JOURNAL OF TROPICAL PEDIATRICS, VOL. 59, NO.

6, 2013

Evaluation of Window-Tinting Films for

Sunlight Phototherapy
by Hendrik J. Vreman,1 Tina M. Slusher,2 Ronald J. Wong,1 Stephanie Schulz,1 Bolajoko O. Olusanya,3 and David K. Stevenson1
1

Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine,
Stanford, CA 94305-5208, USA
2
Center for Global Pediatrics, University of Minnesota, Minneapolis, MN 55414-1932, USA
3
Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos State, Nigeria

Summary
We evaluated nine semi-transparent plastic window-tinting films for their ability to block ultraviolet
A (UVA) and infrared (IR) radiation and transmit therapeutic blue light (400520 nm) for treating
jaundiced newborns. For indoor testing, three light sources (TL/52 special blue fluorescent, Black Light
UVA and IR heat lamps) were positioned above each film and measured successively using a thermocouple thermometer, UVA radiometer and blue light irradiance meter, placed below each film.
For outdoor testing, the same setup was used with the sun at zenith and a cloudless sky. Compared
with unfiltered radiation, blue light transmission through films ranged from 24 to 83%, UVA transmission was 0.17.1% and reductions in IR heat were 612 C and 510 C for heat lamp and sun,
respectively. The data suggest that most of the relatively low-cost window-tinting films tested can
effectively reduce sunlight UV and IR and offer a range of significant attenuations of therapeutic
blue light.
Key words: bilirubin, Jaundice, Hyperbilirubinemia, Newborn, Phototherapy

Introduction
Sunlight phototherapy (PT) has been investigated as
a treatment for hyperbilirubinemia because of its
ability to reduce jaundice and serum total bilirubin
levels in infants with hyperbilirubinemia [13].
However, direct sunlight is undesirable for treatment
because it has a number of significant clinical and

Acknowledgements
The authors received editorial support from John J.
Mahoney. They express their thanks for offers of expertise and donation of samples of window-tinting
films by Tom King of V-KOOl, Inc., Houston, TX
(V-KOOl 55 and 70), and Tammy OMeara of
Window Innovations, Inc., Brentwood, CA (Huper
Optik, Select Sech).
Funding
This work was supported by the Mary L. Johnson
Research Fund, the Christopher Hess Research Fund
and the H.M. Lui Research Fund.

practical disadvantages [4]. For instance, harmful

ultraviolet (UV) radiation (100400 nm) in sunlight
can seriously and permanently damage human skin
[5]. Furthermore, sunlight also contains warming infrared (IR) radiation, which can cause hyperthermia
and dehydration with insufficient cooling, especially
in vulnerable neonates [6]. For these reasons, the
American Academy of Pediatrics does not recommend its use for treating hyperbilirubinemia [7].
Mitigating these risks is likely to make sunlight safe
and effective as a low-cost alternative to artificial
light PT. Technological methods using pigments,
coatings and films exist for blocking UV and IR radiation, and some will allow transmission of desirable
portions of the solar energy spectrum. One innovation (already used in vehicles and buildings) is
the application of semi-transparent plastic tinting
films to windows. However, it is not known if any
of these films would permit the transmission of sufficient therapeutic levels of blue light (400520 nm)
necessary to treat hyperbilirubinemia in newborns.
This study investigates nine such films for their
blocking ability of UV and IR radiation and
the transmission of therapeutic blue light to

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doi:10.1093/tropej/fmt062
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Correspondence: Hendrik J. Vreman. Tel: 1 650-7235-5859. Fax: 1 650-725-7724. E-mail <henk.vreman@stanford.edu>.

