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.
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