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• W2016041092 abstract "Mehdizadeh and Nowroozzadeh discuss the chromatic aberration effect that results in blue light focusing anterior to the retina in an emmetropic eye but focusing on the retina in some low level of a hyperopic pseudophakic eye and potentiating blue light–related phototoxicity by this effect. Such an unintended hyperopic error may occur while selecting IOL power for targeted emmetropia. Mehdizadeh and Nowroozzadeh suggest that induced myopia as in monovision will avoid such an error. They cite the study by Wang et al.4 describing the Blue Mountain Study results of refractive error and AMD to support their hypothesis. We think chromatic, aberration–related blue light–focusing details, such as they discussed in pseudophakic eyes, are far more complex. This complexity results from various interacting factors such as (1) a variety of corneal shapes and consequent aberrations, (2) a variety of IOL materials with different dispersive properties, (3) a variety of IOL materials with different UV-visible light-filtering properties, (4) a variety of IOL optical designs now available that are no longer simply spherical or monofocal, as the letter considers, but consist of a variety of asphericity and multifocality, and (5) optical effects of unintended and difficult-to-measure decentering and tilting of the IOL optic after implantation. Thus, in reality, retinal focusing is extremely complex and determined by the cornea, the final position and type of IOL, and the interaction between the pupil size–dependent monochromatic aberrations and the chromatic aberration of the resultant optics of the pseudophakic eye. The simple explanation given in the letter ignores this complexity. Additionally, Mehdizadeh and Nowroozzadeh refer to the Blue Mountain Study results4 to support their letter. However, this reference does not show any association of mild hyperopia defined as from 1.0 to 3.0 D but does show mild association with early AMD with greater than 3.0 D of hyperopia. Such a high level of hyperopia is too high for any reasonable expectation of simple chromatic effect, as the letter suggests, or even if one considers the complex overall imaging as we described with various interacting factors. Actually, the reference to Wang et al.4 conjectures that some mild association between more than 3.0 D of hyperopia and AMD may be linked to associations of genes common to these 2 entities. Our article's message is that retinal phototoxicity significantly increases with age, and the protection by IOLs is independent of age. The AcrySof Natural IOL (Alcon Laboratories), which filters UV radiation and blue light, provided the highest protection consistently against selected light sources among the examined IOLs. This message of increased retinal protection by UV radiation and blue light filtering is even more relevant with the possibility of enhanced blue light focusing by chromatic effect for the retina of simple hyperopic eyes, as Mehdizadeh and Nowroozzadeh have discussed, or even for any other complex image forming in real eyes, as we discussed above. In summary, blue light–filtering IOLs are also expected to serve patients with various refractive outcomes well since they significantly reduce the amount of short wavelength blue light reaching the retina. We thank Mehdizadeh and Nowroozzadeh for stimulating this discussion." @default.
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• W2016041092 title "Reply : Refractive error and age-related lipofuscin accumulation-mediated retinal phototoxicity" @default.
• W2016041092 doi "https://doi.org/10.1016/j.jcrs.2009.02.021" @default.
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