LENTES AMARILLAS12 de Marzo de 2009

Fco Javier Hurtado CeñaHospital Universitario Ramón y Cajal. Madrid.

ANTECEDENTES

Alteraciones en la percepcióndel color

• Comparison of contrast sensitivity and color discrimination after clear and yellow intraocular lens implantation. Rodriguez-Galietero et a. J. Cataract Refract Surg. Vol 31, Sept 2005

• De Fez et al. Enhancement of contrast sensitivity and losses of chromatic discrimination with tinted lenses. Optom Vis Sci. 2002 Sep;79(9):590-7

• Effect of a yellow intraocular lens on scotopic vision, glare disability, and blue color perception.Orkun Muftuoglu, MD, Fatih Karel, MD, Rahmi Duman, MD.J Cataract Refract Surg 2007; 33:658–666 Q 2007 ASCRS and ESCRS

• Are there advantages in implanting a yellow IOL to reduce the risk of AMD? Sven Erik Nilsson Department o Ophthalmology, Linko¨ ping University, Linko¨ ping, Sweden Acta Ophthalmol. Scand. 2004: 82: 123–125

• Age-related maculopathy and the impact of blue light hazard Peep V. Algvere,John Marshall and Stefan Seregard. Acta Ophthalmol Scand 2006.

• Could Blue Light–Blocking Lenses Decrease the Risk of Age-Related Macular Degeneration? RETINA 26:1–4, 2006

• Protective effects of soft acrylic yellow filter against blue light-induced retinal damage in ratsExperimental Eye Research, Volume 83, Issue 6, December 2006, Pages 1493-1504

• Laboratory Science “Effects of yellow intraocular lenses on light-induced upregulation of vascular endothelial growth factor. yasuo yanagi et al.J Cataract Refract Surg - Vol 32, September 2006.

• How much blue light should an IOL transmit? M A Mainster, J R Sparrow Br J Ophthalmol. 2003 Dec;87(12):1523-9

• Intraocular Lenses Should Block UV Radiation and Violet but Not Blue Light. Mainster Martin.Archives Ophthalmol 2005

Preguntas de la Dra Puerto:

• ¿Hay que filtrar luz azul o solo la violeta? Lentes (cromóforos adecuados)

• ¿Cómo de fototóxica es la luz azul en la retina humana adulta?

• ¿Puede considerarse, con las evidencias que tenemos hoy en día, una medida profiláctica como los antioxidantes?¿Tienen que pagar los pacientes algún precio?

• ¿Hay suficientes evidencias que relacionen luz azul-DMAE (progresión-aparición)?

• Si existe, ¿Mejor cuanta más protección (sin saber cuanta) pero peor visión nocturna (cuánta)?

• ¿Cuánto afecta a la sensibilidad al contraste y a la visión escotópica ?

• ¿Se ve alterado el ciclo vigilia-sueño?

OBJETIVO

• Evaluar los efectos de las LIOs con filtro amarillo sobre la visión cromática y la sensibilidad al contraste en comparación con las lentes monofocales estándar.

¿Cómo es una revisión sistemática?

• Exhaustiva, objetiva y verificable.

• Estrategia predefinida, sistemática y completa.

• Criterios explícitos de evaluación de la calidad.

COCHRANE DATABASE

Study Audren 2006 

Methods Study design: Method of randomization: Number randomized:

Method of allocation concealment:Outcome assessor masking:

Losses to follow up: Intention-to-treat analysis:

Participants Inclusion criteria: Exclusion criteria: Types of DME: Prior laser treatment:Age: Comparability of baseline

characteristics:

Interventions Test intervention: Control intervention:Repeat IVTA treatment:

Outcomes Primary outcome: Measurement of primary outcome: Secondary outcomes:

Notes Data source: Funding souce:Country:Others:

Allocation concealment

B - Unclear 

Estudio

Método

Randomizado

Uni o multicéntrico

Ciego simple (paciente) o doble (explorador)

Duración del estudio

Puntuación de Jadad

Participantes

Raza o país

% de hombres media edad

N grupo LIO amarilla:

N grupo LIO monofocal:

Uni o bilateral

AV media en grupos

Amarilla

Blanca

Intervenciones

Marca de LIO

Faco

Tipo de capsulotomía

Medidas de resultado

AV

Sensib contraste

Colores

Seguimiento

Anotaciones Patrocinado

Otros detalles

Ocultación de la asignación

A: adecuada

B: no clara

ESCALA DE JADAD

ESTUDIO RANDOMIZADODOBLE CIEGO

MÉTODO DE RANDOMIZ.

