Blue Light-filtering Intraocular Lens Research Articles

The effect of blue-light filtering intraocular lenses on the development and progression of macular atrophy in eyes with nAMD

PurposeTo assess the effect of blue-light filtering (BLF) intraocular lenses (IOLs) on the development and progression of macular atrophy (MA) in eyes with neovascular age-related macular degeneration (nAMD). DesignRetrospective clinical cohort study. MethodsnAMD patients with anti-vascular endothelial growth factor (VEGF) injections who underwent uneventful cataract surgery between 2007 and 2018 with follow-up until June 2023. Subsequent MA rates were compared between subjects who received a BLF IOL or a non-BLF IOL. All OCT scans were manually reviewed in a masked manner regarding patient baseline variables and IOL status by an experienced research technician. Using the Heidelberg software, the area of MA was manually evaluated and calculated (mm2) by the program. The overall risk of developing new-onset MA and the effect of IOL type on disease progression were assessed. Death was included as a censoring event. ResultsIncluded were 373 eyes of 373 patients (mean age 78.6±6.7 years at surgery, 67.4% females). 206 eyes were implanted with BLF IOLs and 167 with non-BLF IOLs with comparable follow-up times (3164±1420 days vs. 3180±1403 days, respectively, P=0.908), and other baseline parameters (age, gender, corrected distance visual acuity, macular thickness, cumulative number of anti-VEGF injections). Nine pre-existing and 77 new-onset MA cases were detected, with similar distribution between BLF and non-BLF eyes (P=0.598 and P=0.399, respectively). Both univariate Kaplan-Meier (P=0.366) and multivariate Cox regression analysis adjusted for age and gender showed that BLF-IOLs were comparable to non-BLF IOLs regarding hazard for new-onset MA (HR 1.236, 95% CI 0.784-1.949, P=0.363). Final MA area at the last visit was 5.14±4.71mm2 for BLF IOLs and 8.56±9.17mm2 for non-BLF IOLs (P=0.028), with the mean annual MA area increase of 0.78±0.84mm2 and 1.26±1.32mm2, respectively (P=0.042). ConclusionsBLF IOLs did not show added benefit over non-BLF IOLs in terms of MA-free survival but were associated with less progression over time in a cohort of nAMD patients.

Evaluation of visual performance and eye movements in patients with blue light-filtering intraocular lenses versus ultraviolet light-filtering intraocular lenses.

Eye movement plays an important role in visual perception and provides essential visual information for everyday tasks. Our previous study indicated that the visual performance and eye movement pattern were impaired in age-related cataract patients and could be improved after cataract surgery, but the impact of different intraocular lens (IOL) types was obscure. Previous studies found that blue light might affect the eye movement pattern and cognitive function. In this study, we explored the visual performance and eye movement pattern in post-cataract surgery patients implanted with blue light-filtering IOLs or ultraviolet (UV) light-filtering IOLs to further understand the impact of different types of IOLs on and daily visual performance and eye movement pattern and to help ophthalmologists and patients make the personalized option of IOL types in future. Patients after both-eye cataract surgeries were included in this study. Eye movement behaviors were automatically recorded by an eye tracker while performing three performance-based everyday tasks (non-social object search, face recognition, and reading). Visual performance and eye movement parameters were compared between participants with blue light-filtering IOLs and UV light-filtering IOLs. The correlation between visual performance and eye movement parameters was explored to determine which eye movement parameters had a significant influence on visual performance outcomes. A total of 30 patients (16 with blue light-filtering IOLs and 14 with UV light-filtering IOLs) were included. In this study, we found that the eye movement pattern was slightly different with these two IOLs: during non-social object visual search task, time to first fixation and fixation counts before first fixation were notably increased in yellow-tinted blue light-filtering IOL patients. During reading task, a higher total fixation count was also found in blue light-filtering IOL patients. However, the visual performance of these two IOLs was close, except for a quicker search of the target object with clear UV light-filtering IOLs. Both blue light-filtering and UV light-filtering IOLs were able to successfully restore visual function and yield satisfactory outcomes after cataract surgery. Although subtle, yellow-tinted IOLs did have a slight but significant impact on visual performance and the eye movement pattern of elderly patients when handling everyday tasks.