H. J. VREMAN ET AL.

determine the feasibility of using any of the films for

sunlight PT.
Materials and Methods

Laboratory Bench Tests

Because the radiation properties of sunlight cannot be
easily reproduced in the laboratory by any one light

TABLE 1
Light (%T) and heat (IR) transmission ( C) for lamp- and sunlight through n 9 flexible window-tinting
films with attached liner
Light
source

Bluea (400520 nm)

mW/cm2/nm (%Tb)

Film (Type)

UVAc (315400 nm)

mW/cm2 (%Tb)

IRd  C (
Te)

t (min)f

Lamp

No Film
1. TAP R-20 (Mh)
2. Gila Titanium (M)
3. Gila Platinum (M)
4. V-KOOl 55 (Si)
5. Gila Light (M)
6. Huper Select (S)
7. TAP R-50 (M)
8. V-KOOl 70 (S)
9. Air Blue 80 (S)

21.5
7.1
9.3
10.1
12.3
12.5
12.9
14.0
15.4
17.9

(100)
(33)
(43)
(47)
(57)
(57)
(60)
(66)
(71)
(83)

2226
9
8
157
1
11
1
12
2
<1

(100)
(0.4)
(0.4)
(7.1)
(0.1)
(0.5)
(0.1)
(0.5)
(0.1)
(<0.1)

36
24.5
24.5
24
24
26
26.5
28
24
30

(0)
(11.5)
(11.5)
(12)
(12)
(10)
(9.5)
(8)
(12)
(6)

NDg
ND
ND
ND
ND
ND
ND
ND
ND
ND

Sunj

No Film
1. TAP R-20 (M)
2. Gila Titanium (M)
3. Gila Platinum (M)
4. V-KOOl 55 (S)
5. Gila Light (M)
6. Huper Select (S)
7. TAP R-50 (M)
8. V-KOOl 70 (S)
9. Air Blue 80 (S)

114
28
38
44
60
64
66
68
78
91

(100)
(24)
(33)
(38)
(53)
(56)
(53)
(60)
(68)
(79)

1526
8
7
75
4
8
4
13
4
2

(100)
(0.5)
(0.4)
(4.9)
(0.2)
(0.5)
(0.2)
(0.8)
(0.2)
(0.1)

36
26
26.5
27
28
29
29
31
29
30

(0)
(10)
(9.5)
(9)
(8)
(7)
(7)
(5)
(7)
(6)

4.0
10.0
10.2
7.4
8.0
10.2
7.7
8.0
7.2
4.7

Notes:
a
Blue Light Tl 20W/52 (Philips, Amsterdam, The Netherlands) measured by BiliBlanket Meter II.
b
%T is the percentage of light transmitted by a film relative to the light presented to that film (no film 100%).
c
UVA Black light, F15T8-BLB (General Electric, Hartford, CT) measured by Goldilux UVA photometer.
d
IR Heat Lamp, 115VAC, 250W powered at 80VAC (General Electric) measured by a thermocouple thermometer.
e
Ambient temperatures for lamp and sun experiments were 20 C and 18 C, respectively.
f
The t is the number of minutes required for the bilirubin concentration to decrease to half its original value.
g
ND not determined.
h
M metalized.
i
S spectrally selective transition metal oxynitride.
j
Sunlight @ zenith, cloudless sky.
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Films
Representative samples of nine metalized (M) and
metal oxynitride (S) films [TAP R-20 (M), Titanium
(M), Gila Platinum (M), V-KOOl 55 (S), Gila Light
(M), Huper Select (S), TAP R-50 (M), V-KOOl 70 (S)
and Air Blue 80 (S)] were obtained from the companies
listed in Table 1. Presently, Solutia, Inc. (St Louis,
MO) owns these brands. The retail price of the films
tested range from US $0.50 (for M-type film) to $2.00
(for S-type film) per 30  30 cm (or 1 sq. ft.).

