Tinted Intraocular Lens Research Articles

Effect of surface-modified intraocular lenses on long-term postoperative inhibition of posterior capsule opacification

We compared the posterior capsule opacification incidences at 5 years postoperatively and the neodymium–yttrium–aluminum–garnet capsulotomy rates at 10 years postoperatively for two types of intraocular lenses with different optical properties and shapes. This randomized, controlled, prospective, single-blinded study with intra-individual comparisons was conducted between July 21, 2009, and August 31, 2011, at the Dokkyo Medical University Hospital, Tochigi, Japan. Thirty patients (60 eyes) underwent bilateral cataract surgery and received a XY1 intraocular lens in one eye and a FY-60AD intraocular lens in the other. Both intraocular lenses are acrylic and manufactured by HOYA. The XY1 lens is a single-piece, tinted intraocular lens featuring an ultraviolet/ozone treatment on the posterior surface of the lens optic, aimed at enhancing posterior capsule adhesion to prevent posterior capsule opacification. Conversely, the FY-60AD is a tinted intraocular lens with modified polymethylmethacrylate C-loops and no ultraviolet/ozone treatment of the optic. Scheimpflug images were taken using EAS-1000 (NIDEK Co., Ltd., Aichi, Japan), and the scattered light intensity (computer compatible tape) on the posterior surface of the intraocular lens was calculated and evaluated as the posterior capsule opacification. The scattered light values of the XY1 and FY-60AD groups were 6.50 ± 5.69 and 11.64 ± 5.30 computer compatible tape, respectively, at 5 years postoperatively. The cumulative survival incidence after neodymium–yttrium–aluminum–garnet laser capsulotomy was 74.8 % in the XY1 group and 13.8 % in the FY-60AD group at 10 years postoperatively. The surface-modified intraocular lens XY1 reduced the incidence of posterior capsule opacification even 10 years after surgery. Surface modification to increase the adhesion between the intraocular lens and the capsule effectively prevents posterior capsule opacification.

Comparison of post-op quality of vision of spheric IOL and aspheric hydrophilic acrylic yellow tinted intraocular lens implantation following phacoemulsification cataract surgery

Purpose: To compare the post-op visual quality of spheric and aspheric acrylic yellow tinted intraocular lens following phacoemulsification cataract surgery. Place of study: Al-Majeed Laser Eye Hospital. Methods: Total 60 subjects (aged 40-65years) with age related mature cataracts were included. Data was assembled by non-probability convenient sampling technique at Al-Majeed Laser Eye Hospital. All patients presenting with mature cataract were include in this study without any other pathology and fundus abnormality. Pre and post-operative visual acuity was measured by using standard snellen visual acuity testing chart. For the purpose of accuracy repetitive values were taken for each patient. Post-operative vision was recorded one month followed by phacoemulsification. Comparisons was made between spheric and asphereic acrylic yellow tinted intraocular lens by applying (descriptive) statistics and paired sample t test for the analysis of results. Results: Quality of vision was compared post-operatively after implantation of aspheric hydrophilic acrylic IOL and spheric IOL in posterior chamber under the same phaco surgeon. All subjects after intra ocular implantation had better corrected visual acuity of 6/9 and more improved 6/6. There were found statistically differences in recorded visual acuity with aspheric yellow tinted iol implanation and spheric iol (p = 0.15) between the two types of intra-ocular lens. The mean, standard deviation, t-value found with spheric IOL were.1867, .18889, 2.517 respectively. However, of aspheric hydrophilic acrylic intra-ocular lens mean, standard deviation and t values found .800, .13493 and 2.5493 respectively. There was significant variance in statistics and quality of vision between the two types of lenses. Conclusions: This study concludes that post –operative improvement in quality of vision was better with aspheric hydrophilic yellow tinted lenses than spheric iol implantation. Implanting a foldable aspheric acrylic IOL gave much advantage in visual outcome to pseudophakes by protecting retina from light of shorter wavelength and decrease of chromatic aberration under the photopic circumstances particularly in subjects at hazard of age-related macular degeneration (AMD).

