The effect of blue‐blocking and neutral intraocular lenses on circadian photoentrainment and sleep one year after cataract surgery

Brøndsted, Adam Elias; Haargaard, Birgitte; Sander, Birgit; Lund‐Andersen, Henrik; Jennum, Poul; Kessel, Line

doi:10.1111/aos.13323

Cited by 29 publications

(25 citation statements)

References 37 publications

(60 reference statements)

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“…Even though photoreception is improved by cataract surgery, its impact on circadian rhythm and sleep is still unclear. In other words, whether improved sleep quality reflects increased life quality due to the cataract surgery or related to changes in the circadian rhythm is not known yet (Brondsted et al 2015(Brondsted et al , 2016. Two patients with NTG had undergone selective laser trabeculoplasty in the consensual eye, which might influence pupil metrics.…”

Section: Discussionmentioning

confidence: 99%

Melanopsin‐mediated pupillary light reflex and sleep quality in patients with normal tension glaucoma

Ahmadi

Lund‐Andersen

Kolko

et al. 2019

Acta Ophthalmologica

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Purpose: The intrinsically photosensitive retinal ganglion cells (ipRGCs) and sleep quality are impaired in patients with primary open-angle glaucoma (POAG). In this study, we investigated whether ipRGCs and sleep quality were also impaired in patients with normal tension glaucoma (NTG). Methods: We performed pupillometry and sleep quality assessment in 15 patients with NTG and 17 healthy age-matched controls. Pupillometry protocol consisted of monocular stimulation with high illuminance (100 lux) red (633 nm, 300 cd/m 2 or 15.23 log quanta/cm 2 /s) and blue light (463 nm, 332 cd/m 2 or 15.27 log quanta/cm 2 /s) and binocular pupil measurements. Prior to light stimulation, patients were dark-adapted for 5 min. The late postillumination pupillary response (PIPR Late ) to blue light was used as marker of ipRGC activity. Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI) questionnaire. Results: The PIPR Late to blue light was significantly reduced in patients with NTG compared to healthy subjects (p < 0.001), indicating impairment of the melanopsin-mediated pupillary pathway. There was no significant difference in the response elicited by red light (p = 0.6). Baseline pupil diameter and pupillary constriction amplitude to both red and blue light were reduced in patients with NTG (p < 0.05). The global score in PSQI was not significantly different between healthy controls and patients with NTG, indicating normal sleep quality (p = 0.6). Furthermore, we found no correlation between sleep parameters and pupillary light reflex parameters. Conclusion: Patients with NTG exhibited reduced ipRGC activity compared to healthy subjects, while no differences were observed in sleep quality.

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Section: Discussionmentioning

confidence: 99%

Melanopsin‐mediated pupillary light reflex and sleep quality in patients with normal tension glaucoma

Ahmadi

Lund‐Andersen

Kolko

et al. 2019

Acta Ophthalmologica

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“…The underlying assumption is that the retina might be protected from phototoxic blue light, purported to be involved in age‐related macular degeneration (Cruickshanks, Klein, Klein, & Nondahl, 2001). Although visual function between BB and UV‐only IOLs might be comparable (Mester, Holz, Kohnen, Lohmann, & Tetz, 2008; but see also Steinemann et al, 2019) for differences between these IOLs, the reduced transmittance of blue light, which is pivotal to circadian photoentrainment, has led to concern that BB IOLs may adversely impact circadian rhythmicity (Brondsted et al, 2017; Chellappa et al, 2019). Taken together, the benefits of specific IOLs for circadian rhythmicity and cognitive function still remain to be fully established.…”

Section: Discussionmentioning

confidence: 99%

Intraocular cataract lens replacement and light exposure potentially impact procedural learning in older adults

Chellappa

Bromundt

Frey

et al. 2020

Journal of Sleep Research

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Procedural learning declines with age and appropriately timed light exposure can improve cognitive performance in older individuals. Because cataract reduces light transmission and is associated with cognitive decline in older adults, we explored whether lens replacement (intraocular blue-blocking [BB] or UV-only blocking) in older patients with cataracts enhances the beneficial effects of light on procedural learning. Healthy older participants (n = 16) and older patients with post-cataract surgery (n = 13 with BB or UV lens replacement) underwent a randomized withinsubject crossover laboratory design with three protocols. In each protocol, 3.5 hr dim-dark adaptation was followed by 2 hr evening blue-enriched (6,500K) or nonblue-enriched light exposure (3,000K or 2,500K), 30 min dim post-light, ~8 hr sleep and 2 hr morning dim light. Procedural learning was assessed by the alternating serial reaction time task (ASRT), as part of a larger test battery. Here, ASRT performance was indexed by type of trial (random or sequence) and sequence-specific (high or low probability) measures. During evening light exposure, we observed a significant effect of the interaction of "group" versus "light condition" on the type of trial (p = .04; p = .16; unadjusted and adjusted p-values, respectively) and sequencespecific learning (p = .04; p = .16; unadjusted and adjusted p-values, respectively), whereby patients with UV lens replacement performed better than patients with BB lens or non-cataract controls, during blue-enriched light exposure. Lens replacement in patients with cataracts may potentially be associated with beneficial effects of blue light on procedural learning. Thus, optimizing spectral lens transmission in patients with cataracts may help improve specific aspects of cognitive function, such as procedural learning.

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“…Previous studies have evaluated circadian photoentrainment and sleep following implantation of blue-blocking intraocular lenses (IOLs). 54,55 The authors reported that patients with blue-blocking IOLs showed no differences in any ipRGC-driven pupil responses, sleep-specific actigraph measures, melatonin onset or PSQI scores compared to subjects with neutral IOLs after 1 year. The authors did find that peak melatonin concentration was 50% lower in the blue-blocking IOL group compared to the neutral IOL group.…”

Section: Discussionmentioning

confidence: 99%

Attenuation of short wavelengths alters sleep and the ipRGC pupil response

Ostrin

Abbott

Queener

2017

Ophthalmic Physiologic Optic

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The use of short wavelength-blocking glasses at night increased subjectively measured sleep quality and objectively measured melatonin levels and sleep duration, presumably as a result of decreased night-time stimulation of ipRGCs. Alterations in the ipRGC-driven pupil response suggest a shift in circadian phase. Results suggest that minimising short wavelength light following sunset may help in regulating sleep patterns.

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The effect of blue‐blocking and neutral intraocular lenses on circadian photoentrainment and sleep one year after cataract surgery

Abstract: Blue-blocking IOLs increased sleep efficiency but lowered nocturnal melatonin secretion compared with neutral IOLs. Cataract surgery improved the response of ipRGCs and sleep quality. However, the effect of cataract surgery on sleep quality may be unrelated to circadian photoentrainment.

Cited by 29 publications

References 37 publications

Melanopsin‐mediated pupillary light reflex and sleep quality in patients with normal tension glaucoma

Melanopsin‐mediated pupillary light reflex and sleep quality in patients with normal tension glaucoma

Intraocular cataract lens replacement and light exposure potentially impact procedural learning in older adults

Attenuation of short wavelengths alters sleep and the ipRGC pupil response

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