Solar radiation and the eye: a review of knowledge relevant to eye care.

Solar radiation has been implicated, with a variety of evidence, as a causative agent in photokeratoconjunctivitis, pinguecula and pterygium, nodular band keratopathies, epidermoid carcinoma, cataract, solar retinopathy, and macular degeneration. Much of the support for claims relating to chronic conditions having serious consequences and significant prevalence in the United States rests on investigations using animals and short-time exposures at high intensities. The direct applicability of these studies to humans in natural environments is uncertain, but they have been relied on because one cannot deliberately induce significant trauma in humans. The use of animal data is made difficult by the need to convert animal thresholds to human equivalents, to equate laboratory cycles and magnitudes of exposure to those in the natural environment, and to quantify the impact of avoidance and protective mechanisms. Risk can be assessed adequately only by epidemiological studies, but their potential has been only partially realized because of poorly controlled confounding variables. Epidemiologic evidence suggests that corneal trauma from ultraviolet radiation (UVR) is a risk of prolonged exposure in regions containing much ultraviolet (UV) or in highly reflective environments. The impact of UV-B on cataractogenesis has been investigated inadequately and no evidence exists for retinal trauma arising from routine exposure in even the brightest surroundings. However, there can be no question that enough solar energy reaches the earth to harm the eye if unattenuated. Damage to vision as a result of direct solar viewing demonstrates that unequivocally. The lack of clear evidence of radiation damage occurring other than in regions of high reflectivity and/or low horizons suggests that in normal surroundings there is little or no risk to the eye, although more careful epidemiological investigation is required before all concern can be ruled out completely. The major improvement required is the quantification of individual exposure histories. This step is necessary if we are to make significant progress toward better understanding the practical impact of solar radiation on the eye.