Effects of Cataract Surgery on Melatonin Secretion in Adults 60 Years and Older: A Randomized Clinical Trial | Cataract and Other Lens Disorders | JAMA Ophthalmology | JAMA Network
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1.
Karlsson  B, Knutsson  A, Lindahl  B.  Is there an association between shift work and having a metabolic syndrome? Results from a population based study of 27,485 people.   Occup Environ Med. 2001;58(11):747-752. doi:10.1136/oem.58.11.747 PubMedGoogle ScholarCrossref
2.
Morikawa  Y, Nakagawa  H, Miura  K,  et al.  Shift work and the risk of diabetes mellitus among Japanese male factory workers.   Scand J Work Environ Health. 2005;31(3):179-183. doi:10.5271/sjweh.867 PubMedGoogle ScholarCrossref
3.
Fujino  Y, Iso  H, Tamakoshi  A,  et al; Japanese Collaborative Cohort Study Group.  A prospective cohort study of shift work and risk of ischemic heart disease in Japanese male workers.   Am J Epidemiol. 2006;164(2):128-135. doi:10.1093/aje/kwj185 PubMedGoogle ScholarCrossref
4.
Bara  AC, Arber  S.  Working shifts and mental health–findings from the British Household Panel Survey (1995-2005).   Scand J Work Environ Health. 2009;35(5):361-367. doi:10.5271/sjweh.1344 PubMedGoogle ScholarCrossref
5.
Brown  DL, Feskanich  D, Sánchez  BN, Rexrode  KM, Schernhammer  ES, Lisabeth  LD.  Rotating night shift work and the risk of ischemic stroke.   Am J Epidemiol. 2009;169(11):1370-1377. doi:10.1093/aje/kwp056 PubMedGoogle ScholarCrossref
6.
Pietroiusti  A, Neri  A, Somma  G,  et al.  Incidence of metabolic syndrome among night-shift healthcare workers.   Occup Environ Med. 2010;67(1):54-57. doi:10.1136/oem.2009.046797 PubMedGoogle ScholarCrossref
7.
Vyas  MV, Garg  AX, Iansavichus  AV,  et al.  Shift work and vascular events: systematic review and meta-analysis.   BMJ. 2012;345:e4800. doi:10.1136/bmj.e4800 PubMedGoogle Scholar
8.
Flo  E, Pallesen  S, Åkerstedt  T,  et al.  Shift-related sleep problems vary according to work schedule.   Occup Environ Med. 2013;70(4):238-245. doi:10.1136/oemed-2012-101091 PubMedGoogle ScholarCrossref
9.
Schernhammer  ES, Berrino  F, Krogh  V,  et al.  Urinary 6-sulfatoxymelatonin levels and risk of breast cancer in postmenopausal women.   J Natl Cancer Inst. 2008;100(12):898-905. doi:10.1093/jnci/djn171 PubMedGoogle ScholarCrossref
10.
Schernhammer  ES, Hankinson  SE.  Urinary melatonin levels and postmenopausal breast cancer risk in the Nurses’ Health Study cohort.   Cancer Epidemiol Biomarkers Prev. 2009;18(1):74-79. doi:10.1158/1055-9965.EPI-08-0637 PubMedGoogle ScholarCrossref
11.
McMullan  CJ, Schernhammer  ES, Rimm  EB, Hu  FB, Forman  JP.  Melatonin secretion and the incidence of type 2 diabetes.   JAMA. 2013;309(13):1388-1396. doi:10.1001/jama.2013.2710 PubMedGoogle ScholarCrossref
12.
Obayashi  K, Saeki  K, Iwamoto  J,  et al.  Physiological levels of melatonin relate to cognitive function and depressive symptoms: the HEIJO-KYO cohort.   J Clin Endocrinol Metab. 2015;100(8):3090-3096. doi:10.1210/jc.2015-1859 PubMedGoogle ScholarCrossref
13.
Khalsa  SB, Jewett  ME, Cajochen  C, Czeisler  CA.  A phase response curve to single bright light pulses in human subjects.   J Physiol. 2003;549(Pt 3):945-952. doi:10.1113/jphysiol.2003.040477 PubMedGoogle ScholarCrossref
14.
Pascolini  D, Mariotti  SP.  Global estimates of visual impairment: 2010.   Br J Ophthalmol. 2012;96(5):614-618. doi:10.1136/bjophthalmol-2011-300539 PubMedGoogle ScholarCrossref
15.
Kessel  L, Lundeman  JH, Herbst  K, Andersen  TV, Larsen  M.  Age-related changes in the transmission properties of the human lens and their relevance to circadian entrainment.   J Cataract Refract Surg. 2010;36(2):308-312. doi:10.1016/j.jcrs.2009.08.035 PubMedGoogle ScholarCrossref
16.
Turner  PL, Mainster  MA.  Circadian photoreception: ageing and the eye’s important role in systemic health.   Br J Ophthalmol. 2008;92(11):1439-1444. doi:10.1136/bjo.2008.141747 PubMedGoogle ScholarCrossref
17.
Brøndsted  AE, Sander  B, Haargaard  B,  et al.  The effect of cataract surgery on circadian photoentrainment: a randomized trial of blue-blocking versus neutral intraocular lenses.   Ophthalmology. 2015;122(10):2115-2124. doi:10.1016/j.ophtha.2015.06.033 PubMedGoogle ScholarCrossref
18.
Shenshen  Y, Minshu  W, Qing  Y, Yang  L, Suodi  Z, Wei  W.  The effect of cataract surgery on salivary melatonin and sleep quality in aging people.   Chronobiol Int. 2016;33(8):1064-1072. doi:10.1080/07420528.2016.1197234 PubMedGoogle ScholarCrossref
19.
