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Recent Studies Provide an Updated Clinical Perspective on Blue Light-Filtering Iols

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Recent Studies Provide an Updated Clinical Perspective on Blue Light-Filtering Iols Graefes Arch Clin Exp Ophthalmol (2011) 249:957–968 DOI 10.1007/s00417-011-1697-6 REVIEW ARTICLE Recent studies provide an updated clinical perspective on blue light-filtering IOLs James A. Davison & Anil S. Patel & Joao P. Cunha & Jim Schwiegerling & Orkun Muftuoglu Received: 9 September 2010 /Revised: 7 April 2011 /Accepted: 8 April 2011 /Published online: 17 May 2011 # The Author(s) 2011. This article is published with open access at Springerlink.com Abstract clinical and two computational studies on photoreception, and Background Recent reviews of blue light-filtering intraocular several studies related to retinal photoprotection, all of which lenses (IOLs) have stated their potential risks for scotopic were not available in the previous reviews. These results vision and circadian photoentrainment. Some authors have provide a clinical risk/benefit analysis for an updated review challenged the rationale for retinal photoprotection that these for these IOLs. IOLs might provide. Our objective is to address these issues Results Most clinical studies comparing IOLs with and by providing an updated clinical perspective based on the without the blue light-filtering feature have found no results of the most recent studies. difference in clinical performance for; visual acuity, Methods This article evaluates the currently available contrast sensitivity, color vision, or glare. For blue light- published papers assessing the potential risks and benefits of filtering IOLs, three comparative clinical studies have blue light-filtering IOLs. It summarizes the results of seven shown improved contrast sensitivity and glare reduction; but one study, while it showed satisfactory overall color perception, demonstrated some compromise in mesopic comparative blue color discrimination. Comparative results Electronic supplementary material The online version of this article of two recent clinical studies have also shown improved (doi:10.1007/s00417-011-1697-6) contains supplementary material, performance for simulated driving under glare conditions which is available to authorized users. and reduced glare disability, better heterochromatic contrast J. A. Davison (*) threshold, and faster recovery from photostress for blue Wolfe Eye Clinic, light-filtering IOLs. Two computational and five clinical 309 East Church Street, studies found no difference in performance between IOLs Marshalltown, IA 50158, USA e-mail: [email protected] with or without blue light-filtration for scotopic vision performance and photo entrainment of the circadian A. S. Patel rhythm. The rationale for protection of the pseudophakic Seattle, WA 98115, USA retina against phototoxicity is discussed with supporting J. P. Cunha results of the most recent computational, in-vitro, animal, Department of Ophthalmology, clinical, and epidemiological investigations. Centro Hospitalar de Lisboa Central, Conclusions This analysis provides an updated clinical Lisbon, Portugal perspective which suggests the selection of blue light- filtering IOLs for patients of any age, but especially for J. Schwiegerling College of Optical Sciences, University of Arizona, pediatric and presbyopic lens exchange patients with a longer Tucson, AZ 85721, USA pseudophakic life. Without clinically substantiated potential risks, these patients should experience the benefit of overall O. Muftuoglu better quality of vision, reduced glare disability at least in Department of Ophthalmology, Ankara University School of Medicine, some conditions, and better protection against retinal photo- Ankara, Turkey toxicity and its associated potential risk for AMD. 958 Graefes Arch Clin Exp Ophthalmol (2011) 249:957–968 Keywords Intraocular lens . Blue light-filtering IOL . Patel) in International Ophthalmology Clinics provided a Light-normalizing IOL . Age-related macular degeneration . detailed history, rationale for potential retinal photoprotection, Scotopic vision . Circadian photoentrainment . Glare . correction of cyanopsia, and a possible improvement in Driving simulation contrast sensitivity by these IOLs [1]. It also reviewed epidemiological literature available in 2005, and concluded that long-term clinical study would be required to provide Introduction the ultimate support to the hypothesis that blue light-filtering IOLs might provide retinal photoprotection against the The most common cause of vision loss in elderly patients is development or progression of AMD. the development of cataract, and intraocular lens (IOL) For several reasons, a contrary school of thought began implantation at the time of cataract surgery is the most to develop in opposition to the use of blue light-filtering