Effect of a blue-light-blocking intraocular lens on the quality of sleep

Department of Ophthalmology, Repatriation General Hospital, Adelaide, Australia.
Journal of Cataract and Refractive Surgery (Impact Factor: 2.72). 02/2009; 35(1):83-8. DOI: 10.1016/j.jcrs.2008.10.015
Source: PubMed


To evaluate whether implantation of a blue-light-blocking intraocular lens (IOL) affects sleep quality.
Repatriation General Hospital, Adelaide, Australia.
This study comprised patients who had bilateral cataract surgery during the preceding 12 months with implantation of a conventional SI40NB IOL or an AcrySof Natural SN60WF blue-light-blocking IOL. Patients were contacted by telephone at least 6 months after second-eye surgery, and the Pittsburgh Sleep Quality Index (PSQI) questionnaire was administered. Results were compared between groups.
Of the 49 patients, 31 received conventional IOLs and 18, blue-light-blocking IOLs. The mean age of the patients was 80 years +/- 8.1 (SD). The median PSQI score was 6 (interquartile range 3 to 8). There were no statistically significant differences in PSQI scores between the 2 IOL groups (P = .65). This remained true after adjustment for sex, age, medication, and time since surgery.
The blue-light-blocking IOL had no effect on the sleep quality of patients, indicating that these IOLs might serve as an alternative to conventional IOLs without a detrimental effect on circadian rhythm.

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    • "Landers et al. reported a comparative retrospective sleep study in patients with bilateral implantation of either UVR-filtering or blue light-filtering IOLs [12]. The results of the Pittsburg Sleep Quality Index (PSQI) questionnaire, with almost 20 years of demonstrated validity and reliability, showed no significant difference on any effect of sleep quality between the two groups of patients, who had a mean age of 80 ± 8 years [12]. "
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    ABSTRACT: Recent reviews of blue light-filtering intraocular lenses (IOLs) have stated their potential risks for scotopic vision and circadian photoentrainment. Some authors have challenged the rationale for retinal photoprotection that these IOLs might provide. Our objective is to address these issues by providing an updated clinical perspective based on the results of the most recent studies. This article evaluates the currently available published papers assessing the potential risks and benefits of blue light-filtering IOLs. It summarizes the results of seven clinical and two computational studies on photoreception, and several studies related to retinal photoprotection, all of which were not available in the previous reviews. These results provide a clinical risk/benefit analysis for an updated review for these IOLs. Most clinical studies comparing IOLs with and without the blue light-filtering feature have found no difference in clinical performance for; visual acuity, contrast sensitivity, color vision, or glare. For blue light-filtering IOLs, three comparative clinical studies have 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 of two recent clinical studies have also shown improved performance for simulated driving under glare conditions and reduced glare disability, better heterochromatic contrast threshold, and faster recovery from photostress for blue light-filtering IOLs. Two computational and five clinical studies found no difference in performance between IOLs with or without blue light-filtration for scotopic vision performance and photo entrainment of the circadian rhythm. The rationale for protection of the pseudophakic retina against phototoxicity is discussed with supporting results of the most recent computational, in-vitro, animal, clinical, and epidemiological investigations. This analysis provides an updated clinical perspective which suggests the selection of blue light-filtering IOLs for patients of any age, but especially for pediatric and presbyopic lens exchange patients with a longer pseudophakic life. Without clinically substantiated potential risks, these patients should experience the benefit of overall better quality of vision, reduced glare disability at least in some conditions, and better protection against retinal phototoxicity and its associated potential risk for AMD.
    Albrecht von Graæes Archiv für Ophthalmologie 05/2011; 249(7):957-68. DOI:10.1007/s00417-011-1697-6 · 1.91 Impact Factor
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    • "% to 57% could have detrimental consequences for the biological clock ( Cuthbertson et al . , 2009 ; Mainster and Turner , 2009 ; Patel and Dacey , 2009 ; Turner and Mainster , 2008 ) . The first attempt to quantify the effects of blue - blocking IOLs in comparison with UV - blocking IOLs on non - visual responses in a field study was conducted by Landers et al . ( 2009 ) . By means of the Pittsburgh Sleep Quality Index ( PSQI ) , subjects who underwent cataract surgery were asked to rate the quality of their sleep . The measurements took place 12 months after surgery had been conducted on both eyes . The authors con - cluded that subjective ratings of sleep quality were not impaired by the use of blue"
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    ABSTRACT: Light is the signal that entrains the biological clock in humans to the 24-hour external time. Recently, it has been shown that short wavelengths play a key role in this process. In the present study, we describe a procedure to measure, objectively and in a quick way, the spectral composition of the light reaching the retina in vivo. The instruments involved are the foveal reflection analyzer (FRA) and the macular pigment reflectometer (MPR). By making use of these reflectometers, we show quantitatively that in subjects with cataracts, the light input is especially reduced in the short wavelength range. After cataract surgery during which the crystalline lens is replaced by a transparent artificial lens, the transmittance of the short wavelengths (between 420-500 nm) improved on average by a factor of 4. We conclude that this technique holds great promises for the chronobiological field because it allows for quantification of the spectral composition and light levels reaching the retina in vivo.
    Journal of Biological Rhythms 04/2010; 25(2):123-31. DOI:10.1177/0748730409360888 · 2.77 Impact Factor
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    ABSTRACT: Violet and blue light are responsible for 45% of scotopic, 67% of melanopsin, 83% of human circadian (melatonin suppression) and 94% of S-cone photoreception in pseudophakic eyes (isoilluminance source). Yellow chromophores in blue-blocking intraocular lenses (IOLs) eliminate between 43 and 57% of violet and blue light between 400 and 500 nm, depending on their dioptric power. This restriction adversely affects pseudophakic photopic luminance contrast, photopic S-cone foveal threshold, mesopic contrast acuity, scotopic short-wavelength sensitivity and circadian photoreception. Yellow IOL chromophores provide no tangible clinical benefits in exchange for the photoreception losses they cause. They fail to decrease disability glare or improve contrast sensitivity. Most epidemiological evidence shows that environmental light exposure and cataract surgery are not significant risk factors for the progression of age-related macular degeneration (AMD). Thus, the use of blue-blocking IOLs is not evidence-based medicine. Most AMD occurs in phakic adults over 60 years of age, despite crystalline lens photoprotection far greater than that of blue-blocking IOLs. Therefore, if light does play some role in the pathogenesis of AMD, then 1) senescent crystalline lenses do not prevent it, so neither can blue-blocking IOLs that offer far less photoprotection, and 2) all pseudophakes should wear sunglasses in bright environments. Pseudophakes have the freedom to remove their sunglasses for optimal photoreception whenever they choose to do so, provided that they are not encumbered permanently by yellow IOL chromophores. In essence, yellow chromophores are placebos for prevention of AMD that permanently restrict a pseudophake's dim light and circadian photoreception at ages when they are needed most. If yellow IOLs had been the standard of care, then colorless UV-blocking IOLs could be advocated now as "premium" IOLs because they offer dim light and circadian photoreception roughly 15-20 years more youthful than blue-blocking IOLs.
    Survey of Ophthalmology 10/2009; 55(3):272-89. DOI:10.1016/j.survophthal.2009.07.006 · 3.85 Impact Factor
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