Ophthalmic & Physiological Optics ISSN 0275-5408
GUEST EDITORIAL
Blue-light filtering ophthalmic lenses: to prescribe, or not to
prescribe?
Although essential to visual perception, light can poten-
tially act as an ocular hazard. Sunlight comprises of radia-
tion from the electromagnetic spectrum, extending from
the longer wavelengths of the ultraviolet (UV) region
(~290 nm) to the far infrared. Importantly, the natural
absorbance characteristics of the eye limit the amount of
potentially damaging radiation that can reach the retina.
The cornea absorbs UV radiation below 300 nm1 and the
crystalline lens attenuates the transmission of most wave-
lengths between 300 and 400 nm, particularly those up to
360 nm.1,2 With advancing age, and an associated physio-
logic yellowing of the crystalline lens, there is a relatively
increased degree of attenuation of blue light transmission;
the aged crystalline lens thus shows blue-light filtering
properties.3 The macular pigments, lutein and zeaxanthin,
are also proposed to impart retinoprotection by absorbing
short-wavelength visible light.4
It is retinal exposure to shorter-wavelength visible light
(400 to 500 nm), being of relatively higher energy than visi-
ble light of other wavelengths, which forms the basis for the
so-called ‘blue-light hazard’ (Figure 1a). Data from cell
culture experiments5–7 and animal studies8 demonstrate
that short-wavelength visible light can induce phototoxic
retinal damage. Extrapolating these empirical findings,
international standards were developed to define safety
limits relating to blue-light ocular exposure in humans.9
However, the past decade has witnessed dramatic changes
to the adoption of a range of modern light sources, in both
domestic and commercial settings; in particular, there has
been significantly increased use of light emitting diodes
(LEDs) and compact fluorescent lamps, which emit
relatively higher levels of blue light than traditional
incandescent sources.10 Furthermore, white-light LEDs,
which are currently utilised in the backlit displays of tablet
computers, laptops and smartphones, show weighted peak
spectral emissions at wavelengths that correspond to the
peak of the blue-light hazard function (Figure 1b).
Reassuringly, recent research suggests that even under
extreme, long-term viewing conditions, the level of blue-
light exposure from computer screens and mobile devices
is significantly less than the levels of blue-light exposure
from natural daylight, and further, such exposures do not
approach international safety limits.10 However, in addi-
tion to potential retinal damage, exposure to short-wave-
length light has been suggested to yield other clinically
significant effects. For example, excessive exposure to
640 © 2017 The Authors Ophthalmic & Physiological Optics © 2017 The College of Optometrists
visible blue light has been suggested to cause eye strain,11
and to potentially promote sleep dysfunction due to a shift
in circadian phase with nighttime blue light exposure.12
Given the frequency and duration of digital device use in
modern society, should blue-light exposure be a public
health concern?
Over the past decade, there has been heightened interest
amongst researchers, the optical industry and eye care clini-
cians in relation to ophthalmic lenses that have blue-light
filtering properties. A PubMed search of the keywords
‘blue-block*’ or ‘blue-light filter*’ reveals that since 2008
there has been a notable increase in the number of publica-
tions focusing on this topic (Figure 2). Blue-light filtering
lenses, also termed ‘blue-blocking’ lenses, selectively attenu-
ate the transmission of both UV light (involving wave-
lengths in the 200 to 400 nm range), and short-wavelength
visible light (including violet light: 380 to 440 nm and blue
light: 440 to 500 nm). These ophthalmic devices, which
include both intra-ocular lenses (IOLs) and spectacle
lenses, may contain, or be coated with, chromophores that
absorb incident short-wavelength light; the extent of atten-
uation depends upon the specific absorbance properties of
the chromophore. An alternative approach involves the
application of anti-reflective interference coatings to the
ophthalmic lens surfaces, to selectively reduce the transmis-
sion of regions of the violet-blue spectrum. In addition,
some digital devices offer the option of blue-light filtering
‘night’ settings, which reduce the emission of short-wave-
length light, with the intent of limiting evening blue light
exposure, to improve subsequent sleep quality.
