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Desmettre T, Baillif S, Mathis T, Gatinel D, Mainster M. [Blue light and intraocular lenses (IOLs): Beliefs and realities]. J Fr Ophtalmol 2024; 47:104043. [PMID: 38241770 DOI: 10.1016/j.jfo.2023.104043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/18/2023] [Accepted: 10/22/2023] [Indexed: 01/21/2024]
Abstract
The first intraocular lenses (IOLs) used for cataract surgery transmitted both ultraviolet (UV) radiation and visible light to the retina. Colorless UV-blocking IOLs were introduced and rapidly adopted in the 1980s. Yellow-tinted blue-blocking (also known as blue-filtering) IOLs were marketed in the early 1990s. Blue-blocking IOLs were intended to simulate age-related crystalline lens yellowing to reduce the cyanopsia that some patients experienced after cataract surgery. When blue-filtering IOLs were introduced in North America, however, blue-blocking chromophores were advocated as a way to protect patients from age-related macular degeneration (AMD) despite the lack of evidence that normal environmental light exposure causes AMD. The "blue light hazard" is a term that describes the experimental finding that acute, abnormally intense light exposures are potentially more phototoxic to the retina when short rather than long wavelengths are used. Thus, in brief exposures to intense light sources such as welding arcs, ultraviolet radiation is more hazardous than blue light, which is more hazardous than longer wavelength green or red light. International commissions have cautioned that the blue light hazard does not apply to normal indoor or outdoor light exposures. Nonetheless, the hazard is used for commercial purposes to suggest misleadingly that ambient environmental light can cause acute retinal phototoxicity and increase the risk of AMD. Very large epidemiological studies show that blue-blocking IOLs do not reduce the risk or progression of AMD. Additionally, blue-filtering IOLs or spectacles cannot decrease glare disability, because they decrease image and glare illuminance in the same proportion. Blue light is essential for older adults' scotopic photoreception needed to reduce the risk of nighttime falling and related injuries. It is also critical for circadian photoreception that is essential for good health, sleep and cognitive performance. Unfortunately, age-related pupillary miosis, retinal rod and ganglion cell photoreceptor degeneration and decreased outdoor activity all reduce the amount of healthful blue light available to older adults. Blue-restricting IOLs further reduce the available blue light at a time when older adults need it most. Patients and ophthalmologists are exposed to hypothesis-based advertisements for blue-filtering optical devices that suppress short wavelength light critical for vision in dim lighting and for good physical and mental health. Spectacle and intraocular lens selections should be based on scientific fact, not conjecture. Ideal IOLs should improve photoreception rather than limit it permanently. Practice efficiency, surgical convenience and physician-manufacturer relationships may eliminate a patient's opportunity to choose between colorless blue-transmitting IOLs and yellow-tinted, blue-restricting IOLs. Cataract surgeons ultimately determine whether their patients have the opportunity to make an informed choice about their future photoreception.
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Affiliation(s)
- T Desmettre
- Centre de rétine médicale, 187, rue de Menin, 59520 Marquette-Lez-Lille, France.
| | - S Baillif
- Département d'ophtalmologie, hôpital Pasteur, 30, voie Romaine, 06000 Nice cedex 1, France
| | - T Mathis
- Service d'ophtalmologie, hôpital de la Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France
| | - D Gatinel
- Service d'ophtalmologie, fondation A.-de-Rothschild, 25, rue Manin, 75940 Paris cedex 19, France
| | - M Mainster
- Department of Ophthalmology, University of Kansas School of Medicine, Prairie Village, Kansas, États-Unis
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Karesvuo M, Kanclerz P, Hecht I, Achiron A, Tuuminen R. 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. J Cataract Refract Surg 2023; 49:679-685. [PMID: 36940191 PMCID: PMC10284132 DOI: 10.1097/j.jcrs.0000000000001184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/26/2023] [Accepted: 03/08/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE 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. SETTING Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland. DESIGN 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. METHODS 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. RESULTS 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). CONCLUSIONS BLF IOLs were not associated with mental and behavioral disorders or diseases of the nervous system.