source, three light sources were used for the bench

tests (Fig. 1). For IR testing, a reflector IR heat
lamp (115125 V, 250 W, General Electric, Fairfield,
CT) powered with 80VAC from a Variac transformer
was clamped to a laboratory stand 23 cm (a) above a
rectangular wire film support positioned 7.5 cm (b)
above a thermocouple thermometer (Type K,
EA11A, Extech Instruments, Melrose, MA) that
was placed 2.5 cm (c) above an insulating layer of
1-cm polyester batten and 5-cm thick polystyrene
foam. The heating effect of the lamp, with no film
present, was measured. Temperatures were recorded
as  C. Ambient temperature was kept constant.
For UVA testing, a black light fluorescent lamp
(F15T8-BLB, General Electric) with a spectral range
of 315400 nm was clamped to the laboratory stand at
a 2-cm distance (a) above the film support with 0-cm
distance (b) from the film to the meter. UVA intensity
was measured as mW/cm2 using a UVA meter
(Goldilux Radiometer/Photometer with a GAP-1

H. J. VREMAN ET AL.

Light Source

(a)

(b)

Detectors (UV-A, Blue, IR)

(c)
Insulated detector stage

FIG. 1. Bench test system used for evaluating samples

of window-tinting films. The setup consists of a light
source (IR, UVA or blue lamp) clamped separately
to a laboratory stand, or the sun, under which a wire
frame is positioned to support the 22  28-cm sheets
of film. To make the measurements, each detector
(i.e., a thermocouple thermometer, a UVA photometer or a blue light irradiance meter) was placed in
turn on the insulating layer so that its sensor was
located 2.5 cm above the insulation. For IR, UVA,
Blue lamps and sun, the distances for (a) were 23, 2,
23 cm and infinity; (b) were 19, 0, 23 and 5 cm and
(c) were all 2.5 cm.

Probe, Oriel Instruments, Stratford, CT), with the top

of the photometer at 2.5 cm (c) above the insulating
layer. This meter has a spectral sensitivity range of
315400 nm, with peak sensitivity at 365 nm.
For therapeutic blue light (spectral range of
400520 nm) testing, a fluorescent lamp (TL
20W/52, Philips Electronics, Amsterdam, The
Netherlands) fitted with a Clip-On Reflector (3M
Inc., Minneapolis, MN) was clamped to the laboratory stand 23 cm (a) above the film support and a
23-cm distance (b) from film to meter. Light intensity
(irradiance) was measured as mW/cm2/nm, with the
top of the meter 2.5 cm above the insulating layer (c)
using a BiliBlanket Meter II (GE HealthCare
Technologies, Waukesha, WI), which has a spectral
sensitivity range of 400520 nm and peak sensitivity
498

Determinations of t
The method and calculations for the determination
of t (min) for bilirubin photodestruction to diazonegative compounds were performed as previously
described [8]. In summary, sets of (n 3) hematocrit
tubes containing 25 ml of a bilirubin/human serum
albumin (BR/HSA, 25 mg/dl/4% HSA in buffer)
solution were exposed at 37 C to filtered sunlight.
The remaining BR concentrations were quantitated
using a diazo-reaction assay. The rate of BR photodegradation (t1/2) was then determined through
interpolation of plotted % BR degraded vs. time
(min). We found that the t1/2s (efficacy) for a
number of artificial light PT devices ranged from 16
to 67 min (in Table 3, ref 8).
Data Analysis
Percent transmission (%T) for blue and UVA radiation was calculated for each film using the equation:
[%T (Film/No Film)  100%]. The transmission of
IR is expressed as the difference [
(delta) T] in temperature ( C) between unfiltered and filtered sunlight.
Results and Discussion
The results of testing the films with the three types of
radiation are shown in Table 1, with the data
arranged in order of increasing %T of therapeutic
blue light (range 3383%) relative to unfiltered
lamp light. The sunlight %T values for the films
were similar, but relatively lower (range: 2479%)
than for lamplight. This is likely due to the meters
response to the broader-spectrum and higherJournal of Tropical Pediatrics

