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Thread: Best paper I've read on Blue Light...

  1. #1
    sub specie aeternitatis Pete Hanlin's Avatar
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    Best paper I've read on Blue Light...

    Disclaimer- I am employed by Essilor.

    Over the past few years, I've read dozens of papers on the subject of blue light, as well as studies on the effects high energy visible light may have upon the eye. This week, I came upon an article written by a British professor named John Marshall that packs pretty much all the important information into just a few pages. If you only read one paper on blue light, this would definitely be my pick. There were one or two pearls I had not come across previously which explain why an eye care professional should pay attention to this subject.

    http://www.pointsdevue.com/sites/def...utm_medium=PDF

    Further disclaimer- Points de Vue is a publication funded by Essilor International. It contains articles on eye heath and ophthalmic optics authored by subject matter experts internal and external to Essilor. The content is scientific in nature, so there is very little if any marketing. If you like to geek out on these subjects (or if you are writing an article), you'll find a lot of resource material here. http://www.pointsdevue.com/
    Pete Hanlin, ABOM
    Vice President Professional Services
    Essilor of America

    http://linkedin.com/in/pete-hanlin-72a3a74

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    Master OptiBoarder
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    Thanks Pete. Enjoyed that.

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    Master OptiBoarder OptiBoard Silver Supporter lensmanmd's Avatar
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    +1
    This is worth sharing with our ODs and MDs. I'm glad to see that there is a study that points away from the 455nm of tablets and smartphones and focuses more on artificial light that is lower on the spectrum and more in line with blue violet. Good stuff, indeed.

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    Went to Lowe's the other day to replace a lightbulb and realized that they've completely gotten rid of CFLs and incandescents in favor of an exclusively LED selection. Looks like Wally World is in the process of doing the same.

    What're the long-term implications for human eyesight when the entire country has, in 10-15 years, switched over to exclusively LED light sources?

  5. #5
    sub specie aeternitatis Pete Hanlin's Avatar
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    Quote Originally Posted by Browman View Post
    Went to Lowe's the other day to replace a lightbulb and realized that they've completely gotten rid of CFLs and incandescents in favor of an exclusively LED selection. Looks like Wally World is in the process of doing the same.

    What're the long-term implications for human eyesight when the entire country has, in 10-15 years, switched over to exclusively LED light sources?
    I think this is an interesting question, and it is one that merits research. The Europeans are a decade or so ahead of us in heading down the LED path, and their governments have more or less determined there is no impact on human health (of course, they also have an interest in ensuring conversion to LED lighting occurs- since it helps them keep ahead of the power capacity vs. power consumption equation).

    While it is quite possible the switch to blue emitting lighting may indeed have no effect on our vision and health, it's probably important to actually study the issue, and not dismiss it with papers such as one that created a lot of noise last year (Low-energy light bulbs, computers, tablets and the blue light hazard, JB O'Hagan, M Khazova and LLA Price). The authors conclude that LEDs pose "no appreciable hazard," even though they cite no research that validates this conclusion. Rather, they base their assumptions on "safe levels" of exposure on the Guidelines on limits of exposure to incoherent visible and infrared radiation (published by the International Commission on Non-ionizing Radiation Protection). What they fail to note is the guideline is only intended to note safe levels of exposure to avoid immediate and acute damage. Within the guideline, the ICNIRP notes there are no long term studies to determine what adverse effects may occur from long-term low-intensity exposure, so they have not attempted to determine safe levels of long-term exposure.

    And there's the rub. Unlike the link between UV exposure and cataracts- which was conclusively made by the Beaver Damn Eye Study and the Chesapeake Watermen Study- there is no long-term study indicating safe levels of blue light exposure (although researchers have gone back through the data of the aforementioned studies and have found evidence to link blue light exposure to AMD). There is no question that blue light around the 435nm range has a phototoxic effect, what we don't know is "to what extent."

    Personally, I suspect the "truth" probably falls where it usually does (i.e., between the extremes). The thing that concerns me the most is the way we meddle with the eye's "natural defense" against blue light. As we age, our crystalline lenses start to filter blue light (which is convenient, because as we age our retinas become less capable of dealing with the effects of blue light). However, in the USA we do a great job of removing those aging lenses (>3 million people have cataract surgery each year in the US), and- about 50% of surgeries- the patient is fitted with a non-blue filtering IOL. Therefore, each year the retinas of about 1.5 million Americans are introduced to a much increased dose of blue light at a stage of life when they aren't readily able to handle it. Makes one think...

