Exudative AMD Risk Following Blue Light-Filtering IOL Implantation: A Population-Based Study According to Non-Exudative AMD Status

Purpose: To evaluate whether blue light-filtering (BLF) intraocular lenses (IOLs) reduce the risk of exudative age-related macular degeneration (AMD). Design: A nationwide, population-based cohort study using data from the Korean National Health Insurance Sharing Service (NHISS) database. Participants: Individuals who underwent cataract surgery and received the same type of IOL (BLF or clear) in both eyes within one year between January 2012 and December 2018. Methods: Participants were categorized into BLF IOL or clear IOL groups, and the risk of exudative AMD was compared between the 2 groups. The 10-year cumulative incidence of exudative AMD was estimated using Kaplan-Meier analysis. Cox proportional hazard models and the Fine-Gray model were applied to calculate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs), adjusting for age, sex, socioeconomic status, and systemic diseases. The same analysis was performed in the cohort matched by age, sex, and the calendar year of the index date. Main outcome measures: 10-year cumulative incidence, incidence rate, and HR for exudative AMD. Results: A total of 21,741 individuals with BLF IOLs were compared to 56,357 individuals with clear IOLs. The mean follow-up duration was 7.0 ± 2.5 years in the BLF IOL group and 6.7 ± 2.5 years in the clear IOL group (P = .069). The 10-year cumulative incidence of exudative AMD was 1.8% (95% CI, 1.5%–2.0%) in the BLF IOL group and 1.7% (95% CI, 1.5%-1.8%) in the clear IOL group. The incidence rates per 100,000 person-years were 162.8 and 153.9 in the BLF IOL group and clear IOL groups, respectively, with no significant difference in the adjusted Cox model (aHR 1.12; 95% CI, 0.96-1.30; P = .149) and the Fine-Gray model (aHR 1.15; 95% CI, 0.97-1.36; P = .120). Subgroup analyses based on age, sex, and history of nonexudative AMD showed no protective effect of BLF IOLs, with comparable incidence rates across all subgroups. Similar results were observed in the matched cohort analysis. Conclusions: BLF IOL implantation in cataract surgery does not reduce the risk of developing exudative AMD in the South Korean population, regardless of a history of nonexudative AMD.