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Pembimbing : dr. A Saubari, Sp.M
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Introduction
Animal and laboratory studies have shown that blue light damages the
retinal pigment epithelium and choriocapillaris through generation of
reactive oxygen species and may be a factor in the pathogenesis of age-
related macular degeneration (AMD)
Protection against the harmful effects of blue light is provided by the retinal
anti-oxidant defense system,which includes antioxidant enzymes supported
by vitamins C and E, the carotenoids (lutein and zeaxanthin), and zinc.
Little attention has been paid to possible interactions between antioxidant
levels and light exposure, though the adverse effects of sunlight may be
attenuated by the protective effects of anti-oxidants.
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Methods
Participants were recruited from random sampling of the population aged
older than 65 years in Bergen, Norway; Tallinn, Estonia; Belfast,
Northern Ireland; Paris, France; Verona, Italy; Thessaloniki, Greece; and
Alicante, Spain
Written informed consent was obtained from all study participants.
Ethical approval was obtained from the relevant ethics committee of
each country
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Methods
Measurement of Sunlight Exposure
We used a questionnaire that asked about time spent outdoors between
the hours of 9 AM and 5 PM and between 11 AM and 3 PM daily
throughout an individuals working life for different occupational periods
(including homecare) and in retirement up to ones current age.

For each period, we collected information on the use of hats and eyewear
(glasses, contact lenses, and sunglasses)
Dietary Questionnaire
We used the United Kingdom version of the European Prospective
Investigation Into Cancer and Nutrition Study Food Frequency
Questionnaire.
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Methods
Fundus Photography and Grading
Fundus images were graded at a single reading center using the
International Classification System for Age-Related Maculopathy,which
identifies 5 mutually exclusive grades
Grade 0 : no early or late AMD
Grade 1 : soft distinct drusen (63 m and <125 m) only or pigmentary
irregularities only)
Grade 2 : soft indistinct (125 m) or reticular drusen only or soft
distinct
drusen with pigmentary irregularities
Grade 3 : soft indistinct or reticular drusen with pigmentary irregularities
Grade 4 : either neovascular AMD (presence of any of the following:
serous or hemorrhagic retinal or retinal pigment epithelial detachment,
subretinal neovascularmembrane, periretinal fibrous scar) or
geographic atrophy (well-demarcated are of retinal pigment atrophy
with visible choroidal vessels)
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Methods
Blood Samples
Blood samples were sent to a single laboratory for analysis by reverse-
phase high-performance liquid chromatography for lutein, zeaxanthin, -
cryptoxanthin, -carotene, carotene, -tocopherol, -tocopherol,
lycopene, and retinol levels. Total vitamin C levels were measured using
an enzyme-based assay in plasma stabilizedwithmetaphosphoric acid.
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Methods
Statistical Analysis
We used survey logistic regression to investigate the association
between blue light exposure and neovascular AMD. We also examined
this association by quartiles of key antioxidant levels by including
interaction terms in the models with design-adjusted Wald tests. We used
multinomial survey logistic regression to investigate associations with
blue light, key antioxidants, and early AMD
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Results
Of 5040 participants (45%response rate), 4753 had gradable fundus
images. There were 109 cases of neovascular AMD, 49 of geographic
atrophy, 2333 of early AMD (1734 grade 1, 482 grade 2, and 117 grade 3),
and 2262 controls with grade 0 AMD
Full data on all sunlight and antioxidant variables were available for 2117
controls and 101 neovascular AMD, 43 geographic atrophy, and 2182
early AMD cases.
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Results
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Results
When the
association of blue
light exposure by
antioxidant quartile
was analyzed, a
consistent pattern
was observed of
increased ORs of
blue light in the
quartile of lowest
antioxidant level