Saeki  K, Obayashi  K, Nishi  T,  et al.  Short-term influence of cataract surgery on circadian biological rhythm and related health outcomes (CLOCK-IOL trial): study protocol for a randomized controlled trial.   Trials. 2014;15(1):514. doi:10.1186/1745-6215-15-514 PubMedGoogle ScholarCrossref
20.
World Medical Association.  World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.   JAMA. 2013;310(20):2191-2194. doi:10.1001/jama.2013.281053PubMedGoogle ScholarCrossref
21.
Chylack  LT  Jr, Wolfe  JK, Singer  DM,  et al; The Longitudinal Study of Cataract Study Group.  The Lens Opacities Classification System III.   Arch Ophthalmol. 1993;111(6):831-836. doi:10.1001/archopht.1993.01090060119035 PubMedGoogle ScholarCrossref
22.
Sanders  DR, Retzlaff  J, Kraff  MC.  Comparison of empirically derived and theoretical aphakic refraction formulas.   Arch Ophthalmol. 1983;101(6):965-967. doi:10.1001/archopht.1983.01040010965024 PubMedGoogle ScholarCrossref
23.
Schernhammer  ES, Rosner  B, Willett  WC, Laden  F, Colditz  GA, Hankinson  SE.  Epidemiology of urinary melatonin in women and its relation to other hormones and night work.   Cancer Epidemiol Biomarkers Prev. 2004;13(6):936-943.PubMedGoogle Scholar
24.
Graham  C, Cook  MR, Kavet  R, Sastre  A, Smith  DK.  Prediction of nocturnal plasma melatonin from morning urinary measures.   J Pineal Res. 1998;24(4):230-238. doi:10.1111/j.1600-079X.1998.tb00538.x PubMedGoogle ScholarCrossref
25.
Mishima  K, Okawa  M, Shimizu  T, Hishikawa  Y.  Diminished melatonin secretion in the elderly caused by insufficient environmental illumination.   J Clin Endocrinol Metab. 2001;86(1):129-134. doi:10.1210/jc.86.1.129 PubMedGoogle Scholar
26.
Obayashi  K, Saeki  K, Iwamoto  J,  et al.  Positive effect of daylight exposure on nocturnal urinary melatonin excretion in the elderly: a cross-sectional analysis of the HEIJO-KYO study.   J Clin Endocrinol Metab. 2012;97(11):4166-4173. doi:10.1210/jc.2012-1873 PubMedGoogle ScholarCrossref
27.
Turner  PL, Van Someren  EJ, Mainster  MA.  The role of environmental light in sleep and health: effects of ocular aging and cataract surgery.   Sleep Med Rev. 2010;14(4):269-280. doi:10.1016/j.smrv.2009.11.002 PubMedGoogle ScholarCrossref
28.
Brøndsted  AE, Haargaard  B, Sander  B, Lund-Andersen  H, Jennum  P, Kessel  L.  The effect of blue-blocking and neutral intraocular lenses on circadian photoentrainment and sleep one year after cataract surgery.   Acta Ophthalmol. 2017;95(4):344-351. doi:10.1111/aos.13323 PubMedGoogle ScholarCrossref
29.
Algvere  PV, Marshall  J, Seregard  S.  Age-related maculopathy and the impact of blue light hazard.   Acta Ophthalmol Scand. 2006;84(1):4-15. doi:10.1111/j.1600-0420.2005.00627.x PubMedGoogle ScholarCrossref
30.
Sparrow  JR, Miller  AS, Zhou  J.  Blue light-absorbing intraocular lens and retinal pigment epithelium protection in vitro.   J Cataract Refract Surg. 2004;30(4):873-878. doi:10.1016/j.jcrs.2004.01.031 PubMedGoogle ScholarCrossref
31.
Downie  LE, Busija  L, Keller  PR.  Blue-light filtering intraocular lenses (IOLs) for protecting macular health.   Cochrane Database Syst Rev. 2018;5:CD011977. doi:10.1002/14651858.CD011977.pub2 PubMedGoogle Scholar
32.
Obayashi  K, Saeki  K, Maegawa  T,  et al.  Melatonin secretion and muscle strength in elderly individuals: a cross-sectional study of the HEIJO-KYO cohort.   J Gerontol A Biol Sci Med Sci. 2016;71(9):1235-1240. doi:10.1093/gerona/glw030 PubMedGoogle ScholarCrossref
33.
Obayashi  K, Saeki  K, Kurumatani  N.  Association between urinary 6-sulfatoxymelatonin excretion and arterial stiffness in the general elderly population: the HEIJO-KYO cohort.   J Clin Endocrinol Metab. 2014;99(9):3233-3239. doi:10.1210/jc.2014-1262 PubMedGoogle ScholarCrossref
34.
Mauriz  JL, Collado  PS, Veneroso  C, Reiter  RJ, González-Gallego  J.  A review of the molecular aspects of melatonin’s anti-inflammatory actions: recent insights and new perspectives.   J Pineal Res. 2013;54(1):1-14. doi:10.1111/j.1600-079X.2012.01014.x PubMedGoogle ScholarCrossref
35.
Obayashi  K, Saeki  K, Kurumatani  N.  Higher melatonin secretion is associated with lower leukocyte and platelet counts in the general elderly population: the HEIJO-KYO cohort.   J Pineal Res. 2015;58(2):227-233. doi:10.1111/jpi.12209 PubMedGoogle ScholarCrossref
36.
McMullan  CJ, Rimm  EB, Schernhammer  ES, Forman  JP.  A nested case-control study of the association between melatonin secretion and incident myocardial infarction.   Heart. 2017;103(9):694-701. doi:10.1136/heartjnl-2016-310098 PubMedGoogle ScholarCrossref
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    Original Investigation
    March 5, 2020