The Effects of Blue-Light Filtering Intraocular Implants on Glare Geometry

Purpose One common complaint with natural opacified lenses is the deleterious effects of higher-order ocular aberrations and intraocular scatter, such as halos and starbursts, which are not always remedied with surgery and intraocular lens (IOL) implantation. Blue-light filtering (BLF) IOL filter scatter-prone short-wave light. Here, we determine whether BLF IOL reduce halo and starburst size. Methods This study was a case-control design, between- and within-subjects (contralateral implantation). Sixty-nine participants with either the BLF IOL (n = 25; AlconSN60AT), clear IOL (n = 24; AlconSA60AT or WF), or both (n = 20) IOL participated. Participants were exposed to a point source of broadband simulated sunlight, which created the appearance of halos/starbursts. Dysphotopsia was measured as the diameter of broadband light-induced halos and starbursts. Results A case-control analysis. Halo size was significantly larger (t[35.05] = 2.98, p = 0.005) in participants with the clear control lens (M = 3°55′ ± 2°48′), compared to the BLF IOL (M = 1°84′ ± 1°34′). Starburst size was not significantly different between groups. Contralateral analysis. Halo size was significantly smaller (t = −3.89, p = .001) in test eyes with the BLF (M = 3°16′ ± 2°35′) compared to the fellow control eyes (M = 5°42′ ± 3°17′). Starburst size was also significantly smaller (t = −2.60, p < 0.018) in BLF test eyes (M = 9°57′ ± 4°25′) than the fellow eye with the clear IOL (M = 12°33′ ± 5°25′). Conclusions BLF IOL filter short-wave light and mimic retinal screening by the young, natural crystalline lens. Such filtering can reduce some deleterious effects of bright light by decreasing ocular diffusion/halos and starbursts.

The Effect of Blue-Light Filtering Intraocular Lenses on the Development and Progression of Glaucoma.

Among patients who underwent uneventful cataract surgery, an advantage was seen to blue-light filtering (BLF) intraocular lenses (IOLs) in terms of glaucoma-free survival and glaucoma procedure-free survival. Among patients with preexisting glaucoma, no advantage was seen. To assess the effect of BLF IOLs on the development and progression of glaucoma after cataract surgery. A retrospective cohort study of patients who underwent uneventful cataract surgery between 2007 and 2018 at Kymenlaakso Central Hospital, Finland. Survival analyses for the overall risk of developing glaucoma or undergoing glaucoma procedures were assessed between patients who received a BLF IOL (SN60WF) and a non-BLF IOL (ZA9003 and ZCB00). A separate analysis was performed on patients with preexisting glaucoma. Included 11,028 eyes of 11,028 patients with a mean age of 75 ± 9 years (62% females). The BLF IOL was used in 5188 eyes (47%) and the non-BLF IOL in 5840 eyes (53%). During the follow-up (mean: 55 ± 34 mo), 316 cases of glaucoma were diagnosed. Glaucoma-free survival rates showed an advantage to the BLF IOL ( P = 0.036). In a Cox regression analysis controlling for age and sex the use of a BLF IOL was again associated with a lower ratio of glaucoma development (hazard ratio:0.778; 95% CI: 0.621-0.975). Furthermore, glaucoma procedure-free survival analysis revealed an advantage to the BLF IOL (hazard ratio:0.616; 95% CI: 0.406-0.935). Among 662 cases, which already had glaucoma at the time of surgery, no significant differences were seen in any outcome. Among a large cohort of patients who underwent cataract surgery, the use of BLF IOLs was associated with favorable glaucoma outcomes compared with the use of non-BLF IOLs. Among patients with preexisting glaucoma, no significant advantage was seen.

Association of clear vs blue-light filtering intraocular lenses with mental and behavioral disorders and diseases of the nervous system among patients receiving bilateral cataract surgery.

