Welcome to the first issue of the Blue Light Bulletin. In this newsletter series we will discuss the risk factors surrounding this phenomenon and the science of helping to protect vision from damage that may be linked to cumulative blue light exposure. Scientific research has demonstrated the harmful effects of ultra violet radiation and the blue violet spectrum between 415 and 455 nanometers.1 Researchers have built a strong case for the oxidative stress on retinal pigment epithelium cells caused by excessive exposure to chemicals induced by blue light.1 Such damage is irreversible and can result in the loss of and misfiring of these cells, which may be linked to age related macular degeneration (AMD).2
Exposure factors are ubiquitous and can be revealed in a thorough blue light risk patient history. First we need to explore genetic factors which may be clues to a patient's susceptibility to the effects of blue light. Certainly a family history of age related macular degeneration would send signals of a need for blue light protection. However, other retinal diseases such as retinal detachments, retinitis pigmentosa and retinal blood vessel occlusions, just to name a few, may send up red flags when revealed in a patient's family ocular history. Also, eye care professionals should not ignore dermatological red flags such as a family history of skin cancer. A thorough medical history is critical to providing patients with an acceptable standard of care which may subsequently include recommendations for blue light protection.
Next we need to examine environmental factors. Explore the patient's occupation, current and past. Do past or present hobbies include sports such as skiing, golf, fishing, SUP or surfing? Also, we should not overlook reflected light when considering patient exposure such as light bouncing off surfaces like water, sand or snow.
Normally we would think of outdoor exposure to sunlight but when it comes to damaging blue light exposure we also need to consider patient exposure to indoor sources such as plasma televisions, smart phones, LCD and CRT monitors, metal halide lamps, and cool light fluorescent bulbs. The Vision Council reported that 25% of the population spends over 3 hours per day in front of a computer screen and of this 25%, two in five people spend in excess of 9 hours a day.3 That translates into approximately 10% of the population as a whole receiving over 9 hours a day of computer generated blue light exposure.
However, despite all the publicity regarding blue light and indoor exposure sources, according to data released by Transitions Optical, the sun is 100 to 500 times more intense than electronic screens and devices when measured at various nanometer wavelengths in the blue light spectrum for integrated irradiance values.4 Thus, though indoor exposure is certainly a factor, we simply cannot afford to overlook the responsibility of protecting our patients from direct and reflected sunlight.
In conclusion, the damaging effect to retinal cells from cumulative exposure to blue light is real. I have been personally fortunate enough to visit the Paris Vision Institute where scientific studies were conducted involving the exposure of animal retinal pigment epithelial cells to blue light. I have spoken to the scientists involved and the cell damage is real. Eyecare professionals have an obligation to protect their patients. Initial clues can be provided by a thorough patient history. We need to predetermine patient risks and look for ways of protecting them from not only the damaging outdoor rays of the sun but indoors where modern technology is utilized.
Arnault E. Barrau C, Nanteau C. Gondouin P, Bigot K, et al. Phototoxic Action Spectrum on a Retinal Pigment Epithelium Model of Age-Related Macular Degeneration. Exposed to Sunlight Normalized Conditions. PLoS ONE. 2013 Aug 23;8(8):e71398. doi: 10.1371/journal.pone.0071398. Identified Harmful Blue Light through in vitro experiment on swine retinal cells, where the most toxic wavelengths are high energy visible light falling between 415-455 nm (blue-violet light).
Dr. Allan Barker practices optometry in Wilmington, North Carolina and serves on the Board of Directors for Eyecare Partners. He also currently serves as board president of the American Optometric Association's charity foundation, Optometry Cares, and is a former State Association president in North Carolina. Dr. Barker first learned about blue light danger while serving on the Essilor Advisory Panel from 2010 to 2015. He has published over 40 journal articles on various subjects, both research and practice management.