Too much sun is not a good thing. While adults are used to wearing sunglasses and eye protection, children aren't. There is a tendency to think that children don't need eye protection because sunglasses are still viewed as a fashion accessory and a luxury item.
The truth is children need protective eyewear to shield their eyes from the harmful ultraviolet (UV) light. And, if sunglasses are too expensive, then a cap will do.
The sun's UV light is just too intense and although we do not see the damage now, there is a cumulative effect which will be seen when that individual is in their senior years.
Eye surgeon and paediatric opthalmologist Dr Choong Yee Fong says that while UV light is harmful to everybody, it is more so for children.
“Why are children's eyes more vulnerable to UV light damage at a young age? Firstly, children are much less likely to wear eye protection because most parents think it's just an accessory and they feel children don't need it. We don't have a school system that actually encourages eye protection wear. In fact, if you wear sunglasses to school you'll probably be hauled up by the disciplinary master and get reprimanded for it, which I think is completely wrong.
“Secondly, a child's eye lens is very clear when they are young as opposed to the adult lens which is yellowish and tinged. The yellow tinge actually filters away a lot of the UV light so the amount of UV light that actually reaches the retina is much reduced. In children, almost all the harmful rays go into the eyes and reach the retina which is the part that we are worried about.
“As a result, a lot of damage is being done at a young age.
“Also, for children living in tropical countries like Malaysia, where the average sun exposure is very high, it is of particular concern,” explains Dr Choong.
UV light has been identified as the chief cause cataract and age-related macular degeneration. UV exposure to the retina can cause irreversible blindness. Although the damage begins at young, the effects are only seen when the person reaches old age.
It starts from young
According to Dr Choong, it is only recently that the opthalmologists worldwide have come to understand that the damage starts from young because the UV light damage is cumulative. Recent studies suggest that harmful exposure to the eye actually occurs at a younger age than previously thought.
“Most of us used to think that young children won't be affected when they go out in the hot sun. We used to think that the exposure to UV light is only harmful when they are old. But, this has been proven to be the wrong concept. In fact, the damage starts from young. So, the people who have accumulated exposure since young will have more risk of developing early cataract and other eye diseases.
“Cataract is not such a big problem because it can be easily dealt with with surgery but macular degeneration, which is a disease of the retina, is a big problem because macular degeneration today is the No 1 cause of irreversible blindness worldwide. The tragedy of this condition is that if you get it, the retina is damaged, it is not reversible and people go blind.
“Actually a lot of the damage occurs because of the exposure to UV light at a young age but the manifestation of the disease happens when they are older. Now, a lot of countries like the United States, Australia and some European countries have moved towards advocating for eye protection from UV light from young rather than just for old people.
“I advocate for eye protection from a young age because we opthalmologists now realise that a lot of the damage actually occurs from young,” he says.
According to Dr Choong, for populations that live near the Equator, in hot sunny climates like Malaysia, the rate of cataract development is much earlier compared to a country like Britain. The average age of those going for cataract surgery in Britain is about 70-72, and in Malaysia it's about 58.
This is because Malaysia receives a lot more sun compared to Britain.
In terms of macular degeneration, if you compare Caucasians in the northern Scandinavian countries, where there is less sun, with those in Australia, where they get a lot more sun exposure, the Australians get a lot more macular degeneration compared to the northern Europeans.
Explains Dr Choong, “It could also be due to other contributing factors but a lot of studies have been done looking at big populations and the correlation between the amount of sun and macular degeneration is quite conclusive.
“Even if you look at just one country like the United States – those who live in New York, which is in the north, and those in Florida in the south, the Floridans get earlier cataract and more macular degeneration and skin cancer, as well, due to sun exposure.
“I see all of these situations quite often, and because of that, I feel strongly that we should advocate and encourage sun protection for children, such as sunglasses and hats. These will help reduce incidences of eye diseases when they are older.”
Short-term effects of UV rays
The short-term effects of UV rays are more direct and involve an incredible amount of exposure. For example, people who look directly at the sun. That will cause solar burn where the intensity of the light is focused directly on the centre of the retina. It can cause a burn, essentially.
By and large this is quite rare because most people would not look directly at the sun.
In certain countries like Australia they have passed a law to mandate sunglasses wearing for all school activities under the sun.
However, in Malaysia schoolchildren are not allowed to wear sunglasses in school as it is still thought to be a fashion accessory.
“I'm not saying we should mandate it in Malaysia but I'm saying please don't prevent children from wearing sunglasses because they should be protected from UV rays.
“The only reason, traditionally, that sunglasses are not allowed in school is that it was perceived as an accessory and the headmaster and teachers don't like children having cool sunglasses because it is seen as being rebellious.
“That is actually a wrong stand because you are harming children by refusing them permission to wear sunglasses,” explains Dr Choong.
Citing a case where he had to write a letter to the school clarifying that the child needed to wear sunglasses, Dr Choong says he finds such situations frustrating because “on one hand we know that it affects the child's eyes but due to some kind of misunderstanding on the part of the school system they don't allow it. So, we want to raise this issue that children should be allowed to wear sunglasses and parents should actually advocate for it.”
Sunglasses can be bought at the optometrist or even in departmental stores. A lot of them claim to offer “UV protection”.
In certain countries like the United States, Australia and some of the European countries, to use the label of “UV protection” on your product, it must meet certain criteria. The product might need to filter 99% of UV light. Only then would you be able to use the “UV protection” label.
Unfortunately, in Malaysia there doesn't seem to be standards or enforcement for such products.
“I think, if you get your sunglasses from a proper optical shop or optometrist, generally it should be valid protection purely because the cost of producing such lenses are not very high anyway.”
Can diet help slow down or prevent macular degeneration?
According to Dr Choong, there is very good evidence now to suggest that certain dietary supplements are retina protective.
“They are not necessarily lens protective, they do not reduce the rate of cataract development, they are certainly not glasses power protective (in other words if you eat those supplements they won't improve your eye's focusing power) but the retina protection is certainly well documented and well researched. The supplements would be vitamin A, beta-carotene, lutein and zeaxanthin – those are all antioxidants. Lutein and zeaxanthin are molecules that is accumulated at high levels in the retina. So, they form a natural filter for the retina.
“The way the eye is designed is marvellous because we have our own filter system in it and lutein and zeaxanthin is part of that. But if you lack lutein and zeaxanthin, the rate of macular degeneration is much higher.
“We know that the damage is throughout life and children are exposed to UV light, so such supplements should also be encouraged for children.
“Children's lens are totally clear so the amount of light transmitted to the retina is much higher compared to an adult. So, actually children need more protection compared to adults.”
This is a very real issue, not something hyped up by sunglasses companies, says Dr Choong.
“Otherwise countries like United States, Australia and Italy wouldn't include it in their legislation to protect children when they go out in the open.
“It's actually a shame that older people get this condition because when you talk about irreversible blindness you're talking about the last 20 years of life when you have very poor quality of eyesight. And, I think that is a tragedy when the prevention of it is just a matter of putting on sunglasses when you're young.
“I think that is the message we want to get across. Parents should take charge of this by protecting their children's eyes and schools should allow the use of sunglasses,” he says.
According to him, children can start wearing sunglasses from any age. However, because there is lack of demand for infant sunglasses in Malaysia it will be harder to find such items in shops.
Also, for very young children they can't tolerate having something on their face so they might just take it off and throw it.
If that is the case, then they can wear caps or parents can just prevent them from going out in the hot sun, particularly from 10am-4pm when the light intensity in Malaysia is at its most severe.