Eyeworld

22 January 2018 EW NEWS & OPINION Research highlight by Vanessa Caceres EyeWorld Contributing Writer burns (Fisher's exact test, P<0.001) and a history of severe sunburns with blisters (Fisher's exact test, P=0.034)," the researchers wrote. The dermatologic exams found a statistically significant association between iris freckles and actinic len- tigines, sun-damaged skin, and the presence of freckles on the skin. "In our study we found that the presence of iris freckles is associat- ed with a higher total nevus body count, suggesting a relationship of pathways involved in iris freckle formation and nevogenesis of the skin," the researchers wrote. However, individuals with a dark iris color were less likely to exhibit iris freckles, indicating that a dark iris color is less photosensitive than a light iris color. The association between iris freckles and older age may tie into the association with estimated num- ber of sunburns, actinic lentigines, and sun-damaged skin—and overall lifetime sun exposure. The high percentage of individ- uals with iris freckles compared with of which 57% were female. The mean participant age was 38.4 years. Patients filled out a questionnaire regarding age and factors indicating sun exposure, such as total num- ber of sunburns and the use of sun protection. Dermatologists reviewed participants to provide a total esti- mated body nevus count and assess sun damage. Participants had a slit lamp examination with an ophthal- mologist. Iris freckles were documented by color and location. Researchers defined an iris freckle as a small fleck of pigment ranging in color from yellow/tan to deep chocolate brown on the anterior surface of the iris without iris stroma involvement. In the study, 76.1% of partic- ipants had at least one iris freckle, with a median number of five. Most people (72.6%) had bilateral freckles. Iris freckles were statistically signifi- cantly linked with older age. Most participants noted that they protected themselves from sun exposure; however, 27.6% had experienced a severe sunburn, and the majority had experienced at least one sunburn. "Individuals with iris freckles were statistically signifi- cantly associated with an estimated higher number of lifetime sun- Iris freckles associated with higher age and more sunburns F reckles on the skin are often associated with genetics or sun exposure. But what do iris freckles mean? A study published in Investigative Ophthalmology & Visual Science focused on the role of iris freckles as a potential biomarker for sun exposure. 1 Researchers, led by Chris- toph Schwab, MD, Department of Ophthalmology, Medical University Graz, Graz, Austria, stated in their introduction that iris freckles occur in 60% of people and that they are the most common melanocytic iris lesion. They wrote that iris freckles appear to have no malignant poten- tial but that they might be inter- esting from a clinical point of view. "In dermatology the appearance of hyperpigmented spots—especially in chronic sun-damaged skin—is linked to a high lifetime accumulation of sunlight," they wrote. The prospective, interdisciplin- ary study included individuals at a skin cancer screening campaign in Austria. There were 632 participants, Iris freckles appear to indicate excess sun exposure Sun damage that may prompt further exams O phthalmologists aren't in the business of checking for sun damage on the skin. However, it's inevitable that they might spot some suspicious signs of sun damage near the eyes that could prompt a talk about sun protection or even a referral to a dermatologist. "Besides iris freckles, I often diagnose patients with pinguecula and pterygium, both of which can be caused by excessive ultravio- let exposure," Dr. Fishkin said. "For my patients with symptomatic pinguecula or large or growing pterygia, I discuss the importance of sun protection." He occasionally detects suspicious skin lesions near the eye that could resemble basal cell carcinoma. Those can prompt a referral to a skin doctor. Although a sun protection discussion with each patient isn't practical, it does come up sometimes. "Recently a woman came to me for an initial visit due to concern over a visible growth in her eye. I identified it as a pterygium, and due to her young age, I made it a point to discuss with her ways to avoid excessive UV exposure," Dr. Fishkin said. Dr. Jachens will sometimes ask screening questions about the use of sunglasses, sunblock, and when the last skin check took place. This may especially occur if a patient has new skin freckles or ones that have enlarged. "Past history of skin cancer as well as family history of skin cancer are worth asking about if you are concerned," he said. "Depending on those answers, I would refer to a dermatologist for a full skin check."

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