Benefits of blue light-filtering intraocular lenses for subjective sleep quality: A systematic review and...

The increasing use of digital devices has raised concerns about the effects of blue light exposure on overall well-being. Blue light-filtering intraocular lenses (BF-IOLs) have been developed to mitigate these effects, particularly in cataract surgery. This systematic review and meta-analysis aimed to evaluate and compare the benefits of BF-IOLs and standard intraocular lenses (IOLs) on the subjective sleep quality of cataract patients.

Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive literature search was conducted across PubMed, Embase, and the Cochrane Library from inception to May 2024. Studies that compared BF-IOLs with standard IOLs in cataract patients were included. Risk of bias was assessed using the revised Cochrane Risk-of-Bias tool for randomized trials (RoB 2.0).

A total of 8 studies, including 1007 patients, were analyzed. These studies showed variability in design and quality, with some exhibiting moderate-to-high risks of bias. The random-effects model indicated that BF-IOLs were associated with a slight, statistically nonsignificant improvement in subjective sleep quality in cataract patients, with limited clinical relevance compared with standard IOLs (4-12 months postimplantation), with a standardized mean difference of 0.10 (95% confidence interval [CI]: 0.00-0.21). However, no significant between-group difference was observed in the longer term (6-12 months), with a standardized mean difference of 0.03 (95% CI: -0.08 to 0.13). Objective sleep parameters, such as sleep efficiency and total sleep time, also showed favorable effects for BF-IOLs. For sleep efficiency, the overall combined effect size was small-to-medium (Hedge's g = 0.18; 95% CI: 0.17-0.92), with moderate heterogeneity (I2 = 26.94%). For total sleep time, a small-to-medium effect size was observed (Hedge's g = 0.22; 95% CI: -0.18 to 0.76), with low heterogeneity (I2 = 17.41%). A moderate effect was found in Pittsburgh Sleep Quality Index scores (Hedges' g = 0.41), while the wide confidence interval (95% CI: 0.08-1.83) indicated high imprecision and uncertainty in the estimate.

BF-IOLs exhibited potential benefits in improving subjective sleep quality shortly after implantation. Further high-quality, long-term randomized controlled trials are required to substantiate these findings and optimize clinical recommendations for cataract surgery patients.