# Optical Forums > General Optics and Eyecare Discussion Forum >  Transitions in Pediatrics

## skirk1975

Do you suggest Transitions lenses to your Pediatric patients?  Explain please.

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## Judy Canty

Why?  Because 9 times out of 10, they're going to lose either the matching clip-on or the sunglasses.  I recommend Transitions and a back up pair.

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## Shutterbug

I vote no.  Like any other muscle, the muscle that controls the aperature needs to be exercised or it becomes weak.  With the transition doing the work for the eye, you may create a dependency and light sensitivity (IMHO).  I would reserve the transitions for your older patients.

shutterbug

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## LaurieC

Yes I do, not only as an Optician but as the mother of two daughters who wore RX sun throughout their adolescent and teen years. Back then it was photo gray, first generation transition or RX Sun. In an effort to assure they looked "cool", they had great rx sun. Because they were not easily discernable as Rx, guess hoe often they were stollen in school cafeterias? But I agree with Judy, back up should always exist.

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## chip anderson

It's a way to make more money.

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## paw

In our area, parents aren't about to shell out the extra money for Transitions.  A lot of the kids are so rough on their glasses.  I about fell out of my chair the other day when I suggested Transitions to the daughter and the mother agreed.  That's a rarity in our office.

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## Joann Raytar

I voted yes.  We usually recommend Quantum Transitions for kids getting sport goggles.  Many of our parents come in requesting Transitions because they feel their kids are going to loose a second pair or a clip on.  Our stores are in rural areas where folks spend a great deal of time outdoors.

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## aaron

I don't usually because I am an advocate of children having a second pair of sunglasses.  But on the other hand,  kids ruin there glasses so quickly that shelling out the extra 80 or 90 for transitions isn't usually practical.  The poly all by itself is usually pretty inexpensive and can be replaced at a discounted rate to keep the patient happy.

                                                  ad

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## optigoddess

I agree with what Shutterbug said as far as my personal opinion goes...our corporate policy is ONLY poly lenses for children 12 & under and we do not have access to poly transitions .  

Karen

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## Joann Raytar

http://www.extenza-eps.com/extenza/l...&type=abstracthttp://www.informedparent.com/articl...olarprotection



> ... Infants and children under ten years of age may be at an increased risk for eye injury because ultraviolet light more easily penetrates the lens of the eye. As children get older the lens is able to increase its absorptive powers, thus limiting deeper eye injury to the retina. But, this increased absorption of UV light by the lens may predispose the person to the formation of cataracts. ...
> 
> ... Sunglasses protect against UV light by a chemical that is added to the lens which absorbs this type of light, not because the lens is dark. In fact, dark lenses without proper UV absorbing capabilities may be harmful, because they allow more harmful light to pass through the open pupil of the eye. ...
> 
> ... Fortunately, many children find that wearing sunglasses makes outdoor activities more comfortable, and that comfort may be saving their vision for the future. For further specifics, including how certain medications affect this process, see your doctor. It is never too early to encourage proper use of sunglasses.
> http://www.informedparent.com/articl...olarprotection


Wouldn't Transitions, which have a relatively controlled level of light transmission, be a better option than a tinted lens for an adolescent?

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## chip anderson

Remember you can control the UV with a clear lenses and the pupil will contract normally.  Transitions doesn't block UV any better than a tranpearent UV coating.  If I have been taught correctly a darkened transitions isn't blocking any more UV than an undarkened transtions or a CR 39 with UV or an untreated Poly lens (I don't like poly but it does cut UV).  In fact most lenses of any type and no coating block most UV.


But, you make more money look for more theories.

Chip

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## hcjilson

is ludicrous! As far as the money angle is concerned- who is to say that those charging $30  for a UVAB absorbative tint are not making more money? (particularly AFTER they sell the second "sunglass" pair.

Get Real folks! Transition lenses are beneficial to the patient/customer at *ALL*   ages. They provide protection from light in the visible and invisible spectrums.They do so at less cost than an additional pair of sunglasses. Really, what is there not to like?

hj

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## Joann Raytar

> *chip anderson said:* 
> Remember you can control the UV with a clear lenses and the pupil will contract normally.  Transitions doesn't block UV any better than a tranpearent UV coating.  If I have been taught correctly a darkened transitions isn't blocking any more UV than an undarkened transtions or a CR 39 with UV or an untreated Poly lens (I don't like poly but it does cut UV).  In fact most lenses of any type and no coating block most UV.
> 
> 
> But, you make more money look for more theories.
> 
> Chip


You're correct regarding various forms of UV protection but I was referring more to the ability of Transitions to not end up too dark for children because it is not a dyed lens.  Transitions will only darken to a certain density and there is no room for someone to tint the lens darker than appropriate.

