22 EWAP SEPTEMBER 2023 REFRACTIVE Santaro Noguchi, MD, PhD ASUCA eye clinic SENDAI MARK ONE Sendai Mark One 11F, Chuo 1-2-3, Aoba-ku, Sendai city, Miyagi, Japan s.noguchi@tsukazaki-eye.net Although there are differences in lens material and platform, the blue light filtering (yellow) SN60WF (Alcon) blocks 67% of violet light and 27% of blue light in spectral transmission, while the violet light filtering (OptiBlue) ZCB00V (Johnson & Johnson) blocks 90% and 6% respectively. Blue light-filtering IOLs were originally developed to protect the retina, but their visual function, including visual acuity and contrast, was found to be basically the same as that of non-tinted IOLs. Therefore, yellow IOLs that cut short-wavelength blue light, which is considered harmful to the retina, became widely used for their positive functional implications. On the other hand, IOLs that filter violet light have been developed in recent years, and Japan began implanting monofocal and multifocal IOLs made of OptiBlue material in 2013 ahead of the rest of the world. Gradually, more and more ophthalmologists are preferring violet-filtering IOLs over blue light-filtering IOLs. Of course, because of its coloring, it is expected to reduce glare at night as well as yellow IOLs. In our study of violet light-filtering, and blue light-filtering IOLs in monofocal IOLs in over 2000 eyes, the blue light-filtering IOLs had contrast sensitivity and visual acuity comparable to those with no coloration, but the contrast sensitivity of violet light-filtering IOLs was clearly better than that of the blue light-filtering IOL and non-colored IOL. Clinically, the violet light-filtering IOL was found to be a tinted IOL that significantly improved visual function in bright situations, not to mention its effectiveness in reducing glare at night. It has been reported that short-wavelength illumination enhances light scattering, chromatic aberration, and fluorescende, and that removal of light at wavelengths below 450 nm using a cutoff filter improves contrast sensitivity and image sharpness both in human vision and in mechanical photography. This is consistent with our study. Since this difference was observed with a monofocal IOL, it is likely that a multifocal IOL would be an IOL platform that significantly improves visual function. For these reasons, we believe that more doctors in Japan are choosing the violet light-filtering material, and we expect the market for violet light-filtering IOLs to expand worldwide in the future. Editors’ note: Prof. Noguchi disclosed no relevant financial interests. ASIA-PACIFIC PERSPECTIVES the patient will never be able to recover that. Therefore, it’s better to filter out what is always bad and transmit what may sometimes be good. To do this effectively, one must consider narrow wavelength bands, 10 nm segments, when looking at the filter,” Dr. Chang continued. Dr. Chang said that visual performance is the most important consideration when selecting a chromophore. He recently co-authored a laboratory study looking at the effect of a violet light filter on clinical performance of the Tecnis Symfony. 3 The study showed a 19% improvement in halo performance, up to 17% reduction in retinal veiling luminance (glare, halos, and starbursts), and up to 13% improvement in contrast under challenging light conditions. This aligns with a retrospective study that he presented at the 2022 ASCRS Annual Meeting, in which he compared the clinical performance of Tecnis Symfony OptiBlue with InteliLight to colorless Tecnis Symfony. 4 He demonstrated up to 45% reduction in dysphotopsia complaints and up to 72% reduction in postoperative dysphotopsia counseling in patients with Tecnis Symfony OptiBlue with InteliLight. better image quality because of better contrast sensitivity in general. Dr. Waring added that it’s important to mention that blue light is defined as between 450–500 nanometers (nm) in wavelength, and violet light is shorter than 450 nm in wavelength and is typically associated with higher degrees of light scatter. Dr. Chang noted some recent work on the topic of high energy light filtration. The first is a paper published in the Journal of Ophthalmic Studies that looked at the broad and diverse impact of high energy light. 2 “We broke down the issues into three areas: vision, macular protection/ potential retinal phototoxicity protection, and general health (circadian rhythm),” he said. We realized that the literature on high energy light filtration is vague, Dr. Chang said. “High energy, blue, and violet light are frequently grouped together, but it’s important to differentiate the specific wavelengths being filtered because that can affect real-world performance “When you put a chromophore in the eye, patients will look through it for the rest of their lives. If the particular chromophore is transmitting too much light, they can easily put on sunglasses, but if a chromophore blocks a percentage of useful light,
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