Visual improvement by selective filters in age-related macular degeneration involves effects other than light filtering

Ivan Nisted; Mette Nedergaard; Toke Bek

doi:10.15626/nk6fj025

Authors

Ivan Nisted Senior lecturer https://orcid.org/0000-0002-1680-4949
Mette Nedergaard Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark.
Toke Bek Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark. https://orcid.org/0000-0002-0409-2534

DOI:

https://doi.org/10.15626/nk6fj025

Keywords:

AMD, learning effect, selective filters, neutral density filters

Abstract

The use of wavelength-selective filters for patients with age-related macular degeneration (AMD) is common. An awareness of the expected effect of filters on central vision function, especially the magnitude of learning effects, is essential when deciding whether to prescribe. The aims of the present study were to examine the effect of selective and neutral-density filters on central visual function in patients with exudative AMD and to assess potential learning effects.

The study was a randomised cross-over study of the effect of selective and neutral-density filters on visual acuity (Early Treatment Diabetic Retinopathy Study [ETDRS] charts), contrast sensitivity (Pelli-Robson test), and colour vision (Hardy-Rand-Rittler test) in 31 patients with pseudophakia, aged 69 to 92 years, who had exudative AMD and central visual loss.

Selective filters significantly improved visual acuity (ETDRS), contrast sensitivity (Pelli-Robson), and red/green colour vision (Hardy-Rand-Rittler) in both eyes; however, they reduced blue/yellow colour vision. Neutral-density filters improved visual acuity for the better but not the worse eye and contrast sensitivity for the worse but not the better eye; they had no effect on colour vision. The improvement in contrast vision and red/green colour vision persisted immediately after the filters had been removed.

The study confirmed a positive effect of selective filters on visual acuity, contrast sensitivity, and red/green colour vision but a negative effect on blue/yellow colour vision, in patients with exudative AMD. The effect of neutral-density filters in these patients, however, was more ambiguous. There was evidence that the effect of the filters may have persisted immediately after their removal, suggesting the involvement of factors other than just the filtering of light.

References

Abraham, C. H., Morny, E., Aboagye-MacCarthy, A., Ocansey, S., Ntodie, M., Sakyi-Badu, G., Dadzie, A. K., Addo, N. A., Holdbrook, S., & Abu, E. K. (2023). The effect of filters and varying illumination on contrast sensitivity in eyes with moderate to severe visual impairment. International Ophthalmology, 43(9), 3329–3337. https://doi.org/10.1007/s10792-023-02738-7

Bailie, M., Wolffsohn, J. S., Stevenson, M., & Jackson, A. J. (2013). Functional and perceived benefits of wearing coloured filters by patients with age-related macular degeneration. Clinical and Experimental Optometry, 96(5), 450–4. https://doi.org/10.1111/cxo.12031

Bek, T., & Bech, B. H. (2023). Visual acuity and causes of central visual loss in the adult Danish population 2020-2022. results from the FORSYN study. Acta Ophthalmologica, 101(5), 504–513. https://doi.org/10.1111/aos.15641

Bek, T., & Klug, S. E. (2018). Age, sex, and type of medication predict the effect of anti-VEGF treatment on central retinal thickness in wet age-related macular degeneration. Clinical Ophthalmology, 12, 473–479. https://doi.org/10.2147/OPTH.S158760

Caballe-Fontanet, D., Alvarez-Peregrina, C., Busquet-Duran, N., Pedemonte-Sarrias, E., & Sanchez-Tena, M. A. (2020). Improvement of the quality of life in patients with age-related macular degeneration by using filters. International Journal of Environmental Research and Public Health, 17 (18). https://doi.org/10.3390/ijerph17186751

Ciulla, T. A., Hussain, R. M., Pollack, J. S., & Williams, D. F. (2020). Visual acuity outcomes and anti-vascular endothelial growth factor therapy intensity in neovascular age-related macular degeneration patients: A real-world analysis of 49 485 eyes. Ophthalmology Retina, 4(1), 19–30. https://doi.org/10.1016/j.oret.2019.05.017

Coia, A. J., Arizpe, J. M., Smith, P. A., Kuyk, T. K., & Lovell, J. A. (2024). Measurements of chromatic adaptation and luminous efficiency while wearing colored filters. Journal of Vision, 24(11), 9. https://doi.org/10.1167jov.24.11.9

Curcio, C. A., Allen, K. A., Sloan, K. R., Lerea, C. L., Hurley, J. B., Klock, I. B., & Milam, A. H. (1991). Distribution and morphology of human cone photoreceptors stained with anti-blue opsin. Journal of Comparative Neurology, 312(4), 610–24. https://doi.org/10.1002/cne.903120411

Diaz-Gonzalez, G., Santiago-Alvarado, A., & Cruz-Felix, A. S. (2015). Simulation of the optical performance of refractive elements to mimic the human eye focusing. Current Developments in Lens Design and Optical Engineering XVI, 9578, 957802.