To analyze new-onset mental and behavioral disorders and nervous system diseases in patients with cataract implanted with either non-blue-light filtering (BLF) or BLF intraocular lenses (IOLs) in both eyes. Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland. A retrospective registry-based cohort study of patients operated between September 2007 and December 2018 who were followed until December 2021. We included 4986 patients who underwent bilateral cataract surgery. Patients were implanted with either non-BLF IOLs (N = 2609) or BLF IOLs (N = 2377) in both eyes. Follow-up before the first-eye surgery and between the first-eye and the second-eye surgery was performed to acknowledge the preexisting disorders and diseases. After the second-eye surgery, the groups were analyzed for the new-onset mental and behavioral disorders and diseases of the nervous system subcategorized by the International Classification of Diseases codes. 1707 male and 3279 female patients, aged 73.2 ± 8.6 years at the first-eye surgery and 74.3 ± 8.8 years at the second-eye surgery, were identified. In univariate log-rank tests, the use of BLF IOLs showed no association in overall new-onset disorders or diseases over non-BLF IOLs, in any subtype diagnosis codes except for sleep disorders, which favored BLF IOLs ( P = .003). A multivariate analysis adjusted for age and sex identified no associations in any new-onset disorders or diseases. Multivariate analysis of sleep disorders showed a nonsignificant advantage for BLF-IOLs (hazard ratio 0.756, 95% CI 0.534-1.070, P = .114). BLF IOLs were not associated with mental and behavioral disorders or diseases of the nervous system.

Visual Performance of a Violet-Filtering Intraocular Lens versus a Blue-Filtering Intraocular Lens of New/Old Manufacturing Processes.

This article compares the visual performance of a violet light-filtering colored lens (ZCB00V) and blue light-filtering intraocular lens (IOL; SN60WF) before and after modifying the manufacturing process for glistening suppression. In this retrospective study, conducted at Saneikai Tsukazaki Hospital, Himeji, Japan, a consecutive sample of 8943 eyes of 5119 patients were included and implanted with blue-filtering IOLs before and after modifying the manufacturing process (SN60WF-J (1318 eyes) and SN60WF-Q,A (1418 eyes), respectively), noncolored UV-cut IOLs (ZCB00 (1418 eyes)), and ZCB00V (3717 eyes). For each patient, the corrected distance visual acuity (CDVA) at 3 months postoperative (3MCDVA) and the area under log contrast sensitivity function (AULCSF) were measured. The 3MCDVA was -0.076 ± 0.1, -0.11 ± 0.13, -0.10 ± 0.17, and -0.11 ± 0.13, for SN60WF-J, SN60WF-Q,A, ZCB00, and ZCB00V, respectively. The SN60WF-J group revealed significant differences as compared to the other three groups (all p < 0.05). The mesopic AULCSF was 2.59 ± 0.20, 2.68 ± 0.19, -2.69 ± 0.18, and 2.76 ± 0.19, respectively, whereas the photopic AULSCF was 2.63 ± 0.23, 2.76 ± 0.25, -2.77 ± 0.25, and 2.88 ± 0.25. The SN60WF-J and ZCB00V groups exhibited significant differences as compared to the other three groups, whereas no significant differences were noted between the SN60WF-Q,A and the ZCB00 groups (all p < 0.05). The violet-filtering lens offers higher visual acuity and contrast sensitivity than the clear and blue-filtering lens. It was also found that the above functions were improved by modifying the manufacturing process.

Association of Blue Light–Filtering Intraocular Lenses With All-Cause and Traffic Accident–Related Injuries Among Patients Undergoing Bilateral Cataract Surgery in Finland

Blue light-filtering (BLF) intraocular lenses (IOLs) have been widely used in clinical practice for more than 20 years and have been implanted in millions of patients with cataracts worldwide. However, little evidence on the association of BLF IOLs with injuries is available. To assess the association of BLF IOLs with all-cause and traffic accident-related injuries and quality of vision while driving after bilateral cataract surgery. This retrospective registry-based cohort study included patients who underwent bilateral cataract surgery between September 3, 2007, and December 14, 2018, and were followed until December 14, 2021. Surgery was performed at the Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland. The 4986 participants received non-BLF IOLs (n = 2609) or BLF IOLs (n = 2377) in both eyes. Patients undergoing bilateral surgery between 2015 to 2016 with non-BLF IOLs (n = 102) or BLF IOLs (n = 91) and currently driving a car were interviewed using a structured questionnaire for visual performance while driving. Follow-up for a mean (SD) of 2166 (1110) days after second eye surgery. Kaplan-Meier and multivariable Cox proportional hazards regression analyses for the risk of all-cause and traffic accident-related injuries after surgery in the second eye obtained from the patient medical records were assessed. To improve follow-up precision, both death and the end of the follow-up were used as censoring events. A total of 4986 patients were included in the analysis (1707 [34.2%] men and 3279 [65.8%] women; mean [SD] age, 73.2 [8.6] years at the first surgery and 74.3 [8.8] years at the second). Injury-free survival rates preceding the first eye surgery were comparable between the non-BLF and BLF IOL groups (hazard ratio adjusted for age and sex, 0.95 [95% CI, 0.81-1.13; P = .57]). In multivariable Cox proportional hazards regression analysis controlling for age and sex, the use of BLF IOLs showed no advantage in overall injuries compared with the use of non-BLF IOLs (hazard ratio, 0.99 [95% CI, 0.88-1.11]; P = .85) or in any injury subtype. Subjective visual performance parameters for driving were all comparable between the non-BLF and BLF IOL groups except for glare when driving in the dark (evening or night), which occurred among 9 of 80 patients with BLF IOLs compared with 0 of 83 non-BLF IOLs (P < .001). The findings of this cohort study suggest that use of BLF IOLs was not associated with reduced risk of injuries, whereas glare during nighttime driving was significantly worse in the BLF IOL group with pseudophakia.

