The visual benefits of blue-violet light filtering

The electro-magnetic spectrum 

Electro-magnetic radiation constantly surrounds us, but we are often unaware of its presence. Sources of electro-magnetic radiation include items important to our daily lives like light bulbs, electrical appliances, computers, Wi-Fi and smartphones. Our eyes can only detect a small portion of the electro-magnetic spectrum ranging from short wavelength violet light (380nm) to long wavelength red light (780nm) (figure 1).¹⁴  

Approximately one-third of the visible light spectrum is blue light and media headlines have focused on the potential risks of this type of light to our ocular health, but these are not yet fully understood.  

While new classifications for HEV are currently in development, the International Organization for Standardization (ISO) 8980-3 defines the blue light hazard range as 380 to 500nm. This blue light is often described when separated into two categories: blue-violet (380 to 450nm) and blue-turquoise (450 to 500nm).¹⁴  

^{Figure 1: The electro-magnetic spectrum}  

Types of blue light 

Blue-violet light has the shortest wavelength in the visible spectrum. It moves at a higher frequency and emits more energy than longer wavelengths. To help us differentiate between the two types of blue light, they are also known as ‘blue-violet light’ and ‘blue-turquoise light’.¹⁵  

When sunlight hits the earth’s atmosphere, light rays are either absorbed, reflected or scattered. Rayleigh scattering occurs when light encounters small particles in the atmosphere.¹⁶ Short wavelengths scatter more than longer ones, which is why the sky appears blue.  

Our eyes are attuned to blue light because the peak sensitivity of short-wavelength cones is between 418 to 441nm (table 1).^{17, 18} Once light reaches the eye, it can either be transmitted, reflected or absorbed. Forward light scatter occurs as light scatters from the cornea or lens towards the retina with blue light scattering the most.¹⁹  

^{Table 1: Peak wavelength sensitivity and function of different types of photoreceptors}

When light reaches the retina, this activates visual pigments in the rods, cones or intrinsically photosensitive retinal ganglion cells (ipRGCs).²³ ipRGCs connect directly to the brain and help regulate our circadian rhythm, which is the body’s internal clock that controls our sleep-wake cycle.  

Additional roles of the ipRGCs include synchronising the circadian rhythm to the environment’s day-night cycle, the pupillary light reflex, mood regulation, and affecting how alert we feel.^{23, 24} 

Blue-violet light can potentially damage the retina^25-27 and has been associated with age-related macular degeneration,²⁸ cataract,²⁹ and photoretinitis.³⁰ However, most of this work was based on animal studies,²⁷ in vitro work,^{25, 26} or high levels of acute exposure.³⁰ 

It is important to remember that blue light per se has not been shown to be definitively harmful in controlled human studies. Blue-turquoise light reduces tiredness,^3-5 improves alertness,^3-5 drives the circadian rhythm,^{4, 31} suppresses melatonin production^{4, 31} and protects our eyes by stimulating the pupillary light reflex.³ The pupil constricts more to blue-turquoise wavelengths than red light and maintains constriction after the stimulus is removed³² to reduce the amount of light reaching the retina.  

Thus, selectively filtering blue-violet light may be of benefit in improving visual performance while not impacting the positive benefits of blue-turquoise light. 

Sources of blue light and exposure levels 

People report using digital devices for an average of 13 hours per day,³³ so how concerned should we be about the risk of blue light emitted from everyday objects?  

The strongest source of blue light is the sun. The levels of blue light emitted from fluorescent and light-emitting diode (LED) lights, and various digital devices are lower than the amount coming from the sun.^{1, 2}  

The maximum level of blue light emitted from digital device is only 0.3% of the International Commission on Non-Ionizing Radiation Protection (ICNIRP) blue light exposure limit.² It is estimated that 10 to 13 hours of continuous digital device use is the same as 15 minutes outside in daylight,² or that 30 hours of screen time is equivalent to 25 minutes in the midday sun.³⁴  

However, that is not to in any way denigrate the notion that filtering blue-violet light may improve visual performance on digital devices. Additionally, the increasing popularity of LED lighting both indoors and outdoors can lead to problems with glare due to its higher luminance and greater emission of blue light. Blue light also enters through windows as daylight and can lead to scatter.  

