Keep an eye on your eyes

ECB Association of Cricket Officials

Richard Kettleborough

Umpires need to look after their eyes especially when standing in the sunshine

If you were to close your eyes and imagine the perfect summer's day, what would you see?

Perhaps a delightful rural cricket ground, warm sunshine, a relaxing cold beer in your hand, the chatter of bird song only interrupted by the sound of leather on willow interspersed with the occasional shouts of “Howzeeee?”.

Maybe it would be a packed Lord’s watching James Anderson rip through the Australian middle order to win a deciding Ashes test.

Perhaps it would be watching Kevin Pietersen and Eoin Morgan smashing the bowling to all parts of the field in a World cup final (against Australia of course).

Whatever your vision might be I’m sure there would be something in common with them all - glorious sunshine with clouds and no rain in sight. What could be wrong with this perfect scene? Well, it could be a little more dangerous than you might think.

Many of us are very aware of the damage prolonged exposure to bright sunlight can do to our skin. Sunburn, melanomas and skin cancers are all well known about, and many will take simple and necessary precautions.

It has been many years since the “Slip, Slap, Slop” campaign began (slip on a shirt, slap on a hat and slop on the sun cream) and this has undoubtedly achieved a great deal in reducing the number of people who suffer from these conditions. But this is not the end of the story. Sunlight can be very damaging to the health of our eyes as well.

There is increasing evidence that both the light we can see (visible light) and the light we don’t see (Ultraviolet or UV light) has potentially damaging effects upon our eyes, especially long term damage from prolonged exposure.

The two most common forms of sight loss in our society are cataracts and macular degeneration. Direct causal links have been shown between exposure to UV light with both of these conditions, as well as less well known conditions such as photokeratitis, pinguecula, pterygium and eye cancers.

Cataracts

The lens in our eye is basically a capsule of water and proteins (crystallins). The protein is arranged in a precise way which keeps the lens clear to allow light to pass through. As we age some of the protein may clump together and start to cloud a small area of the lens, forming a cataract. This means that less light will be allowed to get through to the photoreceptive cells of the retina, blurring vision and giving a gradual loss of brightness and colour perception. They can form at any age but are more common in older people. Indeed, many over the age of 60 will have some form of cataract development. It has been estimated that almost a quarter of a million people in the UK will have significant sight loss due to cataracts, rising by 20 per cent in the next decade. Cataracts are usually operable with a high degree of success.

Macular Degeneration

The macula is the part at the back of the eye where the lens naturally focuses the light. Here the photoreceptive cells are very densely packed together allowing us the fine, central vision that we use for reading or fine work. Away from the macula the cells become more sparse, which give us our peripheral vision. Macular degeneration leads to a gradual and irreversible loss of central vision, although peripheral vision is left largely unaffected. In contrast to cataracts, UV does not appear to be the most damaging, rather it is light in the blue spectrum. There is no known cure for AMD at present, although treatment to help stabilise the condition may be possible in some cases. Well over half a million people in the UK have been diagnosed with Age Related Macular Degeneration (AMD or ARMD), but a more realistic figure for those with the condition is estimated to be around 2 million. This figure is likely to rise to around 2.5 million by 2020.

Other conditions:

Photokeratitis or ultraviolet keratitis is a painful eye condition, caused by exposure to UV rays from either natural or artificial sources. Photokeratitis is akin to a sunburn of the cornea and conjunctiva, and is not usually noticed until several hours after exposure. Symptoms include increased tears or a feeling of gritty pain in the eyes. This can be prevented by wearing eye protection that blocks ultraviolet radiation, such as appropriate UV rated sunglasses or snow goggles. The condition is usually managed by removal from the source of ultraviolet, covering the corneas, and the administration of pain relief. Photokeratitis often occurs when there is a high degree of light from a reflective surface such as water or snow, or even a well prepared cricket pitch.

Pinguecula is a relatively common degenerative condition in the white parts of your eye (the sclera). Pingueculae are yellowish, slightly raised lesions that form on the surface of the sclera, often in the open space between your eyelids (the Palpebral fissure), which is the main area exposed to sunlight. Pingueculae are most common in middle-aged or older people, but can be found in younger people and even children. This usually requires no treatment other than lubricating eye drops to reduce swelling or inflammation, however they may enlarge, at which point surgical excision can be performed. In some cases, the pinguecula may become infected, a condition called pingueculitis. This can be very painful and causes symptoms such as irritation, soreness and redness.

Pterygium, sometimes known as Surfer's Eye, most often refers to a benign growth of the conjunctiva (the white of the eye). A pterygium commonly grows from the nasal side on to the cornea. It is caused by ultraviolet exposure, low humidity, and sand or dust. Symptoms include persistent redness, inflammation, dry and itchy eyes, and a foreign body sensation. The condition can usually be successfully managed with lubrication and anti-inflammatory eye drops. Surgical removal may be considered in severe cases, but recovery is lengthy and there is a high possibility of recurrence.

Eye cancer is very rare in the UK, but not unknown. We don't know exactly what causes it, but we do know about some of the things that increase people’s risk of getting the different types of eye cancer. Melanoma of the eye is more common in people who have had too much exposure to sunlight, people with light eyes, and people with a lot of moles.

