Advancement of a RGBW-LED pen for diaphanoscopic illumination with adjustable color and intensity with tests on ex-vivo porcine eyes in terms of retinal risk and correlated color temperature.

Diaphanoscopic illumination has the disadvantage that the intraocular spectrum is red-shifted due to transmission properties of the eyewall. This red-shift should be counteracted as well as the retinal risk should be reduced with adjusting the spectral distribution of the illumination light. Likewise, the illumination spectrum has to be adapted to the eye color of the patient. With the further development of a red, green, blue and white light-emitting diode (RGBW-LED) diaphanoscopy pen, the intensities of each color can be varied. The functionality of the LED pen is tested on ex-vivo porcine eyes. By measuring the transmission of the sclera and choroidea, the photochemical and thermal retinal hazard and the maximum exposure time are determined according to the standard DIN EN ISO 15004-2:2007. With this RGBW-LED pen the intraocular space can be illuminated clearly of up to 1.5 h without potential retinal damage according to DIN EN ISO 15004:2-2007. By adjusting the illumination spectrum the red-shift can be compensated and retinal risk can be reduced. By varying the LED intensities, the correlated color temperature in the eye can also be varied from cold white to warm white appearance as comfortable to the ophthalmologist. Additionally, a simple adjustment of the illumination to the eye color of the patient is possible. Using this RGBW-LED pen, the ophthalmologist can set the desired intraocular color appearance, which he prefers for special applications. He could also adjust the illumination to the eye color as this would reduce retinal hazard.

Determination of Correlated Color Temperature in Ex Vivo Porcine Eyes during Intraocular Illumination.

(1) Background: In ophthalmic surgery, white light is mostly applied to illuminate the intraocular space, and ophthalmologists are comfortable working with it. Diaphanoscopic illumination changes the spectral composition of light, resulting in a change in the correlated color temperature (CCT) of the intraocular illumination. This color change makes it difficult for surgeons to recognize the structures in the eye. CCT during intraocular illumination has not yet been measured before, and it is the aim of this study to perform such measurement. (2) Methods: CCT was measured inside ex vivo porcine eyes during diaphanoscopic illumination and endoillumination using a current ophthalmic illumination system with a detection fiber inside the eye. By applying pressure on the eye with a diaphanoscopic fiber, the dependency of CCT on pressure was examined. (3) Results: The intraocular CCT values during endoillumination were 3923 K and 5407 K for the halogen and xenon lamps, respectively. During diaphanoscopic illumination, a strong unwanted red shift was observed, resulting in 2199 K and 2675 K for the xenon and the halogen lamps, respectively. Regarding different applied pressures, the CCT did not differ considerably. (4) Conclusions: This red shift should be compensated for in the development of new illumination systems since surgeons are used to white light illumination, which also simplifies the identification of retinal structures.

Sensitivity of influenza virus to ultraviolet irradiation.

Background: The measures implemented against the coronavirus pandemic also led to a sharp decline in influenza infections in the 2020/2021 flu season. In the meantime, however, the number of influenza infections has risen again; it is known from history that influenza viruses can also trigger severe pandemics. Therefore, we investigated the efficacy of ultraviolet radiation in the spectral range of 200-400 nm for inactivating influenza viruses. Materials and methods: The scientific literature was searched for published ultraviolet (UV) irradiation experiments with influenza viruses and the results were standardized by determining the lg-reduction dose. The results were then sorted and analyzed by virus type and wavelength as far as possible. Results: The scope of the published data sets was limited and revealed large variations with regard to the lg-reduction dose. Only for experiments with influenza viruses in liquid media in the UVC spectral range around 260 nm - the emission range of commonly-used mercury vapor lamps - was there sufficient data to compare virus types. No significant difference between the virus (sub-) types was observed. The lg-reduction dose in this spectral range is 1.75 mJ/cm2 (median). It was also shown that influenza viruses are particularly sensitive in the far-UVC spectral range (200-230 nm). Conclusion: UVC, including far-UVC, is suited for influenza virus inactivation as long as the viruses are in UVC-transparent materials. A large difference in the UV sensitivity of different influenza viruses from the last approx. 100 years could not be detected. Thus, it is reasonable to assume that future influenza viruses will also be similarly UV-sensitive or that UV can also inactivate new influenza viruses.

Determination of the intraocular irradiance and potential retinal hazards at various positions in the eye during transscleral equatorial illumination for different applied pressures.