effective treatment for vision restoration. In addition to the IOLs [2–8]. Those authors have expressed concerns about large number of elderly cataract patients, there is an the potential of reduced photoreception due to blue light- increasing global population of pediatric cataract and filtering, and have challenged the rationale for the potential presbyopic lens exchange patients who will have an even of retinal phototoxicity reduction and its possible benefit in longer life expectancy after IOL implantation. Because of modifying the development or progression of AMD. this longevity, the eyes of these patients will be more likely Initially, there was an understandable concern over color to be vulnerable to retinal phototoxic effects which may vision effects for blue light-filtering IOLs, which still cumulatively influence the development of age-related continues for mesopic color vision. But, as clinical macular degeneration (AMD). The natural human lens investigations allayed most of these color vision related filters and thereby protects the potential retinal damage concerns, new discussions emerged regarding potential from high-energy photons of ultraviolet radiation (UVR) effects on scotopic vision performance and concerning and short wavelength light. Since the early 1980s, UVR- possible sleep disturbances related to photoentrainment of filteringIOLshavebeenwidelyused.Theyarecolorless the circadian rhythm [2–8]. The concern for these potential and filter UVR to various degrees. They may not risks has been generated on the basis of theoretical completely block UVR, and hence we will refer to them considerations and computations. This review critically in this article as UVR-filtering IOLs. PMMA (poly examines these potential risks with all currently available methyl methacrylate) yellow tinted IOLs which filter clinical and alternate computational studies. both ultraviolet radiation (UVR) and blue light have been Over the last 5 years, new comparative computational and under investigation since the mid 1980s, and have been clinical investigations including some by the current authors available into the global market with an advanced on blue light-filtering IOLs addressed these potential risks. A technology foldable version which approximates normal 2009 review paper by Cuthbertson et al. [9] cited some of the light transmission by the natural crystalline lens (light available results of investigations addressing the potential normalizing) introduced in 2003 [1]. These lenses, with benefits and side effects of these lenses. However, this paper each brand (and each power within the brand) having [9] did not contain relevant computational and clinical slightly different transmission characteristics, are also studies for scotopic vision and circadian rhythm-sleep referred to in the literature as blue-blocking IOLs, disturbance risks [10–13]. In 2010, the debate continued in yellow-tinted IOLs, ultraviolet-cut noncyanopsia IOLs, two new “viewpoint” papers by Mainster & Turner [14]and or light-normalizing IOLs. But for this article they are Henderson & Grimes [15]. In the viewpoint paper against the generically referred to as blue light-filtering IOLs, with use of blue light-filtering IOLs by Mainster and Turner [14], the proviso that they completely block UVR as well. The there were absences of reference to two relevant clinical rationale for their use has been to better approximate the investigations on scotopic vision [11, 16, 17] and three transmission of electromagnetic radiation via the natural studies related to circadian photoentrainment and sleep crystalline lens, by reducing the relatively excessive disturbance [10, 18]. The authors put forth their computa- transmission of short wavelength energy which colorless tions as evidence for concern for potential risks for scotopic UVR-filtering IOLs allow. It has been assumed that this vision and circadian photoentrainment. These computations normalization would improve overall vision performance and also form their basis for doubt of the rationale of retinal reduce phototoxicity, which might provide retinal protection protection which might be provided by blue light-filtering against the risks of development or progression of AMD. IOLs. Interestingly, and in an apparent contradiction to These IOLs have been judged safe and effective by the himself, the first author of the anti-blue light-filtering rigorous testing process of the US FDA, and obtained viewpoint [14] has previously published an actual preference approval by that body in 2003. An exhaustively complete for violet-blocking IOLs [2, 3], and is the principal inventor 2005 review paper by two of the current authors (Davison and in a patent filed in 2005 and issued in 2007 for violet- Graefes Arch Clin Exp Ophthalmol (2011) 249:957–968 959 blocking IOL technology [19]. This patent states that “high surgery
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