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BlueLightProtection:FromOphthalmicLensestoOmega3’sNorthCarolinaOptometricSocietySpringCongressParaoptometricEducationJune2018
Dr.AnnM.HoscheitMs.SarahE.Marks
WhyIsBlueLightSpecial?“Callingallshoppers!”
WhyshouldWEcareaboutBlueLightProtection?
“…ourresponsibilitytocreateproductstohelppreserveandimprovesight…”
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First,theSCIENCE
Review:ElectromagneticSpectrum
380-780nm
415-455nm 465-495nm
SourcesofBlueLight• Sunlight• LEDlightbulbs• CFLlightbulbs• DigitalDevices
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BlueLightandRetinalCellDamage
• Oxidativeprocessandfreeradicalgeneration• ToxicROS(reactiveoxygenspecies)• LinkedtophotoreceptordeathandinflammatoryprocessescontributingtoAMD
Second,theTRENDS
PopulationDemographicsBlueLightExposure–MorethanEver
Children• 33%>3hrs/day
Millennials• 37.4%atleast9hours/day
Adults40+• 65%
Boomers• 55%
Seniors• 37%
Morethan5hoursperday
UseofDigitalDevicesbyGeneration
65%reportsymptomsofdigitaleyestrain!
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AdultsMasteringTechnology
2ormorehours/day
Deviceuse1hourbefore
bed
Use2ormoredevicesatthesametime• 75%reportdigitaleyestrain
2ormorehours/dayforMORETHAN15YEARS!
90% 76% 70%
~30%
90%havenotsharedsymptomswithECP!
AllBlueWavelengthsareNOTBadVisualUseofBlueWavelengths
• Color• Contrast• DepthperceptionandReactionTimes• Orientation• Abilitytolearn(schools)• Alertness
Non-visualuseofBlueWavelengths
• Sleep• Bodytemperature• Hormonalbalance• Mood(éseratonin)• SeasonalAffectiveDisorder(SAD)
• Photo-dynamictherapy(PDT)
So,what’sthePROBLEM?
TheDarkSideofBlueLight
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BlueLightandVisualFatigue(DigitalEyeStrain)
• Physicaldiscomfortfeltafter2ormorehoursinfrontofadigitalscreen• 32.8%eyestrain• 23.3%blurredvision• 22.8%dryeye• 24%headaches• 32.6%head/shoulder/neckpain
• LEDbacklitscreens(bluelight)screenshascausedanincrease
ChildrenandDigitalEyeStrain• éOver-accommodation• 0.3Dà1.0-1.3D
• DistanceBlur• Asthenopia• Why?• Whatcanwedo?
BlueLightandDryEye• CloselylinkedtoDESandassociatedwithreducedTBUT• Tearfilmstability(andassociatedblur)closelylinkedwithsustainednearactivitieswithANYtypeofdigitalscreenthathasblue-lightemittingLEDlighting• Associationwithc/oglareandhalos(lightscattering)• Contributingfactors(angleofview;distance;blinkrate)
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BlueLightandGlare• Greatersensationofdiscomfortfromglarethanothertypesoflamps• increasingwithproportionofbluelightinthesource
• Entopicphenomena• Pupillaryresponsetobluelight
BlueLightandCircadianRhythm(thebenefitsofbluelight)
Melatonin
Tryptophan
Seratonin
PinealGland Melatonin
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Melatonin• Freeradicalscavenger;antioxidantenzymes• Bluelightexposurescauses1.5-2hoursdelayinthenighttimeriseofmelatonin• HarvardStudy(bluevs.greenlight)
Melatonin(continued)• Readingwithdigitaldevicesatnight:• Delayedonsetofmelatoninrelease
• êREMsleep• Learning• Storingmemories
• Wokemoretiredandlessalertinthemorning
• WorkandSafetyêErrorsêProductionêDrivingalertnesséMVA
• Linkedto:• Depression• Obesity• Diabetes• HeartDisease• Cancer(breast,prostate)
What’stheanswer?PREVENTION
VISUALWELLNESS
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LIFESTYLE:Recommendations?• Distancefordevice
• 20-24”desk/laptop• 16-20”tablet• Harmondistance
• Angleofview• 10-15degreesindowngaze• Perpendiculartowindows
• 20-20-20• Discontinuescreenuse2-3hoursbeforebedtime• Usedimrednightlights
FiltersandDeviceProgramming
• NightShift(Apple)• F.lux• Twilight(Android)• Others..