PURPOSE: With diaphanoscopic illumination of the eye, the intensity of light entering its interior depends on the transmission properties of the eyewall. Light that passes through the eyewall can cause damage to the retina. Therefore, in this study, the intraocular irradiances are determined at different positions on the retina, directly behind the illuminated eyewall, the opposite eyewall and near the macula of ex-vivo porcine eyes. These irradiances are examined for their dependence on the pressure applied on the eyewall with the illuminating fiber and for the influence of the pigmentation of the eye. METHODS: In total 221 ex-vivo porcine eyes were investigated. For transscleral illumination an illumination fiber with a diffusing adapter cap is pressed against the equatorial eyewall. The illumination fiber is pressed onto the eye and the pressure is measured in the anterior chamber. Three different pressures are applied, 23, 78 and 132 mmHg. A detection fiber with diffusing fiber tip is inserted into the eye at the desired position. The eyes were divided in groups with high and less pigmentation to investigate the influence of the pigmentation on the intraocular irradiance. RESULTS: The intraocular irradiances Eintra increases for various increasing applied pressures with the illumination fiber on the eyewall and for various positions inside the eye. With this the irradiances weighted with the photochemical and thermal hazard weighting function, EA-R and EVIR-R, also increases. Differences in Eintra, EA-R and EVIR-R could be found for different pigmented eyes as these values are higher for less pigmented eyes than for strong pigmented ones. CONCLUSION: The hazard to the retina during diaphanoscopic illumination of the eye depends on how strong the surgeon presses the illumination fiber on the eyewall. Depending on the applied pressure and the measuring position in the eye, the specified limit for the photochemical hazard to the retina is partly exceeded. The pigmentation of the eye also plays a role. The irradiance in less pigmented eyes appears to be higher than in strongly pigmented eyes. Because of this, the surgeon should be able to adjust the intensity of the light source to the color of the patient's eye.

Influence of Visible Violet, Blue and Red Light on the Development of Cataract in Porcine Lenses.

Background and Objectives: Cataract is a disease that is globally prevalent in today's population and occurs mostly in the elderly. It is an opacity of the lens that worsens vision and can lead to blindness. One well-known risk factor of cataract is ultraviolet (UV) radiation. However, increasing exposure to modern artificial light sources like light emitting diodes (LEDs) and displays might have an impact on cataract formation due to possible high (and hidden) blue radiation. An ex-vivo study indicates that intense blue radiation causes cataract in porcine lenses. The goal of this work is the investigation whether violet or red light also lead to cataract formation in porcine lenses and to compare the impact of the different wavelengths. Materials and Methods: LEDs with wavelengths of 407 nm (violet), 463 nm (blue) and 635 nm (red) are used to irradiate ex-vivo porcine lenses with a dose of 6 kJ/cm2. Before and after irradiation the lens transmissions are measured and dark field images are taken to determine cataract formation. The same procedure is performed for unirradiated controls. Results: The results of the transmission measurements are in accordance with the results of the dark field images and state that 635 nm (red) is inducing no or only weak cataract. In comparison to the dark field images the transmission measurements exhibit stronger cataract formation for 407 nm than for 463 nm irradiation while the dark field images show similar cataract formation for both wavelengths. Conclusions: Visible light of short wavelengths cause cataract formation in porcine eyes, and it cannot be excluded that these wavelengths, which are emitted by modern LED illuminants, also pose a danger to human eyes.

Intraocular reflectance of the ocular fundus and its impact on increased retinal hazard.

PURPOSE: Inside the eye light can be reflected multiple times due to light-tissue interactions and the spherical geometry of the eye. Due to these optical properties, a defined retinal area is not only illuminated by direct light but also by indirect, reflected light from the inner side of the eyewall. During illumination for ophthalmic surgery, this could lead to an unintended increase in intraocular retinal irradiance, which was already discussed in previous studies but without a detailed consideration of spectral differences and a potential influence of pigmentation. In this study this effect is investigated wavelength-dependent to see if different wavelengths lead to different increase in irradiance, with a special focus on the raise in photochemical and thermal hazard to the retina. It is also examined whether this effect is dependent on the pigmentation of the eye. METHODS: The reflectance properties of either less or highly pigmented porcine eyes are measured in the wavelength range between 350 and 1100nm with an integrating sphere and a spectrometer. With these reflectance spectra the wavelength-dependent Sphere Multiplier M of porcine eyes can be calculated, which represents the increase of radiance due to multiple reflections inside a sphere compared to a planar diffuser of the same size. Based on measurements of the emitted irradiance of ophthalmic illumination fibers the increase in photochemical and thermal retinal hazard due to these multiple reflections is calculated for eyes with small and high amounts of pigmentation. RESULTS: The reflectance of the inner eyewall in the range between 350 and 1100nm is significantly higher for eyes with low pigmentation (between 4.90% and 37.44% reflectance) in comparison to eyes with a high amount of pigmentation (between 4.30% and 28.88% reflectance). The Sphere Multiplier for the inner side of the eyewall (sclera, choroid and retina) ranges between 1.13 and 1.59 and between 1.13 and 1.48 for eyes with low and high pigmentation, respectively, in the range between 350 and 1100nm. The reflectance, as well as the Sphere Multiplier, is strongly wavelength-dependent due to the absorption spectra of melanin and hemoglobin, which are located in the eye. With increasing wavelength, the reflection properties and the Sphere Multiplier also increases. With this, the photochemical retinal hazard of highly pigmented eyes increases by (14.11± 0.09)% and of lightly pigmented eyes by (16.75±0.35)% compared to if the reflection properties are not considered. The thermal retinal hazard increases by (14.30±0.07)% for highly pigmented eyes and by (19.65±0.17)% for low pigmented eyes. CONCLUSION: This study demonstrates that the anatomy and pigmentation of the eye plays an important role for the reflectance properties of the eye and for the photochemical and thermal hazard to the retina.