    Sorry for the length... :^)
    Pete Hanlin, ABOM
    Vice President Professional Services
    Essilor of America

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    Master OptiBoarder OptiBoard Silver Supporter lensmanmd's Avatar
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    Pete,

    You bring up a point that I had not considered, IOLs. I am meeting with our chiefs of optometry next week and I will bring this up to them as well. Thanks for bringing this point up.

    Though much of of the HEV hype, IMO, is mostly about marketing, I do believe that there is a long term risk associated with sub 450nm. We, as an industry, have done well to protect the general public from 400nm and below. I just wish that there was a more emphasis put on studies of HEV from LED and CFL that bombard us on a daily basis in schools, office buildings and homes.

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    What's up? drk's Avatar
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    Nothingburger.

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    Great primer, Pete. Thanks for sharing.

    There's an old white paper I really like on the topic for its logical approach to the state of blue-light research: http://pocklington-trust.org.uk/wp-c...ed-macular.pdf
    It's from 2005 with a 2008 emendation.

    I do present the issue of blue light exposure to patients when discussing coating options. I think it's important to note that "blue-blocking" does come at a cost to the potential anti-glare performance. Particularly in the case of post-cataract surgery patients with new IOLs, new magnitudes of glare are to be largely expected. It's also important to note there are IOLs that block Blue Light as well--with the only loss of color perception being identifiable in scotopic conditions and little-to-no suggestion that patients ever notice the difference in real life. Our lens coating recommendations to patients should factor in the IOL product they're in.

    When it comes to blue-light's danger to public health, the publications I've seen still say the evidence is "equivocal" despite some toxicity being clearly demonstrable in a clinical setting. Would you care to comment on whether your recent source presented here includes/cites anything that diminishes that fog of uncertainty any more than existed ten years ago? Are we any closer to some population studies that help us define the contours of risk? (Namely, blue light exposure causing significant differentials of AMD incidence in the Risk Corridors: Smoking, Being Caucasian, Family History of AMD, and None-of-the-Above?)

    I didn't see your paper try to make any dubious claims, and I'm not trying to snare you into doing so either. I personally lean in the direction of thinking there's enough smoke to let patients decide for themselves if they want to be cautious of fire. (Especially the kids who hold their devices less than a foot away from their face for endless hours.) But taking the devil's advocate position for the sake of good Science, can we check off anything on the list of missing logical validities presented in my older lit review?
    Last edited by Hayde; 02-22-2017 at 03:06 PM.

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    sub specie aeternitatis Pete Hanlin's Avatar
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    As you mention, there are IOLs that filter blue light. My understanding is approximately 50% of the 3.1 million IOLs implanted each year are blue-blocking (usually providing the amount of blue filtering consistent with a 30-40 year old crystalline lens).

    The best "smoking gun" I've seen was a study featured in the Journal of Cataract & Refractive Surgery titled "Prevention of increased abnormal fundus autofluoresence with blue light-filtering intraocular lenses" (you can find the study here http://www.sciencedirect.com/science...86335015010330).

    The study included 131 eyes fit with IOLs (52 with blue-filtering IOLs and 79 with clear IOLs). Two years after surgery, none of the eyes fit with blue-filtering IOLs showed abnormal fundus autofluorescence- however, development or increase of autofluorescence was found in 12 of the eyes fit with clear IOLs. Also, the incidence of AMD was statistically significantly higher in the clear IOL group (p=0.042).

    Yes, the study could have been larger (I would hope there are researchers following up as I type)- but this is the kind of data that leads me to conclude that yes, blue light is a real problem- especially for eyes that are no longer "protected" by a yellowing natural crystalline lens. Once you accept that blue light is likely a contributing factor to AMD, the question becomes "How much exposure is enough to trigger a negative impact (and as an optician, what should I be doing for my patients)?"

