Blue light–blocking intraocular lenses (IOLs) trade off rod-mediated visual function for limited protection against acute retinal phototoxicity.1 Twenty-five years ago, I cautioned ophthalmologists and manufacturers that clear IOLs transmitted potentially harmful 330- to 400-nm UV radiation (UVR) to the retina.2,3 Within a few years, most manufacturers incorporated UVR-blocking chromophores into IOLs.4 Eighteen years ago, I suggested blocking violet light in addition to UVR.4 Violet light has substantial potential retinal phototoxicity but little effect on scotopic (nighttime) or photopic (daytime) vision.5- 7 Nonetheless, visible light–blocking IOLs have been introduced only recently in the United States.
The solid line and dashed lines are the transmittance spectrum of a 20-diopter (D) AcrySof UV only–blocking intraocular lens (IOL) (Alcon Inc, Dallas, Tex) and a 20-D AcrySof Natural IOL (Alcon Inc).11 The area between the curves is amount of violet, blue, and green light transmitted to the retina by an AcrySof UV only–blocking IOL but blocked by an AcrySof Natural IOL. Blocked light theoretically decreases rod-mediated visual function and the risk of acute UV-blue retinal phototoxicity.1
The Purkinje shift is the change in peak spectral sensitivity from longer to shorter wavelengths as illumination decreases.7 Thus, rod-mediated scotopic sensitivity (nighttime vision) is much more dependent on violet and blue light than cone-mediated photopic sensitivity (daytime vision).
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