Blue AR coating:
Blue coatings seem to be the new thing that offices like to charge for and it expands the list of add-ons that people can pay for on their new glasses. I’ve long been on the fence with this product for a number of reasons though the more I research about it the less I like this product. Mostly I dislike the fact that the product is presented incorrectly to patients, that it reduces eye strain when it really isn’t that. In my opinion that’s a little deceptive. I also find that much of the information out there is conflicting. With new technology on our devices it’s mostly redundant. It’s not all hate from me in my research and I did find some concerns were met and when used correctly they can show some amount of benefit. Most of the information on how to use them is incorrect. Here is what I have found.
I have always found it hard to find any research on blue coatings that is not part of advertising for the coatings, done by the manufacturers of coatings, or done using the scientific method at all. Most of the articles about blue light are simply advertisements that offer no research information at all. Some quote studies done at such and such university but those studies aren’t properly referenced and I couldn’t find any of them. I find these hard to trust at all let alone base a recommendation to a patient on them. I was able to find one research paper from a university in Hong Kong that is very thorough and presents some empirical data that I can trust.
I have found several research articles that tests the lenses on how much blue light they actually do block and at what wavelengths. These studies are here and there and they all show that yes they do block those wavelengths of light. In this way all the manufacturers are completely right and these lenses do exactly what they say. They block nearly all UV light, a high amount of the blue wavelengths while leaving a high transmittance of visual light. Well done on that front. But it’s how it’s applicable that I start to have a problem with.
Lets start with the effects of blue light. Studies have shown, by studies I mean medical studies not studies on coatings, that blue light effects our circadian rhythm and can be a contributing factor to eye diseases such as age related macular degeneration.
I’m far from an expert but my understanding of circadian rhythm is when the sun is up we are awake and when the sun goes down we are sleepy. It has a lot to do with melatonin and how your body sets a schedule to sleep and wake up. More information on that at the national sleep foundation https://sleepfoundation.org/sleep-topics/what-circadian-rhythm .
All the theories behind blue light and controlling your intake of blue light deal with regulating and maintaining your sleep cycle and with protecting your eyes to reduce the risk of diseases or damage. None of the theories claim to reduce eye strain or fatigue. Most of the people and material selling blue coatings boast about reducing eye strain and eye fatigue but don’t even mention circadian rhythm. It’s also important to note that the diseases and damage that we talk about blue light contributing to is just that, a contributing factor. We have to remember that UV light and Blue light are only one contributing factor to many that can cause macular degeneration or cataracts.
In my opinion trying to sell this coating in this way is a little deceptive. Saying that it reduces eye strain when the theory isn’t really there to support that claim is misleading. If a product isn’t strong enough to sell and has to be misrepresented to successfully market it then should we really be selling it to our patients. Yes we are sales people but we are also health care practitioners and there has to be a balance.
I don’t think that most opticians and optometrists deliberately mislead their patients, but even if they are passing off misinformation because they are uneducated or incorrectly educated, the end result is the same. The patient is given a product that they expect will reduce fatigue, the product doesn’t do that and they are ultimately disappointed in their glasses that they paid more for. The study I found by a university in Hong Kong http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0169114 showed that just over one third of the people studied claimed to have better vision and over all better comfort. So there is some support that you can experience more comfort wearing a blue light coating. Though I don’t think one in three is strong enough support to claim “You will definitely have more comfort.” Also, the study didn’t really even cover eye strain and fatigue, mostly because they aren’t even theorized to reduce those things. This statistic shows that the majority of people reported no difference or a decrease in visual comfort.
One of my biggest concerns with selling the Blue coating was I expected a decrease in colour perception and contrast and visual acuity at night. Because we are restricting an amount of blue light in the visual spectrum can we expect the same performance in acuity? Also in a low light situation will that extra light being blocked make a difference in how much we see. I had concerns of actually impeding my patients vision for night driving. This study did confront this and did it very thoroughly.
Given contrast testing and colour distinction testing there is no measurable effect on either. The Blue light tint lens had some colour effect though (The brown lens that looks like tobacco stained). As expected with a tinted lens, but the contrast was still unaffected. There also was no effect on low light situations. They found that the amount of light they did block didn’t make a difference for night wear. They concluded that these lenses did not have an adverse affect for colour and contrast perception or low light vision.
As I’ve said, I did find this one study, there are more. Or, there would have to be more. Most of the articles I have read, are written by manufacturers of blue light coatings and lenses. I don’t really trust that those are unbiased, and they typically have a small sample selection when you even can find that information. They will sometimes quote that their findings are from a larger study but then never give proper reference to that study. Further those studies are impossible to find or if I did find them they were not complete but still undergoing, so there are no hard conclusions just hypothesis.
