With climate change, prevention matters more than ever

Sue Lowe, O.D., has a regular message for patients—and it goes beyond the usual suggestions to wear sunglasses, rest their eyes or look away from their computers for 20 seconds every 20 minutes. Hers is about the environment.

"The eye is a unique organ," she tells patients. "It's only 22 mm long, but it's susceptible to the air, to UV light, to everything in the environment."

For Dr. Lowe, who chairs AOA's Health Promotions Committee, that means counseling more and more patients about the effects of climate change. Coinciding with Beijing's red alert on its air pollution is new research out of Johns Hopkins University's Wilmer Eye Institute finding that many of the eye problems people struggle with today are likely to be exacerbated by global warming.

By the numbers

The research, sponsored by the National Institutes of Health Global Health Interest group, found that increased airborne particles—from wildfires, pollution and other natural phenomena—may be independently associated with increased corneal scarring, which damages vision.  Researchers studied women in rural parts of Africa, who often cook over wood fires. Even after controlling for other factors that contribute to trachoma-associated scarring, the more time the women spent cooking over wood-burning stoves, the more likely they were to have moderate to severe scarring of the eyelid.

It was performed by studying women in rural parts of Africa, where women often cook over wood fires. Even after controlling for other factors that contribute to trachoma-associated scarring, the particulates from the fires still caused increased scarring.

The National Eye Institute at the National Institutes of Health also is warning of the effect of climate change on the eye, specifically focusing on an increase of UV radiation and dry climate, leading patients already disposed to dry eye to worse outcomes.

Real-world application

Dr. Lowe says treating conditions related to climate change won't look much different. But the stress on prevention will increase.

1. Dry eye care
   Common eye conditions, such as dry eye and cataracts, are likely to be exacerbated and increased under climate change, she says.
   
   "The important thing is to always question the patient: Do they have dry, itchy, burning eyes?" she says.
   
   Even if the answer is no, she runs them through the Ocular Surface Disease Index, a 12-question list that can diagnose dry eye even in patients who aren't uncomfortable at present.
   
   "Then you can treat, whether there are symptoms or no symptoms," she says. "After all, we know that eyes get dryer as we age."
   
   
2. Look outside the eye for eye care
   Dr. Lowe often talks to patients about eye care being global. That means that caring for eyes doesn't end with eyewear.
   
   For instance, she often recommends omega 3 consumption for dry eye and the Mediterranean diet for better vision overall.
   
   "We're all going to need to practice more preventative care as time goes on," she says.
   
   
3. Test lens strength of sunglasses
   Even when her patients have $20 sunglasses from the drugstore, she tests them on a UV meter to see how much UV protection they really have. As UV exposure grows with loss of the ozone layer, having sufficient and wide-ranging protection will be key.
   
   "Some of those lenses are fine, and some are definitely not," she says. "I talk to all patients about that."
   
   If the lenses have insufficient UV protection, she will talk to patients about how to achieve better protection affordably. After all, she says, for the patients, it's often about appearance.
   
   But for her, it's about eye health—for years to come.