High levels of vitamin C were associated with reduced ORs of
neovascular AMD with blue light
(Table 2), but no significant associations between blue light
exposure and high levels of other antioxidants were observed.
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Results
Certain
combinations of
low levels of
antioxidants,
especially
thosewith lowlevels
of 3 antioxidants,
showed higher
ORs of blue light
exposure
compared with
single antioxidants
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Results
There was no
association of blue
light exposure at
different ages
during
adult life with
neovascular AMD
(Figure 1)
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Results
Odds ratios
increased from
early adult life to
middle age and
older for
the associations of
blue light in those
with low
antioxidant levels
at the time of study,
with the highest
ORs at
ages 50 to 59 (OR,
4.71; 95% CI, 2.16-
10.30) (Figure 2)
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Results
Relative risk ratios were between 1.5 and 2 for blue light and
early AMD in those with low levels of several antioxidantsvitamin C,
zeaxanthin, and either alpha-tocopherol
or zincbut in 2 of the 6 risk ratios, the 95% CIs crossed1.
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Comments
In our study, the associations of blue light exposure in those with low
antioxidant levels appeared stronger at older ages, reaching a peak at
ages 50 to 59 years. Penetration of shorter wavelengths of blue light
into the retina decreases with age, principally as a result of a yellowing
of the lens and a decreasing pupil diameter.
The aging eye also accumulates chromophores, indicating increased
susceptibility to oxidative damage fromblue light.
It has been estimated that either the process of lens yellowing and
chromophore accumulation are approximately balanced with no change
in susceptibility with age or that susceptibility peaks in midlife followed
by a decline from the age of 60 years. This latter estimate is broadly in
line with our results
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Comments
We have no information on genetic factors in the EUREYE Study. The
effects of blue lightmay bemodified by specific polymorphisms, but it is
unlikely that our results could be explained solely by genetic susceptibility
We found that the combination of blue light exposure and low plasma
concentrations of antioxidants was also associated with the early stages
of AMD, which are common in the population, and that blue light exposure
in middle age might be more damaging than at younger ages.
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Judul dan Pengarang
No. Kriteria Ya (+) atau Tidak (-)
1 Jumlah kata dalam judul < 12 kata
Patient Safety in Delayed Diagnosis
of Acute Appendicitis
+
(8 kata)
2 Deskripsi judul Menggambarkan isi
utama penelitian, cukup
menarik dan tanpa
singkatan
3 Daftar penulis sesuai aturan jurnal -
4 Korespondensi penulis -
5 Tempat & waktu penelitian dalam judul -
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Abstrak
No. Kriteria Ya (+) atau Tidak (-)
1 Abstrak satu paragraf +
2 Mencakup komponen IMRC +
3 Secara keseluruhan informatif +
4 Tanpa singkatan selain yang baku +
5 Kurang dari 250 kata + (220 kata)
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Pendahuluan
No Kriteria Ya (+) atau Tidak (-)
1 Terdiri dari dua bagian atau dua paragraf +

2 Paragraf pertama mengemukakan alasan
dilakukan penelitian
+
3 Paragraf kedua menyatakan hipotesis atau
tujuan penelitian
+
4 Didukung oleh pustaka yang relevan +
5 Kurang dari satu halaman +
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Bahan dan Metode Penelitian
No. Kriteria Ya (+) atau Tidak (-)
1 Jenis dan rancangan penelitian -
2 Waktu & tempat penelitian +
3 Populasi sumber +
4 Teknik sampling +
5 Kriteria inklusi -
6 Kriteria ekslusi -
7 Perkiraan dan perhitungan besar
sampel
-
8 Perincian Cara penelitian +
9 Blind -
10 Uji statistik +
11 Program komputer +
12 Persetujuan subjek (IC) -
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Hasil
No. Kriteria Ya (+) atau Tidak (-)
1 Jumlah subjek +
2 Tabel karakteristik subjek -
3 Tabel hasil penelitian +
4 Komentar & pendapat penulis ttg hasil +
Pada diskusi
5 Tabel analisis data dengan uji chi-square +
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Pembahasan, Kesimpulan, dan Daftar Pustaka
No. Kriteria Ya (+) atau Tidak (-)
1 Pembahasan & kesimpulan dipaparkan
terpisah
-
2 Pembahasan & kesimpulan dipaparkan
dengan jelas
+
3 Pembahasan mengacu dari penelitian
sebelumnya
+
4 Pembahasan sesuai landasan teori +
5 Keterbatasan penelitian -
6 Simpulan utama +
7 Simpulan berdasarkan hasil penelitian +
8 Saran penelitian -
9 Penulisan daftar pustaka sesuai aturan +