Effect of the spectral power distribution on visual performance of subjects implanted with intraocular lenses with or without a blue light-filter under night-driving conditions

In old subjects, the effect on visual performance of the interaction between the spectral power distribution of street lamps and the different types of intraocular lenses (IOLs) is unknown. Contrast threshold (CT) and reaction time (RT) were analysed in off-axis vision at mesopic illumination conditions provided by high-pressure sodium and metal-halide lamps, using a Maxwellian view optical system. Four groups of subjects participated: 10 young subjects, 20 elderly subjects with cataracts and the same subjects after cataract surgery were divided into two groups, 10 subjects implanted with a blue light-filtering and 10 subjects with a non-blue light-filtering IOL (NBIOL). Age-related cataract impairs detection and reaction capabilities; tasks that are nevertheless improved after surgery. The type of lamp does not affect both tasks in the case of the blue light-filtering IOL group, but it does in the NBIOL group. When comparing the two lenses, no detrimental effect of the blue light filter is observed in both tasks. In conclusion, at representative night-driving conditions, the spectral power distribution of the street lamp does not have a clinically relevant effect on visual tasks such as CT and visual RT in pseudophakic subjects, regardless of the type of IOL implanted.

Effect of Blue Light–Filtering Intraocular Lenses on Insomnia After Cataract Surgery: A Nationwide Cohort Study With 10-Year Follow-up

To compare the incidence of clinically diagnosed insomnia after cataract surgery in pseudophakic eyes with blue light-filtering intraocular lenses (BF-IOLs) and non-BF-IOLs. Nationwide cohort study using the Taiwan National Health Insurance Research Database. We enrolled 171,415 patients who underwent cataract surgery in both eyes between 2008 and 2013 and followed them till 2018. Propensity score matching (PSM) was used to balance the baseline characteristics between the 2 IOL groups. The Cox model and cause-specific hazard model were used to estimate the hazard ratios (HRs) and subdistribution hazard ratio (SHR). Overall, 19,604 (11.4%) and 151,811 (88.6%) patients had BF-IOL and non-BF-IOL implants, respectively. The BF-IOL group tended to be younger and had fewer chronic diseases. Within a mean follow-up period of 6.2 years, the incidence rates of insomnia (per 100 person-years) in the BF-IOL and non-BF-IOL groups were 2.97 and 3.21, respectively. There was no significant difference in the incidence rate of insomnia between the 2 IOL groups after treating all-cause mortality as a competing risk (SHR 0.98, 95% CI 0.95-1.01) and after PSM (HR0.97, 95% CI0.92-1.01), respectively. Subgroup analysis revealed no significant difference in the insomnia rate between the 2 IOL groups for various age groups, 2 sex groups, and men with and without benign prostatic hyperplasia. In Taiwan, the use of a BF-IOL for up to 10 years had no apparent disadvantage over non-BF-IOLs with respect to insomnia.

The Effects of a Blue-Light Filtering Versus Clear Intraocular Implant on Color Appearance.

