w. andrew maxwell, md, phd rob gray, phd disclosures: this study was funded by alcon research, ltd,...
TRANSCRIPT
W. Andrew Maxwell, MD, PhD
Rob Gray, PhD
Disclosures:This study was funded by Alcon Research,
Ltd, which also assisted with the preparation of
these slides.
Impact of glare on driving performance in patients with
blue-light filtering IOLs
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IntroductionPurpose
Assess the impact of glare in pseudophakic patients implanted with blue light filtering intraocular lenses
Study Design Two groups of subjects
Study group: Previously implanted (unilaterally or bilaterally) with AcrySof Natural (SN60AT)
Control group: Previously implanted (unilaterally or bilaterally) with AcrySof IOL (SA60AT)
Groups identical with the exception of blue-light filtering technology
Eligible subjects also had…
Best Corrected Distance Visual Acuity better than -0.18 logMAR (20/30) A valid driver’s license at the time of participation in the study
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STUDY PATIENTS
Parameter Study Group:Blue light filtering IOL
Control Group:Clear IOL
Sample size
(Men, Women)
17
(6 Men, 11 Women)
17
(8 men, 9 Women)
Age 71.6 ± 8.6 yrs 72.7 ± 9.9 yrs
Duration of Pseudophakia
(Range)
69.14 ± 9.82 months
(44 - 77 months)
68.81 ± 8.93 months
(55- 85 months)
No statistically significant difference between study and control group for any of the above parameters
At 2 clinical sites, a total of 34 subjects provided driving performance measures.
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DRIVING SIMULATOR
3 Components: Steering wheel, Pedals and three 19” LCD monitors positioned side by side
Driving performance in this simulator has been shown to correlate well with real-world driving in previous studies
Methods: Subjects and Apparatus
Subjects performed left turn maneuvers in front of an oncoming car
Measures repeated with a glare source (150 lux) positioned at an angle of 20 degrees above simulated road
Monocular testing and subjects were best corrected for test conditions 5
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STUDY VARIABLES
NUMBER OF COLLISIONS–Describes the number of times (percentage) the
participants car collided with the oncoming car.
INTERSECTION APPROACH SPEED–Speed at which the participants car approached
the intersection
LANE POSITION VARIANCE–Describes the variance in the position of the
participants car when driving straight ahead on a lane
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NUMBER OF COLLISIONS: NO GLARE
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NUMBER OF COLLISIONS: WITH GLARE
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NUMBER OF COLLISIONSIn no-glare conditions, no statistically significant
difference was noted between study and control groups.
In the presence of glare, patients in the study group demonstrated significantly lower number of collisions with the on-coming car compared to controls
Within group effects showed control group had significantly more collisions in the presence of glare compared to no-glare conditions.
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INTERSECTION APPROACH SPEEDPatients in the study group were significantly less impacted by glare as they approached the intersection compared to controls
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LANE POSITION VARIANCE
Study Control p value
Glare 0.107±0.126 0.076±0.056 0.391
No Glare 0.144±0.226 0.103±0.061 0.469
Glare - No Glare 0.037±0.108 0.028±0.027 0.644
Deviations (variance) about a mean lane position (expressed in meters) were not significantly different between control and study groups
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Discussion & Conclusions Key finding: Compared to eyes with control IOLs, the patients with blue-filtering IOLs
demonstrated a significantly better safe driving performance.
Proposed mechanism: The image of the oncoming car in the eye was dynamically changing (increasing in size) thereby creating a sensation of motion-in-depth. The light entering the eye from the glare source resulted in forward retinal scatter causing a reduction in the retinal image contrast. This resulted in misjudging (overestimating) the time taken by the car to reach the intersection causing unsafe left turns. Blue-filtering IOLs reduced glare, improved retinal image contrast and allowed a more accurate estimation of the oncoming car and this resulted in safe driving performance.
Real-world applications: Analogous situations could occur under day-time driving conditions (e.g. when driving towards the sun during sun-set). By improving disability glare, blue light filtering technology provide an improvement in driving performance as demonstrated in this study.
Read more at: Gray R, Perkins SA, Suryakumar R, Neuman B, Maxwell WA. Reduced effect of glare disability on driving performance in patients with blue light–filtering intraocular lenses J Cataract
Refract Surg 2011;37:38-44 Hammond BR, Renzi LM, Sachak S, Brint SF. Contralateral comparison of blue-filtering and non-blue-filtering intraocular lenses: glare disability, heterochromatic contrast, and
photostress recovery. Clin Ophthalmol. 2010;4:1465-1473