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## Darris Chambless

Transition lenses can be tinted to garner a darker lens effect although minimally but they do retain that tint even once they've lightened. As to what Chip said I'm gonna back him up on his assertion because he has a valid point. All muscles can and will adapt to more or less work or stress including the eye.

To say that "The idea that transitions CREATES light sensitivity .... 
is ludicrous!" is in and of itself a bit on the ludicrous side (sorry Harry). For instance if one spends a lot of time sitting at a desk you will develope adaptive shortening of the hamstrings. If you lift weights you will develope more strength and more muscle mass. If you are sedentary you will lose the muscle developement and stabalizer muscle control. If you repeat a task day in and day out the body will adapt for it in one way or another. The eye is an  orbit controled by voluntary and involuntary muscle movement. 

Overuse eyedrops and over time the eye will produce less tear film on its own. So it stand to reason that putting a lens in front of the eye that will lessen its need for accodating to light and dark will also create the same adaptive problems. Is it permamnent? Not to my knowledge, because taking the deterent away will cause the eye to accomodate in the opposit manner (or back to normal) If I wear sunglasses on a regular basis I am more light sensative when I don't have the sunglasses and it takes longer for my eyes to accomodate going from light to dark and back again. It does happen. Will it cause long term problems? I don't know. Is it a bad thing to do to these children? I don't know. Do you make more money by selling the Transitions? Yup. Unless you charge nothing for it.

Sunglasses and Transitions have their place, but they are a want more than a necessity when clear lenses will block out UV light just as well.

In short, the body adapts to everything you do to it and there are always side effects good or bad.

Take care all,

Darris C.

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## hcjilson

All sighted humans are light sensitive in the strict sense. When I was refering to light sensitivity I was talking about the condition that we encounter with some folks who are light sensitive in the extreme sense. No spectacle lens has created that problem, it just exists. I maintain that no tinted lens can cause that problem either. I have worn Transitions lenses since their inception. (I'm talking first generation that did virtually nothing other than recoup some of the development costs on the joint venture between Essilor and PPG)

I stand by what I said. I am no more light sensitive today than I was then, and according to the reasoning which appears above, I should be a lot more  light sensitive than I was. The fact remains that I am not......nor are any of my transitions wearing clientel. You may draw your own conclusions.

Have a good Columbus Day weekend everyone!

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## Darris Chambless

Not to get too far off topic here but... I just had a Popeye's apple pie and man oh man! Take a thin flaky outer crust, stuff it with sugar enrich, sugar fortified, sugar coated little bits of sugar (and apple) deep fry it and roll the whole thing in cinnamon and sugar and BAMMO! You got yourself one heck of a sugar rush. Nothing like spiking the insulin to get your day going in a hurry :D

Hello Harry,

Please don't be offended by my remarks and I hope you're not, but I did want to point out that the human body will adapt to its environment and the conditions thereof. Can a person become light sensative by wearing sunglasses or Transitions lenses for prolonged periods of time? I don't know for sure but it would stand to reason since every other process in the body can and will adapt to the conditions it is exposed to. I would assume the eye and it's components would fall into that category as well.

A person can become acclimated to colder or warmer weather conditions over time. The body can acclimate to higher altitudes over time. The body can acclimate to losing certain organs or even limbs. For me there is too much evidence to support the idea that Transitions or tinted lenses over a period of time could make one light sensative, not unlike blind folding a person for a long period of time would do the same and would possibly even reduce the amount of pigment in the iris over time. I can't see why it wouldn't.

One thing I would like to address if I may:

"I have worn Transitions lenses since their inception..."

"I stand by what I said. I am no more light sensitive today than I was then, and according to the reasoning which appears above, I should be a lot more light sensitive than I was."

I don't know if you're like me but I can't see without my glasses so I'm never without them. How often do you go with your Transitions lenses? Can you go without your glasses and see? Because I'm blind without mine.

Take care Harry. Always a pleasure to talk with you.