MÉTODO DE ENMASCARAM.

PERDIDOSPUNTUACIÓN TOTAL

+1 +1 ±1 ±1

Comienza la búsqueda…

PUBMED (desde 1966 hasta el 21 de abril de 2008)

1. Randomized Control Trial o Clinical Trial o Multicenter Study o Controlled Clinical Trial o Comparative study

• Acrysof natural IOL + 1• Blue-light intraocular + 1• Yellow intraocular lens + 1• Blue light filtering + 1• Yellow-tinted intraocular lens + 1• Scotopic sensivity + 1• Cataract extraction + Randomized Control Trial + Clinical Trial• SN60AT• Scotopic sensitivity + 1• Photopic sensitivity + 1• Hue discrimination + 1• Short-wavelength-absorbing IOL• Dark-adapted sensitivities + 1• Pseudophakia + 1• Color perception + 1• Lens implantation intraocular + 1

4308 artículos

MEDLINE

MEDLINE (desde 1950 hasta Junio 2008)1. Randomized Control Trial o Clinical Trial o Multicenter Study o

Controlled Clinical Trial o Comparative study• Phacoemulsification 469• Intraocular lens 523• Cataract extraction 215• Scotopic sensitivity + 1 86• SN60AT + 1 17• Lens implantation + 1 316• Color perception + 1 264• Contrast sensitivity 252• Acrysof natural IOL 77• Yellow intraocular lens 138• Blue-light intraocular 96• Blue light filtering 105• Yellow-tinted intraocular lens 138• Photopic sensitivity 121• Hue discrimination. 41• Dark-adapted sensitivities + 1 45• Farnsworth + 1 92• Cataract surgery 209

3204 artículos

COCHRANE CENTRAL REGISTER OF CONTROLLED TRIALS (1st Quarter 2008)

1. Clinical trial or comparative study or controlled clinical trial or multicenter study or randomized controlled trial

Scotopic sensitivity + 1 17

SN60AT 9

Lens implantation + 1 535

Color perception 259

Contrast sensitivity 363

Acrysof natural IOL 28

Yellow intraocular lens + 1 180

Blue-light intraocular + 1 888

Blue light filtering 41

Yellow-tinted intraocular lens 132

Photopic sensitivity + 1 36

Hue discrimination + 1 26

Dark-adapted sensitivities 13

Dark-adapted sensitivity 6

Farnsworth 36

Cataract surgery + 1 412

Phacoemulsification + 1 472

Intraocular lens + 1 570

Cataract extraction + 1 999

4452 artículos

EMBASE

EMBASE (desde1980 a 2008, semana 24)Scotopic sensitivity and clinical trial Scotopic sensitivity and randomized controlled trial

Scotopic sensitivity and comparative study Scotopic sensitivity and controlled clinical trial

Scotopic sensitivity and multicenter study Scotopic sensitivity and randomization

Scotopic sensitivity and random Scotopic sensitivity and evaluation study

Scotopic sensitivity and clinical trial Scotopic sensitivity and randomized controlled trial

Scotopic sensitivity and comparative study Scotopic sensitivity and controlled clinical trial

Scotopic sensitivity and multicenter study Scotopic sensitivity and randomization

Scotopic sensitivity and random Scotopic sensitivity and evaluation study

SN60AT Lens implantation and clinical trial

Lens implantation and randomized controlled trial Lens implantation and comparative study

Lens implantation and controlled clinical trial Lens implantation and multicenter study

Lens implantation and randomization Lens implantation and random

Lens implantation and evaluation study Color perception

Contrast sensitivity and clinical trial Contrast sensitivity and randomized controlled trial

Contrast sensitivity and comparative study Contrast sensitivity and controlled clinical trial

Contrast sensitivity and multicenter study Contrast sensitivity and randomization

Contrast sensitivity and random Contrast sensitivity and evaluation study

Acrysof natural IOL and clinical trial Acrysof natural IOL and randomized controlled trial

Acrysof natural IOL and comparative study Acrysof natural IOL and controlled clinical trial

Acrysof natural IOL and multicenter study Acrysof natural IOL and randomization

Acrysof natural IOL and random Acrysof natural IOL and evaluation study

Yellow intraocular lens and clinical trial Yellow intraocular lens and randomized controlled trial

