Effect of Blue Light-Filtering Intraocular Lenses on Age-Related Macular Degeneration: A Nationwide Cohort Study With 10-Year Follow-up

Purpose To estimate the incidence rate of age-related macular degeneration (AMD) after cataract surgery and to compare the relative incidence of AMD in pseudophakes with blue light-filtering intraocular lenses (BF-IOLs) and non-BF-IOLs. Design This is a nationwide cohort study conducted using the Taiwan National Health Insurance Research Database. Methods We enrolled 186,591 patients who underwent cataract surgery in both eyes between 2008 and 2013 and followed them from the index date (the date of first cataract surgery) until AMD; death; loss to follow-up; or December 31, 2017; whichever occurred first. Propensity score matching (PSM) was used to balance the baseline characteristics between the two IOL groups, namely BF-IOL and non-BF-IOL groups. Results In total, 21,126 (11.3%) and 165,465 (88.7%) patients had BF-IOL and non-BF-IOL implants, respectively. Patients in the BF-IOL group tended to be younger, with fewer males, different cataract surgery years, higher income, more non-manual workers, more patients from urban and suburban areas, and fewer chronic diseases compared to the non-BF-IOL group. With a mean follow-up period of 6.1 years (range: 1–10 years) after cataract surgery, 12,533 and 1,655 patients developed non-exudative AMD and exudative AMD, respectively. The incidence rate of non-exudative AMD and exudative AMD (per 1000 person-years) was 9.95 and 1.22 for the BF-IOL group, and 11.13 and 1.44 for the non-BF-IOL group, respectively. After PSM, no statistical difference in the incidence rate of non-exudative AMD [Hazards ratio = 0.95, 95% confidence interval = 0.88–1.03] and exudative AMD [Hazards ratio = 0.96, 95% confidence interval = 0.77–1.18] was observed between the two IOL groups. Conclusions In Taiwan, the incidence rate of AMD after cataract surgery was 11.59 per 1000 person-years. The use of a BF-IOL for up to 10 years had no apparent advantage over non-BF-IOL in the incidence of AMD.