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      Reducing Short-Wavelength Blue Light in Dry Eye Patients with Unstable Tear Film Improves Performance on Tests of Visual Acuity

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          Abstract

          Purpose

          To investigate whether suppression of blue light can improve visual function in patients with short tear break up time (BUT) dry eye (DE).

          Methods

          Twenty-two patients with short BUT DE (10 men, 12 women; mean age, 32.4 ± 6.4 years; age range, 23–43 years) and 18 healthy controls (10 men, 8 women; mean age, 30.1 ± 7.4 years; age range, 20–49 years) underwent functional visual acuity (VA) examinations with and without wearing eyeglasses with 50% blue light blocked lenses. The functional VA parameters were starting VA, functional VA, and visual maintenance ratio.

          Results

          The baseline mean values (logarithm of the minimum angle of resolution, logMAR) of functional VA and the visual maintenance ratio were significantly worse in the DE patients than in the controls ( P < 0.05), while no significant difference was observed in the baseline starting VA ( P > 0.05). The DE patients had significant improvement in mean functional VA and visual maintenance ratio while wearing the glasses ( P < 0.05), while there were no significant changes with and without the glasses in the control group ( P > 0.05),

          Conclusions

          Protecting the eyes from short-wavelength blue light may help to ameliorate visual impairment associated with tear instability in patients with DE. This finding represents a new concept, which is that the blue light exposure might be harmful to visual function in patients with short BUT DE.

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          Most cited references17

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          Impaired functional visual acuity of dry eye patients.

          Eiki Goto, Yukiko Yagi, Yukihiro Matsumoto … (2002)
          To report dry eye patients' functional visual acuity, which was measured after sustained eye opening for 10-20 seconds, as a simulation of visual function of daily acts of gazing, which is defined as looking at an object with involuntary blink suppression. Interventional clinical nonrandomized comparative trial. We measured ordinary best-corrected visual acuity and functional visual acuity in non-Sjögren's syndrome (non-SS, N = 10) and Sjögren's syndrome (SS, N = 12) patients and in normal controls (N = 8), prospectively. Surface regularity index (SRI) of corneal topography was also measured under routine circumstances and after sustained eye opening. Blink rates while gazing were measured during reading in another 28 dry eye patients and during driving in another 8 normal controls. Functional visual acuity did not change (1.27-1.16) in normal controls, but decreased significantly from 1.18-0.336 in non-SS patients (P = .0007) and from 1.15-0.228 (P < .00001) in SS patients. SRI after sustained eye opening increased in non-SS (P = .032) and SS patients (P = .0007), but not in the normal controls. Blink rates during reading (P < .001) and driving (P = .012) were significantly decreased from baseline blink rates. This study shows that the visual function of dry eye patients becomes abnormal with ocular surface irregularity when the eye is kept open for 10-20 seconds. Our data indicate impaired visual function in dry eye patients while gazing. Functional visual acuity may be important in daily activities.
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            Sensitivity of the human circadian system to short-wavelength (420-nm) light.

            George Brainard, David Sliney, John Hanifin … (2008)
            The circadian and neurobehavioral effects of light are primarily mediated by a retinal ganglion cell photoreceptor in the mammalian eye containing the photopigment melanopsin. Nine action spectrum studies using rodents, monkeys, and humans for these responses indicate peak sensitivities in the blue region of the visible spectrum ranging from 459 to 484 nm, with some disagreement in short-wavelength sensitivity of the spectrum. The aim of this work was to quantify the sensitivity of human volunteers to monochromatic 420-nm light for plasma melatonin suppression. Adult female (n=14) and male (n=12) subjects participated in 2 studies, each employing a within-subjects design. In a fluence-response study, subjects (n=8) were tested with 8 light irradiances at 420 nm ranging over a 4-log unit photon density range of 10(10) to 10(14) photons/cm(2)/sec and 1 dark exposure control night. In the other study, subjects (n=18) completed an experiment comparing melatonin suppression with equal photon doses (1.21 x 10(13) photons/cm(2)/sec) of 420 nm and 460 nm monochromatic light and a dark exposure control night. The first study demonstrated a clear fluence-response relationship between 420-nm light and melatonin suppression (p<0.001) with a half-saturation constant of 2.74 x 10(11) photons/cm(2)/sec. The second study showed that 460-nm light is significantly stronger than 420-nm light for suppressing melatonin (p<0.04). Together, the results clarify the visible short-wavelength sensitivity of the human melatonin suppression action spectrum. This basic physiological finding may be useful for optimizing lighting for therapeutic and other applications.
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              Dry eye with only decreased tear break-up time is sometimes associated with allergic conjunctivitis.