Yellow intraocular lens and comparative study Yellow intraocular lens and controlled clinical trial

Yellow intraocular lens and multicenter study Yellow intraocular lens and randomization

Yellow intraocular lens and random Yellow intraocular lens and evaluation study

Blue-light intraocular and clinical trial Blue-light intraocular and randomized controlled trial

Blue-light intraocular and comparative study Blue-light intraocular and controlled clinical trial

Blue-light intraocular and multicenter study Blue-light intraocular and randomization

Blue-light intraocular and random Blue-light intraocular and evaluation study

Blue-light intraocular and clinical trial Blue-light intraocular and randomized controlled trial

Blue-light intraocular and comparative study Blue-light intraocular and controlled clinical trial

Blue-light intraocular and multicenter study Blue-light intraocular and randomization

Blue-light intraocular and random Blue-light intraocular and evaluation study

Blue light filtering and clinical trial Blue light filtering and randomized controlled trial

Blue light filtering and comparative study Blue light filtering and controlled clinical trial

Blue light filtering and multicenter study Blue light filtering and randomization

Blue light filtering and random Blue light filtering and evaluation study

Yellow-tinted intraocular lens and clinical trial Yellow-tinted intraocular lens and randomized controlled trial

Yellow-tinted intraocular lens and comparative study Yellow-tinted intraocular lens and controlled clinical trial

Yellow-tinted intraocular lens and multicenter study Yellow-tinted intraocular lens and randomization

Yellow-tinted intraocular lens and random Yellow-tinted intraocular lens and evaluation study

Photopic sensitivity and clinical trial Photopic sensitivity and randomized controlled trial

Photopic sensitivity and comparative study Photopic sensitivity and controlled clinical trial

Photopic sensitivity and multicenter study Photopic sensitivity and randomization

Photopic sensitivity and random Photopic sensitivity and evaluation study

Hue discrimination and clinical trial Hue discrimination and randomized controlled trial

Hue discrimination and comparative study Hue discrimination and controlled clinical trial

Hue discrimination and multicenter study Hue discrimination and randomization

Hue discrimination and random Hue discrimination and evaluation study

Dark-adapted sensitivities and clinical trial Dark-adapted sensitivities and randomized controlled trial

Dark-adapted sensitivities and comparative study Dark-adapted sensitivities and controlled clinical trial

Dark-adapted sensitivities and multicenter study Dark-adapted sensitivities and randomization

Dark-adapted sensitivities and random Dark-adapted sensitivities and evaluation study

Dark-adapted sensitivity and clinical trial Dark-adapted sensitivity and randomized controlled trial

Dark-adapted sensitivity and comparative study Dark-adapted sensitivity and controlled clinical trial

Dark-adapted sensitivity and multicenter study Dark-adapted sensitivity and randomization

Dark-adapted sensitivity and random Dark-adapted sensitivity and evaluation study

Farnsworth and clinical trial Farnsworth and randomized controlled trial

Farnsworth and comparative study Farnsworth and controlled clinical trial

Farnsworth and multicenter study Farnsworth and randomization

Farnsworth and random Farnsworth and evaluation study

Cataract surgery and clinical trial Cataract surgery and randomized controlled trial

Cataract surgery and comparative study Cataract surgery and controlled clinical trial

Cataract surgery and multicenter study Cataract surgery and randomization

Cataract surgery and random Cataract surgery and evaluation study

Phacoemulsification and clinical trial Phacoemulsification and randomized controlled trial

Phacoemulsification and comparative study Phacoemulsification and controlled clinical trial

Phacoemulsification and multicenter study Phacoemulsification and randomization

Phacoemulsification and random Phacoemulsification and evaluation study

Intraocular lens and clinical trial Intraocular lens and randomized controlled trial

Intraocular lens and comparative study Intraocular lens and controlled clinical trial

Intraocular lens and multicenter study Intraocular lens and randomization

Intraocular lens and random Intraocular lens and evaluation study

Cataract extraction and clinical trial Cataract extraction and randomized controlled trial

Cataract extraction and comparative study Cataract extraction and controlled clinical trial

Cataract extraction and multicenter study Cataract extraction and randomization

Cataract extraction and random Cataract extraction and evaluation study

OTRAS BÚSQUEDAS…

• Se revisaron las referencias bibliográficas de los artículos.