The yellow intraocular lens and the natural ageing lens

The purpose of this study is to review and evaluate the advantages and disadvantages of blue light (400-480 nm) filtering intraocular lenses (IOLs) when compared with the ultraviolet (UV)-blocking IOLs. Theories that blue light could be related to the pathogenesis of age-related macular degeneration (AMD) have led to the use of yellow tinted IOLs in cataract surgery to filter short wavelength light. In spite of the potential benefits, some concerns have been raised. The potential advantages of the blue light filtering IOLs are that they could better mimic the conditions of phakia and therefore be more protective for the retina in decreasing the incidence of AMD. However, the potential disadvantages are that blue light filtering could negatively affect scotopic vision and circadian rhythms in older patients. These advantages and disadvantages of blue light filtering IOLs have not been proven clinically and thus many questions remain. Studies have shown that each type of IOL may have its own benefits and the type of IOL should be picked on the basis of patients' specific situations. In cataract surgery, considerations such as preexisting AMD, night vision problems or sleep problems may be considered with the choice of IOL.

Effect of aspherical and yellow tinted intraocular lens on blue-on-yellow perimetry

To investigate the possible effect of aspherical or yellow tinted intraocular lens (IOL) on contrast sensitivity and blue-on-yellow perimetry. This prospective randomized bilateral double-masked clinical study included 52 patients with visually significant bilateral cataracts divided in two groups; 25 patients (50 eyes) received aspherical intraocular lens in one eye and spherical intraocular lens in the fellow eye; and 27 patients (54 eyes) received ultraviolet and blue light filter (yellow tinted) IOL implantation in one eye and acrylic ultraviolet filter IOL in the fellow eye. The primary outcome measures were contrast sensitivity and blue-on-yellow perimetry values (mean deviation [MD] and pattern standard deviation [PSD]) investigated two years after surgery. The results were compared intra-individually. There was a statistically significant between-group (aspherical and spherical intraocular lens) difference in contrast sensitivity under photopic conditions at 12 cycles per degree and under mesopic conditions at all spatial frequencies. There were no between-group significant differences (yellow tinted and clear intraocular lens) under photopic or mesopic conditions. There was no statistically significant difference between all intraocular lens in MD or PSD. Contrast sensitivity was better under mesopic conditions with aspherical intraocular lens. Blue-on-yellow perimetry did not appear to be affected by aspherical or yellow tinted intraocular lens. Further studies with a larger sample should be carried out to confirm or not that hypotheses.

Effects of blue light–filtering intraocular lenses on the macula, contrast sensitivity, and color vision after a long-term follow-up

To evaluate the possible side effects and potential protection 5 years after implantation of an intraocular lens (IOL) with a blue-light filter (yellow tinted). Ophthalmology Department, University of São Paulo, São Paulo, Brazil. Prospective randomized clinical study. Patients with bilateral visually significant cataract randomly received an ultraviolet (UV) and blue light-filtering IOL (Acrysof Natural SN60AT) in 1 eye and an acrylic UV light-filtering only IOL (Acrysof SA60AT) in the fellow eye. The primary outcome measures were contrast sensitivity, color vision, and macular findings 5 years after surgery. The study enrolled 60 eyes of 30 patients. There were no significant clinical or optical coherence tomography findings in terms of age-related macular degeneration in any eye. There were no statistically significant differences in central macular thickness between the 2 IOL groups (P=.712). There were also no significant between-group differences under photopic or scotopic conditions at any spatial frequency studied. No statistically significant differences in the color discrimination test were found between the 2 IOL groups (P=.674). After 5 years, there were no significant differences in color perception, scotopic contrast sensitivity, or photopic contrast sensitivity between the blue light-filtering (yellow-tinted) IOL and the IOL with a UV-light filter only (untinted). The potential advantage of the tinted IOL in providing protection to macular cells remains unclear.

In vivo evaluation of blue-light attenuation with tinted and untinted intraocular lenses

To evaluate blue-light attenuation in eyes with a tinted intraocular lens (IOL) or an untinted IOL. Department of Ophthalmology, University Hospital of Crete, Crete, Greece. Comparative case series. Patients had lens extraction and implantation of an Acrysof Natural tinted or Tecnis ZA9003 or Softec III untinted acrylic IOL. The luminance ratio of green (530 nm) and blue (465 nm) light (green:blue ratio) required for isoluminant perception was determined by heterochromatic flicker photometry. Patients were tested preoperatively and 20 days postoperatively. The parafoveal measure of the green:blue ratio, expressed in decibels, is proportional to the blue-light attenuation by the lens. Twenty-two patients received the tinted IOL and 21 the untinted IOL. Preoperatively, age was strongly linearly correlated with the green:blue ratio (r = 0.59, P < .001). The mean postoperative decrease in the green:blue ratio was greater in the untinted IOL group (P = .003). Postoperatively, the tinted IOL group had a significantly higher green:blue ratio than the untinted IOL group (P < .001). In the tinted IOL group, the green:blue ratio was linearly related to IOL dioptric power. Less blue light reached the retina with tinted IOLs than with untinted IOLs. The absorption properties of tinted IOLs seemed to resemble those of the aging human crystalline lens, while untinted IOLs resembled the lower levels of blue-light attenuation of younger lenses. Thus, tinted IOLs may protect against the presumed blue-light hazard. No author has a financial or proprietary interest in any material or method mentioned.