Practitioner and consumer beliefs about blue light 

There is a large gap in the knowledge of both consumers and eye care professionals regarding the predominant source of blue light. A survey reported that 80% of consumers in the United States and 67% in the United Kingdom thought that digital screens were the largest source of blue light (figure 2).³⁵  

Only 50% of eye care professionals in the United States and 43% in the United Kingdom knew that sunlight was the most common source of blue light, with 46% of practitioners in both countries believing that it came from digital screens.  

That is not to say the long-term exposure from digital devices is irrelevant or should not be ameliorated since the cumulative effect is unknown. Glare that results from short-term exposure to LEDs or xenon high-intensity discharge headlights can also be particularly disconcerting, especially to older drivers who may choose to stop driving due to difficulty seeing at night.³⁶  

Types of blue-light filtering optical devices  

How can we reduce the amount of blue light that reaches our eyes? The three main types of optical devices created to filter blue light are spectacles, contact lenses (CLs), and intraocular lenses (IOLs).  

While there are varying degrees of filtration in CLs on the market today, we will be focusing on a 60% selective blue-violet light filtering CL, because the peer reviewed evidence base indicates this level of filtration could provide visual benefits to the wearer.¹⁰  

A summary of the advantages and disadvantages of each device is shown in table 2: 

CLs and IOLs have a stable placement with unobstructed field-of-views, whereas the size of a spectacle lens and proximity of the frame to the eye will influence the amount of light that reaches the eye.⁴²  

The range of light filtered by spectacles is also more variable than CLs or IOLs. Cosmesis with spectacles is impacted more with higher levels of absorption of blue light. Differences between products can make it difficult to form generalisations and stresses the importance of knowing the specific transmission characteristics of the product that was tested.  

An example of spectral transmission curves for three blue-blocking spectacle lenses in comparison to a control lens without a blue filter⁴⁶ is shown in figure 3.

^{Figure 3: Spectral transmission curves of three blue-blocking spectacle lenses Blu-OLP, Crizal Prevencia, and Blue Guardian investigated by Alzahrani et al,₄₆ which filter approximately 17.80% to 36.44% of blue light₃₇ compared to a clear control lens without a blue filter} 

Evidence for use of blue-light filtering spectacles 

Systematic reviews and meta-analyses help condense the results of multiple studies to enable practitioners to make informed decisions on the best way to manage their patients.  

Reviews published by the Cochrane Database of Systematic Reviews are considered the ‘gold-standard’⁴⁷ in health care because of their strong methodology that aims to minimise bias and avoid conflicts of interest.  

A recent Cochrane Review investigated the effect of blue-light filtering spectacle lenses on visual performance, sleep and macular health.³⁸ The review did not find high levels of evidence to support the reported benefits.  

It concluded that there may be no difference in the visual fatigue scores and critical flicker fusion frequency (CFF) for people wearing blue-light filtering spectacle lenses compared to ones that do not filter blue-light.  

The Grading of Recommendations Assessment, Development and Evaluation (Grade) levels of certainty for both primary outcome measures were low,³⁸ which means that there was limited confidence in the results and that the true effect may be substantially different.⁴⁸ It was also only carried out on spectacle lenses with an average filtering percentage of 10-25%.⁴⁹  

Evidence for use of blue-light filtering intraocular lenses and 60% selective blue-violet filtering contact lenses†  

High contrast visual acuity is a poor predictor of visual performance. Different ways that light can adversely impact visual performance are listed in table 3, right. The addition of psychometric tests under low lighting conditions^{6, 50} can help gain more insight into how well a treatment has performed. 