• Se buscó en los resúmenes de ARVO.

• Se solicitó bibliografía a Alcon.

• No se buscaron estudios no publicados.

• 2 artículos no fueron revisados por estar escritos en chino.

12.117 artículos revisados

Valen 25

Separar el grano de la paja

¿Es grano de calidad?

ESCALA DE JADAD

Estudio Randomizado Doble ciego PerdidosMétodo

randomiz.Método de

ciegoPuntuación

Cionni 2006 0 0 0 0 0 0

Rodríguez Galietero 2005

0 0 0 0 0 0

Pierre 2007 0 0 0 0 0 0

Muftuoglu 2007 0 0 0 0 0 0

Baker 2005 0 0 0 0 0 0

Jackson 2005 0 0 0 0 0 0

Beauchamp 2007

0 0 0 0 0 0

Landers 2007 0 0 +1 0 0 1

Greenstein 2007

0 0 0 0 0 0

Artículos eliminados

ESCALA DE JADAD

Estudio RandomizadoDoble ciego

PerdidosMétodo de randomiz.

Método del ciego

Puntuación

Hayashi K 2006 +1 +1 +1 +1 0 4

Leivobitch 2006 +1 0 +1 +1 0 3

Marshall 2005 +1 0 +1 0 0 2

Pandita 2007 +1 +1 +1 +1 0 4

Cristóbal 2005 +1 0 0 0 0 1

Kara-Júnior 2006 +1 0 0 0 0 1

Caporossi 2006 +1 0 +1 +1 0 3

Espindle 2005 +1 +1 +1 0 0 3

Falkner-Radler 2008

+1 0 0 0 0 2

Rocha 2006 +1 0 +1 +1 0 3

Rocha 2007 +1 0 +1 +1 0 3

Vuori 2006 +1 +1 0 +1 0 3

Ueda 2005 +1 +1 0 0 0 1

Raj 2005 +1 +1 +1 +1 0 4

Yuan 2003 +1 +1 0 0 0 1

Bhattacharjee 2006

+1 0 +1 0 0 2

Ejemplo de revisión. Peribulbar vs retrobulbar.

¿Mezclamos churras con merinas?

Farnsworth Munsell D100

Yuan 2003 J1 N = 57

Leivobitch 2006 J3 19Marshall 2005 J2 297Cristóbal 2005 J1 32Falkner-Radler 2008 J2 60Vuori 2006 J3 52Raj 2005 J4 30Bhattacharjee 2006 J2 26 ¿?

CSV-1000E

Utiliza frecuencias de 3, 6, 12 y 18 ciclos/grado.

Pandita 2007 J4 73(asféricas con filtros)Cristóbal 2005 J1 32Rocha 2006 J3 80(asféricas con filtros)

Hayashi K 2006 J4 73Leivobitch 2006 J3 19Marshall 2005 J2 297Falkner-Radler 2008 J2 60Bhattacharjee 2006 J2 26

¿?

Landers 2007 J1 96Espindle 2005 J3 157

Espindle 2005

Visión generalActividades de cercaActividades de lejosDependenciaConducciónVisión del colorVisión periféricaDolor ocular

Landers 2007

76% no diferenciaronla LIODel 24%, 11% preferíanla amarilla y al resto ledaba igual.

¿Fotofobia? 26% en natural y 73% en normal. A la semana se igualaron. Yuan 2003

Cristóbal 2005 J1 32

¿Ve mejor con un ojo que con otro?18,8% veían peor por el ojo con más graduación

¿Percibe los colores de distinto tono?100% NO

¿Nota más deslumbramiento con algún ojo?3 pacientes sí, 2 Blanca y 1 Amarilla

Falkner-Radler 2008 J2 60

Duración de la operación: 65,17 minutos con Blanca 63,33 minutos con Amarilla

ComplicacionesCuestionario al cirujano (de 0 a 2):

Sabían que era amarillaIntensidad y calidad de la luzVisión de células del vítreoVisión de la retinaMayor o menor uso de colorantesCalidad de la luz durante el endoláserFenómenos de glare durante la cirugía

Beauchamp 2007 J0 85

Greenstein 2007 J0 9

MORALEJA

• De momento sólo podemos decir no causan alteraciones en la visión cromática o la sensibilidad al contraste.

• No hay nada publicado.

• Una buena revisión en Pubmed te garantiza el 80% de los trabajos.

• Una revisión es un infierno.