The Effect of Yellow Tinted Intraocular Lenses on the Result of Frequency Doubling Perimetry after Cataract Surgery

PurposeTo investigate the effect of yellow tinted intraocular lenses (IOLs), implanted in the bag after phacoemulsification, on the result of frequency doubling technique (FDT) perimetry.MethodsFor 68 eyes of 52 patients, an IOL was implanted in the bag after phacoemulsification. The patients were categorized into three groups according to the type of implanted IOLs used. IOLs were selected randomly among two types of yellow IOLs (Acrysof SN60WF IOL, Hoya YA60BBR IOL) and a clear IOL was used as a control. A FDT Humphrey matrix was performed 2 months after the surgery. The mean deviation (MD) and pattern standard deviation (PSD) among these three groups was analyzed using Mann-Whitney U-test.ResultsTwo months after the procedure, there was no significant difference between each of the three groups: the clear IOL and Hoya YA60BBR IOL (MD, p = 0.21; PSD, p = 0.27), the clear IOL and Alcon SN60WF IOL (MD, p = 0.11; PSD, p = 0.22), and the Hoya YA60BBR IOL and Alcon SN60WF IOL (MD, p = 0.33; PSD, p = 0.56).ConclusionsWhen interpreting the result of the FDT after cataract surgery, the color and type of IOLs used should not be considered.

Influence of a yellow-tinted intraocular lens on laser beam transmittance

To compare the transmittance of laser beams that are used for photocoagulation through a yellow-tinted intraocular lens (IOL) and a clear IOL. The transmittance of laser beams of different wavelengths (488 + 514, 514, 521, 568 and 647 nm) through yellow-tinted and clear IOLs of varying dioptric powers [+10, +20 and +30 dioptres (D)] was measured using a laser power meter. The transmittance ratio was defined as the ratio of the transmittance thorough a tinted IOL to that through a clear IOL, assuming that the transmittance value of the latter is 1; this ratio was calculated for each IOL and each wavelength of the laser beam. There were no apparent differences in the transmittance values between the tinted and clear IOLs when the 521, 568 and 647 nm wavelengths were used. In contrast, the transmittance ratio decreased for the tinted IOL when the short wavelengths - 488 + 514 and 514 nm - were used, especially when an IOL of a higher dioptric power was used. This ratio was found to be 91.9% for a +10 D, 86.7% for a +20 D and 82.2% for a +30 D lens when a 488 + 514 nm wavelength beam was used. When treating patients using photocoagulation, we must bear in mind the decreased transmittance ratio of short-wavelength laser beams when passed through tinted IOLs and increase the setting power of the beam accordingly.

Relative effectiveness of a blue light–filtering intraocular lens for photoentrainment of the circadian rhythm

To compare the relative effectiveness of photoentrainment of the circadian rhythm by a blue light-filtering tinted intraocular lens (IOL) (AcrySof Natural SN60), an untinted UV-only filtering IOL (AcrySof SA60), and human lenses in 4 age groups. Scientific consultant and Department of Biological Structure and National Primate Research Center, University of Washington, Seattle, Washington, USA. Three of 8 action spectra for circadian photoentrainment published from 2001 to 2007 were used to compute the relative effectiveness of the cumulative photon flux absorption from 400 to 600 nm reaching the retina from 4 light sources through the cornea, pupil, and 6 lenses. The effectiveness of the tinted IOL was 35% to 54% and 69% to 114% greater with the action spectra of 2002 to 2007, with a peak around 484 nm and 492 nm, respectively, compared with the 2001 action spectra, with a peak around 460 nm. The difference in effectiveness between the 2 IOLs ranged from 32% to 12%. With newer action spectra, differences in effectiveness between the tinted IOL and the lenses of a young standard observer and a 30- to 39-year-old were age dependent (+7% to -10% and +6% to -13%, respectively). The tinted IOL was significantly more effective for photoentrainment of the circadian rhythm with newer action spectra. The computational results suggest that the effectiveness of the tinted IOL in 60- to 85-year-old patients would be within +6% to -13% of that in 30 to 39 year olds. Both tinted and untinted IOLs are expected to be effective for melatonin suppression under average household illumination.

