Yao Jinglei, Jiang Zhaocai, Zhang Hui, Chen Hong, Li Tian, Yuan Mengke
Department of Ophthalmology, Beijing Jingmei Group General Hospital, Beijing, China.
Medicine (Baltimore). 2025 Aug 29;104(35):e43915. doi: 10.1097/MD.0000000000043915.
The increasing use of digital devices has raised concerns about the effects of blue light exposure on overall well-being. Blue light-filtering intraocular lenses (BF-IOLs) have been developed to mitigate these effects, particularly in cataract surgery. This systematic review and meta-analysis aimed to evaluate and compare the benefits of BF-IOLs and standard intraocular lenses (IOLs) on the subjective sleep quality of cataract patients.
Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive literature search was conducted across PubMed, Embase, and the Cochrane Library from inception to May 2024. Studies that compared BF-IOLs with standard IOLs in cataract patients were included. Risk of bias was assessed using the revised Cochrane Risk-of-Bias tool for randomized trials (RoB 2.0).
A total of 8 studies, including 1007 patients, were analyzed. These studies showed variability in design and quality, with some exhibiting moderate-to-high risks of bias. The random-effects model indicated that BF-IOLs were associated with a slight, statistically nonsignificant improvement in subjective sleep quality in cataract patients, with limited clinical relevance compared with standard IOLs (4-12 months postimplantation), with a standardized mean difference of 0.10 (95% confidence interval [CI]: 0.00-0.21). However, no significant between-group difference was observed in the longer term (6-12 months), with a standardized mean difference of 0.03 (95% CI: -0.08 to 0.13). Objective sleep parameters, such as sleep efficiency and total sleep time, also showed favorable effects for BF-IOLs. For sleep efficiency, the overall combined effect size was small-to-medium (Hedge's g = 0.18; 95% CI: 0.17-0.92), with moderate heterogeneity (I2 = 26.94%). For total sleep time, a small-to-medium effect size was observed (Hedge's g = 0.22; 95% CI: -0.18 to 0.76), with low heterogeneity (I2 = 17.41%). A moderate effect was found in Pittsburgh Sleep Quality Index scores (Hedges' g = 0.41), while the wide confidence interval (95% CI: 0.08-1.83) indicated high imprecision and uncertainty in the estimate.
BF-IOLs exhibited potential benefits in improving subjective sleep quality shortly after implantation. Further high-quality, long-term randomized controlled trials are required to substantiate these findings and optimize clinical recommendations for cataract surgery patients.
数字设备的使用日益增加，引发了人们对蓝光暴露对整体健康影响的担忧。已研发出蓝光滤过型人工晶状体（BF-IOL）来减轻这些影响，尤其是在白内障手术中。本系统评价和荟萃分析旨在评估和比较BF-IOL与标准人工晶状体（IOL）对白内障患者主观睡眠质量的益处。
按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，从创刊至2024年5月在PubMed、Embase和Cochrane图书馆进行了全面的文献检索。纳入了比较白内障患者中BF-IOL与标准IOL的研究。使用修订后的Cochrane随机试验偏倚风险工具（RoB 2.0）评估偏倚风险。
共分析了8项研究，包括1007例患者。这些研究在设计和质量上存在差异，一些研究存在中度至高度的偏倚风险。随机效应模型表明，BF-IOL与白内障患者主观睡眠质量的轻微改善相关，但与标准IOL相比，临床相关性有限（植入后4 - 12个月），标准化均差为0.10（95%置信区间[CI]：0.00 - 0.21）。然而，从长期来看（6 - 12个月），组间未观察到显著差异，标准化均差为0.03（95% CI：-0.08至0.13）。客观睡眠参数，如睡眠效率和总睡眠时间，也显示出BF-IOL的有益效果。对于睡眠效率，总体合并效应量为小到中等（Hedge's g = 0.18；95% CI：0.17 - 0.92），异质性中等（I2 = 26.94%）。对于总睡眠时间，观察到小到中等的效应量（Hedge's g = 0.22；95% CI：-0.18至0.76），异质性较低（I2 = 17.41%）。匹兹堡睡眠质量指数评分中发现了中等效应（Hedges' g = 0.41），而较宽的置信区间（95% CI：0.08 - 1.83）表明估计的不精确性和不确定性较高。
BF-IOL在植入后不久改善主观睡眠质量方面显示出潜在益处。需要进一步开展高质量、长期的随机对照试验来证实这些发现，并优化针对白内障手术患者的临床建议。