    For sure, patients should be encouraged to protect themselves from sunlight (which they should be doing anyway, to prevent UV damage). In some ways, blue light from the sun is worse than UV (after all, a crystalline lens can be replaced- but a retina cannot). If I'm not encouraging patients to wear a hat and either sunglasses or photochromic lenses when they go outside, I'm just not doing my job (good lord, it only takes a moment to make such a recommendation). Personally, after reading study after study on blue light I find myself religiously wearing my sunglasses when I'm outside (plus, light really bothers me anyway).

    Indoors? Admitting to possible bias, I think I would be pretty comfortable recommending lenses with the Smart Blue Filter feature (yes, these lenses are made by Essilor). The lenses are basically clear, there's no extra charge for it (found in Eyezen+ and digital Varilux progressive lenses), and they reduce exposure to blue-violet light which has no known beneficial effect and may be a contributing factor to retinal disease.
    Pete Hanlin, ABOM
    Vice President Professional Services
    Essilor of America

    http://linkedin.com/in/pete-hanlin-72a3a74

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    Quote Originally Posted by Pete Hanlin View Post
    As you mention, there are IOLs that filter blue light. My understanding is approximately 50% of the 3.1 million IOLs implanted each year are blue-blocking (usually providing the amount of blue filtering consistent with a 30-40 year old crystalline lens).

    The best "smoking gun" I've seen was a study featured in the Journal of Cataract & Refractive Surgery titled "Prevention of increased abnormal fundus autofluoresence with blue light-filtering intraocular lenses" (you can find the study here http://www.sciencedirect.com/science...86335015010330).

    The study included 131 eyes fit with IOLs (52 with blue-filtering IOLs and 79 with clear IOLs). Two years after surgery, none of the eyes fit with blue-filtering IOLs showed abnormal fundus autofluorescence- however, development or increase of autofluorescence was found in 12 of the eyes fit with clear IOLs. Also, the incidence of AMD was statistically significantly higher in the clear IOL group (p=0.042).

    Yes, the study could have been larger (I would hope there are researchers following up as I type)- but this is the kind of data that leads me to conclude that yes, blue light is a real problem- especially for eyes that are no longer "protected" by a yellowing natural crystalline lens. Once you accept that blue light is likely a contributing factor to AMD, the question becomes "How much exposure is enough to trigger a negative impact (and as an optician, what should I be doing for my patients)?"

    For sure, patients should be encouraged to protect themselves from sunlight (which they should be doing anyway, to prevent UV damage). In some ways, blue light from the sun is worse than UV (after all, a crystalline lens can be replaced- but a retina cannot). If I'm not encouraging patients to wear a hat and either sunglasses or photochromic lenses when they go outside, I'm just not doing my job (good lord, it only takes a moment to make such a recommendation). Personally, after reading study after study on blue light I find myself religiously wearing my sunglasses when I'm outside (plus, light really bothers me anyway).

    Indoors? Admitting to possible bias, I think I would be pretty comfortable recommending lenses with the Smart Blue Filter feature (yes, these lenses are made by Essilor). The lenses are basically clear, there's no extra charge for it (found in Eyezen+ and digital Varilux progressive lenses), and they reduce exposure to blue-violet light which has no known beneficial effect and may be a contributing factor to retinal disease.
    Thanks again!

    The sample size isn't too bad, p=0.042 I think limbos under the wire just enough to make a clear point. Agreed a larger follow-up to punctuate it will surely be welcome. As you say, then the next question to answer "how much exposure...?" We might call it 'blue light sensitivity,' which I imagine will present another tangle of knots to untie for individualized patient care.

    The study you mention reiterates the point that we need to be up to speed on an individual patient's IOL brand before determining eyewear recommendations. (For those of us serving an Ophthalm practice's patient base, usually the docs have just a few go-to's that make up the bulk of their IOL implants.)

    When we're selling "risk aversion," doing so responsibly means doing all we can to accurately assess & articulate the real risk for any given patient as much as possible so they can make an informed decision. (Science, she's slow to give up the answers....) I like that the Big E started doing blanket blue-blocking of their newer product lines--makes life a little simpler. It'll be a long while before we can assume any given patient has an IOL with the same protection.

    You're right that indoors is a bigger can of worms. I tend to go with the basics of radiation: intensity, distance, time. The first variable is harder to come by...(and we don't have an equation to plug it into yet anyway,) but the latter two a patient can self-report fairly well. If they're short/long, then they're getting the "Blue" spill from me even if they're vampires who never see the sun.