PurposeMore than a dozen studies have investigated whether blue-light filtering (BLF) intraocular lens (IOL) implants influence color vision, generally finding they do not. These studies have not tested color vision per se; rather, they have measured color vision deficiencies or chromatic discrimination. Here, we used additive trichromatic colorimetry to assess color appearance in participants with BLF and clear IOL.MethodsSeventy-six participants were recruited from two populations: older participants (n = 52) with BLF and clear IOL (n = 98 eyes; M = 67.33 ± 7.48 years; 58.8% female; 25.5% non-White), and young adult control participants (n = 24; M = 21.0 ± 5.13 years; 70.8% female; 41.5% non-White). Participants used a custom-built tricolorimeter to mix three primaries until a perceived perfect neutral white was achieved. Color appearance, expressed as chromaticity coordinates, was measured with a spectral radiometer (ILS950).ResultsBetween subjects, the BLF IOL chromaticity coordinates (x = 0.34, y = 0.35, u′ = 0.21, v′ = 0.48) were not significantly different from the clear IOL (x = 0.34, y = 0.33, u′ = 0.22, v′ = 0.48). BLF and clear IOL were also not different within-contralateral subjects (n = 21; BLF x = 0.34, y = 0.33, u′ = 0.22, v′ = 0.47; clear x = 0.34, y = 0.33, u′ = 0.21, v′ = 0.48). Both IOL groups differed from young adults (v′[0.45; P = 0.001], x[0.31; P = 0.008], and y[ 0.30, P < 0.000], but not u′[0.21]).ConclusionsOne advantage of geometric representation of color space is the ability to specify the appearance (rather than spectral composition) of any light mixture by specific coordinates. Using this system, only minor differences in color appearance were found between a BLF, clear IOL, and young natural lens.Translational RelevanceWhen color perception is directly measured, the BLF and clear IOL are not meaningfully different.

Effect of Blue Light-Filtering Intraocular Lenses on Age-Related Macular Degeneration: A Nationwide Cohort Study With 10-Year Follow-up

To determine the incidence rate of age-related macular degeneration (AMD) after cataract surgery and compare the relative incidence of AMD in pseudophakes with blue light-filtering intraocular lenses (BF-IOLs) and non-BF-IOLs. A nationwide cohort study conducted using the Taiwan National Health Insurance Research Database. We enrolled 186,591 patients who underwent cataract surgery in both eyes between 2008 and 2013 and monitored them from the index date (the date of first cataract surgery) until AMD, death, loss to follow-up, or December 31, 2017, whichever occurred first. Propensity score matching (PSM) was used to balance the baseline characteristics between the BF-IOL and non-BF-IOL groups. BF-IOLs were implanted in 21,126 patients (11.3%) and non-BF-IOLs were implanted in 165,465 patients (88.7%). Patients in the BF-IOL group tended to be younger, with fewer men, different cataract surgery years, higher income, more nonmanual workers, more patients from urban and suburban areas, and fewer chronic diseases compared with the non-BF-IOL group. With a mean follow-up period of 6.1 years (range, 1-10 years) after cataract surgery, 12,533 and 1655 patients developed non-exudative AMD and exudative AMD, respectively. The incidence rate of non-exudative AMD and exudative AMD (per 1000 person-years) was 9.95 and 1.22 for the BF-IOL group and 11.13 and 1.44 for the non-BF-IOL group, respectively. After PSM, no statistical difference in the incidence rate of nonexudative AMD (hazards ratio, 0.95; 95% CI, 0.88-1.03) and exudative AMD (hazard ratio, 0.96; 95% CI, 0.77-1.18) was observed between the BF-IOL and non-BF-IOL groups. In Taiwan, the incidence rate of AMD after cataract surgery was 11.59 per 1000 person-years. The use of a BF-IOL for up to 10 years had no apparent advantage over a non-BF-IOL in the incidence of AMD.

The Influence of Blue-Filtering Intraocular Lenses Implant on Exudative Age-Related Macular Degeneration: A Case-Control Study.