Darris C.

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## Joann Raytar

> *Darris Chambless said:* 
> Transition lenses can be tinted to garner a darker lens effect although minimally but they do retain that tint even once they've lightened. As to what Chip said I'm gonna back him up on his assertion because he has a valid point. All muscles can and will adapt to more or less work or stress including the eye.


Yeah, I know Transitions can be tinted but odds are that they won't be tinted. (Disclaimer: It may be more common to tint Transitions in Darris' neck of the woods than in mine so I am not going to say that it won't happen.)

To take Chip's take a step farther, scratch coated lenses block out a certain amount of UV so isn't anyone wearing an SRC lens protected from harmful wavelengths without any additional lens treatments?

Now, I think I have gotten a bit off track myself here.  I intended to make a point about comfort issues more so than actual proctective issues.

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## hcjilson

3 days ago I visited my internist for a follow up visit after my pneumonia last winter. I got the "quit smoking, excercise more, and lose weight" sermon. So I have been a good boy for 3 days.....well almost good, I am addressing 2 out of three as we speak and Sunday is Q day. Right about now I would KILL for an apple pie....

In answer to your question I am a plus 4.25 hyperope with a 3 add.I could not see a thing without my glasses. I have multiple pairs of spectacles and wear them more or less interchanably however I must admit my " go to" pair is trivex transitions. They're my "go to" pair because they are comfortable, and as I try to explain to Pete, comfort is the name of the game. My Transitions lenses did not '"cause" my light sensitivity because I was born with it as were you and all other sighted folks. It is not possible for lenses to cause light sensitivity....in my opinion.

Now If you want to do me a real favor.....email me some pie!:D

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## chip anderson

Just to muddy up the waters a little more.  I used to wear photo-grays (before transitions) but I had several pairs of glasses.  One day I couldn't find my photo-grays and wore a pair of clear glass lenses.  Boy was I amazed to see what I had not been seeing at work.

Chip

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## hcjilson

if you don't see what you want, you're in the right place! You wouldn't be able to mail me some pie tonight, would you?? It doesn't look as if Darris is going to come through! :D 

harry

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## Judy Canty

I decided it was time to get a second opinion, so I emailed the American Academy of Pediatric Ophthalmology.  This morning I received a reply from Rick Blocker, MD.  He states that there is no indication that Transitions technology has any adverse affect on light sensitivity in children.  His greater concern was that children be fitted with polycarbonate lenses in every case.

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## Traci

Isn't light sensitivity more a question of subjectivity? Some people are more sensitive to light than others and wouldn't a light tint, transitions, or sunglasses be more for visual comfort to an individual rather than a necessity or want? 

Children usually have strong opinions as to what works for them, I know my kids do! My older kid hates sunglasses while my youngest loves them. 

Just ask the kids who are old enough to speak and can speak for themselves. For those who are too young - place sunglasses on them and watch their reaction.

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## Darris Chambless

Well Harry,

If and when you need support on the road to wellsville let me know. I don't have the healthiest diet in the world but I am an avid weight lifter and have been for years. I like staying in decent shape, but do smoke and drink on occasion. Tell me what eating habbits you have and I can tell you how to take off weight without starving yourself and even give you a good excercise routine that will work for you if you don't already have either of these things yet. 

Back to the light sensativity thing...

Perhaps I should pose this as a question rather than a statement. All muscles when left unused or not used to their full potential will atrophy. So do the muscles of the eye not atrophy if kept shaded with Transitions or sun lenses? Detrimental or not long term does it happen? If the intraocular muscles of the eye do not atrophy like all other muscles in the body then why not? Has there been a study of this?

"This morning I received a reply from Rick Blocker, MD. He states that there is no indication that Transitions technology has any adverse affect on light sensitivity in children."

While I tend to put more stock in an MD's ability to discern this type of thing I have to ask what test he or anyone else has used to determine increases or decreases in light sensativity in any fashion? Other than muscle reaction time (which determines very little) I know of no test that can measure increased or decreased light sensitivity but then I've not been around the ophthalmological side of the business for a while.

Anyway, take care to all and Harry I'm rooting for you.

Darris C.

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## hcjilson

My friend Darris said:
"All muscles when left unused or not used to their full potential will atrophy."...."If the intraocular muscles of the eye do not atrophy like all other muscles in the body then why not?" My feeble attempt at an explanation follows.