Halos 

Halos appear as a ring of light surrounding a central point of light and the size can be determined by measuring the diameter of the diffused light (figure 4).⁷ Halos primarily occur due to forward light scatter from crystalline lens.⁵⁰  

Photostress recovery time 

When the eye views a bright source of light, like a camera flash, an afterimage forms, which temporarily impairs our vision. A photostress recovery test measures the length of time that it takes for vision to recover back to normal following exposure to an intense stimulus of light.^{51, 52} This duration corresponds to the time required to regenerate bleached visual pigments.  

 ^{Figure 4: Examples of halos and starbursts with the red lines showing the total distance of the spread of light} 

Scatter 

Light scatter can be assessed by measuring the minimum distance needed to distinguish two spots of light as separate objects.^{6, 9} Spots of light need to be moved further apart when there is greater scatter (figure 5).⁹ 

The resolution of two point sources can be investigated using white light that simulates the midday sun⁵² and a narrow band of blue-violet light.⁹ Blue-violet light was used to create the greatest amount of scatter and visual distortion.⁶  

^{Figure 5: Example of light scatter. When greater amounts of light spread across the retina, two-point sources of light appear as a single unit. As scatter increases, the further apart the two spots of light need to be moved to be seen as separate objects}  

Squint Response 

Blue-violet light can negatively impact visual clarity and cause subjective feelings of discomfort compared to longer wavelengths.⁵³ People may adopt compensatory mechanisms, such as squinting, in order to relieve the discomfort.⁵⁴ 

Glare is commonly encountered at night when oncoming headlights dazzle us on a dark road, or when the sun is low in the sky.⁵⁵ The level of discomfort caused by glare can be assessed using a grading scale.^{55, 56} Objective methods have also been used to quantify the amount of change in extraocular muscles after exposure to a bright light,¹⁰ which causes the extraocular muscles to contract. One method involves assessing the size of the palpebral aperture before a stimulus is shown and comparing it to the maximum amount of squint induced by a light.⁵⁷  

Starbursts 

Starbursts appear as spokes radiating out from a central source of light – the so called ciliary corona.⁷ The size of a starburst can be measured by viewing a point source of light and measuring the total distance that the spokes spread from the light (figure 4).  

Visual range 

We require good visual range to complete daily tasks, such as driving down the road to avoid cars and pedestrians. Visibility is significantly affected by blue haze,¹⁶ which makes distant objects appear as if they are surrounded by blue smoke.  

A summary of the results from different psychometric tests performed with blue-light filtering IOLs and CLs appears in table 4: 

Blue-violet light filtering contact lenses†  

As the amount of screen time and symptoms related to use of digital devices increases, CLs must address the challenge of these problems. Acuvue Oasys Max 1-Day CLs (Johnson & Johnson Vision) were specifically designed to maximise tear-film stability.¹¹  

Digital eye strain is a prevalent problem⁶⁰ with over 97% of medical students experiencing symptoms in one Saudi Arabian study.⁶² Acuvue Oasys Max 1-Day is a silicone hydrogel lens made using senofilcon A with a state of the art manufacturing process,¹² offering TearStable Technology together with the OptiBlue Light Filter Technology that filters around 60% of blue-violet light (figure 6) without affecting blue-turquoise light. ^10†  

TearStable Technology provides superior comfort and increased clarity*,¹³ by optimising the distribution of polyvinylpyrrolidone throughout the lens and at the surface, reducing evaporation and prolonging tear film stability. ^{11, 12, 63**}  

OptiBlue Light Filter Technology is a patented chromophoric technology that reduces light scatter¹⁰ and improves distance vision⁶⁴ by filtering blue-violet light. The lens filters the highest amount of blue-violet light in comparison to other daily wear CLs on the market. ^{12, 63††} The lenses are available in spherical and multifocal designs to fit a wide range of patients. 