Cytoprotective effects of a blue light–filtering intraocular lens on human retinal pigment epithelium by reducing phototoxic effects on vascular endothelial growth factor-α, Bax, and Bcl-2 expression

To compare the possible protective effects of the ultraviolet (UV)-filtering and blue light-filtering SN60AT intraocular lens (IOL) and the untinted UV-filtering SA60AT IOL with regard to light-induced stress on human retinal pigment epithelium (RPE). Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany. Primary human RPE cells were exposed to white light, and a tinted or untinted IOL was placed in the light beam. After 15 to 60 minutes of irradiation, cell viability was determined by a colorimetric test (tetrazolium dye-reduction assay) and a microscopic live/dead assay. The expression of vascular endothelial growth factor-alpha (VEGF-alpha), Bax, and Bcl-2 and their mRNA was determined by reverse-transcription polymerase chain reaction (RT-PCR) and Western blotting. Without an IOL, white-light exposure decreased cell viability compared with the decrease with the nonirradiated control in a time-dependent manner. Light-induced cell death was significantly reduced by both the tinted IOL and untinted IOL. The combined UV and blue-light filtering attenuated light-induced cell damage significantly more than UV filtering alone. Results of RT-PCR and Western blotting showed a significant time-dependent decrease in Bcl-2 and increase in Bax and VEGF-alpha that were significantly less with the tinted IOL than with the untinted IOL. Both IOLs reduced light-induced RPE damage. The UV- and blue light-filtering IOL reduced damage more than the conventional IOL. This supports the hypothesis that blue light-filtering IOLs may prevent retinal damage in clinical use.

Photoprotective effect of yellow-tinted intraocular lenses

The aim of this study was to experimentally investigate changes in visible light-induced photo-oxidation and to evaluate the inhibitory effect of various acrylic tinted intraocular lenses (IOLs) on photooxidation. Three types of nontinted (VA-60BB, HOYA; SA60AT, Alcon; AU-6, Menicon) and tinted (YA-60BB, HOYA; SN60AT, Alcon; AN-6, Menicon) IOLs were used. In the first experiment, we investigated oxidation related to ultraviolet rays by using a mixed solution of reduced glutathione, nicotinamide adenine dinucleotide phosphate (NADPH), and glutathione reductase. The mixed glutathione solution was irradiated for 30, 60, or 90 min with direct artificial sunlight or artificial sunlight that had been passed through various IOLs. Oxidation was detected at 340 nm. In the second experiment, human retinal pigment epithelium (RPE) cells were prepared and cultured in a 96-well dish until confluent. After light exposure for 30 min or 48 h, lactate dehydrogenase (LDH) levels of the culture supernatant were measured to assess the amount of cell damage. Visible light-induced glutathione oxidation progressed over time. Intraocular lenses inhibited photooxidation, with the inhibitory effect shown to increase when tinted IOLs were used. LDH levels in RPE cells increased as a result of exposure to visible light. There was a higher increase in LDH with nontinted than with tinted IOLs. Visible light causes photooxidation, which damages intraocular tissue in vitro. These results suggest that tinted IOLs effectively inhibit tissue damage from visible light.

In vivo assessment of blue light attenuation of the crystalline lens and tinted and not tinted intraocular lenses

