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EW Supplement: Achieving Success with Cataract and Refractive Technology



     

High energy blue light filtration: An evidence-based assessment


 
 




“Yellow is the gold standard. Yellow is the color that prevents blue light toxicity and
concomitant problems.”
Miguel N. Burnier Jr., M.D.

 

UV and blue light filtering IOLs (pictured above), like the AcrySof Natural and AcrySof IQ, may prevent visual diseases like macular degeneration, but could also prevent life-threatening diseases like uveal melanoma


There is growing evidence implicating welding as a possible risk factor for uveal melanoma. The major culprit is high-energy blue light exposure (only UV-light is filtered by protective eyewear)
Source: Miguel N. Burnier Jr., M.D.

Innovations in IOLs are seemingly endless. Whether you chart the progress from monofocal to multifocal technology or silicone to acrylic material, we live in a world in which cataract patients are better off today than yesterday.
Without a doubt, that progress continues with adding a protective chromophore to the lens to achieve wonderful health benefits, according to Miguel N. Burnier Jr., M.D., professor of ophthalmology, pathology, medicine, and oncology, McGill University, Montreal, Canada.
“Yellow is the gold standard,” Dr. Burnier said. Yellow is the color that prevents blue light toxicity and concomitant problems, he said. If cataract patients don’t get a yellow lens, such as the AcrySof IQ IOL (Alcon, Fort Worth, Texas) or the AcrySof Natural IOL (Alcon), their eye health – and much more – is in jeopardy, Dr. Burnier said.
“Over the lifetime of each patient, the retinal pigment epithelium [RPE] accumulates the fluorescent material called lipofuscin,” Dr. Burnier explained. “Blue light absorption by the lipofuscin generates substances which are toxic to the RPE. As a result, RPE cells die and no longer nourish the retina, affecting vision.”
Age-related macular degeneration clearly could result under such circumstances, he said. Putting excellent vision aside for the moment, consider life-threatening consequences of blue light toxicity, like uveal melanoma.
“Laboratory rats exposed to long-term blue light develop intraocular masses, pathologically diagnosed as ocular melanoma,” Dr. Burnier said.
Further, Dr. Burnier cited a study linking high energy light emitted from commercial welding to uveal melanoma. “There was evidence implicating welding as a risk factor for uveal melanoma,” Dr. Burnier said. But he added that there is a high emission of blue light in arc welding.
In a letter to the journal Ophthalmology, Dr. Burnier wrote, “There is evidence suggesting that the major culprit is not ultraviolet light but blue light exposure. Okuno et al evaluated various light sources for blue light hazard. Among these sources, arc welding was found to have extremely high effective radiance, with corresponding permissible exposure times of only 0.6 to 40 seconds, suggesting that viewing this light source is very hazardous to the retina.”
Dr. Burnier added that using UV and blue light filtering IOLs should be preferred for all adult patients undergoing cataract surgery, as it could be a preventative measure against possible blue light-induced malignant transformation.
Critics of the AcrySof Natural IOLs have incorrectly suggested that the AcrySof Natural “blocks” blue light. They have suggested that blocking blue light could interfere with natural circadian rhythms regulated by melatonin and negatively impact sleep patterns and mood levels.
The AcrySof Natural IOLs filter only a specific range of very high-energy blue light. A patient satisfaction questionnaire used at McGill, under the oversight of Dr. Burnier’s research team, found some enlightening results that all ophthalmologists need to know. Of 360 AcrySof Natural patients answering questions related to quality of vision after cataract surgery, none said they experienced insomnia or depression after cataract surgery.
There is no definitive evidence to justify statements that the AcrySof Natural chromophore causes alleged problems with visual acuity, color perception, contrast sensitivity, circadian rhythms, or sleep pattern. These and other criticisms are shallow, Dr. Burnier said, such as those related to glistenings.
The bottom line is that the AcrySof blue light filtering technology is not only beneficial to vision, but can prevent serious life-threatening conditions, Dr. Burnier said. There are strong indications that blue light filtering IOLs may play an important part in preserving vision for the long term.
“For all these reasons, surgeons must use the gold standard in cataract surgery: Alcon blue light filtering IOLs,” Dr. Burnier said.

Dr. Burnier has no financial interests related to this supplement. He can be contacted at 514-843-1544 or miguel.burnier@mcgill.ca.





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