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Affiliation(s)
- Minna Karesvuo
- From the Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland (Karesvuo, Kanclerz, Hecht, Tuuminen); Health Services Dental Care, City of Helsinki, Helsinki, Finland (Karesvuo); Hygeia Clinic, Gdańsk, Poland (Kanclerz); Department of Ophthalmology, Shamir Medical Center, Tel Aviv, Israel (Hecht); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Hecht, Achiron); Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Achiron); Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland (Tuuminen)
| | - Piotr Kanclerz
- From the Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland (Karesvuo, Kanclerz, Hecht, Tuuminen); Health Services Dental Care, City of Helsinki, Helsinki, Finland (Karesvuo); Hygeia Clinic, Gdańsk, Poland (Kanclerz); Department of Ophthalmology, Shamir Medical Center, Tel Aviv, Israel (Hecht); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Hecht, Achiron); Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Achiron); Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland (Tuuminen)
| | - Idan Hecht
- From the Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland (Karesvuo, Kanclerz, Hecht, Tuuminen); Health Services Dental Care, City of Helsinki, Helsinki, Finland (Karesvuo); Hygeia Clinic, Gdańsk, Poland (Kanclerz); Department of Ophthalmology, Shamir Medical Center, Tel Aviv, Israel (Hecht); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Hecht, Achiron); Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Achiron); Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland (Tuuminen)
| | - Asaf Achiron
- From the Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland (Karesvuo, Kanclerz, Hecht, Tuuminen); Health Services Dental Care, City of Helsinki, Helsinki, Finland (Karesvuo); Hygeia Clinic, Gdańsk, Poland (Kanclerz); Department of Ophthalmology, Shamir Medical Center, Tel Aviv, Israel (Hecht); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Hecht, Achiron); Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Achiron); Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland (Tuuminen)
| | - Raimo Tuuminen
- From the Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland (Karesvuo, Kanclerz, Hecht, Tuuminen); Health Services Dental Care, City of Helsinki, Helsinki, Finland (Karesvuo); Hygeia Clinic, Gdańsk, Poland (Kanclerz); Department of Ophthalmology, Shamir Medical Center, Tel Aviv, Israel (Hecht); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Hecht, Achiron); Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Achiron); Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland (Tuuminen)
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Mainster MA, Findl O, Dick HB, Desmettre T, Ledesma-Gil G, Curcio CA, Turner PL. The Blue Light Hazard Versus Blue Light Hype. Am J Ophthalmol 2022; 240:51-57. [PMID: 35227699 PMCID: PMC10243475 DOI: 10.1016/j.ajo.2022.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE The blue light hazard is the experimental finding that blue light is highly toxic to the retina (photic retinopathy), in brief abnormally intense exposures, including sungazing or vitreoretinal endoillumination. This term has been misused commercially to suggest, falsely, that ambient environmental light exposure causes phototoxicity to the retina, leading to age-related macular degeneration (AMD). We analyze clinical, epidemiologic, and biophysical data regarding blue-filtering optical chromophores. DESIGN Perspective. METHODS Analysis and integration of data regarding the blue light hazard and blue-blocking filters in ophthalmology and related disciplines. RESULTS Large epidemiologic studies show that blue-blocking intraocular lenses (IOLs) do not decrease AMD risk or progression. Blue-filtering lenses cannot reduce disability glare because image and glare illumination are decreased in the same proportion. Blue light essential for optimal rod and retinal ganglion photoreception is decreased by progressive age-related crystalline lens yellowing, pupillary miosis, and rod and retinal ganglion photoreceptor degeneration. Healthful daily environmental blue light exposure decreases in older adults, especially women. Blue light is important in dim environments where inadequate illumination increases risk of falls and associated morbidities. CONCLUSIONS The blue light hazard is misused as a marketing stratagem to alarm people into using spectacles and IOLs that restrict blue light. Blue light loss is permanent for pseudophakes with blue-blocking IOLs. Blue light hazard misrepresentation flourishes despite absence of proof that environmental light exposure or cataract surgery causes AMD or that IOL chromophores provide clinical protection. Blue-filtering chromophores suppress blue light critical for good mental and physical health and for optimal scotopic and mesopic vision.
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Affiliation(s)
- Martin A Mainster
- Department of Ophthalmology, University of Kansas School of Medicine, Prairie Village, Kansas, USA.
| | - Oliver Findl
- Vienna Institute for Research in Ocular Surgery, A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
| | - H Burkhard Dick
- Department of Ophthalmology, Ruhr University Eye Hospital, Science, Bochum, Germany
| | | | - Gerardo Ledesma-Gil
- Retina Department, Institute of Ophthalmology, Fundación Conde de Valenciana, Mexico City, Mexico
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Patricia L Turner
- Department of Ophthalmology, University of Kansas School of Medicine, Prairie Village, Kansas, USA
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See LC, Li PR, Lin KK, Hou CH, Lee JS. Effect of Blue Light-Filtering Intraocular Lenses on Insomnia After Cataract Surgery: A Nationwide Cohort Study With 10-Year Follow-up. Am J Ophthalmol 2022; 239:26-36. [PMID: 35123954 DOI: 10.1016/j.ajo.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE 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. DESIGN Nationwide cohort study using the Taiwan National Health Insurance Research Database. METHODS 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). RESULTS 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 (HR 0.97, 95% CI 0.92-1.01), 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. CONCLUSION 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.
