RECOMMENDATION OF PROTECTIVE EYE WEAR FOR PATIENTS SUFFERING FROM DEGENERATIVE RETINAL DISEASES.

CH. E. REME, LABORATORY OF RETINAL CELL BIOLOGY, UNIVERSITY EYE CLINIC, ZUERICH, SWITZERLAND

On the basis of recent research data the scientific and medical advisory board of Retina International strongly recommends UV-blocking and blue-reducing sunglasses for patients affected with retinal degenerations and dystrophies.

For review of human light damage: [23, 24, 16]

Apart from possible contrast enhancement and reduction of visual discomfort by minimizing glare, there are now medical indications for the use of protective sunglasses. The overall level of transmission of visible light in such glasses may vary according to the needs of the respective patients, however, UV-blockade (i.e. at 400 nm) and a reduction of blue light transmission (i.e. up to 470 nm) is mandatory in view of several scientific publications (see below).

Scientific rationale:

A growing number of animal models which mirror human retinal dystrophies and certain cases of human RP show an increased sensitivity to bright light exposure, which accelerates the death of visual cells [4, 22, 15, 1, 3, 12, 10]. There is also increasing experimental evidence for light as a risk factor initiating or enhancing age-related macular degeneration [17, 18, 20, 14, 19].

Conclusive experimental evidence reveals that short wavelength blue light has a distinct potential to damage and destroy visual cells [2, 9, 7, 8, 11, 6, 13, 21].

Even though epidemiological studies regarding prevalence of AMD in relation to sunlight exposure are controversially discussed, recent evidence from a longitudinal, population based study indicates that extended exposure to sunlight in teenagers and young adults is associated with the development of early AMD in later years of life [5].

-------------------------------------------
Selected references:

[1] Chen, C.K., Burns, M.E., Spencer, M., Niemi, G.A., Chen, J., Hurley, J.B., Baylor, D.A. and Simon, M.I., Abnormal photoresponses and light-induced apoptosis in rods lacking rhodopsin kinase. Proc Natl Acad Sci U S A, 96 (1999) 3718-3722.

[2] Chen, E., Inhibition of cytochrome oxidase and blue-light damage in rat retina. Graefes Arch Clin Exp Ophthalmol, 231 (1993) 416-423.

[3] Chen, J., Simon, M.I., Matthes, M.T., Yasumura, D. and LaVail, M.M., Increased susceptibility to light damage in an arrestin knockout mouse model of Oguchi disease (stationary night blindness). Invest Ophthalmol Vis Sci, 40 (1999) 2978-2982.

[4] Cideciyan, A.V., Hood, D.C., Huang, Y., Banin, E., Li, Z.Y., Stone, E.M., Milam, A.H. and Jacobson, S.G., Disease sequence from mutant rhodopsin allele to rod and cone photoreceptor degeneration in man., Proc Natl Acad Sci USA, 95 (1998) 7103 - 7108.

[5] Cruickshanks, K.J., Klein, R., Klein, B.E. and Nondahl, D.M., Sunlight and the 5-year incidence of early age-related maculopathy: the beaver dam eye study, Arch Ophthalmol, 119 (2001) 246-250.

[6] Delmelle, M., Possible implication of photooxidation reactions in retinal photo-damage. Photochem Photobiol, 29 (1979) 713-716.

[7] Grimm, C., Reme, C.E., Rol, P.O. and Williams, T.P., Blue Light's effects on rhodopsin: photoreversal of bleaching in living rat eyes. Invest Ophthalmol Vis Sci, 41 (2000) 3984-3990.

[8] Grimm, C., Wenzel, A., Hafezi, F., Yu, S., Redmond, T.M. and Reme, C.E., Protection of Rpe65-deficient mice identifies rhodopsin as a mediator of light-induced retinal degeneration.Nat Genet, 25 (2000) 63-66.

[9] Grimm, C., Wenzel, A., Williams, T.P., Rol, P.O., Hafezi, F. and Reme, C.E., Rhodopsin-Mediated Blue-Light Damage to the Rat Retina: Effect of Photoreversal of Bleaching. Invest Ophthalmol VisSci, 42 (2001) 497 - 505.

