQUpM9APY_TZ3BMNB_nEoaTuLeUTcJwRFviMGBA8DfdNlqDFsc/s1600/fig3.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgC2u4-ZTrD9f8qzGD5B2o60yfHanMqswq_rCOphst1FFM_YguGnqHvkQA_gFNjoyIxiwtANWOQRh-hOPiMMEV0gma82pQUpM9APY_TZ3BMNB_nEoaTuLeUTcJwRFviMGBA8DfdNlqDFsc/s1600/fig3.jpg" /></a></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Figure 3: Early nuclear sclerotic cataract in a 58-year-old patient who admitted to excessive sun exposure over many years.</strong>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgg3k26TkfbvZky8osCQLdhXHfMGQE9NMxa_VmFx8-0r_TsSkrsziWER35J7HieJLAn4JlLleCx1D9cx2BbGqddrs3XEj638cM8vSNuHpq6zZfHosqPdpRGwAhwiVdhgVizS7vRSU-CBJw/s1600/fig4.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgg3k26TkfbvZky8osCQLdhXHfMGQE9NMxa_VmFx8-0r_TsSkrsziWER35J7HieJLAn4JlLleCx1D9cx2BbGqddrs3XEj638cM8vSNuHpq6zZfHosqPdpRGwAhwiVdhgVizS7vRSU-CBJw/s1600/fig4.jpg" /></a></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Figure 4: A 43-year-old patient with a sebaceous cell carcinoma.</strong>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><br /></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><i style="font-family: Tahoma, Arial, Helvetica, sans-serif;"><b>* Cataract:</b></i> One of the most common ocular conditions associated with UV exposure is cataract development. A crystalline lens is made up of proteins. These proteins can be altered or denatured by exposure to UVB or UVC radiation. In fact, all three layers of the lens— nucleus, cortex and capsule—can have alterations in their protein structures.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">8</sup></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Depending on the location of the change, the type of cataract can range from nuclear sclerotic to cortical and others.</strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Once again, patients who live in high UV exposure areas, such as the equator, are more likely to have advanced cataract development. Although this is not too much of an issue in the United States, cataract is the leading cause of blindness in non-industrialized countries.</strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><i style="font-family: Tahoma, Arial, Helvetica, sans-serif;"><b>* AMD. </b></i>Another condition highly associated with UV exposure is age-related macular degeneration (AMD). The worldwide prevalence rate of AMD resulting in impairment and blindness is 8.7%, making it one of the most common causes of blindness in patients over age 60. In the United States, for example, it is the number one cause of vision impairment in patients over age 50. Research suggests that AMD is the result of free radical damage.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">9 </sup>One of the more common reasons for free radical damage is exposure to ultraviolet radiation. Studies have shown that many individuals with macular degeneration have had greater UV exposure over their lifetime.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">10</sup></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><i style="font-family: Tahoma, Arial, Helvetica, sans-serif;"><b>* Solar Maculopathy: </b></i>Solar maculopathy results in a burn to the foveal area due to excessive exposure to UV light. Reports show that even 20 seconds of sun gazing may be enough to burn the macula in certain patients.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">11</sup> Of course, this can be an even shorter period of time if a person gazes at the sun during its zenith or uses binoculars or a telescope to watch a solar eclipse.</strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Damage associated with solar maculopathy is not reversible. It often mimics that of age-related macular degeneration, but of course it occurs in patients of any age who are not educated about the risks of solar gazing or staring at the sun. Unfortunately, most patients diagnosed with solar retinopathy or solar maculopathy tend to be those with mental disorders or patients with drug or alcohol abuse who do not have the understanding of the importance of not gazing directly at the sun.</strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">The term solar retinopathy is sometimes interchangeable with solar maculopathy, but includes peripheral vision loss. It is indeed possible for patients to have peripheral retinopathy due to sun gazing or significant UV exposure. Because there are no pain receptors in the retina, patients may be unaware of any significant exposure until it is too late and the damage is done. In cases of short duration exposure, damage may be temporary and have some reversal; but if patients gaze at the sun for significant periods of time, it is more often a permanent vision loss.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">12</sup></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Patients with solar maculopathy present with a macula that typically shows retinal pigment epithelium (RPE) changes. There can also often be areas of hypopigmentation of the RPE at the fovea, which may show as hyperfluorescence on fluorescein angiography. Optical coherence tomography (OCT) will manifest an area of tissue loss or a punched-out lesion within an otherwise normal-thickness retina scan. This indicates the loss of the outer segments of the photoreceptors, as well as a loss of the inner portion of the hyperreflecting layer of the RPE.</strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZD9IDlfnKJRkhEhMyBs7H3vZX3bjvGLe0GGmfOKvVh_2se2fctygjF8BNCTcWSrCjib82jhFVydlQlz2EttX0xL5YgLXjGBvccqoSQJDB4bfaTvjUPnilOykUUEQzcj6aMnU_zkLWm4U/s1600/fig5.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZD9IDlfnKJRkhEhMyBs7H3vZX3bjvGLe0GGmfOKvVh_2se2fctygjF8BNCTcWSrCjib82jhFVydlQlz2EttX0xL5YgLXjGBvccqoSQJDB4bfaTvjUPnilOykUUEQzcj6aMnU_zkLWm4U/s1600/fig5.jpg" /></a></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Figure 5: A patient presenting with madarosis and a diagnosis of a basal cell carcinoma.</strong>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><br /></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Research suggests that the pathophysiology of solar maculopathy involves fragmentation and vesiculation of the photoreceptors of the rod and cone outer segment lamella, as well as pyknosis of the receptor nuclei.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">13</sup> However, because the cones are less likely to be affected, patients still may maintain relatively good vision. Even patients with significant solar maculopathy typically have vision of 20/50 to 20/70.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">13</sup></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">The classic presentation of solar maculopathy is that of a brick red, well-defined lesion in the central fovea. In the very early stages of maculopathy, a small yellow-white spot, often surrounding a faint gray zone, is initially noted in the fovea. This may fade over one to two weeks, resulting in the classic, well-circumscribed brick red macular appearance.</strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">UV LIGHT AND SKIN CANCER</strong></strong></strong></h2>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">In the last three decades, there have been more skin cancers diagnosed in the United States than all other cancers combined. In fact, 60% of all malignant melanomas are directly correlated to UV radiation, and 90% of squamous cell and basal cell carcinomas can be attributed to sun exposure.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">14</sup> The direct cost to treat non-melanoma cancers is approximately $1.5 billion per year and continues to rise at a 4% per year increase.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">14</sup></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><i style="font-family: Tahoma, Arial, Helvetica, sans-serif;"><b>* Sebaceous Cell Carcinoma: </b></i>The patient in <a href="http://www.revoptom.com/continuing_education/tabviewtest/lessonid/108520/#fig4" style="color: #003366; font-family: Tahoma, Arial, Helvetica, sans-serif; text-decoration: none;"><strong>Figure 4</strong></a> was a 43-year-old white male who had noted a lesion return to the left upper eyelid for the third time in the exact location. Close examination shows that the raised area of tissue mimics a potential chalazion. However, there is significant madarosis (missing eyelashes) and tissue displacement.</strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Given the appearance of the lesion, this certainly could be a chalazion; however, certain skin cancers, such as a sebaceous cell carcinoma, can mimic a chalazion in presentation. Patients with this type of presentation should be asked about sun exposure; this gentleman worked outdoors approximately 12 hours a day. In his case, the lesion was removed, a biopsy was conducted, and the biopsy results were positive for sebaceous cell carcinoma.</strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRhSHuoEB-zNY1B5_4MS0Scot9DMJ9WuyeIvIZWKZ3l0AKiLj-kA1MaR7AJJf7dl-yoq5UmPrBT9Mzf0W6iQu-DmoNQqLEfgf3hpaMeo4eTeR6DeNKlPY6qAnsinANBIdCpyO9xMthuEg/s1600/fig6.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRhSHuoEB-zNY1B5_4MS0Scot9DMJ9WuyeIvIZWKZ3l0AKiLj-kA1MaR7AJJf7dl-yoq5UmPrBT9Mzf0W6iQu-DmoNQqLEfgf3hpaMeo4eTeR6DeNKlPY6qAnsinANBIdCpyO9xMthuEg/s1600/fig6.jpg" /></a></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Figure 6: A diagnosis of photokeratitis in a skiier.</strong>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><br /></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Sebaceous cell carcinomas are relatively rare forms of skin cancer. However, optometrists can often be the ones to identify them because they usually originate in the meibomian glands. With time, they start to show alterations to skin tissue, typically madarosis.</strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">This type of cancer can be highly malignant, significantly infiltrative and may metastasize. In fact, the mortality rate for sebaceous cell carcinomas reaches 30% in the United States.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">15</sup> Surgical excision is the usual management; unfortunately, they are non-responsive to any further treatment.</strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><i style="font-family: Tahoma, Arial, Helvetica, sans-serif;"><b>* Basal Cell Carcinoma:</b></i> A much more common type of cancer is basal cell carcinoma <i style="font-family: Tahoma, Arial, Helvetica, sans-serif;">[<a href="http://www.revoptom.com/continuing_education/tabviewtest/lessonid/108520/#fig5" style="color: #003366; text-decoration: none;"><strong>Figure 5</strong></a>]</i>; here, a different patient presents with madarosis. However, note that the lesion in this area is raised, with an umbilicated center and a glossy or pearly margin appearance. Also take note of the significantly large blood vessel, known as a feeder vessel, which is common in skin cancer presentations.</strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEilB_iRlROGpRnM4U5svH7d8E9JfEBOVL1At0w1aZ2yiS52CrJrO4V6ZlBCjKAl457QuGpoJ6q7wd80PV6JVfkwZXMJ03aoj0IaoYLe9WRE8aPHoi8Uf_62wBAOt4eFLvx_MgHzE9-jDGI/s1600/fig7.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEilB_iRlROGpRnM4U5svH7d8E9JfEBOVL1At0w1aZ2yiS52CrJrO4V6ZlBCjKAl457QuGpoJ6q7wd80PV6JVfkwZXMJ03aoj0IaoYLe9WRE8aPHoi8Uf_62wBAOt4eFLvx_MgHzE9-jDGI/s1600/fig7.jpg" /></a></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Figure 7: A young patient presenting with an advancing pterygium.</strong>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><br /></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">The most common complaints of patients with basal cell carcinoma are cosmetic changes and loss of lashes, as well as persistent scabbing or crusting, and bleeding. Optometry once again may be well positioned to make the diagnosis of basal cell carcinoma. This type of skin cancer is 10 times more common than any other form of skin cancer and is often found on the eyelid margins or even the caruncle region.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">16</sup> Other common locations are the inner nose area as well as behind the ears.</strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><i style="font-family: Tahoma, Arial, Helvetica, sans-serif;"><b>* Malignant Melanoma: </b></i>This is another form of skin cancer often observed by optometrists. Malignant melanomas can appear in the choroid, the iris or even the conjunctiva. Malignant means that the tumor has the potential to metastasize. Melanoma shows that it arises from the pigmented cells of the eye. Because the choroid has the highest blood flow of any structure in the body and is considered part of the uveal tract, which also includes the iris and sclera, these tumors can often be aggressive. In fact, malignant melanomas of the choroid are the most common intraocular malignancy present.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">17</sup></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;"><br /></sup></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Patients with a choroidal nevus are much more likely to develop a malignant melanoma. The difference between a benign choroidal nevus and a malignant melanoma is that nevi are typically smaller in size and flat (or non-elevated). A malignant melanoma, on the other hand, often has significant elevation, associated retinal detachment, and often presents in an overlying finding known as lipofuscin. It is also significantly larger and, depending on the location, may result in a change in refractive error or visual disturbance.</strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Malignant melanomas are life threatening because of their high predisposition to metastasis. They most commonly spread to the lungs, but also to the liver, GI tract and other areas of the skin. The diagnosis of malignant melanoma requires a prompt referral to a primary physician or an oncologist.</strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Malignant melanoma of the ocular surface also stems from the presence of melanin or pigment that is present on the conjunctiva. The presence of unilateral melanosis increases the malignancy potential. However, the incidence of melanonoma is only one in 400.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">18</sup></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Melanosis can range from congenital findings that may involve pigment flecks, usually near the limbus, or it can be significant, such as that of nevus of Ota. Melanosis typically does not change with time and tends to be relatively small. Large areas of pigment or melanin accumulation raise concern for a potential malignant melanoma.</strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Greater concern is warranted if it is found in the upper tarsal plate of the conjunctiva or the lower fornix.</strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Perhaps the most common area for malignant melanoma is on the skin tissue; many times this is found on other sun-exposed areas near the eye or even the forehead, and is brought up by patients. Follow the ABCDE rule to help determine if a lesion of the skin could be a malignant melanoma (<i style="font-family: Tahoma, Arial, Helvetica, sans-serif;">See sidebar: <a href="http://www.revoptom.com/continuing_education/tabviewtest/lessonid/108520/#abc" style="color: #003366; text-decoration: none;"><strong>Know Your ABCDEs</strong></a></i>).</strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">UV RADIATION AND SPECTACLE LENSES</strong></strong></strong></h2>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Most patients and clinicians think that photochromic lenses, polarized lenses, sunglasses and tinted lenses block 100% of ultraviolet A and B radiation. Although that is typically true with direct transmission, it does not account for exposure due to reflected light. In other words, light that reflects off the back surface of a lens—including sunglasses, polarized and any spectacle lens—can still allow significant ultraviolet light to enter the eyes.</strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Furthermore, anti-reflective coatings, which are often applied to many of these types of lenses, may actually increase ultraviolet light radiation exposure to the eyes and skin around the eye area.</strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Dermatological exposure to UV light is highest between the peak times of 10 a.m. to 2 p.m. But, surprisingly, the most significant ocular exposure to UV light does not occur during this time frame. It actually occurs when the light hits at an angle, thus reflecting off the back surface of the lens and entering into the eye. These times are typically between 8 to 10 a.m. and between 2 to 4 p.m.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">19</sup></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Furthermore, these are times when patients are not typically wearing sunglasses. Research shows that 40% of the annual exposure occurs during these non-peak times into the eye.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">19</sup> To add insult to injury, 23% of people never wear eye protection and only 6% of Americans know they need sun protection for their eyes.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">20</sup></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;"><br /></sup></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">To make matters worse, the human skull and orbital configuration is designed to allow a large temporal field of vision. So, this large field of vision also allows for significant light from side exposure. This is known as peripheral light focusing radiation or the Coroneo effect.21 Light reaches the peripheral cornea or limbus as much as 20 times greater than other locations.</strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Furthermore, the limbus is associated with the uvea and is one of the most sensitive areas of the eye.</strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">These zones of blue, blue-violet and UV light have been shown to be damaging to the ocular surface. So, depending on the geometry of the lens, the frame and environmental conditions, an average of 20% of this light (although the range is 10% to 50%) comes from the back and sides of the lens.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">22</sup></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Certain environmental conditions can have extreme UV exposure from the sides and back surface of the spectacle lenses. For example, snow reflectance transmits 94% of UVA light and 88% of UVB light.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">23</sup></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Clear lenses reflect 4% to 6% of UV radiation, while no-glare or an-tireflective lenses actually increase this reflectance to 25% of UV light radiation on average.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">22</sup> Some types of lenses reflect up to 90% of the most damaging short wavelength lights, including UV and blue light transmission.<sup style="font-family: Tahoma, Arial, Helvetica, sans-serif;">22 </sup>So, although UV light protection is found on the front coatings of many lenses, it does not account for back surface reflection.</strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">New technologies, such as Crizal lenses, can now eliminate backside UV radiation reflection and particularly focus on the shorter wavelength light, including UVB and UVC. Specifically, Crizal Sapphire UV and Crizal UV Avancé, which came out earlier this year, provide full-spectrum blocking technology on both the front and back surfaces.</strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><em style="font-family: Tahoma, Arial, Helvetica, sans-serif;">Dr. Karpecki serves as corneal services and ocular disease research director at Koffl er Vision Group in Lexington, Ky., and heads its ocular surface disease clinic. </em></strong></strong></strong></div>
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<strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">REFERENCES</strong></strong></strong></h2>
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<li style="font-family: Tahoma, Arial, Helvetica, sans-serif; line-height: 18px; list-style-type: decimal;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Pfeifer GP, You YH, Besaratinia A. Mutations induced by ultraviolet light. Mutat Res. 2005 Apr 1;571(1-2):19-31. Epub 2005 Jan 20.</strong></strong></strong></li>
