‫‪Title:‬‬
‫‪Damage to the macula induced by LED-derived blue light:a case report‬‬
‫‪Liang Lingling, Cui Zhihua, Hao Qian, *Zheng Yajuan‬‬
‫‪Author Affiliations:‬‬
‫‪Department of Ophthalmology, The First Hospital of Jilin University, Changchun,‬‬
‫‪China‬‬
‫‪*Department of Ophthalmology, The Second Hospital of Jilin University, Changchun,‬‬
‫‪China‬‬
‫‪Corresponding author:‬‬
‫‪Zheng Yajuan, Department of Ophthalmology, The Second Hospital of Jilin‬‬
‫‪University, Changchun, China. E-mail: [email protected]‬‬
‫تضرر بقعة الشبكية العين الذي سببها الضوء األزرق المشتق من الصمام الثنائي‬
‫الباعث للضوء)‪ :(LED‬تقرير حالة‬
‫ليانغ لينج لينج‪,‬تسوي جير خوا‪,‬خاو تشيان‪ ,‬جينج يا جوان*‬
‫انتماءات المؤلفون‪:‬‬
‫قسم طب العيون‪,‬المستشفى األول التابع لجامعة جيلين‪,‬مدينة تشانغ تشون‪,‬الصين‪.‬‬
‫قسم طب العيون‪,‬المستشفى الثاني التابع لجامعة جيلين‪,‬مدينة تشانغ تشون‪,‬الصين‪.‬‬
‫قسم طب العيون‪ ,‬مستشفى الشعب في مدينة تشانغ تشون‪,‬الصين‪.‬‬
‫صيدلية جامعة لونغ أيالند‪ 75,‬شارع ديكلب‪,‬بروكلين‪ 11201,‬نيويورك‪.‬‬
‫المؤلف المناظر‪:‬‬
‫جينغ يا جوان‪ ,‬قسم طب العيون‪,‬المستشفى الثاني التابع لجامعة جيلين‪,‬مدينة تشانغ‬
‫تشون‪,‬الصين‪.‬ايميل‪. [email protected]:‬‬
Abstract
Objectives: We present a case report of a young man with damage to the macula
induced by light-emitting diode (LED)-derived blue light in a bar.
Methods: This is an observational case report.
Results: A 29-year-old man complained of central scotoma in the right eye caused by
the direct blue light exposure in a bar. The retinal lesion was studied by the optical
coherence tomography (OCT) and functional damage was evaluated by the multifocal
electroretinography (mfERG).
Conclusion: Certain types of light, especially light with short wavelengths including
blue and green lights, can cause harm to the macula. Lutein located in the macula can
absorb blue and green lights resulting in the damage to the retina. Supplements such
as lutein, astaxanthin, folic acid, vitamin C, zinc and ginkgo biloba may have
protective effects against LED light-induced photoreceptor cell damage in the retina.
KEYWORDS: blue light, macular damage, LED
‫ نقدم لكم تقرير حالة عن رجل يافع تعرضت بقعة الشبكية عينه لضرر سببته‬:‫أهداف‬
in a ‫( {في بار‬LED)‫االضاءة الزرقاء المستمدة من الصمام الثنائي الباعث للضوء‬
.}bar
.‫هذا البحثعبارة عن رصد و مراقبة حالة‬:‫طرق‬
‫ سنة اشتكى من عتمة مركزية في عينه‬29 ‫مريض ذكر بالغ من العمر‬:‫النتائج‬
‫األفة في شبكية العين تم دراستها‬.}‫اليمنى نتيجة التعرض لضوء أزرق {في بار‬
‫( و الضرر الوظيفي تم تقييمه‬OCT) ‫بالتصوير المقطعي التماسك البصري‬
.(mfERG)‫بالتخطيط الكهربائي للشبكية متعدد البؤر‬
‫ خاصة ذوي الطول الموجي القصير بمافيه الضوء‬,‫ بعض األنواع للضوء‬:‫االستنتاج‬
‫اللوتين الذي يوجد في بقعة الشبكية‬.‫األزرق و األخضر قد يسبب األذى لشبكية العين‬
‫ المكمالت الغذائية‬.‫يمتص األضواء الزرقاء والخضراء مما يؤدي لتضررالشبكية‬
‫ الزنك والجنكة بيلوبا قد يكون‬,C ‫ فيتامين‬,‫ حمض الفوليك‬,‫ أستازانتين‬,‫مثل اللوتين‬
‫( الذي يتلف الخاليا‬LED)‫لهم أثار وقائية ضد الضوء المنبعث من الصمام الثنائي‬
.‫المستقبلة للضوء في الشبكية‬
‫ الصمام الثنائي الباعث‬,‫تضرر بقعة الشبكية‬,‫ ضوء أزرق‬:‫الكلمات األساسية‬
‫للضوء‪LED,‬‬
INTRODUCTION
Exposure to blue light can induce damage to human retinal pigment epithelial
cells [1]. Light-emitting diode (LED) technology is increasingly replacing conventional
light sources. It is widely used for illumination in bars.
