reporting. Resulting data demonstrated the differences observed, and we reported the findings without bias or financial affiliation with any organization or product manufacturer. As per the article’s title, the original focus of the study was to compare fourth-generation fluoroquino- lones with older third-generation fluoroquinolones in postoperative endophthalmitis rates, for which there was a statistically significant difference (P Z .0011). In the process, we observed differences between the 2 fourth-generation products, which was significant (P Z .04) and which we stated merits further research. However, this important difference between the third- generation and fourth-generation fluoroquinolones is completely ignored in McCulley’s letter. We stand by our conclusions that the fourth-generation fluoro- quinolones are superior to the third-generation fluoro- quinolones for prophylaxis of endophthalmitis and that among the fourth-generation fluoroquinolones, at our institution, fewer infections were seen with postoperative use of gatifloxacin than with moxifloxacin.dMajid Moshirfar, MD, Michael Jensen, RPh, Richard G. Fiscella, RPh, MPH REFERENCES 1. Ciulla TA, Starr MB, Masket S. Bacterial endophthalmitis prophy- laxis for cataract surgery: an evidence-based update. Ophthal- mology 2002; 109:13–24; questions for review and CME credit request, 25–26 2. Taban M, Behrens A, Newcomb RL, Nobe MY, Saedi G, Sweet PM, McDonnell PJ. Acute endophthalmitis following cata- ract surgery; a systematic review of the literature. Arch Ophthal- mol 2005; 123:613–620 3. Jensen MK, Fiscella RG, Crandall AS, Moshifar M, Mooney B, Wallin T, Olson RJ. A retrospective study of endophthalmitis rates com- paring quinolone antibiotics. Am J Ophthalmol 2005; 139:141–148 Retinal phototoxicity in the aging pseudophakic and phakic eye Carson et al. 1 calculated the relative phototoxicity protection provided by intraocular lenses (IOLs) for pseudophakes of different ages using Ro ´ _ zanowska et al.’s 2 data for age-related increases in lipofuscin phototoxicity in isolated retinal pigment epithelial (RPE) cells. They found that retinal photoprotection for pseudophakes was independent of age. They con- cluded that their theoretical results could ‘‘act as a guide’’ for clinical IOL selection in different patient age groups but did not consider age-related issues, including decreasing pupil area, rod photoreceptor performance, or circadian photoreception. 3,4 We also performed phototoxicity calculations with Ro ´ _ zanowska et al.’s 2 data on age-related RPE cell pho- totoxicity, Barker and Brainard’s data 5 on age-related crystalline lens spectral transmittance, IOL spectral transmittances, 3 and solar spectra, 6 using previously described methodology. 3 In addition, we considered age-related pupillary miosis 7,8 and analyzed the per- formance of crystalline lenses of different ages, 5 as well as IOLs. We presented our results in 2007 (20th In- ternationale Kongress der Deutschen Ophthalmochir- urgen, Nu ¨ rnberg, Germany, May, 2007; the 5th Congresso Internationale della Societa ` Oftalmologica Italiana, Rome, Italy, May, 2007; the XXV Congress of the European Society of Cataract and Refractive Surgeons, Stockholm, Sweden, September, 2007; and the 20th annual meeting of the Asia-Pacific Associa- tion of Cataract & Refractive Surgeons, Hanoi, Viet- nam, September, 2007; Mainster MA, Turner PL, ‘‘Blue Light: to Block or Not to Block; Cataract Surgery Should Improve Vision and Health, and Blue Light is Essential for Both,’’ Cataract & Refract Surg Today Europe, May 2007, pages 64–68. Available at http:// www.crstodayeurope.com/Pages/whichArticle.php? id=109. Accessed November 20, 2008). 9 Some of our results are shown in Figure 1, which il- lustrates that pseudophakic phototoxicity protection Figure 1. Acute retinal phototoxicity risks relative to a 10-year-old phakic eye, taking into consideration (1) age-related increases in RPE cell phototoxicity 2 due to lipofuscin (2) age-related decreases in crystalline lens transmittance 5 and pupil area, 7,8 and (3) solar illu- mination. 6 Risks are shown for (1) phakic eyes (crystalline lens) (2) pseudophakic eyes with 20 diopter (D) blue-blocking IOLs (Alcon AcrySof Natural SN60AT and Hoya AF-1), and (3) pseudophakic eyes with 20 D UV-only blocking IOLs (Tecnis ZA9003, Advanced Medical Optics), and sunglasses. 12 Phakic eye risks peak around 25 years of age. 9 If phototoxicity risks are compared for phakic and pseudophakic eyes, 65- and 75-year-old pseudophakes with a 20 D blue-blocking IOL (SN60AT) have equivalent risks for acute retinal phototoxicity of 28- and 34-year-old phakic adults, res- pectively. 9,10 A UV-only blocking IOL and sunglasses combination provides better protection at all ages than crystalline lenses or blue-blocking IOLs. 9 Important caveats include the facts that (1) there is no proof that environmental light exposure is a significant risk factor for AMD, 3,10 (2) acute phototoxicity experiments can not simulate AMD, 3,10 and (3) if hypothetical chronic retinal photo- toxicity does occur, its action spectrum is not known. 209 LETTERS J CATARACT REFRACT SURG - VOL 35, FEBRUARY 2009