Dec. 23, 2015
If you aren’t educating your patients about blue light, and prescribing lens treatments with blue light protection, a competitor may beat you to it. Some 63 percent of optical retailers said they offer a new AR lens that also reduced blue light, according to Jobson Optical Research’s 2015 Premium Lens MarketPulse report. These retailers say it has replaced, on average, 22 percent of standard AR.
The discussion around blue light is reminiscent of the discussions around vitamins we’ve been having for years. There are definitely proponents, and definitely opponents, as well as a large number of people who are ambivalent. We are still relatively early in the research on the impact of blue light damage to the retina. As more research comes out, we will have a better understanding. At this stage of the game, it seems reasonable to err on the side of protection.
Here’s what you should know about blue light.
Blue light is implicated in macular degeneration. More research is needed to be able to make conclusive statements.
The specific band of blue light most harmful to the retina and to RPE cells is 415 nm to 455 nm.
We do not want to block all blue light because there is good blue light and bad blue light. We need certain wavelengths of blue light–the blue-turquoise light range from 465 nm to 495 nm–because it impacts the function of our pupillary reflex, helps regulate our Circadian sleep/wake cycle, as well as helping memory, mood and hormonal balance.
LED lights and compact fluorescent lamps (CFLs) emit high levels of blue light. By the year 2020, estimates are that 90 percent of all of our light sources are estimated to be LEDs (CFLs contain about 25 percent of harmful blue light and LEDs contain about 35 percent of harmful blue light).
The damage blue light does is cumulative. There is an argument, that because the sun produces so much blue light, anything done with a lens indoors is irrelevant. This argument misses the point that the damage of blue light is cumulative. If we are erring on the side of protection, because of the cumulative impact of blue light, we want protection both outdoors and indoors.
From a treatment standpoint, consider taking two approaches with blue light: blue light protection and blue light lockdown.
Blue light protection should be considered for anyone who is a blood relative of anyone with macular degeneration. Talk with them about using the settings function or an app to change the background color of their screens from blue to some other color. When discussing light protection with patients, don’t forget the power of a hat with a brim when outdoors. Plus, blue light protection would be blue light protective lenses outdoors, as well as blue light protective lenses indoors.
With lenses you are looking for treatments that selectively filter out the harmful blue light rays while allowing the beneficial to pass through. You prefer indoor lenses that do not have color distortion (Here’s a dispensing tip: If the lens you prescribe does have a hint of tint, use that color with frame style and frame color choices to help patients achieve a fashion-forward look).
Blue light lockdown is for anyone who has a diagnosis of macular degeneration. Now you pull out all the weapons in this fight, in addition to what you are doing for blue light protection. Where you make suggestions in blue light protection, now you are going to prescribe in blue light lockdown: lifestyle choices (e.g.: stop smoking), reduce blood pressure, reduce cholesterol, antioxidants, nutraceuticals, AREDS 2 (with zinc management), lutein, zeaxanthin, meso-zeaxanthin, eat fish high in omega-3 fatty acids, reduce saturated fat intake and reduce processed food intake. Of that list, what do you feel comfortable prescribing? How are you going to handle the rest? Anything else you want to add?
Even though the American Academy of Ophthalmology–rightly so–reports that findings regarding AMD and risk factors are contradictory, it helps to make the issue personal. What do I want done for me? Understanding the life damage changes of macular degeneration, if I have either the risk for, or the early diagnosis of, macular degeneration, what do I want you to prescribe for me?
If I am your patient, I want you to do everything possible to slow it down, or possibly even prevent the terrible consequences of that sight-threatening condition. With only one life to live, I don’t want you to withhold approaches until there is conclusive evidence. I want you to use your best judgement to help me navigate this large volume of information the best you can.
And, yes, I do take a multivitamin every day–in consultation with my physician–even though my sister, who is a registered dietician, tells me I get enough vitamins in my American diet to sustain me.
Take this week to re-evaluate how you present blue light management in your practice.
Click HERE for a helpful article if you would like to read more.