I agree that unused muscles will atrophy, however, the muscles controling the aperature of the pupil are never unused.That is  the case with involuntary muscle reactions. You really cannot will your pupil aperature to open or to close. That is an involuntary response and therefore something over which the individual has no control and the muscles controling it are not in a state of atrophy.

I am not a scientist, nor am I a physician. I have only a rudimentary background in biology and physiology. I freely admit I may be mistaken, but I could be wrong about that too!:D :D 

Now kindly pass the Pie !

hj

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## Stopper

I'm with hcjilson. I don't think the transitions will cause a patient to be light sensitive after prolonged use. The pupil is still dilating and contracting even if you wear tinted lenses. Also lets not confuse light sensitivity with light and dark adaptation. These are different things. The pupil size has only a small role in adaptation. The adaptation mostly occurs at the recepter level. Ones sensitivity to light is more of a hard wiring and doesn't really change. Also the analogy to skeletal muscle and atropy or strengthening from no use or full use doesn't fly. Different types of muscles. If this was true people who go in and out of dark rooms all day (maybe an OD) would have super strong and bulky Iris muscles. 

Personal preference, let the patints decide what they like

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## Stopper

Another thought, If the sphincters in our bodys strenghened or weekend with use, all those people who are full of **** would really be a bunch of tight @$$es. 

Life is too short to drink cheap beer:cheers:

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## Oha

I'm On Harry's side.  About the Transitions AND the pie.

I think it's important to remember that Trasitions or any photochromics dont change instantly.  Whne a child leaves school to go in the playground, there is a lag time where the lens is starting to darken and the pupil is constricting to respond to the increased light.  

If the technology ever got to the point where the lenses instantly changed from light to dark and back, I may rethink this position.

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## Darris Chambless

> *Stopper said:* 
> Another thought, If the sphincters in our bodys strenghened or weekend with use, all those people who are full of **** would really be a bunch of tight @$$es. 
> 
> Life is too short to drink cheap beer:cheers:


LOL! Although a funny thought, it's not that far away from the truth. Think Kageling ;)

Again I agree with Harry on the involuntary muscle responses, but does having a tinted lens in front of the eye not lessen the need for this response? My heart beating is involuntary, however if I become sedentary and overweight just getting up off the couch could make me light headed and cause my heart to run the 100 yard dash where as if I were more active my heart would work more efficiently and I wouldn't have this problem. It is an involuntary muscle repsonse and yet it adapts to conditioning (positive or negative) as do the lungs and other muscles and organs. Involuntary in their basic actions, not involuntary in their response to conditioning. 

My primary point is not that these things "are" a detriment but rather that it could cause a problem either temporary or permanent and we just don't know to what extent. There is no test for this that I'm aware of so I base my position on my knowledge of muscles voluntary and involuntary. They all respond and adapt to conditioning.

"Also the analogy to skeletal muscle and atropy or strengthening from no use or full use doesn't fly. Different types of muscles."

Yes, different types of muscles but they all adapt and respond to conditioning. So then I should assume by what you've said above that certain muscle strengthening exercises used by OD's and MD's are a waist of time then? Fixation is both voluntary and involuntary with the emphasis on "voluntary" (extrinsic muscles) but accomdative is voluntary and involuntary with the emphasis on "involuntary" (intraocular muscles)  There are exercises, devices and tests used to determine and rectify these problems, Yes?

Please forgive me as I'm not trying to be argumentative but rather curious. Not so much curious of functions but rather why someone, anyone would say "Nope. Doesn't happen." when there is nothing definitive to say one way or the other. I'm presenting what I know about muscle function and adaptation to stresses so why are the muscles of the eye not affected? I would like to know.

Thanks in advance,

Darris C.

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## Stopper

Darris,
 I understand and appreciate what you are saying but I just don't think this is a problem. (Like you, not trying to be argumentative). You are correct, there aren't any studies that I know of that say one way or the other. I go in and out of dark rooms all day and I don't think my Iris is becoming more muscular and bulking up. 

Again remember that most of the light and dark adaptation occurs at the receptor level, not due to apeture size of the pupil.

