Patients who have lens surgery while in their 50s or 60s would benefit from blue-light filtering intraocular lenses, according to Dr. Michael Lawless from Vision Eye Institute.
Dr. Lawless said despite some controversy that surrounds blue light-filtering intraocular lenses, he “can see no downside”.
A recent small study published in the European Journal of Ophthalmology found that blue light-filtering intraocular lenses may halt or decrease the progression of the atrophic form of dry AMD following cataract surgery.1
AMD has been associated with cataract surgery because the natural human lens, which has the ability to filter blue light, is removed and replaced with a clear intraocular lens (IOL). Clear IOLs are unable to filter blue light that can damage the retina.
These data support the use of blue light-filtering IOLs as a means of protection for patients with AMD
In what Dr. Lawless describes as a “small… but statistically significant” retrospective study of 66 eyes from 40 patients with AMD from the department of ophthalmology at Klinikum Karlsruhe, 27 eyes were treated with Alcon Laboratories AcrySof SN60WF lenses which filter blue light and 39 with a non-blue light filter IOL.
Patients were monitored for one year using spectral domain optical coherence tomography as well as the advanced retinal pigment epithelium analysis software tool.
The non-blue filter IOL group had a mean geographic atrophy progression of 1.48 ± 0.88 SD mm2 and median of 1.30 mm2; the blue filter IOL group had a mean geographic atrophy progression of 0.72 ± 0.39 SD mm2 and median of 0.70 mm2.
The study did not test the visual performance of blue light-filtering IOLs or their effectiveness in different forms of AMD and other macular diseases.
The authors reported the study “provides data that support the photoprotective role of blue filter IOL in halting or decreasing the progression of the atrophic form of dry AMD after cataract surgery… These data support the use of blue light-filtering IOLs as a means of protection for patients with AMD. It has been suggested that their use could be extended for patients of any age and especially those with a longer pseudophakic life such as pediatric and presbyopic lens exchange patients in order to decrease the risks resulting from prolonged exposure to blue light during their lifetime”.
Dr. Lawless, who personally uses ALCON AcrySof lenses said, “given that lens surgery is being done in younger and younger patients, and that the cumulative effect of possible damage from UV over the next 30 to 40years of a patient’s life if they have had surgery in their 50s, could be significant, this is one extra reason to perhaps consider using a blue blocker.
“Personally I use them because I can see no downside and I would like patients to at least gain the possible and indeed probable advantage to their maculae over many years. I also like this lens because of its other qualities in terms of insertion, biocompatibility and stability within the capsular bag,” said Dr. Lawless.
“Given the Alcon AcrySof is probably the most commonly used lens in the world, the majority of lenses going in around the world have a blue blocker in them. Often the surgeons use this lens because they like its biocompatibility, or its ease of insertion, and the blue blocking component is just an extra but not the primary reason why they use the lens.”
Dr. Lawless said there was insufficient evidence to support expressed concerns that blue blocking lenses decrease overall contrast or quality of vision, alter colour perception in a meaningful way, impair the ability to perform visual field analysis or impact on sleep or circadian rhythms. Similarly he said there was no evidence to support concerns they make subsequent visualisation during vitreoretinal surgery more difficult.
One study2 has found the cost of treating cataract patients with blue light-filtering IOLs was less than the cost of treating patients with non-blue light-filtering IOLs over a five-year period due to the reduced risk of developing AMD in the period after cataract surgery. They noted, “the extent of this benefit is highly dependent on the age of the patient, or more specifically, baseline risk of AMD”.
1. Pipis A; Touliou E; Pillunat LE; Augustin AJ. Effect of the blue filter intraocular lens on the progression of geographic atrophy.
2. Prabashni Reddy; Xin Gao; Rod Barnes; Carol Fairchild; Kreda Boci; Curtis Waycaster; Chris Pashos. Economic impact of blue light filtering intraocular lenses on age-related macular degeneration associated with cataract surgery.