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LENTES AMARILLAS 12 de Marzo de 2009 Fco Javier Hurtado Ceña Hospital Universitario Ramón y Cajal. Madrid.

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Presentation on theme: "LENTES AMARILLAS 12 de Marzo de 2009 Fco Javier Hurtado Ceña Hospital Universitario Ramón y Cajal. Madrid."— Presentation transcript:

1 LENTES AMARILLAS 12 de Marzo de 2009 Fco Javier Hurtado Ceña Hospital Universitario Ramón y Cajal. Madrid.

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3 ANTECEDENTES Alteraciones en la percepción del color

4 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 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 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 rats Experimental Eye Research, Volume 83, Issue 6, December 2006, Pages 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 How much blue light should an IOL transmit? M A Mainster, J R Sparrow Br J Ophthalmol Dec;87(12): Intraocular Lenses Should Block UV Radiation and Violet but Not Blue Light. Mainster Martin.Archives Ophthalmol 2005

5 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?

6 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.

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8 ¿Cómo es una revisión sistemática? Exhaustiva, objetiva y verificable. Estrategia predefinida, sistemática y completa. Criterios explícitos de evaluación de la calidad.

9 COCHRANE DATABASE

10 StudyAudren 2006 MethodsStudy design: Method of randomization: Number randomized: Method of allocation concealment: Outcome assessor masking: Losses to follow up: Intention-to-treat analysis: ParticipantsInclusion criteria: Exclusion criteria: Types of DME: Prior laser treatment: Age: Comparability of baseline characteristics: InterventionsTest intervention: Control intervention: Repeat IVTA treatment: OutcomesPrimary outcome: Measurement of primary outcome: Secondary outcomes: NotesData source: Funding souce: Country: Others: Allocation concealme nt 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 AnotacionesPatrocinado Otros detalles Ocultación de la asignación A: adecuada B: no clara

11 ESCALA DE JADAD ESTUDIORANDOMIZADO DOBLE CIEGO MÉTODO DE RANDOMIZ. MÉTODO DE ENMASCARAM. PERDIDOS PUNTUACIÓN TOTAL +1 ±1±1±1±1

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13 Comienza la búsqueda…

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15 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 artículos

16 MEDLINE

17 MEDLINE (desde 1950 hasta Junio 2008) 1.Randomized Control Trial o Clinical Trial o Multicenter Study o Controlled Clinical Trial o Comparative study Phacoemulsification469 Intraocular lens523 Cataract extraction215 Scotopic sensitivity SN60AT Lens implantation Color perception Contrast sensitivity252 Acrysof natural IOL77 Yellow intraocular lens138 Blue-light intraocular96 Blue light filtering105 Yellow-tinted intraocular lens138 Photopic sensitivity121 Hue discrimination.41 Dark-adapted sensitivities Farnsworth Cataract surgery artículos

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19 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 SN60AT9 Lens implantation Color perception259 Contrast sensitivity363 Acrysof natural IOL28 Yellow intraocular lens Blue-light intraocular Blue light filtering41 Yellow-tinted intraocular lens132 Photopic sensitivity Hue discrimination Dark-adapted sensitivities13 Dark-adapted sensitivity6 Farnsworth36 Cataract surgery Phacoemulsification Intraocular lens Cataract extraction artículos