We present a case of a young man with badly damaged macula due to blue light
exposure in a bar. Out of a curiosity, this man looked directly at the source of blue
light with his right eye. Later he discovered a central scotoma in his right eye.
CASE REPORT
A 29-year-old man complained of central scotoma in the right eye in the early
January, 2015. He consulted an ophthalmologist on January 14. Since he did not
inform the ophthalmologist of the incident in the bar, the ophthalmologist could not
diagnose the disease properly. The young man reported to our hospital on January 18.
His visual acuity was 0.5 and eye pressure was 18mmHg in the right eye. Funduscopy
revealed a round red lesion in the macula of the right eye (Figure 1A). Fluorescein
angiography (FA) revealed no leakage (Figure 1B). OCT revealed a deficiency in the
center of the fovea (Figure 1C). MfERG (GT-2008V-VI, China) revealed a reduction
of the peak value in the right eye compared to the left eye (Figure 1D). Supplements,
mainly lutein, astaxanthin, folic acid, vitamin C, zinc and ginkgo biloba were
prescribed for one month. At the follow-up visit, four weeks after the end of the
treatment, the visual acuity was 1.0 in the right eye and the ophthalmoscopic macular
alteration, reported previously, had disappeared (Figure 2A). The patient underwent
an OCT and mfERG check-up and refused to undergo the FA again. OCT revealed a
hyporeflectivity of the ellipsoid zone (Figure 2B). MfERG still showed a reduction of
the peak value in the right eye compared to the left eye (Figure 2C).
DISCUSSION
High-energy visible light has wavelengths in the range of 380 to 530 nm and is
present in the sunlight, fluorescent light, and LED light. Blue light (450-495nm) is
high energy visible light [2]. Blue light exposure can induce the mRNA and protein
expression of α1D subunit, increasing VEGF and bFGF concentration in retinal
pigment epithelial cells. L-type calcium channel α1D subunit may be involved in blue
light induced damage to human retinal pigment epithelial cells [1]. There was a study,
in which acute blue light damage was applied to eyes of dark Agouti rats over 2 h [3].
Histological analysis confirmed the occurrence of photoreceptor cell death and the
development of cellular damage in the outer retina [3]. In cases of retinal photo injury
it is important for an ophthalmologist to evaluate test results such as OCT and mfERG
during diagnosis and follow-up of the patient because the recovery of visual acuity
cannot exclude the persistence of phototoxic damage to the photoreceptors [4].
In our case even though we observed recovery of visual acuity in the right eye
after treatment with antioxidants, OCT showed persistent phototoxic damage in the
ellipsoid zone. In the experimental conditions, protective effects of lutein against blue
light-induced retinal damage in rats were significant [5]. Bilberry and lingonberry
extracts exert protective effect against LED blue light-induced retinal photoreceptor
cell damage in vitro mainly through inhibition of ROS production and activation of
pro-apoptotic proteins [6] . In this case we can see the protective effect of antioxidants.
We will continue evaluating OCT and mfERG for signs of recovery during the
follow-up visits.
ACKNOWLEDGEMENTS
The authors thank Guote,Chongqing,China for their technical support with the
mfERG.
Competing interests
The authors declare that they have no competing interests.
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Figure 1 A. Funduscopy revealed a round red lesion in the macula of the right eye..
B.Fluorescein angiography (FA) revealed no leakage.
C.Optical coherence tomography (OCT) revealed a deficiency in the center of the
fovea.
D. MfERG showed a reduction of the peak value in the right eye
(down) compared to the left eye (up).
Figure 2. A.Funduscopy revealed that the round red lesion in the macula (Figure 1A)
of the right eye had disappeared.
B OCT revealed a hyporeflectivity of the ellipsoid zone (EZ).
C. MfERG still showed a reduction of the peak value in the right eye (down)
compared to the left eye (up).