Night Vision in the Elderly: Consequences for Seeing Through a ‘‘Blue Filtering’’ Intraocular Lens
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1518 PERSPECTIVE Br J Ophthalmol: first published as 10.1136/bjo.2005.073734 on 18 October 2005. Downloaded from Night vision in the elderly: consequences for seeing through a ‘‘blue filtering’’ intraocular lens J S Werner ............................................................................................................................... Br J Ophthalmol 2005;89:1518–1521. doi: 10.1136/bjo.2005.073734 Relative scotopic spectral sensitivity depends only on the spectral sensitivity maximum. Their analyses considered the percentage change in sensitivity. rhodopsin photopigment and ocular media absorption Here, we shall consider the same issue, but spectra. Rhodopsin is well characterised so the relative illustrated more traditionally in logarithmic units scotopic spectral sensitivity function can be calculated for so that the losses can be seen in the context of the full range of scotopic sensitivity. It will be intraocular lenses (IOLs) of known spectral density. In a shown why IOL absorption of light at wave- recent perspective, Mainster and Sparrow concluded that lengths near the sensitivity maximum is no more an IOL with short wave absorbing chromophores would important for scotopic vision than absorption at any other wavelengths. We shall also consider provide more retinal protection than conventional IOLs, but some aspects of scotopic vision not discussed by the practical consequences for scotopic vision are unclear. Mainster and Sparrow. In particular, the con- This paper uses published experiments to examine the sequences of IOL absorption spectra are evalu- ated in terms of scotopic spatial contrast implications for scotopic vision of the IOLs analysed by sensitivity as a quantitative index of pattern, or Mainster and Sparrow. A 14.6% reduction in scotopic form, vision. sensitivity is expected for a SN60AT (AcrySof Natural) compared to a SA60AT (Conventional AcrySof) IOL under SCOTOPIC SPECTRAL SENSITIVITY WITH AN IOL CONTAINING CHROMOPHORES broadband illumination (equal quantum spectrum). This ABSORBING SELECTIVELY AT SHORT effect (0.07 log unit) is visually insignificant in relation to WAVELENGTHS the ,4.0 log unit range of scotopic sensitivity. More The absorption spectrum of an IOL can be used to calculate the relative spectral sensitivity for importantly, it is expected that scotopic contrast sensitivity scotopic vision because the rods contain only one would be reduced by only ,0.01 log unit. It is thus type of photopigment, rhodopsin, and scotopic improbable that a difference in scotopic vision between sensitivity depends only on the number of quanta absorbed by the photopigment. While observers with the Natural and Conventional IOLs could be some wavelengths are more likely to be absorbed reliably detected using broadband stimuli. than others because of the chromophores in the http://bjo.bmj.com/ ........................................................................... photopigment and preretinal filtering (primarily by the lens), once absorbed, all wavelengths produce the same effects. Rushton3 calls this the cotopic vision refers to vision in darkness, principle of univariance. This principle has and its importance for human behaviour important implications for evaluating the effect Shas often been overlooked by practising of IOL absorption spectra. Both photochemical ophthalmologists. Expressed in terms of mea- hazards and scotopic sensitivity depend upon on October 3, 2021 by guest. Protected copyright. sured light levels, the scotopic range is below a absorbed photons and the probability of absorp- 22 luminance level of about 23.8 log cd m .It tion is wavelength dependent. Considered in encompasses the stimulus range from absolute terms of absorbed photons, photochemical threshold (fewer than 100 quanta delivered to hazards are wavelength dependent, but scotopic the cornea under ideal conditions) to a retinal vision is not. Put another way, IOL absorption at illuminance of ,0.3 photopic trolands, which is short wavelengths is no more consequential for about the maximum light level encountered at scotopic vision than absorption at middle or long 1 ....................... night under natural conditions. Thus, scotopic wavelengths. vision spans approximately 4 log units of ambi- The crystalline lens, or an IOL, will necessarily Correspondence to: ent illumination. Scotopic vision is mediated by a cause a decrease in sensitivity (increase thresh- J S Werner, Department of Ophthalmology & Vision single class of photoreceptors, the rods. Scotopic old) by an amount equivalent to its spectral Science, Section of vision is not, however, synonymous with rod absorption. Thus, when rhodopsin density (a Neurobiology, Physiology