title: Recent studies provide an updated clinical perspective on blue light-filtering IOLs.
abstract: BACKGROUND
  Recent reviews of blue light-filtering intraocular lenses (IOLs) have stated their potential risks for scotopic vision and circadian photoentrainment. Some authors have challenged the rationale for retinal photoprotection that these IOLs might provide. Our objective is to address these issues by providing an updated clinical perspective based on the results of the most recent studies.
  
  
  METHODS
  This article evaluates the currently available published papers assessing the potential risks and benefits of blue light-filtering IOLs. It summarizes the results of seven clinical and two computational studies on photoreception, and several studies related to retinal photoprotection, all of which were not available in the previous reviews. These results provide a clinical risk/benefit analysis for an updated review for these IOLs.
  
  
  RESULTS
  Most clinical studies comparing IOLs with and without the blue light-filtering feature have found no difference in clinical performance for; visual acuity, contrast sensitivity, color vision, or glare. For blue light-filtering IOLs, three comparative clinical studies have shown improved contrast sensitivity and glare reduction; but one study, while it showed satisfactory overall color perception, demonstrated some compromise in mesopic comparative blue color discrimination. Comparative results of two recent clinical studies have also shown improved performance for simulated driving under glare conditions and reduced glare disability, better heterochromatic contrast threshold, and faster recovery from photostress for blue light-filtering IOLs. Two computational and five clinical studies found no difference in performance between IOLs with or without blue light-filtration for scotopic vision performance and photo entrainment of the circadian rhythm. The rationale for protection of the pseudophakic retina against phototoxicity is discussed with supporting results of the most recent computational, in-vitro, animal, clinical, and epidemiological investigations.
  
  
  CONCLUSIONS
  This analysis provides an updated clinical perspective which suggests the selection of blue light-filtering IOLs for patients of any age, but especially for pediatric and presbyopic lens exchange patients with a longer pseudophakic life. Without clinically substantiated potential risks, these patients should experience the benefit of overall better quality of vision, reduced glare disability at least in some conditions, and better protection against retinal phototoxicity and its associated potential risk for AMD.
authors.affiliation: Wolfe Eye Clinic, 309 East Church Street, Marshalltown, IA 50158, USA. jdavison@wolfeclinic.com
authors.forename: James A
authors.initials: JA
authors.lastname: Davison
authors.forename: Anil S
authors.initials: AS
authors.lastname: Patel
authors.forename: Joao P
authors.initials: JP
authors.lastname: Cunha
authors.forename: Jim
authors.initials: J
authors.lastname: Schwiegerling
authors.forename: Orkun
authors.initials: O
authors.lastname: Muftuoglu
mesh_terms: D015350:Contrast Sensitivity / Q000502:physiology; D005374:Filtration / Q000295:instrumentation*; D019466:Glare; D006801:Humans; D007910:Lenses, Intraocular; D008027:Light; D011474:Prosthesis Design; D011832:Radiation Injuries / Q000517:prevention & control; D012160:Retina / Q000528:radiation effects; D014786:Vision Disorders / Q000517:prevention & control*; D014792:Visual Acuity / Q000502:physiology