Thanks for the continued good discussion

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## Shutterbug

Since mine was the first decenting vote on this thread, I'd like to add one more thought.  Darris makes some very sound observations.  All muscles react to activity, both voluntary and involuntary.  It is also true that we have no real data to base a prognosis on.  Here's my question:

If we don't know for sure, is it responsible to go ahead and take a chance or more responsible to try to find out for sure.

When they introduced rabbits to Australia, they were pretty sure no lasting harm would come, and there were certain benefits in the short term.  The same disaster occurred with other domestic animals when they were introduced.  Now the problem can't be fixed.

The point?  If you are going to err, err on the side of caution.  We don't want to do any harm while we're trying to do good.

:D 

shutterbug

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## hcjilson

If you take as a given, that ultra violet radiation (light) has been directly linked to the development of cataracts and macular degeneration, then to err on the side of caution would be to have everyone wearing protection from these burning rays of the sun.

Ergo it follows that you *are*  in favor of the pediatric use of Transitions lenses after all. :D :D 

hj

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## Shutterbug

HJ - Heaven forbid!   No, there are much better options.  I DO recommend polycarbonate for its strength, and it is an excellent UV filter for both UVA and UVB.

:D 

shutterbug

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## hcjilson

Why not Trivex which does all of the above and is stronger. I really think that question is being beaten to death in another thread but have at it if you will. I thought that I had you convinced for a moment but no soap I surmise. At least no one is saying a lens causes light sensitivity!

:D :D :D 
You folks in Iowa have any snow yet??

hj

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## Shutterbug

hj - No snow yet - we're still in the 60-80 degree range.  I'd keep it there if I could!

BTW, no one is saying a lens doesn't cause light sensitivity either.
Just that we don't know yet.


:cheers:

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## varmint

Best I could do Harry.

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## Jim Schafer

Good Afternoon Everyone,
Great thread, I really enjoy the discussion and points of view this group brings to the table. 
The point I want to emphasize, that has not really been discussed, is that cataracts and Age Related Macular Degeneration are linked to cumulative exposure over a whole lifetime.  
Childrens eyes (lenses) transmit 75% of the UV at age 10 and only 10% by age 25[1], as well as the fact that children spend more time outdoors than adults (up to 80% of your lifetime UV exposure occurs before the age of 18 [2].   

In discussing Photophobia, it is important to emphasize that this is a symptom and not a disease. http://www.spedex.com/resource/docum...tophobia.html. 
When one is experiencing photophobia, you want to identify the underlying pathology. Our research information group was unable to identify any papers dealing with photophobia in children as a result of wearing sunglasses.
Another point for dispensing to pediatrics is that Transitions®Lenses reduce the amount of Blue light that has been linked to the development of Cataracts and Age Related Macular Degeneration..[3][4] 
Transitions Gray absorbs 78% of the Blue region and Transitions Brown absorb 80%. You can see the Spectral Transmission charts in Tech Notes on our web page.
 A UV coated clear lense will not serve this need.
You may want to to visit the FUBI (Fashion, UV, Blue Light, IR) site too. http://www.fubisystem.com. 

[1] Lermans: Direct and Photosensitized UV Radiation and the Eye: Experimental and Clinical Observations. Metab Pediatr Sys Ophthalmol 6:27-32, 1982.
[2] Young, S; Sands, J. Sun and the eye: Prevention and Detection of Light-Induced Diseases, Clinics in Dermatology 1998:16:477-485.
[3] Am. Optical ***. Sunglasses Consumer Reports, 1988, 53(8), 504-509.
[4] Hall, G.; Schultmeyer, M. Optometry, 2002, 73:7, 

As a few Optiboarders refered to "err on the safe side", the more research (here and overseas) being done on UV exposure leans to photochromic or fixed tint lenses as the best overall protection for your eyes.

Australia is a great example because the inhabitants suffer the highest rates of skin cancer anywhere. In 1980, the Anti-Cancer Council of Victoria launched "Slip! Slop! Slap!" (Slip on a shirt, slop on sunblock, slap on a hat!).  This evolved to the SUNSMART Program.  On aspect of this program is that in many Australian schools, students are not permitted to play outdoors in summer months without a hat, sunblock and, in some cases, sunglasses. ("the Slip! Slop! Slap! Wrap!) (-with wrapping a sunglass added.) [Note, I do not see much on their website about sunglasses, but UV damage to skin, face etc. is one of the things we report in the Light, Sight and Photochromics monograph.] http://www.cancervic.org.au/cancer1/...2/20021117.htm

Sorry for the long post, just wanted to add more information and leads to the discussion.