[10] Haider, N.B., Jacobson, S.G., Cideciyan, A.V., Swiderski, R., Streb, L.M., Searby, C., Beck, G., Hockey, R., Hanna, D.B., Gorman, S., Duhl, D., Carmi, R., Bennett, J., Weleber, R.G., Fishman, G.A., Wright, A.F., Stone, E.M. and Sheffield, V.C., Mutation of a nuclear receptor gene, NR2E3, causes enhanced S cone syndrome, a disorder of retinal cell fate. Nat Genet, 24 (2000) 127-131.

[11] Keller, C., Grimm, C., Wenzel, A., Hafezi, F. and Reme, C.E., Protective Effect of Halothane Anesthesia on Retinal Light Damage: Inhibition of Metabolic Rhodopsin Regeneration. Invest Ophthalmol Vis Sci, 42 (2001) 476 - 480.

[12] LaVail, M.M., Gorrin, G.M., Yasumura, D. and Matthes, M.T., Increased susceptibility to constant light in nr and pcd mice with inherited retinal degenerations, Invest Ophthalmol VisSci, 40 (1999) 1020-1024.

[13 ]Masuda, K. and Watanabe, I., Short wavelength light-induced retinal damage in rats. Jpn J Ophthalmol, 44 (2000) 615 - 619.

[14] Mata, N.L., Weng, J. and Travis, G.H., Biosynthesis of a major lipofuscin fluorophore in mice and humans with ABCR - mediated retinal and macular degeneration. Proc Natl Acad Sci USA, 97.

[15] Naash, M.L., Peachey, N.S., Li, Z.Y., Gryczan, C.C., Goto, Y., Blanks, J., Milam, A.H. and Ripps, H., Light-induced acceleration of photoreceptor degeneration in transgenic mice expressing mutant rhodopsin. Invest Ophthalmol Vis Sci, 37 (1996) 775-782.

[16] Remé, C.E., Hafezi, F., Marti, A., Munz, K. and Reinboth, J.J., Light damage to retina and pigment epithelium. In M.F. Marmor and T.J. Wolfensberger (Eds.), The retinal pigment epithelium, function and disease. Oxford University Press, Oxford, 1998b, pp. 563 - 586.

[17] Rozanowska, M., Jarvis-Evans, J., Korytowski, W., Boulton, M.E., Burke, J.M. and Sarna, T., Blue light-induced reactivity of retinal age pigment. In vitro generation of oxygen-reactive species. J. Biol. Chem., 270 (1995) 18825-18830.

[18] Sparrow, J.R., Nakanishi, K. and Parish, C.A., The lipofuscin fluorophore A2E mediates blue light - induced damage to retinal pigmented epithelial cells. Invest Ophthalmol VisSci, 41 (2000) 1981 - 1989.

[19] Sun, H. and Nathans, J., ABCR, the ATP-binding cassette transporter responsible for Stargardt Macular Dystrophy, is an efficient target of all-trans-retinal-mediated photooxidative damage in vitro. J Biol Chem, 276 (2001) 11766 - 11774.

[20] Suter, M., Remé, C., Grimm, C., Wenzel, A., Jaattela, M., Esser, P., Kociok, N., Leist, M. and Richter, C., Age-related macular degeneration. The lipofuscin component n-retinyl-n-retinylidene ethanolamine detaches proapoptotic proteins from mitochondria and induces apoptosis in mammalian retinal pigment epithelial cells. J Biol Chem, 275 (2000) 39625-39630.

[21] Van Norren, D. and Schellekens, P., Blue light hazard in rat. Vision Res, 30 (1990) 1517-1520.

[22] Wang, M., Lam, T.T., Tso, M.O. and Naash, M.I., Expression of a mutant opsin gene increases the susceptibility of the retina to light damage, Vis Neurosci, 14 (1997) 55-62.

[23] Young, R.W., Solar radiation and age-related macular degeneration, Surv Ophthalmol, 32 (1988) 252-269.

[24] Young, R.W., The family of sunlight-related eye diseases, Optom Vis Sci, 71 (1994) 125-144.