In an in-practice survey, 69% of Acuvue Oasys Max 1-Day spherical and 72% of the multifocal wearers report that the lenses are the best they have ever worn.^‡‡  

Additionally, in a clinical study, wearers also reported superior performance when using digital devices,***,~ along with better clarity of vision,***, and were two times more likely to report a reduction in the feeling of tired eyes,^§§,∞ and more comfortable vision≠ versus Dailies Total1 sphere and multifocal (Alcon).^65,66  

Spherical lens wearers were two times more likely to report a reduction in the feelings of tired eyes when using digital devices and were two times less likely to experience feelings of tired eyes at the end of the day.^α,§§,65  

Multifocal wearers reported similar results when their responses were compared to Dailies Total1 Multifocal: they were 1.7 times more likely to report a reduction in tired eyes and two times more likely to have comfortable vision when using digital devices.^65***  

  ^{Figure 6: Transmission spectrum of the blue-violet light filtering Acuvue Oasys Max 1-Day compared to Acuvue Oasys 1-Day}

Conclusions 

Blue light is ubiquitous and we are unable to avoid it regardless of whether we are indoors or outdoors. Although the levels of blue light emitted from digital devices is relatively low per se, the cumulative effect of our increased screen time combined with high levels of short wavelength scatter and tear film instability can potentially lead to visual discomfort and fatigue, which impacts patients’ ocular comfort and visual performance. 

Many of our patients experience times in their everyday lives where light bothers them. This includes needing to squint in the sun or having difficulty seeing when exposed to oncoming headlights, which can have high levels of HEV light.  

The development of blue-light filtering optical devices, like contact lenses and intraocular lenses, have been shown to improve aspects of functional vision in comparison to clear or visibility tinted lenses.  

Practitioners should consider proactively asking their patients about visual symptoms related to problematic light and explain the different options available to help alleviate these problems.  

One helpful option is Acuvue Oasys Max 1-Day, which filters more blue-violet light than any other daily wear contact lens^{†††,†} and together with the TearStable™ technology^12,65 helps provide wearers with superior comfort and reduced fatigue.^65‡‡‡  

• Meredith Bishop OD, MS, FAAO is Senior Manager Global Professional Education and Development, Patricia Martin BS is Principal Research Scientist and John Buch OD, MS, FAAO is Senior Principal Research Optometrist at Johnson & Johnson Vision Care, Inc.
• David Ruston BSc, FCOptom, DipCLP, FAAO, FIACLE is Director of Global Professional Education and Development at Johnson & Johnson Medical Ltd.  

^{† Filtering of HEV light by contact lenses has not been demonstrated to confer any systemic and/or ocular health benefit to the user. The eye care professional should be consulted for more information.} 

^{†† Versus publicly available information for standard daily use contact lenses as of June 2023.} 

^{†††Versus publicly available information for standard daily use contact lenses as of June 2023.} 

^{* Versus Acuvue Oasys 1-Day} 

^{** Versus Dailies Total1, My Day and Infuse, also significantly lower versus Acuvue Oasys 1-Day.} 

^{***Versus Dailies Total1 Multifocal} 

^{‡ More wearers achieved a visual tear break up time ≥ 10 seconds versus Acuvue Oasys 1-Day.} 

^{‡‡ JJV Data from the Acuvue Oasys Max 1-Day In-Practice Assessment, with 81 participating Optometrists and 605 spherical and 390 multifocal patients in the US from July to October 2022} 

^{‡‡‡Versus Dailies Total1} 

^{§§ Versus Dailies Total1}  

^{~ 1 clinical study, n= 143 & meta-analysis involving five clinical studies (n=509)} 