    Enjoyed the resources and the discussion! Thank you, Pete.


    ***
    ('accurately assess and articulate'...probably a personal record for alliteration.)

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    Master OptiBoarder OptiBoard Silver Supporter ak47's Avatar
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    Pete, perhaps you can shed some light on why most of these only cut down on 10-20% of the 400-450 nm wavelengths. I believe that these wavelengths may mean real (not imagined or market-invented) trouble, but I am far from convinced that reducing these by a mere 10% or so if going to make a meaningful difference in outcomes. What portion of this light is eliminated by some IOLs?

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    Eyes eastward... Uilleann's Avatar
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    Quote Originally Posted by drk View Post
    Nothingburger.
    This makes me giggle.

    And agree profusely. :)

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    What's up? drk's Avatar
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    Well, not to get too political, but the guy refers to evolution like, six or seven times. That's a warning. So is the reference to the ozone hole. It's tells you a little about how he thinks.

    He's amazingly credentialed though.

    Secondly, there's no evidence in the paper, save some oblique reference.

    It's just a bunch of re-stating what we already have known: maybe, maybe not.

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    Quote Originally Posted by drk View Post
    ...He's amazingly credentialed though...
    I find that often has little effect on being totally wrong, or just being plain old crazy.

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    sub specie aeternitatis Pete Hanlin's Avatar
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    Quote Originally Posted by ak47 View Post
    Pete, perhaps you can shed some light on why most of these only cut down on 10-20% of the 400-450 nm wavelengths. I believe that these wavelengths may mean real (not imagined or market-invented) trouble, but I am far from convinced that reducing these by a mere 10% or so if going to make a meaningful difference in outcomes. What portion of this light is eliminated by some IOLs?
    There's a couple of reasons why most "blue filtering" products only block 10-20% of the 415-455nm range (Harmful Blue Light, or HBL).
    Cosmetics- There are two ways an ophthalmic lens can reduce exposure to HBL- reflection or absorption. Products that reflect (e.g., Hoya Recharge EX3, Crizal Prevencia, Kodak BlueReflect) will look purplish (because that is the color of the HBL they are reflecting). Dialing up the level of blue light filtering would involve turning these no-glare products into mirrored products (mirror and no-glare surfaces are created the same way in the same equipment, just with different stacks). The result would be a strikingly "hey I can see your purple lenses from across the room" effect. That probably wouldn't be acceptable to the majority of consumers.
    Products that absorb (e.g., Transitions, Zeiss PhotoFusion, and Hoya Sensity adaptive lenses, Essilor Smart Blue Filter, BluTech, Kodak Total Blue, etc.) will become yellowish if they absorb large amounts of blue-violet light. You can reduce this appearance somewhat by managing the transmission spectrum (i.e., introducing another color into the lens to neutralize the yellow effect), but filtering above 20-25% of HBL is going to cause an unavoidably yellow appearance. Market research suggests most consumers (at least today) are not willing to wear a "clear" lens that filters more than 25% of HBL.
    Beneficial Blue Light- The other reason you can't filter 100% of HBL is the presence of beneficial blue light (blue-turquoise), which is camped out right next door on the spectrum (465-490nm). A lens that absorbs 50%+ of HBL is going to absorb the light that helps regulate your circadian rhythm. There are several products on the market with a decidedly yellow appearance- they all block at least part of the 465-490nm band of light.

    Most products which reduce exposure to an undesirable substance or element do not totally eliminate exposure. For example, to call a product "low fat" or "low sugar," the FDA requires only that the product have 20-25% less fat/sugar/etc. than a "normal" version of the same food. Both Crizal Prevencia and the Smart Blue Filter feature reduce exposure to HBL by at least 20% (and if you combine the two, that increases to around 30%). As has been discussed in this thread, although it seems pretty clear that HBL has the potential to cause damage to the retina, the question of how much exposure is required to trigger negative effects is still open. In vitro testing seems to indicate reducing exposure by 20% has a positive effect, but (this is a personal opinion) IMO products that filter 20-40% of HBL should not be considered adequate protection during outside activities. Indoors, reducing 20% or so of the already low levels of HBL may be beneficial. However, if I'm outside, I want to reduce HBL by 80-90+%, and this can only be accomplished with either a dedicated sunlens or a photochromic product. Bias aside, if you have a patient who really does require protection from HBL (i.e., patient has already been diagnosed with AMD or RP) that patient should be wearing Transitions XTRActive adaptive lenses- period. Even in their non-activated (indoors) state, these lenses block 34% of HBL. Outside, they block up to 95% of HBL (depending on activation level). I am unaware of any other single lens option that provides more comprehensive HBL reduction and can be worn both indoors and outside (disclaimer, I am employed by Essilor- who manufactures Transitions adaptive lenses).
    Pete Hanlin, ABOM
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    Eyes eastward... Uilleann's Avatar
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    When are the double blind, blue light in vivo trials scheduled to begin? I'll be paying close attention to those of course!

