How effective are blue-light filtering IOLs in preventing nAMD?

Use of a blue-light filtering (BLF) intraocular lens (IOL) does not offer any clear advantage over a non-BLF IOL in the incidence of neovascular age-related macular degeneration (nAMD) or its progression, nor in clinical variables associated with nAMD severity, among patients who underwent cataract surgery, results of a study have shown.

Patients who underwent uneventful cataract surgery between 2007 and 2018 at the Ophthalmology Unit of Kymenlaakso Central Hospital in Kotka, Finland, participated in this cohort study. The authors compared subsequent nAMD rates between patients who received BLF IOLs and those who received non-BLF IOLs.

Kaplan-Meier and Cox regression analyses were performed to assess the overall risk of developing nAMD. Secondary outcomes included best-corrected visual acuity (BCVA), foveal thickness, treatment interval, and total number of intravitreal injections.

A secondary analysis was conducted on patients with pre-existing nAMD to examine the effect of BLD IOLs on nAMD progression. A single eye of each patient was included.

A total of 11,397 eyes of 11,397 patients (mean age, 75.4 years; 62.5 percent women) were included. BLF IOL was used in 5,245 eyes (47.6 percent) and non-BLF IOL in 5,972 eyes (52.4 percent). One hundred sixty-four cases of new-onset nAMD were recorded (BLF group: n=88; non-BLF group: n=76) during follow-up (BLF group: 55.2±34.1 months; non-BLF group: 50.5±30.1 months; p<0.001).

The nAMD-free survival was comparable between groups (p=0.465, log-rank test). Cox regression analysis controlling for age, gender, and a documented diagnosis of macular degeneration revealed that use of BLF IOLs did not predict nAMD development (hazard ratio [HR], 1.075, 95 percent confidence interval [CI], 0.79–1.47; p=0.652).

In nAMD patients, secondary clinical outcomes for BLF and non-BLF IOLs at 1 year were similar for the following: BCVA (0.57±0.4 vs 0.45±0.4 logarithm of the minimum angle of resolution; p=0.136), foveal thickness (285±109 vs 299±103 μm; p=0.527), number of antivascular endothelial growth factor injections (6.5±2.5 vs 6.2±2.7; p=0.548), and treatment interval (7.5±2.4 vs 8.1±2.4 weeks; p=0.271).

Clinical outcomes were also similar among patients with nAMD before surgery (BLF: n=71; non-BLF: n=74; p>0.05 for all).