I will be at the East West Eye Conference at the Cleveland Convention Center for the rest of the week. If any Optiboarders are around please stop and say hello at Booth 308.
best to all 
Jim

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## Darris Chambless

> *Stopper said:* 
> Darris,
>  I understand and appreciate what you are saying but I just don't think this is a problem. (Like you, not trying to be argumentative). You are correct, there aren't any studies that I know of that say one way or the other. I go in and out of dark rooms all day and I don't think my Iris is becoming more muscular and bulking up. 
> 
> Again remember that most of the light and dark adaptation occurs at the receptor level, not due to apeture size of the pupil.
> 
> Thanks for the continued good discussion


Sorry I haven't paid attention to this post in a few days.

I realize what you are referring to regarding the receptor levels but you're on the wrong page. The pupil physically constricts to limit the amount of light passing in to the retina which is a muscle reaction not a receptor reaction. Going from light to dark and dark to light is a receptor function but has little or nothing to do with the muscle responses of the Iris. If the intraocular muscles are limited in their function then they cannot work as efficiently to contract the pupil allowing more light to pass through when unshaded hypothetically speaking. 

Let's talk a little about muscles and their structure and function. I'm a power lifter and weight trainer as well as having a pretty good understanding of most functions of the body (Just for some background, when my wife gets done with nursing school in May I'm going to finish what I need for my Sciences and apply to Medical school)

As to the muscles of the eye that control the reactions of the Iris, "bulking up" in the manner that you appear to be describing; doesn't work that way. Different excercise creates thickening or toning (lengthening and thinning) of the muscle itself. "Bulking" requires increased resistance to the point of failure to make gains that would be considered "bulking." Isometric, although resistance, will tone and thin a muscle. More efficient? Yes. Bulk? No. Putting or not putting a tinted lenses in front of the eye would be isometric in its function only. Anything one does to lessen the need for a muscle to operate fully will decrease its efficiency, plain and simply, regardless of the kind of muscle or its location. Will it make people blind? No, but more light sensitivity due to less pupil contraction is very plausible IMO.

Harry said:

"If you take as a given, that ultra violet radiation (light) has been directly linked to the development of cataracts and macular degeneration, then to err on the side of caution would be to have everyone wearing protection from these burning rays of the sun.

Ergo it follows that you are in favor of the pediatric use of Transitions lenses after all."

It's already been discussed that you can block out 100% of Ultraviolet light with a clear lenses. Tinting or changeable tinted lenses block out, additionally, a percentage of the visible light spectrum as well as the invisible light spectrums of UV-A, B and C. I realize you are kidding around and it is funny ;) BUT to err on the side of caution and have everyone wearing protection from these harmful burning rays? Well...guess what? That's what is being done already. Sunscreens for the skin, UV for lenses, PSA's for the same. Even an uncoated stock plastic lens will block 30 to 40% of UV and most skin care products have UV blockers in them. Even my bug repellent has UV protection in it. It is a problem and it is being addressed.

Again I will say that long term effects of tinted lenses on pediatrics is completely unknown. Do I think it's a problem? Not based on my, as well as others lack of knowledge on the subject due to no known test for such a thing. To me this subject equates to this:

Me: "Does this create or cause a problem knowing muscle function?"
Other: "No."
Me: "How do you know?"
Other: "Because it doesn't."
Me: "Based on what?"
Other: "This is a silly discussion."

And that's how it seems to play out to me. Not saying I'm right or wrong and not saying anyone else is right or wrong, but the fact is we don't know and are apathetic about it. So much for Science and research I guess.

Take care everyone,

Darris C.

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## Shutterbug

Darris - Don't give up yet, you're just getting warmed up!

:cheers: 

Dale

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## Joann Raytar

Jim,

There is published material on Australian studies regarding children and UV protection and sunwear.



> *http://www.extenza-eps.com/extenza/l...&type=abstract
> 
> Knowledge of sunlight effects on the eyes and protective behaviors in adolescents* 
> 
> *Author(s):* Graham A. Lee MBBS 1 | Lawrence W. Hirst MD 2 | Mary Sheehan Ph.D. 3 
> *Article DOI:* 10.1076/opep.6.3.171.1501
> 
> *Ophthalmic Epidemiology 
> 
> ...

