Q&A: Optometrist discusses eye safety, solar retinopathy ahead of April total eclipse
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Key takeaways:
- Eclipse eye protection must be ISO 12312-2 compliant.
- There is no known cure for solar retinopathy, which can occur without eye protection when viewing an eclipse.
Looking directly at the sun is never safe, but the temptation is high during a rare event like a solar eclipse.
On April 8, a total solar eclipse — one of the longest in the 21st century — will be visible throughout most of the U.S., with its path of totality crossing through Texas, Oklahoma, Arkansas, Missouri, Illinois, Kentucky, Indiana, Ohio, New York, Vermont, New Hampshire and Maine.
In preparation for the event, Prevent Blindness and the American Optometric Association have released eye safety information to help educate clinicians and the public on safe-viewing tips and solar retinopathy. These organizations and others, including the Vision Council, recommend the use of solar eclipse glasses that meet the safety guidelines of the International Organization for Standardization (ISO). These glasses, which should be marked with ISO 12312-2, are available for purchase through Prevent Blindness as well as other authorized retailers listed on the Vision Council’s website.
“This April, everyone in the contiguous United States will be able to view this spectacular astral event — one not to be seen again for more than 20 years,” Jeff Todd, president and CEO of Prevent Blindness, said in an organization press release. “Prevent Blindness wants to ensure all eyes are protected while doing so.”
“As there is no known treatment [for solar retinopathy], prevention is key,” AOA President Ronald L. Benner, OD, told Healio. “Steroids have been attempted to improve and reverse symptoms, but there is no proof that they work for solar retinopathy. Whether it’s via your social media channels, newsletter or simply talking to patients in-person, spreading awareness about the eclipse and how looking at it can affect their eyes is critical.”
Healio spoke with Jill C. Autry, OD, RPh, a partner at the Eye Center of Texas, to discuss solar retinopathy and what optometrists should keep in mind about the upcoming solar eclipse.
Healio: What eye safety measures should clinicians recommend for patients viewing the eclipse?
Autry: The best way to avoid solar retinopathy is to not look the sun, and even during an eclipse, to not view it directly. A lot of people hear that when the moon is directly over the sun — the complete eclipse — they can look at it. While technically that’s true, to judge exactly when can be difficult, so I recommend people not look at it.
You can put a solar-viewing filter on glasses or pinhole projectors, but you want to make sure it is an ISO 12312-2, which is the standard filter for viewers and glasses. Your regular sunglasses or photochromic glasses do not have the type of solar filtration on them to the extent needed.
People also think if they look at the eclipse through their camera or smartphone that it would work, but those don’t have solar filters either.
In addition, some people buy solar filters and keep them around for the next eclipse, but if there’s a crack or scratch on them, solar energy can get through. You have to make sure that they are either new or, if you’ve had them for a while, they don’t have scratches or areas where the sun can get through. People who wear glasses should make sure filters go over their glasses.
Healio: How do you identify patients with solar retinopathy?
Autry: When patients come in with symptoms from solar retinopathy it is not usually a complete loss of vision. The vision is often actually pretty good — usually still 20/20, 20/30 or 20/40 — but most of the time they will complain of a central blind spot, or scotoma, and it is usually pretty small.
A lot of people think at first that they have a floater because they see it straight ahead, but floaters move around. Solar retinopathy is usually a static, little black circle or scotoma, and if it occurs anytime around the eclipse — within a day or week or month — it is pretty easy to diagnose based on history.
When you look in the eye, often you don’t see anything or you may see a little change. If it’s early, there may not even be any pigment changes. You may see a little window defect in the retinal pigment epithelium, but often it is difficult to tell clinically at the slit lamp. The best way to tell is with OCT. Usually it is near the fovea or just adjacent to the fovea.
There is a line in the OCT called the IS/OS junction, and that often has a little disruption too; it looks like somebody went down in the retina and made a little divot or hole right into the fovea. That gives it away. Most of the time it is bilateral because people tend to look at the sun with both eyes. However, you may see it unilaterally if someone closed one eye due to the brightness.
The good news is it often resolves over time, and most people end up having fairly good vision long term, maybe over 6 months or so. If they have little blind spots or scotomas, those may be more permanent. You can continue to monitor them on OCT, but most patients learn to adjust to it, which is true with any blind spot. Even if we have a vein occlusion or glaucoma or age-related macular degeneration, our body learns to ignore little things it doesn’t like. But most people come in quickly if they notice it and it’s fairly close to the eclipse.
Over time, it does have a good prognosis, so that’s nice to be able to tell patients that. Prevention is key because no treatments have been shown to be effective.
Healio: What guidance do you have for pediatric patients?
Autry: It is important that parents are educated. It doesn’t hurt to tell a child that if they look at the sun it could hurt their eyes, but children are going to take that with a grain of salt.
There is no difference in the treatment or recommendations for children vs. adults who have solar maculopathy. You sometimes see it in children who use a laser pointer. I have probably seen just as many solar retinopathy cases in children from laser pointers as I have from eclipses.
References:
- American Optometric Association shares eye safety information & resources ahead of total solar eclipse. https://www.aoa.org/about-the-aoa/press-room/press-releases/american-optometric-association-shares-eye-safety-information-and-resources-ahead-of-total-solar-eclipse?sso=y. Published March 18, 2024. Accessed March 21, 2024.
- Eclipse retailers. https://thevisioncouncilfoundation.org/2024/03/22/eclipse-retailers/. Accessed March 26, 2024.
- Prevent Blindness encourages eye safety for upcoming total solar eclipse in April. https://preventblindness.org/prevent-blindness-total-solar-eclipse-april-2024/. Published Feb. 8, 2024. Accessed March 13, 2024.
- Protect your eyes, see the skies. https://thevisioncouncilfoundation.org/eclipsePublished March 26, 2024. Accessed March 26, 2024.
For more information:
Jill C. Autry, OD, RPh, is a partner at the Eye Center of Texas in Houston. She can be reached at jill_autry@hotmail.com.
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