Prevention

Get your eyes checked regularly. Whether you need prescription glasses or not, getting your eyes checked by a reputable optician will allow early diagnosis of any developing problems. Ideally get your eyes checked annually, but certainly bi-annually.

Anti-glare protection

It is important to protect our eyes from the harmful elements in sunlight, including ultraviolet and blue light, with appropriate anti-glare glasses. Apart from protecting our eyes from harmful glare, these will improve our visual comfort, especially for those with light coloured eyes. UV radiation levels can increase markedly and can be especially dangerous when they are reflected off surfaces such as snow, water, sand, or even a well prepared cricket pitch. It is also important to understand that UV and blue light radiation can occur in damaging levels even on days that are not sunny, and the damaging effects are cumulative in nature. Make sure your sunglasses are marked with either the CE mark, which means they meet European standards regarding UV protection or the British standard BSEN 1836:1997. These may also be marked with the UV400 optical industry standard. Ideally these should be of the wraparound kind, protecting from glare from the sides and above as well. This design will also help protect against dust and grit. Using a broad brimmed hat can offer a good deal of protection too, as well as helping protect from sunstroke.

Most modern clear spectacle lenses are made of plastic (CR-39) or polycarbonate, and these materials absorb a substantial proportion or UV-A radiation and almost all UV-B. Further protection can be afforded by the use of chromophores that can be incorporated into the lens material without affecting the transmission of visible light. Some sports sunglasses allow for prescription inserts, but these can be a little expensive. The use of over-shields with standard prescription glasses could prove to be a much cheaper and effective solution for many, although they would be unsuitable for players who have to move quickly. These are available from low vision suppliers such as IC Vision Ltd. UV absorbing contact lenses are available from a number of lens manufacturers and are preferable to those made of non-absorbing materials for individuals who spend a lot of time outdoors. However, they may shield the cornea and retina (including the macula), but these will offer no light protection to the conjunctiva, sclera or eyelids.

Photochromic or variable tint lenses are proving to be increasingly more popular, becoming darker as the UV radiation increases. However, these are not ideal. Firstly, they do take some time to react, albeit a short time, which leads to unnecessary exposure. Secondly, because these are often manufactured by adding a layer or coating on the lens, they can lead to a slight “ghosting” effect, hardly suitable for following a fast moving cricket ball!

But ultraviolet protection is only part of the story. It is important to get adequate protection from blue light too. This can be done by the use of blue block lenses, which are normally yellow in colour. These allow enough light to come into the eye for you to see clearly, even in fairly low visible light conditions, but protect against dangerous UV and blue light. These are available for prescription lenses, but are usually only obtainable from specialist suppliers such as Norville, Optima and Medi-view. Please note, cosmetic lens tints do not necessarily offer any UV or blue light protection. Also, the darker the smoking on the glass does not necessarily mean the greater the protection from UV. If in any doubt, talk with an eye care specialist, such as an optician.

Don't wear sunglasses that are not UV rated. They may be substantially cheaper but you will run the risk of allowing even more damaging UV radiation into your eyes because your pupils will dilate.

Nutrition

Nutrition plays a significant role in cataract and AMD development or protection. Dark coloured (green, red, purple, and yellow) fruits and green leafy vegetables (such as kale or spinach) usually have high levels of important plant chemicals (phytochemicals) associated with a lower risk for macular disease and cataracts. Studies have demonstrated that antioxidant vitamin supplements (such as vitamins C and E) do not help prevent cataracts, but have been shown helpful in preventing AMD. Lutein and zeaxanthin are the two carotenoids that have been most studied for eye health. They are xanthophyllous compounds, which are a particular type of carotenoid. Some evidence indicates that xanthophyll-rich foods (such as dark green leafy vegetables) may help retard the aging process in the eye and promote general eye health. Antioxidants have also been identified as useful for general as well as eye health. Some of the best examples are goji berries, prunes, raisins, and blueberries.

There can be few amongst us that are unaware of the general health implications of smoking, but the habit can have severe implications on eye health too. Smoking reduces the protective effects of antioxidants and can damage the delicate structure of the eye. In fact, smokers are up to three times more likely to develop many eye conditions, including cataracts and AMD, than non-smokers. Excessive alcohol is also linked with depleting the body’s level of antioxidants, and a diet high in hydrogenated or saturated fats also increases the risk of cataracts and AMD. Those with high cholesterol are also at higher risk.

Basically, look to do what our doctors have been telling us for years! Eat good fresh fruit and vegetables, drink sensibly, keep reasonably fit and give up smoking!

As cricket lovers we spend a lot of time following our summer sport, ideally in glorious sunshine, and probably over many years. Don’t stop following or participating in our wonderful sport, but take sensible precautions. Our eyes are, arguably the most important of our sense organs, and they are certainly one of the most fragile. A batsman would not think twice about the need to look after his bat, shouldn’t we do the same with our eyes? You can always buy another bat, but you only get one pair of eyes!

For further information and advice on these risk factors contact the Macular Disease Society Helpline by email help@maculardisease.org, or by phone on 0845 241 2041.

Useful Websites:

Macular Disease Society
IC Vision Ltd
Norville
Optima
MediView

If you are interested in joining the Blind Cricket England and Wales (BCEW) Umpires Panel then click here.