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    sub specie aeternitatis Pete Hanlin's Avatar
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    Re: Nothingburger
    Unfortunately, a lot of the HBL messaging has involved sensational reports of how electronic devices are potentially damaging to the eye. IMO, some practitioners have understandably reacted negatively to this messaging, because there simply isn't any solid research to definitively prove that the amount of HBL produced by electronic devices (or even LED lighting, which creates higher levels of exposure) is capable of damaging the eye (to quote drk "maybe, maybe not").
    However, there is practically 0% doubt that the levels of HBL in sunlight do cause retinal damage- and that is the message that seems to be getting lost. Here's the deal, we're living longer. In the past, we died in our late 60s or early 70s- right before our retinas were about to give in to the issues discussed in John Marshall's paper. Today, many are commonly living into their 80s and 90s (hooray for modern medicine), which provides enough time for the retina to give out- potentially resulting in AMD and blindness (AMD is on the rise and predicted to double over the coming decades). Since the effects of HBL are cumulative, reducing exposure to it may indeed buy the retina some more time and reduce the number of 80-somethings out there with AMD. Yes, your genetics, lifestyle (stop smoking), and diet (eat your veggies) are the primary determiners of whether you will develop AMD (or actually live into your 80s-90s, for that matter :^). However, HBL is kinda like sugar. Reducing exposure to it reduces stress on the system- which may prevent the development of bad things. Sugar may not cause diabetes, but a diet high in corn syrup (aka "the American diet") can certainly push a system that is already stressed due to genetic and other factors over the edge.

    For anyone inclined to do a bit of reading, there is a whole slew of studies that rather definitively demonstrate that HBL is damaging to the eye. Besides the earlier posted link (which studied post-cataract patients), there is a 2001 paper based upon the Beaver Dam eye study which delved back into the original data to see if blue light could be associated with AMD. The researchers were able to separate out individuals by not only their exposure to UV but by their exposure to HBL, and the data suggested that yes, there was a correlation between HBL exposure and incidence of AMD.
    Cruickshanks, K.J., et.al. (2001) Sunlight and the 5 year incidence of early age-related maculopathy: the Beaver Dam eye study. Arch Ophthalmol. 119(2):246-50.

    There is also some discussion among practitioners regarding exactly what bands of light are most harmful. Numerous "blue-filtering" products on the market block mainly 380-420nm light (if the product is demonstrated by showing that it blocks a blue laser pen, this is probably the range of light the product filters- because the blue laser pen is going to be a 405nm light source). The important band of light to filter is 415-455nm (and the problem with the laser pen demo is you can completely block a 405nm laser pen and still allow a lot of this band of light through the lens). An example of a paper explaining why the 415-455nm band of light is important would be:
    Guo-Yuan Sui, Guang-Cong Liu, Guang-Ying Liu, et.al. Is sunlight exposure a risk factor for age-related macular degeneration? A systematic review and meta-analysis. Br J Ophthalmol (link http://bjo.bmj.com/content/97/4/389).

    A couple other interesting reads:
    Fletcher, A.E., et.al. (2008) Sunlight exposure, antioxidants, and age-related macular degeneration. Arch Ophthalmol. 126(10):1396-403.
    Marquioni-Ramella MD, Suburo AM. Photo-damage, photo-protection and age-related macular degeneration. Photochem.Photobiol.Sci., 2015, 14, 1560.
    Funk RHW, Schumann U, Engelmann K, Becker KA, Roehlecke C. Blue light induced retinal oxidative stress: Implications for macular degeneration. World J Ophthalmol. 2014; 4(3): 23-34.
    Pete Hanlin, ABOM
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  18. #18
    What's up? drk's Avatar
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    Quote Originally Posted by Uilleann View Post
    When are the double blind, blue light in vivo trials scheduled to begin? I'll be paying close attention to those of course!
    No, you'll be double-blind if you don't get a blue blocker.