Non-prescription/PlanoLenses
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PrescriptionLens68.5%havenotdiscusseddigitalusewithECP
73.5%didn’tknowaboutbluelightprotectiveeyewear
SmartBlueFilter
SmartBlueFilter
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CrizalPREVENCIA
EyeZenandEyeZen+The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
Recharge(BlueControl)
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SpecialtyLenses
SYNC5and8 TACT40and60
SeeCoatBlueLenses
SHAMIRBlueZero
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TotalBlueLens
TechShieldBlue
BlueProtect
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EnergizeMe
HowdoIknow?
NutritionandSupplements
MOREVISUALWELLNESS
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QuantifEYE(MPSII) MacuScope
MaculaPigmentOpticalDensity(MPOD)
ANTIOXIDANTS
ANTIOXIDANTSZeaxanthin,Lutein,B-carotene
VitaminsC,E,B12,FolicAcid
Resveratrol,Melatonin,ALA,
CoQ10Manganese,Selenium,
Zinc
Carnosine,NAC,Taurine,Glutathione
Anti-oxidants• XanthophyllCarotinoids• Lutein• Zeaxanthin• Meso-zeaxanthin• AstaXanthin?
• N-acetylcysteine(NAC)• AvoidtheproductionofROS(reactiveoxygenspecies)inducedbyblue-violetlight
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AREDS AREDSII
EssentialFattyAcidsOmega3’s
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FATS
• SaturatedFats• 8-10%ofdailyintake• Wholemilk,cream,cheese,beef,lamb,pork• Liveràcholesterol
• UnsaturatedFats• MUFA • 10-15%totaldailyintake(êLDLw/oΔHDL)• Olive,peanutandcanolaoils
• PUFA•
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Omega-3FattyAcidSynthesis
• ALA(alpha-linolenicacid)• Canolaoil,darkgreenleaves,flax,hemp,soybean,walnuts
• Stearidonicacid(moroticacid)• Blackcurrantseeds
• EPA(eicosapentanoicacid)• Fish(albacore,tuna,mackerel,salmon,sardines,lamb,nuts)• Wildorfarm-raised?
• DHA(docosahexaenoicacid)• Sameasabove
RetinalProtectionfromOmega-3
• DocosahexaenoicAcid(DHA)• Theintegrityof(RPE)iscriticalforphotoreceptorcellsurvival&vision• DHAisastructurallipidconcentratedinretinalphotoreceptorandretinalsynapticmembranes• DHAistheprecursorofneuroprotectinD1àdirectlyprotectsRPEcellsfromoxidativestress• Foundationtopreventvisionloss!!!
• DHAaccountsfor35%ofthefattyacidsintheeye• DHAprotectsfromlight,oxygen,andage-associateddamagetotheeyes
Omega-3’sfromFood
Dietarysources AllfishNOTequal
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GRANDROUNDS
Case#1:Mickey• 60yoWM,C.P.A.whoreportsithasbeenincreasinglymoredifficulttohavecomfortablevisionatworkwhilewearinghisprogressiveadditionlens.
• Prescription:• OD-1.25-0.50x175• OS-1.50-0.25x170• Add+2.75
• HOYATACT40withRecharge• Ergonomicseducationhandout
• Followup:Shouldhavehad“computerglassesyearsago”
Case#2:Lily• 14yoBFwhocomplainsofeyestrainandintermittentblueatdistanceandnear
• Rx • OD:+0.25-0.25x180• OS:+0.25DS• Binocular/Accommodativetesting:1.00accommlag
• EyeZen+2(SmartBlueFilter)withPrevencia
• Followup:Symptomshaveresolvedandshereportsfindingiteasiertoreadandcompletehomework/assignments
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Case#3:Joe• 60yearoldWMpresentsforanannualcontactlenseyeexamwiththetypicalconcern“checkmymaculas”
• CLRx(TotalDailiesMF)• OD:-4.00med• OS:-4.25med• Wears+100to+150readersovercl’sdependingontask
• EyeZen+3withPrevencia(planotop)• NutritionalSupplements• HPMMMV• ProDHAEYE• D35000IU/day
PracticeManagementPearls• Doctoreducation• Staffeducation• OpticalTraining• PatientEducation• Marketing• Selectingsupplements
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[email protected]@gmail.com
Otherwaysto“enjoy”BLUELIGHT!