Eyeworld

JULY 2023 | EYEWORLD | 51 R by Ellen Stodola Editorial Co-Director About the physicians Daniel Chang, MD Cataract and Refractive Surgeon Empire Eye and Laser Center Bakersfield, California George Waring IV, MD Waring Vision Institute Mt. Pleasant, South Carolina References 1. Chang DH, et al. Clinical eval- uation of a modified light trans- mission short-wavelength filter- ing intraocular lens compared to a colorless control. Ophthalmol Ther. 2023;12:1775–1785. 2. Chang DH, et al. Violet and blue light: impact of high-energy light on vision and health. J Oph- thalmic Stud. 2020;3. E-pub. 3. van der Mooren M, et al. Effect of violet light-filtering and manufacturing improvements in an extended depth-of-focus intraocular lens on visual performance. Clin Ophthalmol. 2023;17:701–709. 4. Chang DH, et al. The effect of violet light filtration and manufacturing improvements on the clinical performance of an extended depth of focus IOL. Presentation at the 2022 ASCRS Annual Meeting, Washington, D.C. 5. Chang DH, et al. Violet light-fil- tering IOLs: visual and non-visual benefits. Presentation at the 2020 American Academy of Ophthalmology Annual Meeting, virtual. D aniel Chang, MD, and George Waring IV, MD, have studied and used light-blocking and light-filtering IOL technology in clinical practice, and they discussed the concepts behind blocking and filtering certain violet and blue light. Dr. Chang said Alcon popularized the idea of short wavelength/high energy light filtering with its Natural chromophore more than 15 years ago. This was a blue light filter, and it was marketed as a feature for macular protection. There have been studies looking at this chromo- phore and its potential impact on contrast and tolerance to dysphotopsias, bright lights, and challenging lighting conditions, he said. Johnson & Johnson Vision received FDA approval for its OptiBlue chromophore as well. OptiBlue is now a key enabling technology of the InteliLight portfolio, which recently launched with the Tecnis Synergy and Tecnis Symfony OptiBlue with InteliLight IOLs, Dr. Chang said. He was an investigator on the original clinical trials for OptiBlue back in 2006, now published. 1 The technology was studied in monofocal IOLs, and it was shown to decrease difficulty with driving in both day and nighttime conditions, and there was less frustration with vision, Dr. Chang said. Subsequently, Johnson & Johnson Vision added this technology to its range of vision lens portfolio to reduce dyspho- topsias at nighttime as well. Dr. Waring has also evaluated light-filtering technology. "Recently we have had an evolution in IOL technology with the advent of the first violet light-filtering IOL available in the U.S. as part of the InteliLight portfolio," Dr. Waring said. "This is an improvement in IOL perfor- mance for better quality of vision and mitigation of dysphotopsia." Violet light filtration is designed to mit- igate halo, glare, and starbursts, resulting in fewer disturbances during nighttime activities, Dr. Waring said. In addition, the achromatic technology corrects for chromatic aberrations for improved contrast, and the high resolution echelette design reduces light scatter and halo intensity. Dr. Waring and Dr. Chang were two of the first surgeons in the U.S. to have pre-mar- ket access to the Tecnis Symfony OptiBlue with InteliLight. "We performed an informal pilot evaluation in a contralateral series of patients with legacy Symfony in one eye and Tecnis Symfony OptiBlue with InteliLight, or the violet light filter, in the other eye, and with non-di- rected questioning, the patients noticed less dysphotopsia in the eye with Tecnis Symfony OptiBlue with InteliLight," he said. "It seemed to be that there was more of an improvement in the starburst type of dysphotopsia in particular." Dr. Waring explained that low wavelength visible light is becoming more prevalent with LED lights. "We see that with violet filtration, which is in a shorter wavelength than blue light filtration," he said. Violet light produces the most scatter, and it turns out that violet filters reduce halo intensity as well. "In the pilot and original studies comparing the Tecnis violet with clear, it was seen that nighttime driving was statistically better with a violet filtration," he said. "There are other benefits of blocking violet where we might want to preserve blue light." This can regulate circadian rhythms, which is beneficial for sleep and cognitive function. Dr. Waring said that this aids in low-light contrast, and it has been used in diffractive presbyopia-correcting IOLs in the U.S. before. There is better nighttime performance and 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 wave- length, 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 im- pact of high energy light. 2 "We broke down the issues into three areas: vision, macular protec- tion/potential retinal phototoxicity protection, and general health (circadian rhythm)," he said. We realized that the literature on high ener- gy light filtration is vague, Dr. Chang said. "High energy, blue, and violet light are frequently grouped together, but it's important to differ- entiate the specific wavelengths being filtered because that can affect real-world performance. A look at violet-blocking and blue light- filtering technology continued on page 52

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