PurposeTo determine whether the use of a blue light-filtering intraocular lens (IOL) prevents the onset of wet age-related macular degeneration (AMD). More precisely, we examined the proportion of blue light-filtering IOL in a wet AMD patients’ sample and compared it with a general North American pseudophakic population sample.DesignRetrospective case–control study.MethodsCase patients were diagnosed and treated for wet AMD and had prior IOL implantation at least 3 years before the diagnosis of wet AMD. Control patients were randomly selected among patients who had cataract surgery at our institution. They were exempt of AMD and paired for the year of surgery, sex and age at cataract surgery. A total of 196 patients were included in each study group.ResultsAmong patients with wet AMD, 62.8% had a blue light-filtering IOL compared with 63.3% among control patients (p = 0.92). Mean time between implantation and injection of anti-VEGF in AMD patients was 6.62 years (95% confidence interval (CI): 6.04–7.19) in non-blue light-filtering IOL group and 5.76 years (95% CI: 5.41–6.11) in blue light-filtering IOL group (p = 0.0120).ConclusionNo correlations could be established between the presence of a blue light filter in the IOL and the occurrence of wet AMD. AMD patients without blue light-filtering IOL were injected significantly later than patients with an IOL filtering blue light, which contradict the potential clinical benefit of the blue light filter.

Cataract type and pupillary response to blue and white light stimuli

We evaluated the pupil reaction to blue and white light stimulation in 70 eyes with cataract and in 38 eyes with a selective blue-light filtering intra-ocular lens. The diameter of the pupil before stimulation was set as baseline (BPD) and, after a stimulus duration of 1 s, the post-illumination pupillary response (PIPR) was measured using an electronic pupillometer. The BPD showed no significant difference among three grades of nuclear sclerosis (NS). In contrast, the PIPRs differed significantly among the NS grades eyes including with and without subcapsular cataract (SC) and IOL eyes for white light (p < 0.05, Kruskal–Wallis test), but not for blue light. Subcapsular opacity did not affect the BPD or PIPR in all cataract grades for either light stimulus. The tendency of larger PIPR in the pseudophakic eyes than the cataract eyes for both lights, however significant difference was found only for white light (p < 0.05 for white light, p > 0.05 for blue light). Our study demonstrates retention of the PIPR for blue light, but not for white light in cataract eyes. We also confirmed that the pupillary response in pseudohakic eyes with a selective blue light-filtering intra ocular lens was greater than that in cataractous eyes for white light.

Effect of High-Order Aberrations and Satisfaction on Cataract Patients Implanted with Four Types of AcrySof Blue Light Filtering Intraocular Lens

Objective: The objective is to evaluate the visual acuity, high-order aberrations and satisfaction in the cataract patients with the implantation of different types of AcrySof blue light filtering intraocular lens, which would provide the clinical guidance for the selection of individualized intraocular lens. Methods: From January 2019 to December 2020, the patients with age-related cataract in Guangzhou Red Cross Hospital were equally randomized to be divided into four groups. 20 patients (20 eyes) were implanted with AcrySof (SN60WF), which was the blue light filtering single focus group; 20 patients (20 eyes) were implanted with blue light filtering aspheric multifocal intraocular lens (AcrySof ReSTOR IOL +3.0D, SN6AD1), which was the multifocal intraocular lens group; 20 patients (20 eyes) were implanted with aspheric astigmatism correction intraocular lens (Toric SN6AT), which was the astigmatism group; 20 patients (20 eyes) were implanted with blue filtering aspheric multifocal astigmatism correction intraocular lens (AcrySof ReSTOR IOL +2.5D IQ, SV25T0), which was the ART group. Three months after the operation, the patients were followed up with slit lamp to check the visual acuity, including uncorrected distance visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), best corrected distance visual acuity, (BCDVA); the questionnaire surveys on the satisfaction of different intraocular lens implantation (far and near vision, glare, halo and abnormal visual symptoms); the iTrace visual function analyzer was used to check the total high-order aberrations (spherical aberration, wisdom aberration and Clover aberration) in the 3 mm pupil diameter. Results: Three months after cataract surgery, American Simplified version of questionnaire survey showed that the scores of near removing glasses in the multifocal group and the ART group were significantly better than those in the single focus group and the astigmatism group (P P > 0.05). Three months after cataract surgery, there were statistically significant differences about UCDVA, BCDVA and UCNVA among the four groups (F = 18.189, P P P > 0.05). Conclusion: Different types of AcrySof blue light filtering intraocular lens implantation could improve the far vision and satisfaction of cataract patients, without different higher-order aberrations. Multifocal intraocular lens and ART intraocular lens could significantly improve the far vision of patients and reduce the dependence on near glasses.

Effects of ultraviolet and blue-light filtering on sleep: a meta-analysis of controlled trials and studies on cataract patients.

