Blue Light–Filtering Intraocular Lenses Not Associated with Reduced Risk of Injury

Raimo Tuuminen, MD, PhD

A recent cohort study reported a lack of advantage gained from blue light-filtering (BLF) intraocular lenses (IOLs) in terms of injury risk and quality of vision while driving after bilateral cataract surgery.

Moreover, data suggest neither cumulative all-cause nor traffic accidents–related, injury-free survival differed between patients with BLF and non-BLF IOLs.

“Patient age at the second eye surgery was the most important variable influencing the risk of injury,” wrote corresponding study author Raimo Tuuminen, MD, PhD, Department of Ophthalmology, Kymenlaakso Central Hospital. “Furthermore, despite higher levels of glare while driving in the evening or night, the BLF IOLs were not worse than non-BLF IOLs in terms of comfort while driving.”

Despite their wide use in clinical practice for patients with cataracts, there is little evidence available on the association of BLF IOLs with injurities. The retrospective study included consecutive cataract operations performed between September 2007 and December 2018 and all adult patients who underwent uneventful phacoemulsification surgery and in-the-bag implantation of non-BLF IOLs or BLF IOLs in both eyes.

The main outcome measure of the study was the association of BLF IOLs with the incidence of all-cause and traffic accident-related injuries after the cataract surgery in the second eye. An exploratoy analysis according to sex and age was performed as a post hoc analysis, according to investigators.

The investigators used coding from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) to specify injury subtype and evaluated visual performance using a structured questionnaire. Moreover, they generated Kaplan-Meier curves and multivariable Cox proportional hazards regression controlling for age and sex was used to estimate hazard ratios (HRs) for injuries.

The study included in the analysis a total of 4986 patients, or 9972 eyes, who underwent cataract surgery. The population consisted of 1707 (34.2%) men and 3279 (65.8%) women with mean age of 73.2 years at the first surgery and 74.3 years at the second.

Through the multivariable Cox proportional hazards regression analysis, the age- and sex-adjusted injury-free survival before the first eye surgery remained comparable between patients with non-BLF versus BLF IOLs (HR, 0.95 [95% CI, 0.81 - 1.13]; P = .57)

Using the ICD-10 coding, data suggest the overall number of injuries after the second eye surgery was 1226. Of this number, 602 injuries and 727 injury subtypes were among patients with non-BLF IOLs and 624 injuries and 723 injury subtypes were among patients with BLF IOLs.

Further, in multivariable Cox proportional hazards regression analysis, women were found to have lower incidence of injuries compared with men (HR, 0.89 [95% CI, 0.79 - 1.01]; P = .07) and age at the time of the second eye injury was associated with a higher rate of injuries (2.6% for every year; HR, 1.03 [95% CI, 1.02 - 1.03]; P <.001).

However, the type of IOL (BLF vs non-BLF IOL) was not associated with all-cause injury rates (HR, 0.99 [95% CI, 0.88 - 1.11]; P = .85).

The findings on subjective visual performance parameters for driving suggested all were comparable between the non-BLF and BLF IOL groups, except for glare at driving in the dark (evening and night). Data show this was impared among 9 of 80 patients with BFL IOLs compared with 0 of 83 with non-BLF IOLs (P <.001).

“These findings could broaden our understanding of the potential advantages and disadvantages of short-wavelength filtration of IOLs,” Tuuminen concluded.

The study, “Association of Blue Light–Filtering Intraocular Lenses With All-Cause and Traffic Accident–Related Injuries Among Patients Undergoing Bilateral Cataract Surgery in Finland,” was published in JAMA Network Open.