vision because rods and cones overlap in their logarithmic scale) is compared with log spectral & Behavior, University of range of sensitivity by about 3 log units, the sensitivity of an aphakic observer, the two curves California Davis, 4860 Y Street, Suite 2400, range known as mesopic vision. are essentially identical with a small correction 4 Sacramento, CA 95817, The importance of intraocular lens (IOL) for the spectral density of the cornea. This USA; jswerner@ucdavis. absorption spectra on scotopic vision was principle has been demonstrated for the scotopic edu recently discussed by Mainster and Sparrow.2 spectral sensitivity functions of phakic5 and Accepted for publication They noted that chromophores that may be 1 July 2005 useful in protecting the retina from the ‘‘blue Abbreviations: CSF, contrast sensitivity function; IOL, ....................... light’’ hazard also absorb near the scotopic intraocular lens www.bjophthalmol.com Night vision in the elderly 1519 Br J Ophthalmol: first published as 10.1136/bjo.2005.073734 on 18 October 2005. Downloaded from 0 ) 2 0.0 Retinal sensitivity –1 –0.5 –2 –1.0 –3 Blue filtering IOL Log sensitivity (quanta/s/deg –1.5 Log scotopic sensitivity (quanta) –4 350 400 500450 550 600 700650 302010 40 50 60 70 80 90 Wavelength (nm) Age (years) Figure 1 Calculated log scotopic sensitivity plotted in terms of quanta Figure 2 Scotopic sensitivity plotted as a function of age. Symbols delivered to the cornea as a function of wavelength. Calculations are represent thresholds for test lights of 0.04 degree diameter, 10 ms based on a rhodopsin nomogram and 20 D IOLs. Open symbols, flashes, 520 nm presented at 6 degrees nasal along the horizontal Conventional (Alcon SA60AT) and solid symbols, Natural (Alcon meridian. The solid line represents the linear regression fitted to these SN60AT). points. The broken line represents the linear regression obtained when the data are corrected for ocular media density and sensitivity is specified at the retina. The dotted line shows the loss in sensitivity pseudophakic6 observers. Figure 1 utilises this principle to expected from an equal quantum spectrum filtered by an AcrySof compare the expected scotopic spectral sensitivity function Natural IOL. for observers with the SN60AT (AcrySof Natural) and SA60AT (Conventional AcrySof) IOLs. The optical densities through a 1.5 mm exit pupil conjugate with the eye pupil. (2log transmission) of the IOLs were provided by the This effectively bypasses any age related variation as a result manufacturer based upon measurements in saline solution. of pupillary miosis. Following 30 minutes of dark adaptation, This results in somewhat different values from that in the sensitivity was measured for 10 ms, 520 nm circular test analysis by Mainster and Sparrow who used the data of Lin et lights of varying diameters that were superimposed and al7 for the conventional IOL (measured in saline) and concentric with a 10˚, 640 nm circular background. This transmission values from the manufacturer for the natural background was selected to suppress cone sensitivity with no IOL (measured in air). The two conditions of measurement influence on rod sensitivity. The test lights were imaged differ in Fresnel reflection losses, which result in different along the horizontal meridian, 6˚nasal from a foveal fixation transmission values. For this reason, our analyses are based point. Figure 2 shows results for one stimulus diameter; on measurements of both IOL types under identical condi- essentially the same results were obtained for other tions (immersed in balanced salt solution). diameters. The solid line is based on the linear regression The curves presented in figure 1 are consistent with equation fitted to the raw data representing stimuli delivered analyses by Mainster and Sparrow2; however, the figure uses to the cornea. The broken line is from the regression equation conventional logarithmic ordinates to place the effect on obtained after correcting the data to specify sensitivity at the http://bjo.bmj.com/ scotopic sensitivity in perspective. Relative to the range of retina—that is, corrected for age related changes in the ocular scotopic sensitivity, the greater density of the AcrySof Natural media.14 This is what would be expected in a population of IOL for wavelengths between 400 nm and 50 nm would seem aphakes or pseudophakes with a conventional IOL.46 to be trivial for natural (broadband) illuminants when Although much of the loss in scotopic sensitivity is the result integrated across the visible spectrum. Such an integration of the ocular media density, it is clear from these results that is appropriate because this is what the rods do—count age related losses in scotopic sensitivity cannot be explained absorbed photons independent of wavelength. Indeed, the solely by preretinal