^{∞ Randomised control trial (n=340)} 

^{≠ Meta-analysis involving six studies(n=789)} 

^{α Randomised control trial (n=340)} 

References 

1. de Gálvez EN, Aguilera J, Solis A, et al. The potential role of UV and blue light from the sun, artificial lighting, and electronic devices in melanogenesis and oxidative stress. Journal of Photochemistry and Photobiology B-Biology. 2022;228.
2. O’Hagan JB, Khazova M, Price LLA. Low-energy light bulbs, computers, tablets and the blue light hazard. Eye. 2016;30(2):230-233.
3. Lockley SW, Evans EE, Scheer FAJL, et al. Short-wavelength sensitivity for the direct effects of light on alertness, vigilance, and the waking electroencephalogram in humans. Sleep. 2006;29(2):161-168.
4. Zaidi FH, Hull JT, Peirson SN, et al. Short-wavelength light sensitivity of circadian, pupillary, and visual awareness in humans lacking an outer retina. Current Biology. 2007;17(24):2122-2128.
5. Noor MC, Revell V, Saradj FM, et al. The impact of wavelength on acute non-visual responses to light: a systematic review and meta-analysis. Brain Research. 2023;1816.
6. Hammond BR, Buch J, Hacker L, et al. The effects of light scatter when using a photochromic vs. non-photochromic contact lens. Journal of Optometry. 2020;13(4):227-234.
7. Hammond BR, Gardner CR, Renzi-Hammond L. The effects of blue-light filtering intraocular implants on glare geometry. Current Eye Research. 2023;48(7):639-644.
8. Renzi-Hammond L. Evaluating the impact of an HEV-filtering multifocal contact lens on halos and light scatter. 2023. In: British Contact Lens Association Conference June 2023, Manchester, United Kingdom [Internet].
9. Renzi-Hammond LM, Hammond BR. Blue-light filtering intraocular implants and darker irises reduce the behavioral effects of higher-order ocular aberrations. Current Eye Research. 2022;47(5):753-758.
10. Renzi-Hammond LM, Buch J, Xu J, et al. The influence of HEV-filtering contact lenses on behavioral indices of glare. Eye Contact Lens. 2022;48 (12):509-515.
11. JJV Data on file 2022. Effect on tear film and evaluation of visual artifacts of Acuvue Oasys Max 1-Day family with TearStable Technology.
12. JJV Data on file 2022. TearStable Technology definition.
13. JJV Data on File, 2022. CSM Subjective Responses Acuvue Oasys Max 1-Day Contact Lenses- Retrospective Meta-analysis.
14. Cougnard-Gregoire A, Merle BMJ, Aslam T, et al. Blue light exposure: ocular hazards and prevention-a narrative review. Ophthalmology and Therapy. 2023;12(2):755-788.
15. Giannos SA, Kraft ER, Lyons LJ, et al. Spectral evaluation of eyeglass blocking efficiency of ultraviolet/high-energy visible blue light for ocular protection. Optometry and Vision Science. 2019;96(7):513-522.
16. Wooten BR, Hammond BR. Macular pigment: influences on visual acuity and visibility. Progress in Retinal and Eye Research. 2002;21(2):225-240.
17. Stockman A, Sharpe LT, Fach C. The spectral sensitivity of the human short-wavelength sensitive cones derived from thresholds and color matches. Vision Research. 1999;39(17):2901-2927.
18. Chang D, Pastuck T, Rosen R, et al. Violet and blue light: impact of high-energy light on vision and health. Journal for Ophthalmic Studies. 2020;3(2):1-8.
19. Coppens JE, Franssen L, van den Berg TJTP. Wavelength dependence of intraocular straylight. Experimental Eye Research. 2006;82(4):688-692.
20. Lucas RJ, Peirson SN, Berson DM, et al. Measuring and using light in the melanopsin age. Trends in Neurosciences. 2014;37(1):1-9.
21. Bowmaker JK, Dartnall HJA. Visual pigments of rods and cones in a human retina. Journal of Physiology-London. 1980;298(Jan):501-511.
22. St Hilaire MA, Amundadóttir ML, Rahman SA, et al. The spectral sensitivity of human circadian phase resetting and melatonin suppression to light changes dynamically with light duration. Proceedings of the National Academy of Sciences of the United States of America. 2022;119(51).