20 EMBASE

21 EMBASE (desde1980 a 2008, semana 24) Scotopic sensitivity and clinical trialScotopic sensitivity and randomized controlled trial Scotopic sensitivity and comparative studyScotopic sensitivity and controlled clinical trial Scotopic sensitivity and multicenter studyScotopic sensitivity and randomization Scotopic sensitivity and randomScotopic sensitivity and evaluation study Scotopic sensitivity and clinical trialScotopic sensitivity and randomized controlled trial Scotopic sensitivity and comparative studyScotopic sensitivity and controlled clinical trial Scotopic sensitivity and multicenter studyScotopic sensitivity and randomization Scotopic sensitivity and randomScotopic sensitivity and evaluation study SN60ATLens implantation and clinical trial Lens implantation and randomized controlled trialLens implantation and comparative study Lens implantation and controlled clinical trialLens implantation and multicenter study Lens implantation and randomizationLens implantation and random Lens implantation and evaluation studyColor perception Contrast sensitivity and clinical trialContrast sensitivity and randomized controlled trial Contrast sensitivity and comparative studyContrast sensitivity and controlled clinical trial Contrast sensitivity and multicenter studyContrast sensitivity and randomization Contrast sensitivity and randomContrast sensitivity and evaluation study Acrysof natural IOL and clinical trialAcrysof natural IOL and randomized controlled trial Acrysof natural IOL and comparative studyAcrysof natural IOL and controlled clinical trial Acrysof natural IOL and multicenter studyAcrysof natural IOL and randomization Acrysof natural IOL and randomAcrysof natural IOL and evaluation study Yellow intraocular lens and clinical trialYellow intraocular lens and randomized controlled trial Yellow intraocular lens and comparative studyYellow intraocular lens and controlled clinical trial Yellow intraocular lens and multicenter studyYellow intraocular lens and randomization Yellow intraocular lens and randomYellow intraocular lens and evaluation study Blue-light intraocular and clinical trialBlue-light intraocular and randomized controlled trial Blue-light intraocular and comparative studyBlue-light intraocular and controlled clinical trial Blue-light intraocular and multicenter studyBlue-light intraocular and randomization Blue-light intraocular and randomBlue-light intraocular and evaluation study

22 Blue-light intraocular and clinical trialBlue-light intraocular and randomized controlled trial Blue-light intraocular and comparative studyBlue-light intraocular and controlled clinical trial Blue-light intraocular and multicenter studyBlue-light intraocular and randomization Blue-light intraocular and randomBlue-light intraocular and evaluation study Blue light filtering and clinical trialBlue light filtering and randomized controlled trial Blue light filtering and comparative studyBlue light filtering and controlled clinical trial Blue light filtering and multicenter studyBlue light filtering and randomization Blue light filtering and randomBlue light filtering and evaluation study Yellow-tinted intraocular lens and clinical trialYellow-tinted intraocular lens and randomized controlled trial Yellow-tinted intraocular lens and comparative studyYellow-tinted intraocular lens and controlled clinical trial Yellow-tinted intraocular lens and multicenter studyYellow-tinted intraocular lens and randomization Yellow-tinted intraocular lens and randomYellow-tinted intraocular lens and evaluation study Photopic sensitivity and clinical trialPhotopic sensitivity and randomized controlled trial Photopic sensitivity and comparative studyPhotopic sensitivity and controlled clinical trial Photopic sensitivity and multicenter studyPhotopic sensitivity and randomization Photopic sensitivity and randomPhotopic sensitivity and evaluation study Hue discrimination and clinical trialHue discrimination and randomized controlled trial Hue discrimination and comparative studyHue discrimination and controlled clinical trial Hue discrimination and multicenter studyHue discrimination and randomization Hue discrimination and randomHue discrimination and evaluation study Dark-adapted sensitivities and clinical trialDark-adapted sensitivities and randomized controlled trial Dark-adapted sensitivities and comparative studyDark-adapted sensitivities and controlled clinical trial Dark-adapted sensitivities and multicenter studyDark-adapted sensitivities and randomization