Two types of intraocular lenses (IOLs), namely ultraviolet-filtering IOL (UVF-IOL) and blue-light-filtering IOL (BF-IOL), are used to replace the aging lens in cataract patients. This provides a clinical scenario to investigate the BF and UVF effects on circadian rhythm. We revisited this topic and conducted an updated meta-analysis investigating the effects of UVF-IOL and BF-IOL on sleep quality. A literature search was conducted using the PubMed, Embase, and Cochrane Library databases, and finally, four randomized controlled trials, one nonrandomized controlled study, and two cohort studies were included in this meta-analysis. The fixed-effect model revealed a significantly larger sleep quality improvement in the UVF-IOL group than in the BF-IOL group (standard mean difference [SMD] = 0.10, 95% confidence interval [CI]: 0.00-0.21) at 3-8 weeks but not 7-12 months after IOL implantation (SMD = 0.03, 95% CI: -0.08 to 0.13). The random effects model revealed no difference between groups at 3-8 weeks (SMD = 0.16, 95% CI: -0.07 to 0.39) and 7-12 months (SMD = 0.03, 95% CI: -0.08 to 0.13) after IOL implantation. Our study found some weak evidence supporting that UVF-IOL implantation demonstrated a greater improvement in subjective sleep quality than the BF-IOL implantation only in a shorter period but not in a longer period. More trials should be conducted before further recommendations. Nevertheless, our study provides some insights into the effects of short wavelength electromagnetic radiation on the circadian rhythm. PROSPERO registration number: CRD42019128832.

The Effect of Blue-Light Filtering Intraocular Lenses on the Development and Progression of Neovascular Age-Related Macular Degeneration

To assess the effect of blue-light filtering (BLF) intraocular lenses (IOLs) on the prevention of neovascular age-related macular degeneration (nAMD) after cataract surgery. Cohort study. Patients who underwent uneventful cataract surgery between 2007 and 2018 at the Ophthalmology Unit of Kymenlaakso Central Hospital, Kotka, Finland. Subsequent nAMD rates were compared between patients who received BLF IOLs and those who received non-BLF IOLs. Kaplan-Meier and Cox regression analyses for the overall risk of nAMD developing were assessed. Best-corrected visual acuity (BCVA), foveal thickness, treatment interval, and total number of intravitreal injections were secondary outcomes. A separate analysis was performed on patients with pre-existing nAMD to assess the effect of BLF IOLs on nAMD progression. A single eye of each patient was included. Neovascular age-related macular degeneration-free survival. Included were 11 397 eyes of 11 397 patients with a mean age of 75.4 ± 8.3 years (62.5% women). The BLF IOL was used in 5425 eyes (47.6%), and the non-BLF IOL was used in 5972 eyes (52.4%). During follow-up (BLF IOL group, 55.2 ± 34.1 months; non-BLF IOL group, 50.5 ± 30.1 months; P < 0.001), 164 cases of new-onset nAMD were recorded (BLF group, n= 88; non-BLF group, n= 76). The nAMD-free survival was similar between the groups (P= 0.465, log-rank test). In a Cox regression analysis controlling for age, gender, and a documented diagnosis of macular degeneration, the use of a BLF IOL was not predictive of nAMD development (hazard ratio [HR], 1.075; 95% confidence interval [CI], 0.79-1.47; P= 0.652). In nAMD patients, secondary clinical outcomes at 1 year were comparable for BCVA (0.57 ± 0.4 logarithm of the minimum angle of resolution vs. 0.45 ± 0.4 logarithm of the minimum angle of resolution; P= 0.136), foveal thickness (285 ± 109 μm vs. 299 ± 103μm; P= 0.527), number of anti-vascular endothelial growth factor injections (6.5 ± 2.5 vs. 6.2 ± 2.7; P= 0.548), and treatment interval (7.5 ± 2.4 weeks vs. 8.1 ± 2.4 weeks; P= 0.271) for BLF and non-BLF IOLs, respectively. Similarly to patients in whom nAMD developed after the surgery, among patients with nAMD before surgery (BLF, n= 71; non-BLF, n= 74), the clinical outcomes again were comparable (all P > 0.05). In a large cohort of patients who underwent cataract surgery, the use of a BLF IOL resulted in no apparent advantage over a non-BLF IOL in the incidence of nAMD or its progression, nor in clinical variables related to nAMD severity.