23. Berson DM. Strange vision: ganglion cells as circadian photoreceptors. Trends in Neurosciences. 2003;26(6):314-320.
24. Mure LS. Intrinsically photosensitive retinal ganglion cells of the human retina. Frontiers in Neurology. 2021;12.
25. Sparrow JR, Miller AS, Zhou JL. Blue light-absorbing intraocular lens and retinal pigment epithelium protection in vitro. Journal of Cataract and Refractive Surgery. 2004;30(4):873-878.
26. Davies S, Elliott MH, Floor E, et al. Photocytotoxicity of lipofuscin in human retinal pigment epithelial cells. Free Radic Biol Med. 2001;31(2):256-65.
27. Wu JM, Seregard S, Algvere PV. Photochemical damage of the retina. Survey of Ophthalmology. 2006;51(5):461-481.
28. Fletcher AE, Bentham GC, Agnew M, et al. Sunlight exposure, antioxidants, and age-related macular degeneration. Archives of Ophthalmology. 2008;126(10):1396-1403.
29. Zeller K, Muhleisen S, Shanmugarajah P, et al. Influence of visible violet, blue and red light on the development of cataract in porcine lenses. Medicina-Lithuania. 2022;58(6).
30. Sliney DH. Ultraviolet radiation effects upon the eye: problems of dosimetry. Radiation Protection Dosimetry. 1997;72(3-4):197-206.
31. Lockley SW, Brainard GC, Czeisler CA. High sensitivity of the human circadian melatonin rhythm to resetting by short wavelength light. Journal of Clinical Endocrinology & Metabolism. 2003;88(9):4502-4505.
32. Gamlin PDR, McDougal DH, Pokorny J, et al. Human and macaque pupil responses driven by melanopsin-containing retinal ganglion cells. Vision Research. 2007;47(7):946-954.
33. Eyesafe estimate based upon Nielsen Q1 2020 Total Audience Report. https://eyesafe.com/covid-19-screen-time-spike-to-over-13-hours-per-day/.
34. 64% of people unaware of blue light impact on skin [press release]. 2020. Available from: https://www.unilever.com/news/press-and-media/press-releases/2020/sixty-four-percent-of-people-unaware-of-blue-light-impact-on-skin/#footnote-Ti2LXPq8l34h
35. JJV Data on file, 2020 HEV consumer report (n=150 US, 150 UK, & 110 Japan Consumers).
36. Wood JM. Nighttime driving: visual, lighting and visibility challenges. Ophthalmic and Physiological Optics. 2020;40(2):187-201.
37. Alzahrani HS, Khuu SK, Roy M. Modelling the effect of commercially available blue-blocking lenses on visual and non-visual functions. Clinical and Experimental Optometry. 2020;103(3):339-346.
38. Singh S, Keller PR, Busija L, et al. Blue-light filtering spectacle lenses for visual performance, sleep, and macular health in adults. Cochrane Database Syst Rev. 2023;8(8): CD013244.
39. Lin JB, Gerratt BW, Bassi CJ, et al. Short-wavelength light-blocking eyeglasses attenuate symptoms of eye fatigue. Investigative Ophthalmology & Visual Science. 2017;58(1):442-447.
40. Cockburn DM. Why patients complain about their new spectacles. Clin Exp Ophthalmol. 1987;70(3):91-95.
41. Santandreu M, Valero EM, Gómez-Robledo L, et al. Long-term effects of blue-blocking spectacle lenses on color perception. Optics Express. 2022;30(11):19757-19770.
42. Rosenthal FS, Bakalian AE, Lou CQ, et al. The effect of sunglasses on ocular exposure to ultraviolet radiation. Am J Public Health. 1988;78(1):72-4.
43. Hammond BR, Buch J, Renzi-Hammond LM, et al. The effect of a short-wave filtering contact lens on color appearance. J Vis. 2023;23(1):2.
44. Espindle D, Crawford B, Maxwell A, et al. Quality-of-life improvements in cataract patients with bilateral blue light-filtering intraocular lenses: clinical trial. Journal of Cataract and Refractive Surgery. 2005;31(10):1952-1959.
45. Brondsted AE, Haargaard B, Sander B, et al. The effect of blue-blocking and neutral intraocular lenses on circadian photoentrainment and sleep one year after cataract surgery. Acta Ophthalmologica. 2017;95(4):344-351.