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Chellappa SL, Bromundt V, Frey S, Schlote T, Goldblum D, Cajochen C. Cross-sectional study of intraocular cataract lens replacement, circadian rest–activity rhythms, and sleep quality in older adults. Sleep 2022; 45:6515911. [DOI: 10.1093/sleep/zsac027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/22/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study Objectives
Age-related cataract decreases light transmission at the most sensitive spectrum for circadian photoentrainment, with negative ramifications for human health. Here, we assessed whether intraocular lens replacement (IOL) in older patients with previous cataract was associated with increased stability and amplitude of circadian rest–activity rhythms, and improved sleep quality.
Methods
Our cross-sectional study included sixteen healthy older individuals without ocular diseases (controls; 55–80 years; 63.6 ± 5.6y; 8 women) and 13 patients with previous cataract and bilateral IOL (eight with blue-blocking [BB] lens and five with ultraviolet-only [UV] blocking lens; 55–80 years; 69.9 ± 5.2y; 9 women). The study comprised three weeks of at home rest–activity assessments using wrist-worn actigraphs, and each week preceded a laboratory protocol. Primary outcomes were actigraphy-derived interdaily stability, intradaily variability, and relative amplitude of circadian rest–activity rhythms. Secondary outcomes were actigraphy-assessed sleep quality (i.e. time in bed, sleep duration, sleep efficiency, mean wake bout time and fragmentation index).
Results
Patients with IOL had significantly higher interdaily stability (“Group” effect: pFDR =.001), but not intradaily variability (“Group” effect: pFDR = n.s.), and significantly higher relative amplitude of rest–activity rhythms (“Group” effect: pFDR < .001). Moreover, patients with IOL had significantly higher activity levels during the day and lower levels during the evening, as compared to healthy older controls (“Group” effect: pFDR = .03). Analyses of actigraphy-derived sleep parameters yielded no significant differences across groups (“Group” effect: all pFDR > .1).
Conclusions
Our cross-sectional study suggests that enhancing spectral lens transmission in patients with cataract may benefit their circadian health.
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Affiliation(s)
- Sarah L Chellappa
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Vivien Bromundt
- Sleep-Wake-Epilepsy-Center, Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Sylvia Frey
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
- Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
| | | | - David Goldblum
- University of Basel, Basel, Switzerland
- Pallas-Kliniken, Olten and Bern, Switzerland
| | - Christian Cajochen
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
- Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
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Hu L, Xu G. Potential Protective Role of TRPM7 and Involvement of PKC/ERK Pathway in Blue Light-Induced Apoptosis in Retinal Pigment Epithelium Cells in Vitro. Asia Pac J Ophthalmol (Phila) 2021; 10:572-578. [PMID: 34789674 PMCID: PMC8673846 DOI: 10.1097/apo.0000000000000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Blue light triggers apoptosis of retinal pigment epithelium (RPE) cells and causes retinal damage. The aim of this study was to elucidate the protective role of transient receptor potential melastatin 7 (TRPM7) in photodamaged RPE cells. METHODS RPE cells were isolated from Sprague-Dawley (SD) rats and exposed to varying intensities of blue light (500-5000 lux) in vitro. Cell proliferation and metabolic activity were respectively assessed by bromodeoxyuridine (BrdU) incorporation and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assays. Real-time polymerase chain reaction (RT-PCR) and western blotting were used to analyze the TRPM7, protein kinase C (PKC), extracellular signal-regulated kinase (ERK) and Bcl2-associated x/B-cell lymphoma 2 (Bax/Bcl-2) messenger RNA (mRNA) and protein expression levels. The cells were transfected with TRPM7 small interfering RNA (siRNA) or transduced with TRPM7-overexpressing lentiviruses and cultured with or without the pigment epithelium-derived factor (PEDF). RESULTS Blue light inhibited the proliferation and metabolic activity of RPE cells in an intensity-dependent manner when compared to nonirradiated controls (P < 0.05). Compared to the control, photodamaged RPE cells showed decreased levels of TRPM7, PKC, ERK, and Bax, and an increase in Bcl-2 levels (P < 0.01). Forced expression of TRPM7 partially rescued the proliferative capacity of RPE cells (P < 0.01) and restored the levels of TRPM7, PKC, ERK, and Bax (P < 0.01), whereas TRPM7 knockdown had the opposite effects (P < 0.01). TRPM7 and PEDF synergistically alleviated the damaging effects of blue light. CONCLUSIONS Blue light triggers apoptosis of RPE cells, and its deleterious effects can be partially attenuated by the synergistic action of TRPM7 and PEDF via the PKC/ERK signaling pathway.
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Affiliation(s)
- Luping Hu
- First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou City 350005, China
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