Effect of Different Spectral Power Distributions on Mesopic Visual Performance with Blue Light-filtering Intraocular Lens

ABSTRACT The purpose of this work is to analyze the interaction between the spectral transmittance of old-aged subjects, before and after cataract surgery and blue light-filtering intraocular lens implantation, and the spectral power distribution of common street lamps, under conditions typical of nighttime driving. We analyzed contrast threshold and visual reaction time in off-axis vision at different mesopic illumination conditions provided by high-pressure sodium and metal halide lamps. Three groups of subjects with different spectral transmittances participated: young subjects as control group, old-aged subjects with senile cataracts and the same subjects after cataract surgery and blue light-filtering IOL implantation. A clear interaction appears between the spectral power distribution and the spectral transmittance, depending on the visual task. Transparent ocular media allow benefiting from the greater short-wavelength content of the halide lamp. However, cataracts increase contrast threshold and visual reaction time values and also affects how the spectral power distribution influences these visual tasks. After surgery and intraocular lens implantation, visual performance improves for both lamps and the blue light-filter seems to influence spectral transmittance, which affects visual performance under light provided by greater short-wavelength content lamps. Cataract surgery is responsible for an improvement in contrast threshold and visual reaction time tasks, though blue light-filtering of the intraocular lens seems to prevent the visual system from benefiting from lamps with greater emission at short wavelengths.

The Effects of Blue Light-Filtering Intraocular Lenses on the Protection and Function of the Visual System.

Filtration of high-energy short-wave visible light (blue light) to improve vision and protect against damage has evolved both in aquatic animals and terrestrial species. In humans, pigments in the inner layer of the macula absorb wavelengths between 400 and 520 nm and function to improve visual performance. In patients who undergo cataract surgery, replacing cataractous lenses with artificial intraocular lenses (IOLs) that do not mimic normal healthy adult lenses could result in preventable negative visual effects, including glare disability. Blue light–filtering (BLF) IOLs were designed to filter short-wave light in addition to ultraviolet light and mimic the natural crystalline lens. Current studies indicate that BLF IOLs may provide protection from blue light–induced retinal damage and slow the development and progression of age-related macular degeneration. Additionally, BLF IOLs have been shown to improve chromatic contrast, reduce photostress recovery time, reduce glare disability and discomfort, and generally improve visual performance under glare conditions. Although a number of concerns have been raised about the relative risks versus the benefits of BLF IOLs, recent studies reported no adverse effects on visual function or contrast under photopic conditions, no long-term effects on color vision, and no detrimental effects on circadian rhythms with BLF IOLs. Based on the current understanding of the field, evidence suggests that BLF IOLs would be returning the eye to a more natural state compared with non-BLF lenses.

Blue light–filtering and violet light–filtering hydrophobic acrylic foldable intraocular lenses: Intraindividual comparison

To compare the clinical outcomes after cataract surgery and implantation of a blue light-filtering IOL (AcrySof IQ SN60WF) or a violet light-filtering intraocular lens (IOL) (OptiBlue ZCB00V). Four surgical sites in Japan. Prospective case series. One eye of patients with bilateral cataract was randomly allocated to the blue light-filtering IOL and the fellow eye to the violet light-filtering IOL. Visual acuity and contrast sensitivity were assessed over 3months. The incidence of cyanopsia was evaluated using the neutralization method. The study enrolled 110 eyes of 55 patients. There was no significant difference in visual acuity between the two IOLs. Based on the neutralization results 1week postoperatively, 15 cases (27.8%) with the light-filtering IOL and 8 cases (14.8%) with the violent light-filtering IOL had cyanopsia; the difference reached statistical significance (P=.049). After 2weeks, the difference in the incidence of cyanopsia was not significant. Postoperative contrast sensitivity under photopic condition at 1week and 3months and contrast sensitivity under mesopic conditions at 3months were significantly better with the violet light-filtering IOL than with the blue light-filtering IOL (P<.05). The violet light-filtering IOL yielded highly satisfactory clinical outcomes, including reduction of cyanopsia and a potential improvement in contrast sensitivity. The different chromophores of the IOL and its different material and design might have contributed.

Blue-light filtering intraocular lenses (IOLs) for protecting macular health.

Blue-light filtering intraocular lenses (IOLs) for protecting macular health.