Ultraviolet fluorescence photography to detect early sun damage in the eyes of school-aged children

PURPOSE: To develop a method to detect precursors of ocular sun damage using ultraviolet fluorescence photography (UVFP). DESIGN: Observational cross,sectional study. METHODS: SETTINGS: Preschool, primary, and high school in Sydney, Australia. STUDY POPULATION: 71 children ages 3 to 15 years old (both eyes). Inclusion criteria were children attending the schools who gave consent. There were no exclusion criteria. OBSERVATION PROCEDURES: UV and standard (control) photographs were taken of the nasal and temporal interpalpebral regions bilaterally. MAIN OUTCOME MEASURES: Presence of areas of increased fluorescence detected by UVFP, or presence of pinguecula detected by standard photography. RESULTS: Established pingueculae, on standard photography, were seen in seven of 71 (10%) children; all were 13 years of age or older. On UVFP, all of these pingueculae demonstrated fluorescence. In total, 23 of 71 (32%) had increased fluorescence detected on UVFP, including the seven of 23 (30%) with pingueculae. Of the remaining 16 of 23 (70%), the changes were only detectable using UVFP. Fluorescence on UVFP was seen in children ages 9 years and above, with prevalence increasing with age. The presence of fluorescence (in at least one region) was 0 of 15 (0%) for children ages 3 to 5 years, 0 of 12 (0%) of children ages 6 to 8 years, 6 of 23 (26%) for those ages 9 to 11 years, and 17 of 21 (81%) of those ages 12 to 15 years. CONCLUSIONS: We hypothesize that the areas seen to fluoresce on UVFP but not detectable on control photography represent precursors for ophthalmohelioses. Our preliminary data strongly suggests that UVFP is a sensitive method for detecting early ocular sun damage occurring many years before clinical manifestations.