[Light exposition in vitreoretinal surgery. I. Basics]

[Climate change as a factor in the development of retinal diseases: a critical review]

The climate change has multiple effects on health. The eyes are not exempt from these effects and components of climate change, such as the temperature, UV radiation or air pollution that can have a relevant impact on retinal pathologies can be worked out. The alterations to the retina include UV light-induced retinal damage, age-related macular degeneration (AMD), choroidal melanoma, diabetic retinopathy, retinal detachment and vascular occlusion. Overall, there is an urgent need for prospective multicenter studies to be able to further analyze the specific impact of components of climate change on the retina.

Retinal risk of endoillumination: A comparison of different ophthalmic illumination systems

OBJECTIVES

In vitreoretinal surgery, there is always a conflict between bright illumination of the field of operation and retinal safety. This study aimed to investigate different light sources and light guides for their potential retinal risk due to bright illumination.

METHODS

Irradiances in the fovea of ex-vivo porcine eyes resulting from different light sources (halogen lamp, xenon lamp and LED) and light guides are investigated for varying distances between the illumination tip and the fovea. The results are examined with regard to their photochemical and thermal retinal hazard and the maximal exposure time. The examination is carried out with the maximum intensity setting of each light source and with normalization to its brightness.

MAIN RESULTS

With decreasing distance of the tip of the light source, the retinal hazard increases. The photochemical and thermal retinal hazard at maximum brightness are smallest for the halogen lamp, next for the xenon lamp and highest for the LED. Thus, the exposition time is the longest for the halogen lamp followed by the xenon lamp and the LED. Normalizing the results to the same brightness the maximum exposition time is nearly the same for xenon lamp and LED, but still higher in case of the halogen lamp.

CONCLUSIONS

The choice of the most suitable lamp and illumination fiber depends on the intensity and spectral distribution of the illumination system. Concerning brightness, xenon and LED lamp are relatively harmless, but the surgeon should avoid the maximum device intensity.

Intraocular reflectance of the ocular fundus and its impact on increased retinal hazard

PURPOSE

Inside the eye light can be reflected multiple times due to light-tissue interactions and the spherical geometry of the eye. Due to these optical properties, a defined retinal area is not only illuminated by direct light but also by indirect, reflected light from the inner side of the eyewall. During illumination for ophthalmic surgery, this could lead to an unintended increase in intraocular retinal irradiance, which was already discussed in previous studies but without a detailed consideration of spectral differences and a potential influence of pigmentation. In this study this effect is investigated wavelength-dependent to see if different wavelengths lead to different increase in irradiance, with a special focus on the raise in photochemical and thermal hazard to the retina. It is also examined whether this effect is dependent on the pigmentation of the eye.

METHODS

The reflectance properties of either less or highly pigmented porcine eyes are measured in the wavelength range between 350 and 1100nm with an integrating sphere and a spectrometer. With these reflectance spectra the wavelength-dependent Sphere Multiplier M of porcine eyes can be calculated, which represents the increase of radiance due to multiple reflections inside a sphere compared to a planar diffuser of the same size. Based on measurements of the emitted irradiance of ophthalmic illumination fibers the increase in photochemical and thermal retinal hazard due to these multiple reflections is calculated for eyes with small and high amounts of pigmentation.

RESULTS

The reflectance of the inner eyewall in the range between 350 and 1100nm is significantly higher for eyes with low pigmentation (between 4.90% and 37.44% reflectance) in comparison to eyes with a high amount of pigmentation (between 4.30% and 28.88% reflectance). The Sphere Multiplier for the inner side of the eyewall (sclera, choroid and retina) ranges between 1.13 and 1.59 and between 1.13 and 1.48 for eyes with low and high pigmentation, respectively, in the range between 350 and 1100nm. The reflectance, as well as the Sphere Multiplier, is strongly wavelength-dependent due to the absorption spectra of melanin and hemoglobin, which are located in the eye. With increasing wavelength, the reflection properties and the Sphere Multiplier also increases. With this, the photochemical retinal hazard of highly pigmented eyes increases by (14.11± 0.09)% and of lightly pigmented eyes by (16.75±0.35)% compared to if the reflection properties are not considered. The thermal retinal hazard increases by (14.30±0.07)% for highly pigmented eyes and by (19.65±0.17)% for low pigmented eyes.

CONCLUSION

This study demonstrates that the anatomy and pigmentation of the eye plays an important role for the reflectance properties of the eye and for the photochemical and thermal hazard to the retina.

The Molecular Mechanism of Retina Light Injury Focusing on Damage from Short Wavelength Light

Natural visible light is an electromagnetic wave composed of a spectrum of monochromatic wavelengths, each with a characteristic color. Photons are the basic units of light, and their wavelength correlates to the energy of light; short-wavelength photons carry high energy. The retina is a fragile neuronal tissue that senses light and generates visual signals conducted to the brain. However, excessive and intensive light exposure will cause retinal light damage. Within the visible spectrum, short-wavelength light, such as blue light, carries higher energy, and thus the retinal injury, is more significant when exposed to these wavelengths. The damage mechanism triggered by different short-wavelength light varies due to photons carrying different energy and being absorbed by different photosensitive molecules in the retinal neurons. However, photooxidation might be a common molecular step to initiate cell death. Herein, we summarize the historical understanding of light, the key molecular steps related to retinal light injury, and the death pathways of photoreceptors to further decipher the molecular mechanism of retinal light injury and explore potential neuroprotective strategies.

[Impact of ultraviolet radiation on the retina]

Light has a crucial role in the visual process. For nonvisible radiation in the short-wave spectrum, there are natural mechanisms that protect the human retina from damaging ultraviolet (UV) radiation. Here, the dose (= energy) makes the poison. Damage caused by UV light mainly affects the outer retina, particularly the photoreceptors and the retinal pigment epithelium. While retinal damage due to increased UV radiation exposure can potentially still occur up to the age of 20, in adulthood, exposure of the retina to UV radiation can no longer be assumed, due to decreasing transmission properties of the natural lens. The natural lens, modern intraocular lenses, and wearing of sunglasses with appropriate filter function, particularly in childhood and adolescence, provide a relevant reduction in UV radiation exposure of the retina.