    Effects of Cataract Surgery on Melatonin Secretion in Adults 60 Years and Older: A Randomized Clinical Trial

    Author Affiliations
    • 1Department of Ophthalmology, Nara Medical University School of Medicine, Nara, Japan
    • 2Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan
    JAMA Ophthalmol. 2020;138(4):405-411. doi:10.1001/jamaophthalmol.2020.0206
    Key Points

    Question  Does cataract surgery affect melatonin secretion in patients aged 60 years and older undergoing their first cataract surgery?

    Findings  In this randomized clinical trial, 169 patients with cataracts were randomized to receive prompt cataract surgery with a clear or yellow artificial intraocular lens or delayed surgery with a clear or yellow intraocular lens. Urinary melatonin excretion values were significantly higher in the cataract surgery group at 3 months after the operation than the control group.

    Meaning  The results of this study suggest that increased light perception by cataract surgery may align the internal biological rhythm with the external environment accompanied by increased melatonin secretion.

    Abstract

    Importance  Cataract surgery, which increases perception of light, may increase melatonin secretion. Melatonin secretion has been associated with depression, diabetes, cognitive impairment, and breast cancer. To date, no evidence from a randomized clinical trial exists to support this cataract surgery hypothesis.

    Objective  To determine whether cataract surgery modifies the melatonin secretion at 3 months after cataract surgery in 169 adult patients.

    Design, Setting, and Participants  A parallel-group randomized clinical trial was conducted at a single referral center from July 1, 2014, to June 30, 2017. Data were analyzed from January 1, 2018, to March 31, 2019. Patients were aged 60 years or older, had no history of cataract surgery, and had cataracts with grade 2 or higher nuclear opacifications based on the Lens Opacities Classification System III. Analyses were based on intention to treat.

    Interventions  Patients were randomized 1:1:1:1 to receive cataract surgery using artificial clear intraocular lens (IOL) or yellow IOL. Group 1 received prompt surgery with clear IOL, group 2, prompt surgery with yellow IOL, group 3, delayed surgery with clear IOL, and group 4, delayed surgery with yellow IOL. The intervention group consisted of groups 1 and 2, and the control group consisted of groups 3 and 4.

    Main Outcomes and Measures  Urinary melatonin excretion in the intervention group was measured at 3 months after surgery, and urinary melatonin excretion in the control group was measured before delayed surgery.

    Results  Of the 169 randomized patients, 97 were men (57.4%). The mean (SD) age was 75.7 (6.7) years. Mean urinary melatonin excretion was calculated as standardized urinary concentration, the ratio of urinary concentration to urinary creatinine concentration (nanograms per milligram of creatinine), in the intervention group after cataract surgery. Mean urinary melatonin excretion was significantly higher than in the control group (adjusted mean difference of creatinine concentration, 0.159 log ng/mg, 95% CI, 0.045-0.273; P = .007) independent of baseline urinary melatonin excretion and potential confounders. Subgroup analysis comparing group 1 with group 3 revealed that concentration of urinary melatonin excretion in patients who received clear IOLs was higher than the control group by creatinine concentration 0.212 log ng/mg (95% CI of the difference, 0.058-0.365; P = .008). However, the difference between patients in group 2 and group 4 was not significant (adjusted mean difference for creatinine excretion, 0.083 log ng/mg, 95% CI, –0.087 to 0.253; P = .33). The difference of concentration of mean urinary melatonin excretion between patients in group 1 and those in group 2 was not significant (95% CI of the difference for creatinine concentration, –0.19 to 0.40 log ng/mg; P = .48).

    Conclusions and Relevance  The findings in this study support the hypothesis that cataract surgery increases melatonin secretion. The effect of clear IOLs vs yellow IOLs on these outcomes was not shown to be different.

    Trial Registration  UMIN-CTR Identifier: UMIN000014559

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