TY - JOUR

T1 - The Effect of Cataract Surgery on Circadian Photoentrainment

T2 - A Randomized Trial of Blue-Blocking versus Neutral Intraocular Lenses

AU - Brøndsted, Adam Elias

AU - Sander, Birgit

AU - Haargaard, Birgitte

AU - Lund-Andersen, Henrik

AU - Jennum, Poul

AU - Gammeltoft, Steen

AU - Kessel, Line

N1 - Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

PY - 2015/10

Y1 - 2015/10

N2 - PURPOSE: Cataract decreases blue light transmission. Because of the selective blue light sensitivity of the retinal ganglion cells governing circadian photoentrainment, cataract may interfere with normal sleep-wake regulation and cause sleep disturbances. The purpose was to investigate the effect of cataract surgery on circadian photoentrainment and to determine any difference between blue-blocking and neutral intraocular lenses (IOLs).DESIGN: The study was a single-center, investigator-driven, double-masked, block-randomized clinical trial.PARTICIPANTS: One eye in 76 patients with bilateral age-related cataract eligible for cataract surgery was included.METHODS: Intervention was cataract surgery by phacoemulsification. Patients were randomized to receive a blue-blocking or neutral IOL.MAIN OUTCOME MEASURES: Primary outcome was activation of intrinsic photosensitive ganglion cells using post-illumination pupil response (PIPR) to blue light from 10 to 30 seconds after light exposure as a surrogate measure. Secondary outcomes were circadian rhythm analysis using actigraphy and 24-hour salivary melatonin measurements. Finally, objective and subjective sleep quality were determined by actigraphy and the Pittsburgh Sleep Quality Index.RESULTS: The blue light PIPR increased 2 days (17%) and 3 weeks (24%) after surgery (P < 0.001). The majority of circadian and sleep-specific actigraphy parameters did not change after surgery. A forward shift of the circadian rhythm by 22 minutes (P = 0.004) for actigraphy and a tendency toward an earlier melatonin onset (P = 0.095) were found. Peak salivary melatonin concentration increased after surgery (P = 0.037). No difference was detected between blue-blocking and neutral IOLs, whereas low preoperative blue light transmission was inversely associated with an increase in PIPR (P = 0.021) and sleep efficiency (P = 0.048).CONCLUSIONS: Cataract surgery increases photoreception by the photosensitive retinal ganglion cells. Because of inconsistency between the significant findings and the many parameters that were unchanged, we can conclude that cataract surgery does not adversely affect the circadian rhythm or sleep. Longer follow-up time and fellow eye surgery may reveal the significance of the subtle changes observed. We found no difference between blue-blocking and neutral IOLs, and, because of the minor effect of surgery in itself, an effect of IOL type seems highly unlikely.

AB - PURPOSE: Cataract decreases blue light transmission. Because of the selective blue light sensitivity of the retinal ganglion cells governing circadian photoentrainment, cataract may interfere with normal sleep-wake regulation and cause sleep disturbances. The purpose was to investigate the effect of cataract surgery on circadian photoentrainment and to determine any difference between blue-blocking and neutral intraocular lenses (IOLs).DESIGN: The study was a single-center, investigator-driven, double-masked, block-randomized clinical trial.PARTICIPANTS: One eye in 76 patients with bilateral age-related cataract eligible for cataract surgery was included.METHODS: Intervention was cataract surgery by phacoemulsification. Patients were randomized to receive a blue-blocking or neutral IOL.MAIN OUTCOME MEASURES: Primary outcome was activation of intrinsic photosensitive ganglion cells using post-illumination pupil response (PIPR) to blue light from 10 to 30 seconds after light exposure as a surrogate measure. Secondary outcomes were circadian rhythm analysis using actigraphy and 24-hour salivary melatonin measurements. Finally, objective and subjective sleep quality were determined by actigraphy and the Pittsburgh Sleep Quality Index.RESULTS: The blue light PIPR increased 2 days (17%) and 3 weeks (24%) after surgery (P < 0.001). The majority of circadian and sleep-specific actigraphy parameters did not change after surgery. A forward shift of the circadian rhythm by 22 minutes (P = 0.004) for actigraphy and a tendency toward an earlier melatonin onset (P = 0.095) were found. Peak salivary melatonin concentration increased after surgery (P = 0.037). No difference was detected between blue-blocking and neutral IOLs, whereas low preoperative blue light transmission was inversely associated with an increase in PIPR (P = 0.021) and sleep efficiency (P = 0.048).CONCLUSIONS: Cataract surgery increases photoreception by the photosensitive retinal ganglion cells. Because of inconsistency between the significant findings and the many parameters that were unchanged, we can conclude that cataract surgery does not adversely affect the circadian rhythm or sleep. Longer follow-up time and fellow eye surgery may reveal the significance of the subtle changes observed. We found no difference between blue-blocking and neutral IOLs, and, because of the minor effect of surgery in itself, an effect of IOL type seems highly unlikely.

KW - Aged

KW - Aged, 80 and over

KW - Circadian Rhythm

KW - Double-Blind Method

KW - Female

KW - Humans

KW - Lens Implantation, Intraocular

KW - Lenses, Intraocular

KW - Light

KW - Male

KW - Melatonin

KW - Middle Aged

KW - Phacoemulsification

KW - Photoperiod

KW - Prosthesis Design

KW - Pupil

KW - Retinal Ganglion Cells

KW - Saliva

KW - Sleep

U2 - 10.1016/j.ophtha.2015.06.033

DO - 10.1016/j.ophtha.2015.06.033

M3 - Journal article

C2 - 26233628

VL - 122

SP - 2115

EP - 2124

JO - Ophthalmology

JF - Ophthalmology

SN - 0161-6420

IS - 10

ER -