A range of marketing claims13 have been made with
respect to the potential benefits of blue-light spectacle fil-
ters, including the alleviation of eyestrain and ocular dis-
comfort associated with digital device use,14,15 improving
sleep quality16 and protection from retinal phototoxicity.13
Blue-light filtering IOLs, which more closely mimic the
light transmission characteristics of the ageing human crys-
talline lens compared with UV-filtering IOLs, have been
proposed to potentially protect against retinal damage fol-
lowing cataract surgery. Proponents for such filters suggest
that the attenuation of short-wavelength visible light could
prevent or slow the progression of age-related macular
degeneration (AMD); currently, there are insufficient clini-
cal data to support this position.17,18
As previously detailed, the argument for photoprotection
with blue-light filters is theoretical and/or based upon
Ophthalmic & Physiological Optics 37 (2017) 640–643

Figure 1. (a) Diagram of the blue light hazard function, which plots the relative effectiveness of optical radiation to produce retinal damage as a
function of wavelength. (b) Blue light weighted spectral radiance from incandescent (orange plot) and light emitting diode (purple plot) light sources,
after applying the blue light hazard weighting. Adapted from O’Hagan and colleagues (2016).10
Figure 2. Number of publications in PubMed resulting from a search
of the keywords ‘blue-block*’ or ‘blue-light filter*’.
in vitro studies or laboratory-based experiments, rather
than clinical studies. Thus, while the rationale for using
blue-light filtering ophthalmic devices has scientific plausi-
bility, there is significant debate with respect to the merit of
these products for imparting retinal protection and/or their
other purported benefits in clinical populations. Further-
more, the possible benefits of these devices needs to be con-
sidered in the context of any possible harms, which have
been suggested to potentially include alterations to colour
perception, reduced scotopic sensitivity and disruptions to
circadian rhythms.19 Such factors are particularly relevant
given that the prescription of a blue-light filtering spectacle
lens is typically at additional expense (beyond the cost of a
non-blue light filtering lens) to the consumer. Most
recently, the potential protective effect of violet visible light
for reducing myopia progression in an animal model has
been reported;20 if shown to be consistent in humans, this
© 2017 The Authors Ophthalmic & Physiological Optics © 2017 The College of Optometrists
Ophthalmic & Physiological Optics 37 (2017) 640–643
Guest Editorial
finding may have broader implications for the prescribing
of short-wavelength attenuating filters to children at risk of
myopia development and/or progression.
Recently, questions have been raised, within both the
popular press21,22 and scientific literature,10,23 regarding
whether there is sufficient evidence to support specific
claims that have been made in relation to the beneficial
effects of blue-light filtering ophthalmic lenses. In the Uni-
ted Kingdom (UK) there has been significant controversy
surrounding the promotion, by some optical companies, of
blue-light filtering spectacle lenses for what was deemed
“unproven health claims”.24 In 2015, the UK Advertising
Standards Authority (ASA) found that a national press
advertisement from an optical retailer promoting the use of
a blue-light filtering spectacle lens product to consumers to
“filter out harmful blue light” constituted misleading
advertising “in the absence of adequate substantiation”
linking blue light exposure to retinal damage in clinical
populations.25 As a result of the ASA ruling, the advertise-
ment was prohibited from being reused in its original form.
