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The Effect of Blue Light Exposure on AMD after Cataract Surgery

There has been controversy regarding whether persons who had catracts removed surgically had an increased susceptibility to AMD appeared to be resolved by the study, The Relationship of Cataract and Cataract Extraction to Age-related Macular Degeneration: The Beaver Dam Eye Study. Ophthalmology. 2012 Aug;119(8):1628-33. The study concluded These data strongly support the past findings of an association of cataract surgery with late AMD ...and suggest the importance of considering these findings when counseling patients regarding cataract surgery. However, another study around that time, Risk of Age-related Macular Degeneration 3 Years after Cataract Surgery: Paired Eye Comparisons. Ophthalmology. 2012 Nov;119(11):2298-303. was unable to demonstrate this association within 3 years of cataract surgery.

More recent studies appear to strongly support the premise that increased exposure to blue light that results from cataract surgery does contribute to the development of AMD. As the authors of the paper Prevention of Increased Abnormal Fundus Autofluorescence with Blue Light-Filtering Intraocular Lenses. J Cataract Refract Surg. 2015 Oct 12. [Epub ahead of print] conclude that their study demonstrated that after 2 years "The incidence of AMD was lower in eyes with a yellow-tinted [blue-light blocking] IOL.5

The controversy originated primarily from the publication of the paper Progression of Age-Related Macular Degeneration After Cataract Surgery. JAMA Ophthalmology {formerly the Archives of Ophthalmology} Nov. 2009; 127(11):1412-1419 by Dong et al. which concluded The low incidence rate of neovascular AMD development between 1 week and 1 year after cataract surgery did not support the hypothesis that cataract surgery increases the risk of AMD progression1.

Some reasearchers who had previously claimed that blue light exposure does not contribute to the development of of AMD seized on the JAMA Ophthalmology paper to support their proposition. However, the results and implications of this study were controversial from the outset, as expressed in an editorial published in that same issue Is the Risk of Incidence or Progression of Age-Related Macular Degeneration Increased After Cataract Surgery? 1a

Additionally, many earlier studies, such as Age-Related Maculopathy and the Impact of Blue Light Hazard, by Algarve et al. found increased progression of AMD after cataract surgery2. Subsequent studies, including Ocular Risk Factors for Age-Related Macular Degeneration. Fraser-Bell et al. the American Journal of Ophthalmology (May 20, 2010) had also determined that cataract surgery increases susceptibility to AMD from blue light exposure. These authors concluded Cross-sectional associations of ocular factors such as cataract, cataract surgery, and refractive errors with early AMD lesions found in Latinos are consistent with those in non-Hispanic Whites. Additionally, prior cataract surgery was associated with advanced AMD.3

This subject was discussed at the 1st World Congress on Controversies in Ophthalmology (COPHy) in Prague, Czech Republic March 4-7, 2010. A. Pollack, of the Kaplan Medical Center at the Hebrew University in Israel, presented data from 6 studies they performed which concluded These studies describe an acceleration of the course of dry AMD progression after cataract surgery. ... The most substantial difference was seen in patients converting to wet AMD within 2 years of cataract surgery in study Six. See THE COURSE OF MACULOPATHY AFTER CATARACT SURGERY IN PATIENTS WITH EARLY DRY AMD, presented at that conference4.

S. Bressler, a co-author of the Dong et al paper in the JAMA Ophthalmology paper cited above, also spoke at the COPHy Conference and acknowledged "inconsistent findings" in the literature. He stated that Both cataract and macular degeneration are common age-related diseases. Many individuals simultaneously manifest both conditions. The literature contains inconsistent findings describing adverse relationships between performance of cataract surgery and development and progression of AMD.

There now appears to be is a growing consensus that the best choice is to use blue blocking lenses to protect against blindness from AMD after cataract surgery, as indicated by the paper Ultraviolet or Blue-Filtering Intraocular Lenses: What is the Evidence? Eye; Feb 2016. which stated

"With the arrival of blue-filtering intraocular lenses (BFIOLs) in 1990's, a further debate was ignited as to their safety and potential disadvantages. ... The potential disadvantages raised in the literature over the last 25 years since their introduction, regarding compromise of visual function and disruption of the circadian system, have been largely dispelled. The clear benefits of protecting the retina from short-wavelength light make [blue-filtering intraocular lenses] BFIOLs a sensible choice"

Users of bright light therapy or blue light therapy should determine whether its worth the risk of blindness from AMD by continuing to use those products, or whether they should convert to a safe and comfortable Lo-LIGHT therapy lamp with low-intensity GreenLIGHT technology that poses no risk of retinal damage.

1. Progression of Age-Related Macular Degeneration After Cataract Surgery

1a. Is the Risk of Incidence or Progression of Age-Related Macular Degeneration Increased After Cataract Surgery?

2. Age-Related Maculopathy and the Impact of Blue Light Hazard

3. Ocular Risk Factors for Age-Related Macular Degeneration

4. See The Course of Maculopathy after Cataract Surgery in Patients with Early Dry Amd

5. Prevention of Increased Abnormal Fundus Autofluorescence with Blue Light–Filtering Intraocular Lenses