Protective Eyewear and UV Tanning

Protective Eyewear and UV Tanning Dear Editor: Nearly 10% of Americans are estimated to patronize indoor ultraviolet (UV) tanning facilities at least once yearly.1 Because use of indoor UV tanning devices may result in corneal burns, retinal damage, and cataracts,2– 4 the Food and Drug Administration requires the labeling of sunlamps with the warning: “WEAR PROTECTIVE EYEWEAR; FAILURE TO MAY RESULT IN SEVERE BURNS OR LONG-TERM INJURY TO THE EYES.”5 Previous studies describe that 75% to 89% of facilities comply with protective eyewear regulations.6 – 8 In a crosssectional study, we examined current protective eyewear recommendations, provision, and pricing at a sample of licensed indoor tanning facilities in 4 states (Colorado, Illinois, Texas, and Wisconsin). Lists of licensed indoor tanning facilities were obtained (February–May 2003) from the state health departments of Texas (n ⫽ 2332), Illinois (n ⫽ 1905), Wisconsin (n ⫽ 1447), and Colorado (n ⫽ 580). One hundred facilities from each state were randomly selected using a random number generator (http://www. random.org) and surveyed by telephone in October 2003. The survey consisted of a standardized script including the following questions: “Do I have to wear goggles or glasses while tanning?,” and if answered in the affirmative, “Do I have to buy eyewear, or do you provide it free to customers?” To maximize response rates, minimize social acceptability response bias, and avoid deviation from information currently given to potential customers, facility representatives were not informed that they were participating in a study. This study received Colorado Institutional Review Board approval (no. 03-816). Health departments for each state were contacted by telephone (November 2003–January 2004) to assess indoor tanning regulation revisions, enforcement, and penalties (Table 1 [available at http://aaojournal.org]). Comparisons of responses by state were performed using a nonparametric (Fisher exact) test using the biostatistical software program SAS. Six hundred twenty-eight licensed indoor UV tanning facilities were telephoned (Colorado, 164; Illinois, 129; Texas, 178; and Wisconsin, 157) to obtain 100 survey responses from each state. If a facility representative was unavailable to answer questions after 3 calls, or if the telephone number was incorrect or disconnected, another facility from the same state was randomly selected from the remaining facilities. Overall, 95% of operators recommended the use of

protective eyewear (Table 2 [available at http://aaojournal. org]), and nearly all facilities (99%) had protective eyewear available. States differed significantly from each other with regard to reported provision of eyewear without additional cost (Colorado, 81%; Illinois, 74%; Texas, 82%; and Wisconsin, 93%) (P ⫽ 0.002). From this multistate study, availability of protective eyewear was higher than reported in previous studies, and most indoor UV tanning operators recommend eyewear use. However, charging patrons extra for protective eyewear provides a disincentive for adequately safeguarding against known ocular risks. Furthermore, 16% of Texas facilities charged for eyewear, despite a Texas state regulation requiring eyewear provision free of charge. Enactment and enforcement of free protective eyewear regulations at UV tanning parlors needs further examination and consideration.9 ERIC J. HESTER, MD Portland, Oregon LAUREN F. HEILIG, BA RENEE D’AMBROSIA, MD AMANDA L. DRAKE, BS ROBERT P. DELLAVALLE, MD, PHD Denver, Colorado References 1. Indoor Tanning Association. About indoor tanning. Available at: http://www.theita.com/page.php?ArticleID⫽135. Accessed January 10, 2005. 2. Health issues of ultraviolet tanning appliances used for cosmetic purposes. Health Phys 2003;84:119 –27. 3. Zigman S. Lens UVA photobiology. J Ocul Pharmacol Ther 2000;16:161–5. 4. Walters BL, Kelley TM. Commercial tanning facilities: a new source of eye injury. Am J Emerg Med 1987;5:386 –9. 5. 50 Federal Register 36550 (1985) (codified at 21 CFR §1040.20). 6. Fairchild AL, Gemson DH. Safety information provided to customers of New York City suntanning salons. Am J Prev Med 1992;8:381–3. 7. Fleischer AB Jr, Lee WJ, Adams DP, Zanolli MD. Tanning facility compliance with state and federal regulations in North Carolina: a poor performance. J Am Acad Dermatol 1993;28: 212–7. 8. Culley CA, Mayer JA, Eckhardt L, et al. Compliance with federal and state legislation by indoor tanning facilities in San Diego. J Am Acad Dermatol 2001;44:53– 60. 9. SAS [computer program]. Version 8.0. Cary, NC: SAS Institute.

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Ophthalmology Volume 112, Number 9, September 2005 Table 1. Indoor Ultraviolet Tanning Eyewear Regulations State Colorado

Illinois

Texas

Wisconsin

Regulation

Implementation

Citation

Registrants are responsible to provide protective eyewear to each consumer during use of tanning equipment; tanning facility operators shall instruct the consumer in the proper utilization of the protective eyewear; eyewear must be worn when the lamps are energized. Each consumer shall be provided with protective eyewear before each tanning session, with instructions for its mandatory use. Each consumer shall be provided with protective eyewear and instructions for their use. Protective eyewear shall be provided without charge to each user of a tanning device. The operator shall not allow a person to use a tanning device if that person does not use protective eyewear that meet the requirements of the United States Food and Drug Administration. Customers are not allowed to use a tanning device unless the customer uses protective eyewear.

All facilities audited on a rotating basis; every facility is examined approximately every 3 years.

Colorado Revised Statutes §25-5106(1), (2)(a), (2)(b), Section 3-301 (d)(1), (d)(3)

All facilities audited yearly.

77 Illinois Administrative Code 795.170.

Random selection of 30 facilities, and those with complaints are audited yearly.

25 Texas Administrative Code §§229.352

All facilities with complaints are audited.

2003 Wisconsin Statutes and Acts s. 255.08

Table 2. Protective Eyewear Practices of Indoor Ultraviolet Tanning Facility Operators in Colorado, Illinois, Texas, and Wisconsin

Recommended use of protective eyewear Yes No Don’t know/no answer Provided eyewear Yes No Don’t know/no answer Cost of protective eyewear Charged an additional fee Included in cost of tanning procedure Don’t know/no answer *Fisher exact chi-square test.

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Colorado (n ⴝ 100)

Illinois (n ⴝ 100)

Texas (n ⴝ 100)

Wisconsin (n ⴝ 100)

Mean Percent (95% Confidence Interval)

93 7 0

96 3 1

91 7 2

98 2 0

94.5% (0.93–0.97) 4.75% (0.03–0.07) 0.75%

0.21

98 2 0

100 0 0

98 1 1

99 1 0

98.75% (0.98–1.00) 1.00% (0.00–0.02) 0.25%

0.76

16 81 3

26 74 0

16 82 2

6 93 1

16% (0.13–0.20) 82.5% (0.80–0.87) 1.5%

0.002

P Value*