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    What's up? drk's Avatar
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    So, Pete, let's wear:

    1. polycarb or high index when you can (we are 100% in that category)
    2. sunglasses when we can (we are NOT 100% in that category)

    The computer/digital device scare is possibly real, but we just don't know. Should we be telling patients that "we kind of sort of think it may be an issue, so buy this coating"?

    I have my credibility at stake. I don't tell blue-eyed patients to take lutein supplements because maybe I kinda-sorta-think that probably it will help them.

    We need evidence, man. We're health care professionals, here. You don't want your physician to put you on a statin without some serious evidence of 1. risk and 2. reduction of risk.

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    Quote Originally Posted by drk View Post
    So, Pete, let's wear:

    1. polycarb or high index when you can (we are 100% in that category)
    2. sunglasses when we can (we are NOT 100% in that category)

    The computer/digital device scare is possibly real, but we just don't know. Should we be telling patients that "we kind of sort of think it may be an issue, so buy this coating"?

    I have my credibility at stake. I don't tell blue-eyed patients to take lutein supplements because maybe I kinda-sorta-think that probably it will help them.

    We need evidence, man. We're health care professionals, here. You don't want your physician to put you on a statin without some serious evidence of 1. risk and 2. reduction of risk.
    This is an excellent point, and an issue I struggled with myself when our office decided we were becoming a "blue light practice." I gave patients as much information as I could in as concise a manner as possible, for the sake of my own conscience. I informed them that there was evidence to suggest x, y, z, that the jury was still out on it being 100% "for sure," and left literature in the waiting room for the patients to review themselves, from Essilor's original paper to some documents from science journals regarding blue light. For me, personally, the phrase "POTENTIAL risk" was enough to ease my conscience both that I wasn't conning patients or potentially placing them at risk. To everyone's benefit, this approach really seemed to reach patients, and the majority ended up walking out the door with some sort of blue blocking AR.

  21. #21
    What's up? drk's Avatar
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    If it's in your office, you are endorsing it, IMHO.

    They can get "speculative information" anywhere, like this website.

    They come to you for your professional OPINION. Answers, not questions.

    My conscience can't be pricked by anyone who comes along with a sales pitch.

    What's next? Backside AR that doesn't selectively reflect UV? (Oh, wait.)

    I respect your professionalism, however, and your right to handle it the way you best feel.

  22. #22
    sub specie aeternitatis Pete Hanlin's Avatar
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    I agree, patients trust their eyes to their optometric physician- and your treatment plan has to reflect your informed opinion. Kudos for recommending polycarbonate and sun protection, I wish everyone did. As to recommending the purchase of products that reduce exposure to indoor sources of HBL, proceed as you will with a clean conscious, you'll get no criticism either way from me. After all, I would certainly hope my medical practitioner would not recommend treatments s/he believes to be ineffective/unnecessary! I also join you in being less than fully convinced that the amount of light coming from a smartphone is enough to trigger damage (although when I see my kids spending hour after hour with those things 12" from their eyes, I do wonder what consequences there may be for low-dose exposure over very long periods of time).

    The HBL filtering feature found in many Varilux progressive lenses and all Transitions adaptive lenses is built in and- to the best of my knowledge- included at no additional cost to the patient. Sure, Essilor is hoping that a practitioner who believes it is important to reduce exposure to HBL may elect to recommend Varilux over other products for this reason, but otherwise it's just an included (and practically invisible) feature. When I hung up my PD ruler to join Essilor, I was already using Varilux products. Even with my own doubts as to the impact of electronic devices, I can't think of a reason why I would have objected to having them add a feature that reduces exposure to HBL by 20%, especially if I wasn't being asked to charge for it. Regarding Crizal Prevencia, it is the same cost as Crizal Sapphire UV, so I would probably give the patient access to the brochure, and- if asked about it- would note that yes, HBL at the levels produced by the sun is certainly not good for the eye and yes, electronic devices do emit the same kind of light- albeit at lower levels, and we just don't know if there is cause for alarm. If a thus-informed patient selected Crizal Prevencia no-glare at that point, I'd be fine providing it. As you said, to each his/her own. That's just the way I would handle it if I owned an optical today.

