Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland.
Hygeia Clinic, Gdańsk, Poland.
JAMA Netw Open. 2022 Aug 1;5(8):e2227232. doi: 10.1001/jamanetworkopen.2022.27232.
Blue light-filtering (BLF) intraocular lenses (IOLs) have been widely used in clinical practice for more than 20 years and have been implanted in millions of patients with cataracts worldwide. However, little evidence on the association of BLF IOLs with injuries is available.
To assess the association of BLF IOLs with all-cause and traffic accident-related injuries and quality of vision while driving after bilateral cataract surgery.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective registry-based cohort study included patients who underwent bilateral cataract surgery between September 3, 2007, and December 14, 2018, and were followed until December 14, 2021. Surgery was performed at the Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland. The 4986 participants received non-BLF IOLs (n = 2609) or BLF IOLs (n = 2377) in both eyes. Patients undergoing bilateral surgery between 2015 to 2016 with non-BLF IOLs (n = 102) or BLF IOLs (n = 91) and currently driving a car were interviewed using a structured questionnaire for visual performance while driving.
Follow-up for a mean (SD) of 2166 (1110) days after second eye surgery.
Kaplan-Meier and multivariable Cox proportional hazards regression analyses for the risk of all-cause and traffic accident-related injuries after surgery in the second eye obtained from the patient medical records were assessed. To improve follow-up precision, both death and the end of the follow-up were used as censoring events.
A total of 4986 patients were included in the analysis (1707 [34.2%] men and 3279 [65.8%] women; mean [SD] age, 73.2 [8.6] years at the first surgery and 74.3 [8.8] years at the second). Injury-free survival rates preceding the first eye surgery were comparable between the non-BLF and BLF IOL groups (hazard ratio adjusted for age and sex, 0.95 [95% CI, 0.81-1.13; P = .57]). In multivariable Cox proportional hazards regression analysis controlling for age and sex, the use of BLF IOLs showed no advantage in overall injuries compared with the use of non-BLF IOLs (hazard ratio, 0.99 [95% CI, 0.88-1.11]; P = .85) or in any injury subtype. Subjective visual performance parameters for driving were all comparable between the non-BLF and BLF IOL groups except for glare when driving in the dark (evening or night), which occurred among 9 of 80 patients with BLF IOLs compared with 0 of 83 non-BLF IOLs (P < .001).
The findings of this cohort study suggest that use of BLF IOLs was not associated with reduced risk of injuries, whereas glare during nighttime driving was significantly worse in the BLF IOL group with pseudophakia.
蓝光过滤（BLF）人工晶状体（IOL）在临床实践中已广泛应用超过 20 年，已在全球数百万白内障患者中植入。然而，关于 BLF IOL 与损伤相关的证据很少。
评估 BLF IOL 与双眼白内障手术后所有原因和与交通事故相关的损伤以及驾驶时视力质量的关系。
设计、地点和参与者： 这是一项基于回顾性登记的队列研究，纳入了 2007 年 9 月 3 日至 2018 年 12 月 14 日期间接受双侧白内障手术且随访至 2021 年 12 月 14 日的患者。手术在芬兰科特卡凯梅拉洛斯基中央医院眼科进行。4986 名参与者中，2609 名接受了非 BLF IOL，2377 名接受了 BLF IOL。2015 年至 2016 年间接受双侧手术且目前正在开车的非 BLF IOL（n=102）或 BLF IOL（n=91）患者，使用结构化问卷接受了驾驶时视觉表现的访谈。
第二次手术后平均（SD）随访 2166（1110）天。
从患者病历中评估了第二次眼手术后所有原因和与交通事故相关损伤的风险，使用 Kaplan-Meier 和多变量 Cox 比例风险回归分析。为了提高随访精度，死亡和随访结束均被用作删失事件。
共纳入 4986 名患者进行分析（1707 名[34.2%]男性和 3279 名[65.8%]女性；首次手术时的平均（SD）年龄为 73.2（8.6）岁，第二次手术时的平均（SD）年龄为 74.3（8.8）岁）。第一次眼手术前无损伤生存率在非 BLF 和 BLF IOL 组之间相当（调整年龄和性别后的危险比，0.95[95%CI，0.81-1.13；P=0.57]）。在多变量 Cox 比例风险回归分析中，控制年龄和性别因素后，与非 BLF IOL 相比，BLF IOL 的使用并未显示在总体损伤方面具有优势（危险比，0.99[95%CI，0.88-1.11]；P=0.85）或任何损伤亚组。夜间（傍晚或夜间）驾驶时的眩光除外，非 BLF 和 BLF IOL 组的驾驶主观视觉表现参数均相当，BLF IOL 组中有 9 名患者出现眩光，而非 BLF IOL 组中则有 0 名患者出现眩光（P<0.001）。
这项队列研究的结果表明，BLF IOL 的使用与降低损伤风险无关，而在白内障术后人工晶状体眼的夜间驾驶时，BLF IOL 组的眩光明显更严重。