              K Toda, K. Tsubota, J Shimazaki (1995)
              The authors' clinical experience has suggested that there is a form of dry eye with only decreased tear break-up time, which is associated with allergic conjunctivitis. The current study was performed to verify this hypothesis. The authors recruited patients with two types of dry eye syndrome, those with only decreased tear break-up (BUT type) and those with positive vital staining (staining type). Individuals without any symptoms or signs served as controls. All subjects were compared regarding symptoms, Schirmer and tear clearance test results, conjunctival papillary formation, antigen-specific serum-IgE level (s-IgE), and goblet cell density of the palpebral conjunctiva. Antigen-induced allergic conjunctivitis was produced in guinea pigs, and histopathologic changes of the conjunctiva were examined. Patients with the BUT-type dry eye syndrome were younger and their symptoms were as severe as the staining type. The Schirmer and tear clearance test results were better, and the papillary formation and s-IgE were observed more than in the BUT type. The average goblet cell density in the BUT-type syndrome was 625.4 +/- 193.2/mm2, which was significantly less than 1005.6 +/- 294.5/mm2 in the controls (P < 0.01). The average goblet cell density was significantly decreased in the allergic animals (10.40 +/- 1.11/0.2 mm) compared with that of the controls (16.21 +/- 0.26/0.2 mm) or the anti-allergic drug-treated group (13.69 +/- 0.30/0.2 mm) (P < 0.01). These results support the authors' hypothesis that decreased break-up time is in part associated with the decreased goblet cell density caused by allergic conjunctivitis.
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                Author and article information

                Contributors
                Knut Stieger: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 5 April 2016
                Publication date Collection: 2016
                Volume: 11
                Issue: 4
                Electronic Location Identifier: e0152936
                Affiliations
                [1 ]Department of Ophthalmology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
                [2 ]Wada Eye Clinic, Houjyou, Tateyama-shi, Chiba, Japan
                [3 ]Minamiaoyama Eye Clinic, Kitaaoyama, Minato-ku, Tokyo, Japan
                Justus-Liebig-University Giessen, GERMANY
                Author notes

                Competing Interests: Drs. Kazuo Tsubota and Minako Kaido hold patent rights for the method and apparatus used for the measurement of functional visual acuity (US patent no: 7470026) and receive royalties for it from Kowa Co., Ltd. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials. The other authors have no affiliation with any corporation.

                Conceived and designed the experiments: M. Kaido KT. Performed the experiments: M. Kaido IT YK. Analyzed the data: M. Kaido. Contributed reagents/materials/analysis tools: M. Kaido TO IT M. Kawashima YK. Wrote the paper: M. Kaido KT.

                Article
                Publisher ID: PONE-D-15-48339
                DOI: 10.1371/journal.pone.0152936
                PMC ID: 4821556
                PubMed ID: 27045760
                SO-VID: 78b1d24f-0af8-493c-a454-b99102e61120
                Copyright © © 2016 Kaido et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 4 November 2015
                Date accepted : 20 March 2016
                Page count
                Figures: 4, Tables: 1, Pages: 10
                Funding
                This study was supported by a grant from the Medical School Faculty and Alumni Grants of Keio University Medical School, Tokyo, Japan. Keio University School of Medicine also provided support in the form of salaries for authors M. Kawashima, YK, and KT. Wada Eye Clinic provided support in the form of salaries for author M. Kaito. Minamiaoyama Eye Clinic provided support in the form of salaries for authors IT and TO. Kowa Co., Ltd. Japan and JINS Co., Ltd, Tokyo, Japan provided a monetary grant for research unrelated to the current study to the Department of Ophthalmology of Keio University School of Medicine. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article
                Subject: Physical Sciences
                Subject: Physics
                Subject: Electromagnetic Radiation
                Subject: Light
                Subject: Light Scattering
                Subject: Physical Sciences
                Subject: Physics
                Subject: Scattering
                Subject: Light Scattering
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Ocular System
                Subject: Ocular Anatomy
                Subject: Lens (Anatomy)
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Ocular System
                Subject: Ocular Anatomy
                Subject: Lens (Anatomy)
                Subject: Physical Sciences
                Subject: Materials Science
                Subject: Materials by Structure
                Subject: Amorphous Solids
                Subject: Glass
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Head
                Subject: Eyes
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Head
                Subject: Eyes
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Ocular System
                Subject: Eyes
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Ocular System
                Subject: Eyes
                Subject: Biology and Life Sciences
                Subject: Neuroscience
                Subject: Sensory Perception
                Subject: Vision
                Subject: Visual Acuity
                Subject: Biology and Life Sciences
                Subject: Psychology
                Subject: Sensory Perception
                Subject: Vision
                Subject: Visual Acuity
                Subject: Social Sciences
                Subject: Psychology
                Subject: Sensory Perception
                Subject: Vision
                Subject: Visual Acuity
                Subject: Medicine and Health Sciences
                Subject: Ophthalmology
                Subject: Visual Impairments
                Subject: Medicine and Health Sciences
                Subject: Ophthalmology
                Subject: Eye Diseases
                Subject: Physical Sciences
                Subject: Physics
                Subject: Electromagnetic Radiation
                Subject: Light
                Custom metadata
                Data Availability All relevant data are within the paper and its Supporting Information files.

                ScienceOpen disciplines: Uncategorized
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                ScienceOpen disciplines: Uncategorized

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