    I'm assuming you are also referencing Crizal products with the reference to "selective reflections and UV?" That's another discussion for another day, but suffice it to say that- as you already know- the polycarbonate lenses you recommend naturally prevent 100% of the UV striking the front of the lens from reaching the eye. AND- assuming they have just a scratch coating- those poly lenses reflect only about 6% of the UV striking the back of the lens back into the eye- so, no problem. Unfortunately, some ARCs used on poly lenses reflect 40% (or more) of the UV striking the back surface into the eye, which considerably increases exposure to UV. Crizal no-glare products are designed to reflect less than 4% of UV. In other words, a poly lens with no AR is fine (well, other than the annoying reflections). A poly lens with some types of AR may be exposing the wearer to more UV than you think, and a poly lens with any of the Crizal no-glare coatings will bring the UV reflection back down to- and below- the normal reflection expected from the material.

    Great conversation, and have a splendid weekend!
    Pete Hanlin, ABOM
    Vice President Professional Services
    Essilor of America

    http://linkedin.com/in/pete-hanlin-72a3a74

  23. #23
    Master OptiBoarder
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    Quote Originally Posted by Browman View Post
    This is an excellent point, and an issue I struggled with myself when our office decided we were becoming a "blue light practice." I gave patients as much information as I could in as concise a manner as possible, for the sake of my own conscience. I informed them that there was evidence to suggest x, y, z, that the jury was still out on it being 100% "for sure," and left literature in the waiting room for the patients to review themselves, from Essilor's original paper to some documents from science journals regarding blue light. For me, personally, the phrase "POTENTIAL risk" was enough to ease my conscience both that I wasn't conning patients or potentially placing them at risk. To everyone's benefit, this approach really seemed to reach patients, and the majority ended up walking out the door with some sort of blue blocking AR.
    People are adults. They can navigate decisions about uncertainty. It's ok to talk about uncertainties, so long as they're presented accurately. My experience is identical to Browman's.

    "This treatment filters specific frequencies of blue light which studies have shown are at least a risk factor in the onset of AMD. To what extant that's true in nature, they're still studying...but for those in high-risk categories they make coatings like this for those who want to take the extra precaution."

    As for indoors, I put my kids in Prevencia. Being clear on the state of research, it just makes me feel better. Didn't cost a dime more than Sapphire, which I would have done otherwise. Nobody gets through a day of life without calculating around uncertainties. I don't begrudge patients breaking 'skeptical' or 'risk averse.' (I do begrudge patients who think they're immune to UV rays.) They both get the same presentation and got to make an informed decision. So they both come back.

  24. #24
    Ghost in the OptiMachine Quince's Avatar
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    Quote Originally Posted by drk View Post
    The computer/digital device scare is possibly real, but we just don't know. Should we be telling patients that "we kind of sort of think it may be an issue, so buy this coating"?

    I have my credibility at stake. I don't tell blue-eyed patients to take lutein supplements because maybe I kinda-sorta-think that probably it will help them.

    We need evidence, man. We're health care professionals, here. You don't want your physician to put you on a statin without some serious evidence of 1. risk and 2. reduction of risk.
    I use personal experience and that of my fellow opticians/ techs. If a rep asks me to try a blue blocker of any sort to get a feel for it I will. Then I will base an opinion off of that and the collaborative experiences.

    I feel a difference. I feel it differently between coating and BluTech and clear filters. I'm not asking you to take my word for it. Instead, I think any provider who wants the best for their patients would do their own field research and feel the difference. I understand not wanting to rip off your patients and I don't do that, but I do offer them ways to reduce eye strain and enhance night driving viability.
    Have I told you today how much I hate poly?

  25. #25
    What's up? drk's Avatar
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    1. I appreciate the classiness of Pete Hanlin
    2. I think if a patient is concerned, then essilor's product is top-notch.
    3. I'm not sure that one can feel "strain" from blue light damage, Quince. If you're talking visible light-related "strain", then I agree that some people seem to be sensitive.

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