46. Alzahrani HS, Roy M, Honson V, et al. Effect of blue-blocking lenses on colour contrast sensitivity. Clinical and Experimental Optometry. 2021;104(2) :207-214.
47. Peters JPM, Hooft L, Grolman W, et al. Reporting quality of systematic reviews and meta-analyses of otorhinolaryngologic articles based on the PRISMA statement. Plos One. 2015;10(8).
48. Zhang Y, Akl EA, Schünemann HJ. Using systematic reviews in guideline development: The GRADE approach. Research Synthesis Methods. 2019;10(3):312-329.
49. Blue-light filtering spectacles probably make no difference to eye strain, eye health or sleep quality. 2023 [Accessed November 29, 2023.] Available from: www.cochrane.org/news/blue-light-filtering-spectacles-probably-make-no-difference-eye-strain-eye-health-or-sleep.
50. Hammond BR, Buch J, Sonoda L, et al. The effects of a senofilcon A contact lens with and without a photochromic additive on positive dysphotopsia across age. Eye & Contact Lens-Science and Clinical Practice. 2021;47(5):265-270.
51. Hammond BR, Bernstein B, Dong J. The effect of the AcrySof natural lens on glare disability and photostress. Am J Ophthalmol. 2009;148(2):272-276 e2.
52. Hammond BR, Jr., Renzi LM, Sachak S, et al. Contralateral comparison of blue-filtering and non-blue-filtering intraocular lenses: glare disability, heterochromatic contrast, and photostress recovery. Clin Ophthalmol. 2010;4:1465-73.
53. Stringham JM, Fuld K, Wenzel AJ. Action spectrum for photophobia. Journal of the Optical Society of America a-Optics Image Science and Vision. 2003;20(10):1852-1858.
54. Sliney DH. Eye protective techniques for bright light. Ophthalmology. 1983;90(8):937-944.
55. Tester R, Pace NL, Samore M, et al. Dysphotopsia in phakic and pseudophakic patients: incidence and relation to intraocular lens type. Journal of Cataract and Refractive Surgery. 2000;26(6):810-816.
56. de Boer JS, DA. Glare as a criterion for quality in street lighting. Trans Illum Eng Soc. 1967;32:117-135.
57. Renzi-Hammond LM, Buch J, Xu J, et al. Reduction of glare discomfort and photostress recovery time through the use of a high-energy visible-filtering contact lens. Eye Contact Lens. 2022;48(12):516-520.
58. Muftuoglu O, Karel F, Duman R. Effect of a yellow intraocular lens on scotopic vision, glare disability, and blue color perception. Journal of Cataract and Refractive Surgery. 2007;33(4):658-666.
59. Popov I, Jurenova D, Valaskova J, et al. Effect of blue light filtering intraocular lenses on visual perception. Medicina-Lithuania. 2021;57(6).
60. Hammond BR. Filtering high-energy visible light in multifocal contact lenses reduces glare disability and glare discomfort without altering color perception. British Contact Lens Association Conference; Manchester, United Kingdom; 2023.
61. Wolffsohn JS, Lingham G, Downie LE, et al. TFOS Lifestyle: Impact of the digital environment on the ocular surface. Ocular Surface. 2023;28:213-252.
62. Altalhi AA, Khayyat W, Khojah O, et al. Computer vision syndrome among health sciences students in Saudi Arabia: prevalence and risk factors. Cureus Journal of Medical Science. 2020;12(2).
63. JJV Data on file 2022. Material Properties: 1-DAY Acuvue Moist, 1-DAY Acuvue TruEye, Acuvue Oasys 1-Day with HydraLuxe Technology and Acuvue Oasys Max 1-Day with TearStable Technology brand contact lenses and other daily disposable contact lens brands.
64. JJV Data on file 2022. Blue-violet filter utilized in Acuvue Oasys Max 1-Day contact lenses.
65. JJV Data on file 2022. Comparative subjective claims for Acuvue Oasys Max 1-Day lens vs Dailies Total1 and additional stand-alone claims.
66. JJV Data on file 2022. Acuvue Oasys Max 1-Day Multifocal vs Dailies Total1 multifocal contact lenses comparative and additional descriptive subjective claims.