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## Shutterbug

I just have to muddy the water a bit more :D 

We all agree that UV entering the eye is a bad thing.  Some have implied that transitions are a good thing since in the darkened state they are excellent UV blockers and therefore should be recommended to children.

Some of us have offered that the transitions could actually cause harm in the way of weakening the muscles that contract to close the iris.  This seems to be discounted too easily by most of you.

So how about this - since the transition lens (or sunglass lens) reduces the intensity of the light entering the eye, the natural response is an opening of the iris.  This in turn MIGHT allow more UV to enter from the sides of the eye (unprotected) and MIGHT have long term impact on the health of the eye.

Clear UV blockers, either applied to the lens or inherent in the lens itself allow the iris to function normally and COULD provide more protection in the long run, since more light is restricted from ALL directions.

What do you think?

 :Eek:  

shutterbug

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## hcjilson

To Shutterbug, 

I doubt it!

hj

PS Transitions filters UV light when in its clear state as well.

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## Shutterbug

hj - that's ok, most who said yes to the poll probably look at life through tinted glasses (rose) too! :Cool:  

ps - If you put transition (plastic) under black light in a UV measuring devise you can actually see it increase in effectivness as it gets darker.  Not much better than plastic in it's clear state.

shutterbug

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## Robert Martellaro

> *Jim Schafer said:* 
> Childrens eyes (lenses) transmit 75% of the UV at age 10 and only 10% by age 25[1], as well as the fact that children spend more time outdoors than adults (up to 80% of your lifetime UV exposure occurs before the age of 18 [2].


Jim,

I have always thought that the lens prevented UV from reaching the retina. It seems that's true only for adults. If there is a relationship between UV and ARMD, the majority of damage might be occurring in our formative years. I wonder if there are studies of the population born before 1940 who were exposed to a higher than average amount of direct sunlight, and their rate of ARMD presently. 

Robert

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## Oha

Below is a Q & A from the current issue of Eyecare Business.



Q In a recent "Ask the Labs," you talked about putting photochromic polycarbonate lenses on children. In light of your comments, I have two questions: 1) I recall reading several years ago that putting tints on children prior to puberty makes them more susceptible to photophobia as adults. I don't know if this applies to the modern photo-chromics. Comments? And 2) Does the photochromic feature retard the impact resistance of polycarbonate in any way? 

A Here are your answers: 1) Your caution with tints is commendable. Dr. Eric Borsting, chief of pediatrics at Southern California College of Optometry, says he believes past concerns about long-term effects of tints on children came from the fact the lenses tend to be worn under widely varying circumstances. A solid tint can be useful in bright light situations, but would be counter-productive under lowlight circumstances (overcast days, indoors, evenings, in movies, or watching TV). He points out that modern photochromics eliminate those concerns since the lens adapts quickly to changing light conditions. 2) You'll be pleased to know there is no reduction of impact protection with photochromic poly. The photochromic treatment is on the front surface and does not affect the molecular structure throughout the substrate.

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## LENNY

No NO NO

This is too complicated for me.
My experience with just tints for children:
If you make them a prescription clear and tinted pair of glasses eventualy i see them using suns for allt he time wear!(the clear pair either lost or broken)

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## hcjilson

Shuterbug, are you saying that the UV filtration increases as the Transitions gets darker? My understanding is that the lens is inherently a UV blocker. The only changes in transmission occur in the visible spectrum. I haven't confirmed this but thats what I think I remember. Memory fades with advancing years :D 

hj

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## chip anderson

HC

I don't think anything that is not completely opaque is a 100% blocker of anything (despite adds to the contrary).  If a photochomic lens transmitts 2% of UV  at 98% transmission it will transmitt 2% of 40% when it is transmitting only 40%.

Chip

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## hcjilson

Chip et al,

For Transitions, but I assume (with the full knowledge that there are 3 words contained in that word) that it will fall somewhere in the vicinity of other lenses treated to filter UV light. Usually in the vicinity of 98% up to 400 nanometers. The transitions lens in its clear state will filter out 98 % of UV . Thats a period.For the purposes of eye safety that is considered acceptable, and its good enough for me.My only point in continuing this dialog is to restate that Transitions lenses do not create photosensitivity.