23 Dark-adapted sensitivities and randomDark-adapted sensitivities and evaluation study Dark-adapted sensitivity and clinical trialDark-adapted sensitivity and randomized controlled trial Dark-adapted sensitivity and comparative studyDark-adapted sensitivity and controlled clinical trial Dark-adapted sensitivity and multicenter studyDark-adapted sensitivity and randomization Dark-adapted sensitivity and randomDark-adapted sensitivity and evaluation study Farnsworth and clinical trialFarnsworth and randomized controlled trial Farnsworth and comparative studyFarnsworth and controlled clinical trial Farnsworth and multicenter studyFarnsworth and randomization Farnsworth and randomFarnsworth and evaluation study Cataract surgery and clinical trialCataract surgery and randomized controlled trial Cataract surgery and comparative studyCataract surgery and controlled clinical trial Cataract surgery and multicenter studyCataract surgery and randomization Cataract surgery and randomCataract surgery and evaluation study Phacoemulsification and clinical trialPhacoemulsification and randomized controlled trial Phacoemulsification and comparative studyPhacoemulsification and controlled clinical trial Phacoemulsification and multicenter studyPhacoemulsification and randomization Phacoemulsification and randomPhacoemulsification and evaluation study Intraocular lens and clinical trialIntraocular lens and randomized controlled trial Intraocular lens and comparative studyIntraocular lens and controlled clinical trial Intraocular lens and multicenter studyIntraocular lens and randomization Intraocular lens and randomIntraocular lens and evaluation study Cataract extraction and clinical trialCataract extraction and randomized controlled trial Cataract extraction and comparative studyCataract extraction and controlled clinical trial Cataract extraction and multicenter studyCataract extraction and randomization Cataract extraction and randomCataract extraction and evaluation study

24 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.

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26 artículos revisados Valen 25 Separar el grano de la paja ¿Es grano de calidad?

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28 ESCALA DE JADAD EstudioRandomizadoDoble ciegoPerdidos Método randomiz. Método de ciego Puntuación Cionni Rodríguez Galietero Pierre Muftuoglu Baker Jackson Beauchamp Landers Greenstein Artículos eliminados

29 ESCALA DE JADAD EstudioRandomizado Doble ciego Perdidos Método de randomiz. Método del ciego Puntuación Hayashi K Leivobitch Marshall Pandita Cristóbal Kara-Júnior Caporossi Espindle Falkner-Radler Rocha Rocha Vuori Ueda Raj Yuan Bhattacharjee

30 Ejemplo de revisión. Peribulbar vs retrobulbar.

31 ¿Mezclamos churras con merinas?

32 Farnsworth Munsell D100

33 Yuan 2003 J1 N = 57 Leivobitch 2006J319 Marshall 2005J2297 Cristóbal 2005J132 Falkner-Radler 2008J260 Vuori 2006J352 Raj 2005J430 Bhattacharjee 2006J226 ¿?

34 CSV-1000E Utiliza frecuencias de 3, 6, 12 y 18 ciclos/grado.

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36 Pandita 2007J4 73 (asféricas con filtros) Cristóbal 2005J132 Rocha 2006J3 80 (asféricas con filtros) Hayashi K 2006J473 Leivobitch 2006J319 Marshall 2005J2297 Falkner-Radler 2008J260 Bhattacharjee 2006J226 ¿?

37 Landers 2007J1 96 Espindle 2005J3157 Espindle 2005 Visión general Actividades de cerca Actividades de lejos Dependencia Conducción Visión del color Visión periférica Dolor ocular Landers % no diferenciaron la LIO Del 24%, 11% preferían la amarilla y al resto le daba igual. ¿Fotofobia? 26% en natural y 73% en normal. A la semana se igualaron. Yuan 2003

38 Cristóbal 2005 J132 ¿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

39 Falkner-Radler 2008J260 Duración de la operación: 65,17 minutos con Blanca 63,33 minutos con Amarilla Complicaciones Cuestionario al cirujano (de 0 a 2): Sabían que era amarilla Intensidad y calidad de la luz Visión de células del vítreo Visión de la retina Mayor o menor uso de colorantes Calidad de la luz durante el endoláser Fenómenos de glare durante la cirugía

40 Beauchamp 2007J085

41 Greenstein 2007J09

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43 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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