Attenuating Photostress and Glare Disability in Pseudophakic Patients through the Addition of a Short-Wave Absorbing Filter

To evaluate the effects of filtering short wavelength light on visual performance under intense light conditions among pseudophakic patients previously implanted with a clear intraocular lens (IOL). This was a patient-masked, randomized crossover study conducted at 6 clinical sites in the United States between September 2013 and January 2014. One hundred fifty-four bilaterally pseudophakic patients were recruited. Photostress recovery time and glare disability thresholds were measured with clip-on blue-light-filtering and placebo (clear; no blue-light filtration) glasses worn over patients’ habitual correction. Photostress recovery time was quantified as the time necessary to regain sight of a grating target after intense light exposure. Glare disability threshold was assessed as the intensity of a white-light annulus necessary to obscure a central target. The order of filter used and test eye were randomized across patients. Photostress recovery time and glare disability thresholds were significantly improved (bothP<0.0001) when patients used blue-light-filtering glasses compared with clear, nonfiltering glasses. Compared with a nonfiltering placebo, adding a clip-on blue-absorbing filter to the glasses of pseudophakic patients implanted with clear IOLs significantly increased their ability to cope with glare and to recover normal viewing after an intensive photostress. This result implies that IOL designs with blue-light-filtering characteristics may be beneficial under intense light conditions.

Visual Performance in Patients with Neovascular Age-Related Macular Degeneration Undergoing Treatment with Intravitreal Ranibizumab

Purpose. To assess visual function and its response to serial intravitreal ranibizumab (Lucentis, Genentech) in patients with neovascular age-related macular degeneration (nv-AMD).Methods. Forty-seven eyes of 47 patients with nv-AMD, and corrected distance visual acuity (CDVA) logMAR 0.7 or better, undergoing intravitreal injections of ranibizumab, were enrolled into this prospective study. Visual function was assessed using a range of psychophysical tests, while mean foveal thickness (MFT) was determined by optical coherence tomography (OCT).Results. Group mean (±sd) MFT reduced significantly from baseline (233 (±59)) to exit (205 (±40)) (P=0.001). CDVA exhibited no change between baseline and exit visits (P=0.48andP=0.31, resp.). Measures of visual function that did exhibit statistically significant improvements (P<0.05for all) included reading acuity, reading speed, mesopic and photopic contrast sensitivity (CS), mesopic and photopic glare disability (GD), and retinotopic ocular sensitivity (ROS) at all eccentricities.Conclusion. Eyes with nv-AMD undergoing intravitreal ranibizumab injections exhibit improvements in many parameters of visual function. Outcome measures other than CDVA, such as CS, GD, and ROS, should not only be considered in the design of studies investigating nv-AMD, but also in treatment and retreatment strategies for patients with the condition.

The Visual Effects of Intraocular Colored Filters

Modern life is associated with a myriad of visual problems, most notably refractive conditions such as myopia. Human ingenuity has addressed such problems using strategies such as spectacle lenses or surgical correction. There are other visual problems, however, that have been present throughout our evolutionary history and are not as easily solved by simply correcting refractive error. These problems include issues like glare disability and discomfort arising from intraocular scatter, photostress with the associated transient loss in vision that arises from short intense light exposures, or the ability to see objects in the distance through a veil of atmospheric haze. One likely biological solution to these more long-standing problems has been the use of colored intraocular filters. Many species, especially diurnal, incorporate chromophores from numerous sources (e.g., often plant pigments called carotenoids) into ocular tissues to improve visual performance outdoors. This review summarizes information on the utility of such filters focusing on chromatic filtering by humans.