The material available from suppliers all claim to reduce eye strain and reduce glare from your devices. They all will promote wearing this coating full time on all your glasses. The material from independent studies don’t suggest a reduction in eye strain at all, again the blue light has to do with circadian rhythm and not fatigue. Many studies show that blue light increases cognitive function, stimulates the brain and increases your mood. Independent studies suggest that you wear the blue coating only for a few hours at night, and only when on devices that produce blue light.
There’s so much conflicting information out there who do we believe? Blue light is bad and it causes damage and fatigue. Or that blue light is natural and it stimulates our brain to be awake and active? Well for me I believe the latter and that’s because all the doomsayers are trying to sell you something and the latter is based on good clean science. In my opinion manufacturers have latched on to the small things and exploded them to catastrophic levels in order to sell a product that really doesn’t do what they claim. However because that trait was mentioned in a study they can claim it’s true.
For instance. A study mentions that about a third of people report more comfortable vision. The manufacturers claim that this coating offers superior comfort for everyone. A study brings up that blue light is a contributing factor to age related macular degeneration. The manufactures report that this coating prevents age related macular degeneration. On the surface these claims seem true but underneath there’s not really a strong claim. Blue light is a factor in the development of diseases, so is smoking, and diet and genetics and a host of other factors. By reducing blue light by 25% to 75% depending on the product we aren’t really preventing anything. Okay so they said “helps to prevent.” More accurately they should say that Blue AR can possibly help to reduce one factor that maybe contributes to macular degeneration. But you can’t sell a product with that so that turns into prevents disease definitively. I understand that if we can do something that gives us better odds at prevention of such nasty things it’s good to have. However, we have to realize how little effect it has in reality and compare that to the bold claim that you now won’t get macular degeneration because you are wearing this coating. And further, many insinuate that if you are not wearing blue ar then you are just asking for complications.
Okay all of that said what is the appropriate use for the blue ar coatings? First thing to realize is that this is a tool to regulate blue lights effect on sleep. This means we don’t wear them full time, only during night time hours. And really only for a few hours before we plan on going to sleep. This is not a full time pair of glasses and wouldn’t be appropriate on a distance pair of glasses. Since we are using them to regulate the amount of blue light from devices we don’t need them to drive or walk in the mall or go for a hike, only for mid range and reading glasses. Also we would ideally want two pair of computer glasses. One with standard AR for during the day when we want increased cognitive function and one for evening when we want to start turning down. It’s important to counsel our patients that this is not to reduce eye strain and that they should still adhere to eye strain rules like 20/20/20 and stay hydrated. Wear your Blue AR for a few hours in the evening and then it’s only really necessary when you are using devices.
What you can expect after treatment with this coating is a better more regulated sleep cycle. Your brain will be on and active during the day, and you will be able to shut down during the evening. This way you will be ready for sleep when you go to bed. Fall asleep faster and get a more restful sleep. That’s the goal anyway, it’s not like programming a computer and our brains do everything we tell them to. Using this technique can help to regulate your sleep/wake cycle. If that is what is causing your sleeping issues then this can help.
If however you have other issues with falling asleep then it probably won’t do anything for you at all.
For what it is used for I think that Blue coating is a legitimate product that can really help those few people that really need it. A blanket prescription for everyone to wear all the time is unnecessary and in my opinion an irresponsible way to treat your customers. Simply giving everyone something because it may help a fraction of them isn’t a responsible practice, it’s not like we are vaccinating from blue light or anything like that. Further making patients pay for this product when they don’t have any of the issues isn’t a moral practice befitting of a health care professional. The big let down is that most of the time this is prescribed without consultation or education on what the product does or can achieve for the patient.
After all the education I’ve researched and tried to cover here I feel I can properly prescribe this product. I think I’m quite educated in it’s purpose and how to use it, can identify the patients who can benefit from it and properly sell this product. That said, I will never prescribe, or suggest this product to a patient. I never have sold Blue AR to a patient who didn’t insist on it and I have never brought it up as a product that is available to someone who doesn’t know about it. Even given a person who fits the bill perfectly I will not bring up Blue Ar coating. The plain and simple fact that everyone overlooks is that all our devices have a blue light reduction mode built into them. Android, Windows and Apple have recognized the effects of blue light on sleep patterns and, since they want you to use their device non stop for every waking hour, they have confronted this issue. There is a “Night Shift,” or “Comfort View,” in your setting that reduces the amount of blue light. Many times you can set a timer so it comes on after hours in preparation of sleep time. It’s already there on all our devices with the exception of some older models. All of this debate on Blue AR coating is pretty much for nothing when we can direct our patient to, “Hey, turn on the filter at night, It’s right there on your phone already.” But then we couldn’t charge for that could we?