<li style="font-family: Tahoma, Arial, Helvetica, sans-serif; line-height: 18px; list-style-type: decimal;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Taylor HR, West S, Muñoz B, et al. The long-term effects of visible light on the eye. Arch Ophthalmol. 1992 Jan;110(1):99-104.</strong></strong></strong></li>
<li style="font-family: Tahoma, Arial, Helvetica, sans-serif; line-height: 18px; list-style-type: decimal;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Holick MF. The vitamin D epidemic and its health consequences. J Nutr. 2005 Nov;135(11):2739S-48S.</strong></strong></strong></li>
<li style="font-family: Tahoma, Arial, Helvetica, sans-serif; line-height: 18px; list-style-type: decimal;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Rosen ES. Filtration of non-ionizing radiation by the ocular media. In: Cronly-Dillon J, Rosen ES, Marshall J, eds. Hazards of Light: Myths and Realities of Eye and Skin. Oxford: Pergamon Press; 1986:145-152.</strong></strong></strong></li>
<li style="font-family: Tahoma, Arial, Helvetica, sans-serif; line-height: 18px; list-style-type: decimal;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Sample PA, Esterson FD, Weinreb RN, Boynton RM. The aging lens: in vivo assessment of light absorption in 84 human eyes. Invest Ophthalmol Vis Sci. 1988 Aug;29(8):1306-11.</strong></strong></strong></li>
<li style="font-family: Tahoma, Arial, Helvetica, sans-serif; line-height: 18px; list-style-type: decimal;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Menegay M, Lee D, Tabbara KF, et al. Proteomic analysis of climatic keratopathy droplets. Invest Ophthalmol Vis Sci. 2008 Jul;49(7):2829-37.</strong></strong></strong></li>
<li style="font-family: Tahoma, Arial, Helvetica, sans-serif; line-height: 18px; list-style-type: decimal;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Panchapakesan J, Hourihan F, Mitchell P. Prevalence of pterygium and pinguecula: the Blue Mountains Eye Study.<br />Aust N Z J Ophthalmol. 1998 May;26 Suppl 1:S2-5.</strong></strong></strong></li>
<li style="font-family: Tahoma, Arial, Helvetica, sans-serif; line-height: 18px; list-style-type: decimal;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Bova LM, Sweeney MH, Jamie JF, Truscott RJ. Major changes in human ocular UV protection with age. Invest Ophthalmol Vis Sci. 2001 Jan;42(1):200-5.</strong></strong></strong></li>
<li style="font-family: Tahoma, Arial, Helvetica, sans-serif; line-height: 18px; list-style-type: decimal;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Chalam KV, Khetpal V, Rusovici R, Balaiya S. A review: role of ultraviolet radiation in age-related macular degeneration. Eye Contact Lens. 2011 Jul;37(4):225-32. Review.</strong></strong></strong></li>
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<li style="font-family: Tahoma, Arial, Helvetica, sans-serif; line-height: 18px; list-style-type: decimal;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Mainster MA, Turner PL. Retinal injuries from light: mechanisms, hazards and prevention. In: Ryan SJ, Hinton DR, Schachat AP, et al, eds. Retina. Vol 2. London: Elsevier; 2006:1857-70.</strong></strong></strong></li>
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<li style="font-family: Tahoma, Arial, Helvetica, sans-serif; line-height: 18px; list-style-type: decimal;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Hope-Ross MW, Mahon GJ, Gardiner TA, Archer DB. Ultrastructural findings in solar retinopathy. Eye (Lond). 1993;7 (Pt 1):29-33.</strong></strong></strong></li>
<li style="font-family: Tahoma, Arial, Helvetica, sans-serif; line-height: 18px; list-style-type: decimal;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Skin Cancer Facts. The Skin Cancer Foundation website. Available at: www.skincancer.org/skin-cancer-information/skin-cancer-facts. Accessed August 13, 2012.</strong></strong></strong></li>
<li style="font-family: Tahoma, Arial, Helvetica, sans-serif; line-height: 18px; list-style-type: decimal;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Shields JA, Demirci H, Marr BP, et al. Sebaceous car cinoma of the eyelids: personal experience with 60 cases. Ophthalmology. 2004 Dec;111(12):2151-7.</strong></strong></strong></li>
<li style="font-family: Tahoma, Arial, Helvetica, sans-serif; line-height: 18px; list-style-type: decimal;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Christenson LJ, Borrowman TA, Vachon CM, et al. Incidence of basal cell and squamous cell carcinomas in a population younger than 40 years. JAMA. 2005 Augoculo(dermal) melanocytosis. Ophthalmology. 1998 Jan;105(1):195-8.6. Menegay M, Lee D, Tabbara KF, et al. Proteomic analysis of climatic keratopathy droplets. Invest Ophthalmol Vis Sci. 2008 Jul;49(7):2829-37.</strong></strong></strong></li>
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<li style="font-family: Tahoma, Arial, Helvetica, sans-serif; line-height: 18px; list-style-type: decimal;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;"><strong class="references" style="font-size: 8pt; text-align: left;">Sasaki H, Sakamoto Y, Schnider C, et al. UV-B exposure to the eye depending on solar altitude. Eye Contact Lens. 2011 Jul;37(4):191-5.</strong></strong></strong></li>
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