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Film Support

at 450 nm. Light intensity (irradiance) is a measure of

radiometric flux per unit area (or flux density). It is
typically expressed as W/cm2 (watts per square
centimeter) or mW/cm2/nm (microwatts per square
centimeter per nanometer) by clinically used irradiance meters.
For each indoor bench test, the appropriate lamp
was first powered on and allowed to equilibrate for
30 min. The appropriate detector was then placed at
the center of the radiation footprint and the control
response level (i.e., no film) was recorded. Without
moving the detector, various films (22  28-cm
sheets), with their protective liners attached, were
placed in succession on the film support, with the
liner facing the lamp. The filtered radiation intensity
was then recorded.
For outdoor sunlight testing, a similar experimental procedure was used, except that the lamps were
replaced by sunlight at zenith (11:0014:00 hr) in a
cloudless sky on a roof at the Stanford University
Medical Center (latitude: 37 260 0800 N; longitude:
122 100 2600 W). The experimental setup was shielded
as much as possible from air currents, without interfering with sunlight delivery. Ambient temperatures
were also recorded.

H. J. VREMAN ET AL.

Journal of Tropical Pediatrics

Vol. 59, No. 6

min)] or the Wallaby Term (Senior) (Philips

Healthcare, Monroeville, PA, t 67 min).
Because the films were studied with their liners
(which protect the sticky or window application
side from dust) in place, we also tested if there was
polarity to the films, but no difference in %T was
detected whether the active layer of the films or the
liner faced the light source (data not shown).
Consequently, liners were left attached to serve as
an additional protective layer when panels of the
film were handled and studied, or installed over
canopies, and exposed to sun, rain, wind and dust.
We recommend that the films be mounted with the
liner side facing the sun so that the active layer is
maximally protected from being damaged.
The ideal sunlight PT film should: (i) block UV
radiation to <1% that of unfiltered sunlight
(2000 mW/cm2), (ii) block IR sufficiently to maintain patient thermostasis, (iii) transmit sufficient level
of therapeutic blue light and (iv) be transparent to
facilitate visibility of the patient for purposes of clinical management. Optimally effective blue light irradiance levels have not yet been established, but it
is believed that levels between 30 and 70 mW/cm2/nm
(as measured with the BiliBlanket Meter II) constitute intensive and effective PT for jaundiced newborns [7]. CriglerNajjar syndrome patients are
frequently treated with 100 mW/cm2/nm [14]. The
present data suggest that most of the tested window-tinting films can effectively reduce sunlight UV
and IR and offer a range of clinically significant
attenuations of therapeutic blue light.
Data from the developing world suggest that
severe newborn jaundice and its progression to kernicterus is a leading cause of newborn deaths and
disabilities [15]. Many of these same locales are
underserved clinical settings, where electrical energy
is not reliably available or where hospitals cannot
afford the purchase of effective PT devices [3]. For
example, in Nigeria, there is a shortage of modern PT
units and only intermittent electric power is available
to run these devices [13, 16]. Thus, in such locales,
development of inexpensive sunlight PT methods
might alleviate both cost and health burdens. If one
or more of the films tested in this study can be shown
to be clinically safe and effective, more patients might
receive lifesaving PT treatment and avoid serious lifelong health consequences (i.e., kernicterus) or death.
Clinical studies are in progress to confirm the safety
and efficacy of some of these films for sunlight PT
[10]. Therefore, the use of window-tinting films might
be a viable option for advancing the delivery of safe
and effective PT to patients in these areas.
We envision that the applicability of the films
to physical treatment facility configurations will be
3-fold (Fig. 2):
1. Portable individual treatment configuration,
where the patient receives PT in a bassinet or
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emission peak (>600 nm) of sunlight compared with

