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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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SEMarks10@gmail.comAnnHoscheit@gmail.com

Otherwaysto“enjoy”BLUELIGHT!