Eperjesi, F., & Agelis, L. E. (2011). Effects of yellow filters on visual acuity, contrast sensitivity and reading under conditions of forward light scatter. Graefe’s Archive for Clinical and Experimental Ophthalmology, 249(5), 709–14. https://doi.org/10.1007/s00417-010-1488-5

Fleckenstein, M., Schmitz-Valckenberg, S., & Chakravarthy, U. (2024). Age-related macular degeneration: A review. JAMA, 331(2), 147–157. https://doi.org/10.1001/jama.2023.26074

Frennesson, I. C., & Nilsson, U. L. (1993). Contrast sensitivity peripheral to an absolute central scotoma in age-related macular degeneration and the influence of a yellow or an orange filter. Documenta Ophthalmologica, 84(2), 135–44. https://doi.org/10.1007/BF01206248

Higgins, K. E., Jaffe, M. J., Caruso, R. C., & deMonasterio, F. M. (1988). Spatial contrast sensitivity: Effects of age, test-retest, and psychophysical method. Journal of the Optical Society of America A, 5(12), 2173–80. https://doi.org/10.1364/josaa.5.002173

Huna-Baron, R., Glovinsky, Y., & Habot-Wilner, Z. (2013). Comparison between Hardy-Rand-Rittler 4th edition and Ishihara color plate tests for detection of dyschromatopsia in optic neuropathy. Graefe’s Archive for Clinical and Experimental Ophthalmology, 251(2), 585–9. https://doi.org/10.1007/s00417-012-2073-x

Keselman, H. J., Algina, J., & Kowalchuk, R. K. (2001). The analysis of repeated measures designs: A review. British Journal of Mathematical and Statistical Psychology, 54(Pt 1), 1–20. https://doi.org/10.1348/000711001159357

Kiser, A. K., Deschler, E. K., & Dagnelie, G. (2008). Visual function and performance with blue-light blocking filters in age-related macular degeneration. Clinical and Experimental Ophthalmology, 36(6), 514–20. https://doi.org/10.1111/j.1442-9071.2008.01824.x

Lamoureux, E. L., Pallant, J. F., Pesudovs, K., Rees, G., Hassell, J. B., & Keeffe, J. E. (2007). The effectiveness of low-vision rehabilitation on participation in daily living and quality of life. Investigative Ophthalmology & Visual Science, 48(4), 1476–82. https://doi.org/10.1167/iovs.06-0610

Langagergaard, U., Ganer, H. J., & Baggesen, K. (2003). Age-related macular degeneration: Filter lenses help in certain situations. Acta Ophthalmologica Scandinavica, 81(5), 455–8. https://doi.org/10.1034/j.1600-0420.2003.00142.x

Matchinski, T. L., Crumbliss, K. E., Corgiat, E., & Pang, Y. (2024). Near prescribing trends in two low vision rehabilitation clinics over a ten-year period. Clinical and Experimental Optometry, 107 (5), 563–570. https://doi.org/10.1080/08164622.2023.2246490

Mishra, P., Pandey, C. M., Singh, U., Gupta, A., Sahu, C., & Keshri, A. (2019). Descriptive statistics and normality tests for statistical data. Annals of Cardiac Anaesthesia, 22(1), 67–72. https://doi.org/10.4103/aca.ACA_157_18

Neelam, K., Nolan, J., Chakravarthy, U., & Beatty, S. (2009). Psychophysical function in age-related maculopathy. Survey of Ophthalmology, 54(2), 167–210. https://doi.org/10.1016/j.survophthal.2008.12.003

Nguyen, C. L., Gillies, M. C., Nguyen, V., Daien, V., Cohn, A., Banerjee, G., Arnold, J., & Fight Retinal Blindness! Study Group. (2019). Characterization of poor visual outcomes of neovascular age-related macular degeneration treated with anti-vascular endothelial growth factor agents. Ophthalmology, 126(5), 735–742. https://doi.org/10.1016/j.ophtha.2018.11.036

Shimakura, H., & Sakata, K. (2022). Color compensatory mechanism of chromatic adaptation at the cortical level. Iperception, 13(3), 20416695221105538. https://doi.org/10.1177/20416695221105538

Stelmack, J. A., Tang, X. C., Wei, Y., Wilcox, D. T., Morand, T., Brahm, K., Sayers, S., Massof, R. W., & Lovit II Study Group. (2017). Outcomes of the Veterans Affairs Low Vision Intervention Trial II (LOVIT II): A randomized clinical trial. JAMA Ophthalmology, 135(2), 96–104. https://doi.org/10.1001/jamaophthalmol.2016.4742

Vemala, R., Sivaprasad, S., & Barbur, J. L. (2017). Detection of early loss of color vision in age-related macular degeneration - with emphasis on drusen and reticular pseudodrusen. Investigative Ophthalmology & Visual Science, 58(6), BIO247–BIO254. https://doi.org/10.1167/iovs.17-21771

Wolffsohn, J. S., Dinardo, C., & Vingrys, A. J. (2002). Benefit of coloured lenses for age-related macular degeneration. Ophthalmic and Physiological Optics, 22(4), 300–11. https://doi.org/10.1046/j.1475-1313.2002.00036.x

Wong, W. L., Su, X., Li, X., Cheung, C. M., Klein, R., Cheng, C. Y., & Wong, T. Y. (2014). Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: A systematic review and meta-analysis. The Lancet Global Health, 2(2), e106–16. https://doi.org/10.1016/S2214-109X(13)70145-1

World Medical Association. (2025). World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Participants. JAMA, 333(1), 71–74. https://doi.org/doi.org/10.1001/jama.2024.21972

Wu, D., Zhang, P., Li, C., Liu, N., Jia, W., Chen, G., Ren, W., Sun, Y., & Xiao, W. (2020). Perceptual learning at higher trained cutoff spatial frequencies induces larger visual improvements. Frontiers in Psychology, 11, 265. https://doi.org/10.3389/fpsyg.2020.00265

Zigman, S. (1990). Vision enhancement using a short wavelength light-absorbing filter. Optometry and Vision Science, 67 (2), 100–4. https://doi.org/10.1097/00006324-199002000-00007