the narrow-spectrum and lower-emission peak
(450 nm) of the specialized TL/52 blue light lamp
[8, 9]. Blue light irradiance from unfiltered sun at
zenith ranges from 100 to 150 mW/cm2/nm in a
cloudless sky, but only <25 mW/cm2/nm in an overcast sky (measured with the BiliBlanket II Meter,
unpublished observations). Significant attenuation
of blue light might be desirable depending on geographical latitude, season and the time of day. Thus,
under clear skies, when an attenuated transmission of
blue light is desirable, Gila Titanium film would be a
good choice, because it transmits only 33% (or potentially up to 3350 mW/cm2/nm) of therapeutic blue
light [10]. However, under overcast sky, this film
transmits a barely effective irradiance of 8 mW/cm2/
nm. When maximum blue light transmission is
desired (e.g., under an overcast sky), the Air Blue
80 film (79%T) would still transmit 20 mW/cm2/
nm, which is comparable with standard PT used in
developing [11, 12] and developed countries [13]. The
present data suggest that most of the tested windowtinting films can effectively reduce sunlight UV and
IR and offer a range of clinically significant attenuations of therapeutic blue light.
Except for Gila Platinum film, UVA transmission
for the films was <1%. Therefore, UV radiation is
effectively blocked by all but one of the tested films.
Because UVA light (315400 nm) is more likely to
pass through organic films than UVB (280315 nm)
or UVC (100280 nm) light, it can be inferred that
these forms of UV irradiation will also be blocked.
IR measurements show the greatest difference in
magnitude between lamp- and sunlight. However,
there also exists a corresponding relationship for
this parameter, with the sunlight values being lower
than lamplight by an average of 3 C. It is possible
that air currents or the broader sunlight IR spectrum
[9] affected the results. Nonetheless, the data show
that all films reduced heat transmission, and that
the metalized (M) films were more effective at reducing temperature compared with the spectrally selective transition metal oxynitride (S) films. Relative
temperature reduction is important for designing
clinical field studies. In areas where sunshine is abundant, but ambient temperatures are relatively low
(e.g., at high altitudes or latitudes), films with sufficient heat transmission would probably be needed to
maintain patient thermostasis.
The t data demonstrated the effectiveness of sunlight toward bilirubin degradation. Unfiltered
Stanford sunlight produced a very short t of 4
min, whereas the filtered light showed a range of
longer ts (range: 4.710.2 min). However, compared with our earlier results [8], even the film with
the longest t (Gila Titanium, t 10.2 min) was
more effective than the artificial electric light devices,
such as the BiliBed [Medela, McHenry, IL (t 18

H. J. VREMAN ET AL.

window-tinting film attached to or affixed next

to the inside window surfaces. Moreover, its
non-window surfaces should be painted white to
maximally reflect the incoming light throughout
the room. An advantage of a permanent structure
is the ability to receive sunlight PT without
disruption of care during rain.

References
FIG. 2. Possible applications of sunlight filters.
(A) Photograph of a simple portable individual sunlight PT setup using a rugged wire canopy for support of a 60  90-cm sheet of Air Blue 80 (for use
with an overcast sky). (B) An example of a low-cost
portable canopy (240  240-cm footprint  180 cm in
height) for group or communal sunlight PT, constructed from polyvinyl chloride (PVC) irrigation
tubing. The canopy frame was covered with a panel
(240  360 cm) of Gila Titanium window-tinting film
for use with clear-sky sunlight PT. Note the shadow
cast by the film, which transmits 33% of the suns
therapeutic blue light.
basket, which is placed in sunlight, filtered with a
relatively small panel of film (60  90 cm)
draped over a simple (wire) frame (Fig. 2A);
2. Portable group or community treatment facility
(Fig. 2B). This type of configuration is presently
being studied in Nigeria, where the mothers,
seated in comfortable seats, can hold and bond
with their babies as well as nurse, while interacting with other mothers and infants [10];
3. Permanent hospital-based treatment facility. This
type of facility is economically more expensive
and involves the building of a more or less permanent PT facility with optimal orientation to
the daily and seasonal course of the sun [17] and
maximum and optimally placed overhead and
vertical windows covered with carefully selected
500

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A significant limitation of sunlight PT is that sunlight radiation levels can and do change hourly, daily
and seasonally [3]. It is therefore likely that sunlight
PT will be most practical in medical facilities near
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and intense, and where ambient air temperatures
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powerful therapeutic tool when it is combined
with solar panel energy-capturing/storage systems
and efficient light-emitting diode-based PT devices
for treatment, when sufficient sunlight is not available [18].

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