Furthermore, in 2016, the British Broadcasting Corpora-
tion (BBC) undertook an undercover investigation, as part
of the consumer protection television program Watchdog,
to investigate health claims being made to consumers by
selected optical retailers in relation to the benefits of blue-
light filtering spectacle lenses. The program, which aired on
television in the UK in November 2016, expressed concerns
about “misleading” advice that was provided in relation to
the influence of blue light, emitted from digital devices,
promoting eye strain and visual fatigue.24
There is arguably a need for improved guidance for
clinicians in relation to the appropriateness of prescribing
ophthalmic devices that selectively attenuate short wave-
length light. In Australia, clinical guidelines are being
641
Guest Editorial
developed to assist optometrists with providing evidence-
based advice to their patients in relation to blue-light fil-
tering spectacle coatings.26 The authors of these guidelines
have indicated that recommendations will consider both
the universal applicability of blue-light filters (for prescrip-
tion to the general population), as well as their potential
suitability for ‘at risk’ populations.26 With respect to oph-
thalmology, a Cochrane systematic review is currently in
progress to assess evidence relating to the effects of blue-
light filtering IOLs for protecting macular health following
cataract phacoemulsification surgery.27
Recognising the urgent need for a similar evaluation of
the best available clinical research evidence relating to
blue-light spectacle filters, in the current issue of Oph-
thalmic and Physiological Optics, Lawrenson and col-
leagues present findings from a systematic review that
considers the potential benefits and harms of blue-light
filtering spectacle lenses.28 The findings of this review
have significant implications for ophthalmic practice. In
particular, there is a need for clinicians to adopt an
evidence-based approach when considering whether to
prescribe blue-light filtering spectacle lenses. The review
highlights a current lack of high quality clinical evidence
to support a beneficial effect with blue-blocking spectacle
lenses for reducing eye fatigue, enhancing sleep quality or
preserving macular health, in the general population. No
high quality clinical studies were found to report on the
effects of blue-blocking spectacle lenses with respect to
macular health. Furthermore, none of the studies eligible
for inclusion in the review reported upon potential
adverse effects associated with the use of blue-blocking
spectacle lenses. Further research is essential to improve
scientific understanding of the effects of blue-blocking
spectacle filters on visual performance and eye health.
In the longer term, whether blue-light filtering oph-
thalmic lenses are beneficial to patients, both with respect
to their potential effects on visual fatigue and/or preserving
macular health, is an important public health issue. In par-
ticular, AMD is a major cause of vision impairment world-
wide, and methods that are effective in delaying its
development and/or reducing its progression would be pre-
dicted to yield immense benefits in terms of reducing the
individual and economic burden of the condition.29 Fur-
thermore, such potential gains would be amplified with the
observed worldwide demographic shifts towards enhanced
longevity. Currently, whether blue-light absorbing oph-
thalmic devices impart benefits in relation to reducing the
risk for, or the progression of, AMD are not known.
Appropriately powered, long-term (i.e., multi-year) clinical
trials would be required to investigate such effects. In any
case, it is imperative that claims and clinical recommenda-
tions relating to the prescription of blue-light filtering
642 © 2017 The Authors Ophthalmic & Physiological Optics © 2017 The College of Optometrists
ophthalmic lenses remain consistent with the current, best-
available clinical research evidence.
Disclosure
The author does not have any conflicts of interest relating
to the content of this editorial.
Laura E Downie
Department of Optometry & Vision Sciences,
University of Melbourne, Melbourne, Australia
E-mail address: ldownie@unimelb.edu.au
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Dr Laura Downie is a Senior Lecturer and a recent National Health and

Medical Research Council (NHMRC) Translating Research Into Practice Fel-
low in the Department of Optometry and Vision Sciences at the University
of Melbourne, Victoria, Australia. She completed her undergraduate optom-
etry degree (2003) and doctorate (2008) at the University of Melbourne. In
her current role, she provides didactic and clinical training to Doctor of
Optometry students, leads the specialty Cornea clinic at University of Mel-
bourne eye care clinic and heads the Downie Laboratory: Anterior Eye, Clini-
cal Trials and Research Translation Unit. A major component of her research
focuses upon the translation of evidence into practice in the context of eye
health, including the role of diet and nutritional supplementation as modifi-
able risk factors for sight-threatening eye conditions, such as age-related
macular degeneration. In 2014, she was awarded two prestigious fellowships
from the NHMRC and achieved international recognition for her research as
recipient of the Irvin M. and Beatrice Borish Award from the American
Academy of Optometry.

© 2017 The Authors Ophthalmic & Physiological Optics © 2017 The College of Optometrists 643
Ophthalmic & Physiological Optics 37 (2017) 640–643