Abstract Purpose To compare lens absorption in vivo, as estimated by blue light luminance perception, of patients with tinted IOLs versus patients with clear IOLs, and with their status before cataract surgery. Methods We tested 43 patients with variant density of nuclear senile cataract (18 had 0 to 1+ and 25 more than 1+), before and after lens extraction and IOL implantation. 21 received clear IOL and 22 the AcrySof® Natural (Alcon). The absorption of blue light was assessed by measuring the parafoveal relative sensitivity of blue‐green radiation using Heterochromatic Flicker Photometry (MPS 9000 QuantifEYETM, ZeaVision©). Results Preoperative results indicate that blue light attenuation is increasing with age. The postoperative results show that tinted IOLs absorb significantly more compared to clear IOLs (p&lt;0.001). The difference in postoperative absorption with tinted IOLs from preoperative status was not statistically signifficant (p=0.3), and in the group of patients with 0 to 1+ cataract density the preoperative with the postoperative absorption was similar (p=0.941). On the contrary, the absorption of clear IOLs was significantly reduced postoperatively in the low cataract density group (p&lt;0.001) and also in the total group of patients (p&lt;0.001). Conclusion The tint may simulate the aged crystalline lens of patients with low cataract density in blue light attenuation.This may offer protection to the retina from the photochemical damage caused by high energy short wavelength radiation.

Surgical findings with the tinted AcrySof intraocular lens in children

The AcrySof foldable acrylic intraocular lens (IOL) has become an accepted and frequent means of treating pediatric aphakia. A new version of this lens with blue-light filtering properties purports to offer superior retinal protection. We describe our experience with this tinted lens and compare it to findings with the standard, nontinted IOL. A chart review identified 29 eyes of 21 children (tinted lens group; age 11 months to 13 years) who had the tinted IOL implanted. The standard lens group consisted of 38 eyes (31 patients; age 11 months to 15 years). Most eyes had an intact posterior capsule at the time of implantation. The incidence of postoperative inflammation was fairly high in both groups (71% in the tinted lens group, 60% in the standard lens group). The tinted lens group showed a higher incidence of transient inflammation than the standard lens group (p=0.03) but the rates of nontransient sequelae (posterior synechiae, iris synechiae, membranes formation, capsule, or IOL opacification) were similar (66% versus 47%; p=0.11). Posterior capsule opacification occurred in 15 eyes in the tinted lens group and 16 eyes in the standard lens group (p=0.15) but was visually significant in only 10 and 11 eyes, respectively (p=0.77). Transient inflammation is higher with implantation of tinted versus nontinted IOLs, but long-term inflammatory sequelae are roughly equal, as is the rate of posterior capsule opacification. The question as to whether the chromophore in the tinted lens caused the higher incidence of transient inflammation is unresolved.

Light energy, cataract surgery, and progression of age-related macular degeneration

Some studies suggest an association between light exposure and increased risk of advanced age-related macular degeneration. The natural lens serves as a barrier to some of the higher energy light rays. There is some concern that cataract surgery may be contributing to the increase in prevalence of age-related macular degeneration. It has been shown that blue light absorption by retinal pigment epithelium results in free radical formation, leading to cellular injury, and that blue filters can reduce this rate of cell death. Other studies have shown a tendency for pseudophakic eyes to progress to the wet form of age-related macular degeneration more so than their fellow eyes. Currently there is no conclusive evidence to support a relation between progression of age-related macular degeneration and cataract surgery. Given that nearly two million cataract extractions are performed yearly, a large randomized controlled study is required to prove or disprove the ability of tinted intraocular lenses to aid in preventing the progression of age-related macular degeneration.

Effects of tinted intraocular lens on contrast sensitivity

We evaluated contrast sensitivity and glare in 64 pseudophakic eyes. An ultraviolet-absorbing intraocular lens (IOL) was implanted in 32 eyes and a noncyanopsia yellow-tinted IOL was implanted in 32 eyes. The latter lens was designed to effectively absorb light below a wavelength of 500nm. Contrast sensitivity was measured at a pupil diameter of 3 mm using an artificial pupil. The implanted yellow-tinted IOL showed improved contrast sensitivity in the middle spatial frequencies of 6 and 12c/deg in photopic and mesopic vision. In addition, the yellow-tinted IOL decreased the effect of central glare on the contrast sensitivity.

Effects of tinted intraocular lens on contrast sensitivity

We evaluated contrast sensitivity and glare in 64 pseudophakic eyes. An ultraviolet-absorbing intraocular lens (IOL) was implanted in 32 eyes and a noncyanopsia yellow-tinted IOL was implanted in 32 eyes. The latter lens was designed to effectively absorb light below a wave-length of 500 nm. Contrast sensitivity was measured at a pupil diameter of 3 mm using an artificial pupil. The implanted yellow-tinted IOL showed improved contrast sensitivity in the middle spatial frequencies of 6 and 12 c/deg in photopic and mesopic vision. In addition, the yellow-tinted IOL decreased the effect of central glare on the contrast sensitivity.