no clothes.jpg
這兩天看一篇今年美國眼科醫學會(American Academy of Ophthalmology)Dwayne Logan醫師所發表的文章 When are we going to say it? ,這一篇文章用幽默的筆調寫出他心中的疑慮:這五年間有250萬人植入所謂抗藍光的黃色人工水晶體,但是他認為這是童話故事中『國王的新衣』。

抗藍光的黃色人工水晶體唯一的訴求是過濾光線中的藍光並『減低黃斑部病變
(AMD)的發生率』,但Dr. Logan整理出四點:
  1. 表現審慎是好的
  2. 250萬人植入這樣的產品後,黃斑部病變(AMD)發生率並沒有明顯的降低
  3. 抗藍光黃色人工水晶體唯一的訴求減低黃斑部病變(AMD)的發生率,但是沒有臨床的證據
  4. 嚴謹的證據顯示:植入抗藍光黃色人工水晶體,病人的視覺和生活型態被某種程度的妥協
幾個驗證的臨床論文
  • Kavita Thapan, PhD 最近對視網膜感光神經(retinal ganglion photoreceptors)的重要性與褪黑激素(melatonin suppression)的關聯研究中顯示:藍光將影響55%褪黑激素的分泌(分泌降低),褪黑激素證實可減低失眠和日眠的發生率,分泌不足會造成情緒、記憶和身體系統性健康的問題。
  • Martin Mainster, PhD, MD, FRCOphth. 研究指出藍光對暗視力是十分必要的,最多會影響35%的暗光下對比敏感度。
  • 2006 Mirjam Munch, PhD. 發表藍光對生理節奏健康有重要的影響,而抗藍光的人工水晶體竟濾過14~21%的可用藍光。
  • Anish Shah, MD也指出濾藍光將影響辨色力。
 另一重點在於黃色人工水晶體減低黃斑部病變(AMD)的發生率及關連性被沒有被證實,所以為什麼要病人的視覺和生活型態被某種程度的妥協?  

因為全世界有
250萬人植入黃色人工水晶體,茲事體大,這些事實就像童話故事中『國王的新衣』一樣是公開卻不能說的秘密,但什麼時候才有勇於挑戰威權的孩子告訴國王:「國王原來沒有穿衣服!」

 
When are we going to say it?.



原文全錄於下:

When are we going to say it?
Acting on the blue blocking debate
Dwayne Logan, MD. 

I consider myself a willing participate I none of the largest clinical trials ever held involving real patients.  How many lens implants were involved?  Two- and- a half million. That’s right 2,500,000, the number of cataract lenses replace with blue light blocking lenses over five years. And for me, the verdict is in. And just like the folktale of the Emperor’s New Clothes, it is time for those of us that can see the obvious to say so.

Blue blocking lenses became established in our practices with the promise of lowering AMD incidences. A noble purpose indeed. With prudence in mind, we adapted these lenses for our cataract patients. 

Over the years, on study after another failed to prove we reduced the incidence of AMD by blocking blue light. Today the bibliography of articles on the subject is long and extensive. So here’s my conclusion:
  • We acted out of prudence. That’s a good thing.
  • There isn’t a tangible difference in the incidence of AMD when blocking blue light. After 2.5 million implants.
  • The only reason for a blue blocking lens was reduction of AMD. There is no other clinical reason.
  • Prudence has given way to evidence that patient vision and lifestyle are being compromised.
 I based my decision to abandon blue light lenses a long list of studies that time after time define the benefit of blocking blue light as ambiguous while calling to mind striking compromises. There have been several important studies seminal in my decision:
  • Kavita Thapan, PhD recently documented the importance of retinal ganglion photoreceptors and their relation to melatonin suppression (information new to us, thanks to advancements in scientific research). And allowing blue light provides 55% of the melatonin suppression that affect moods, memory and systemic health. With a proven lower incidence of insomnia and daytime sleepiness.
  • Martin Mainster, PhD, MD, FRCOphth. Has also demondtrated that blue light is necessary for scotopic vision. And blue light makes up 35% for our scotopic sensitivity.
  • In 2006, Mirjam Munch, PhD. proved the importance of blue light in health circadian rhythms. And blue blocking lenses limit blue spectra from 14-21%.
  • The role of blue-blocking IOLs in color disparity problems is well documented by Anish Shah, MD.
 And an extensive list of articles makes it evident a yellow lens has not proven to be a deterrent in AMD. So why continue the compromises they require in patient vision and lifestyle? Patients seek us out for uncompromised solutions. 

The headline of this article asks simply, “ When will we say it is again our obligation to offer patients the best vision possible?” . Prudence was good, but we can now correct our course based on extensive clinical experience. It is time to make CLEAR aspherics and multifocals our primary and best solution.
 

Certainly clear, UV-filtering, hydrophobic acrylics make fine lenses. 

For my own eye, I would choose a clear lens to restore my vision. In the same way, patients deserve a clear lens and a good pair of sunglasses.
 

Just think, Who among us would offer an aspheric or mulitfocal lens to restore optimal vision, and then tell our patient it is deliberately yellowed to match their natural lens- when it was 54 years of age?



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