The view from Fredricksburg VA today.

hj

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## Joann Raytar

A chart on the BPI Photometer website states:
*http://www.callbpi.com/support/photread.html*

*Typical UV Transmittances*

*LENS MATERIAL*  ----------- *UV B Trans.* ----------- *UV A Trans.*
Photogray Extra, faded  -------- 0.0 -------------------- 9.6 
Photogray Extra, darkened ---- 0.0 -------------------- 2.7 
Transitions Plus, faded --------- 0.0 -------------------- 1.0 
Transitions Plus, darkened ----- 0.0 ------------------- 1.1 

Here is a chart on the X-CEL Optical Company's website:
*http://www.x-celoptical.com/UV%20light.htm*

Transitions are at the bottom of the chart and the numbers represent data when Transitions are at a darkened state.

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## Shutterbug

hj - 

The plastic transition blocks about 20% (or less) of uv in its normal undarkened state.  As it darkens, the UV protection increases.  Of course polycarbonate lenses are great UV filters even in the clear state, and with the addition of high index transitions you also find good UV protection (not always great though) in their natural state.

If your lab has a spectrometer you can verify this yourself.  Ask them to put a plastic transition lens into it and you can watch it change and increase UV blockage.  I think you are not alone in the idea that they protect us from UV all of the time.   However, since the newer transitions darken so much faster I wouldn't worry too much about lack of protection.  When you need it, it's there!   Incidently, the change to dark is triggered by UV, not visible light.  The change back to clear in increased with some natural light - it changes slower in total darkness.  Strange, huh?

shutterbug

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## Jim Schafer

Shutterbug,
Transitions®Lenses block 100% UVa and 100% UVb as per ISO 8980.3 and ANSI Z80.3. Depending on the lens material, the 380nm cutoff is 0% to 1.9% Transmission. These are the universal accepted testing procedures for UV protection. The Spectral Transmission charts are on our website for activated and clear product. 
regards
The BPI web information on Transmission is for a product discontinued in 1997, two generations of technology ago, it was a 100% UVa and UVb blockage too. 
The more indoor (no UV source) natural or incandecent light available, the faster a Transitions Lens will return to clear.
Jim.

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## Stopper

Darris,
I'm enjoying this topic. this post has been interesting.

We all know the pupil controls how much light comes into the eye. But what happens after that is relevant to the topic of light sensitivity and is on the "same page". Your discussion of isometrics is quite applicable. The normal pupil is always in an isometric condition no matter what the light level. The dilator and sphincter have a constant opposition with the dilator always receiving the sympathetic stimulation and the sphincter always receiving the para sympathetic stimulation. the isometric is still going on just the balance is shifting when the light levels shift.

The amount of light coming in will effect someones light sensitivity but it is what happens after the light enters the eye that will determine if the patient is sensitive.

Question: Does this create or cause a problem knowing muscle function 
Me: I don't believe so
Others: I think it might
Me: there is no proof either side of the argument
others: Based on what I know I think it does or might
Me: I respect your opinion but we just disagree
Some day some one will study this topic and we may have a better clue to the answer.
Again, I enjoy this topic

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## Shutterbug

So we come down to the responsibility of informed concent.  Since there are no studies to verify or deny harm to the eye from transition lenses (especially in children), shall we hide the issue under a rug and go for the extra sale, or be responsible and inform the prospective buyer that there could be long term negative effects from the lens?  I think parents can make informed decisions for their children if they are given the information they need.  After all, when you are given a new medical prescription you want to know the POSSIBLE side effects, just in case.  That principle applies here as well.

Shutterbug

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## hcjilson

Shutterbug, would you kindly identify the negative affects of wearing   Transitions lenses and attribute your source for those assertions. All I've seen so far in that regard have been opinions.

tx from hj

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## Jim Schafer

I understand the point that "we don't know" all the answers.  However, if this were the danger/problem that some may think it might be, why is there no credible research to show such?  On the contrary, all the research we could find, globally, indicated that the pro's of wearing fixed or variable tint sun wear (with 100% UV blocking) far out weigh the con's.  

Also, another point that is missing is eye fatigue that can lead to tearing, headaches, etc. from squinting while in the sun. Fixed and variable tint lenses can enhance contrast sensitivity which can also improve outdoor vision.  A clear lens with UV coating does not provide all the enhancements to quality vision as a fixed tint or photochromic lens that blocks 100% UVA&UVB.
regards,
Jim

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