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Effect of Blue-Light Filtering IOLs on the Development and Progression of Macular Atrophy in Eyes With Neovascular AMD
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
To assess the effect of blue-light filtering (BLF) intraocular lenses (IOLs) on the development and progression of macular atrophy (MA) in eyes with neovascular age-related macular degeneration (nAMD).
DESIGN
Retrospective clinical cohort study.
METHODS
nAMD patients with anti-vascular endothelial growth factor (VEGF) injections who underwent uneventful cataract surgery between 2007 and 2018 with follow-up until June 2023. Subsequent MA rates were compared between subjects who received a BLF IOL or a non-BLF IOL. All OCT scans were manually reviewed in a masked manner regarding patient baseline variables and IOL status by an experienced research technician. Using the Heidelberg software, the area of MA was manually evaluated and calculated (mm2) by the program. The overall risk of developing new-onset MA and the effect of IOL type on disease progression were assessed. Death was included as a censoring event.
RESULTS
Included were 373 eyes of 373 patients (mean age 78.6±6.7 years at surgery, 67.4% females). 206 eyes were implanted with BLF IOLs and 167 with non-BLF IOLs with comparable follow-up times (3164±1420 days vs. 3180±1403 days, respectively, P=0.908), and other baseline parameters (age, gender, corrected distance visual acuity, macular thickness, cumulative number of anti-VEGF injections). Nine pre-existing and 77 new-onset MA cases were detected, with similar distribution between BLF and non-BLF eyes (P=0.598 and P=0.399, respectively). Both univariate Kaplan-Meier (P=0.366) and multivariate Cox regression analysis adjusted for age and gender showed that BLF-IOLs were comparable to non-BLF IOLs regarding hazard for new-onset MA (HR 1.236, 95% CI 0.784-1.949, P=0.363). Final MA area at the last visit was 5.14±4.71mm2 for BLF IOLs and 8.56±9.17mm2 for non-BLF IOLs (P=0.028), with the mean annual MA area increase of 0.78±0.84mm2 and 1.26±1.32mm2, respectively (P=0.042).
CONCLUSIONS
BLF IOLs did not show added benefit over non-BLF IOLs in terms of MA-free survival but were associated with less progression over time in a cohort of nAMD patients.
Additional Info
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The effect of blue-light filtering intraocular lenses on the development and progression of macular atrophy in eyes with nAMD
Am J Ophthalmol 2024 Apr 29;[EPub Ahead of Print], A Achiron, O Trivizki, B Knyazer, U Elbaz, I Hecht, S Jeon, P Kanclerz, R TuuminenFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Achiron and co-authors reported the results from a retrospective cohort study that examined the protective effect of blue-light filtering (BLF) intraocular lenses (IOLs) against the development and progression of macular atrophy (MA) during anti-VEGF treatment in eyes with neovascular age-related macular degeneration (nAMD). The authors showed promising data indicating that BLF IOLs could slow down the progression of MA when compared with non-BLF IOLs. However, the incidence of MA in the two treatment groups showed no significant difference. These are important findings that not only verify the beneficial effects of BLF IOLs in eyes with nAMD but also present supportive evidence for the phototoxic mechanism of MA progression.
Notably, since anti-VEGF drugs may have a significant impact on outer retinal atrophy,1 anti-VEGF treatment as a confounding factor for MA development and progression in both groups (BLF and non-BLF IOL groups) requires further analysis. Anti-VEGF therapy–related factors, such as the length of the anti-VEGF treatment course, biomarkers indicating nAMD activity, and the type of anti-VEGF agents used, need detailed subgroup analysis.
Reference