This month’s Ophthalmology, the journal of the American Academy of Ophthalmology (Academy) reports on a national study that finds cataract surgery is likely to benefit patients with age-related macular degeneration (AMD) at all stages of the disease, on a clinical trial showing that the steroid triamcinolone may be effective in advanced diabetic macular edema (DME) patients when standard treatment fails, and on the public’s use of two Academy-sponsored online eye health forums.

Multicenter Study Finds AMD Patients Benefit from Cataract Surgery

Cataract surgery improved vision in patients with any stage - from mild to advanced - AMD in the first study to include an adequate number of advanced AMD patients. Data was obtained from the multicenter, prospective Age-Related Eye Disease Study (AREDS), funded by the National Eye Institute (NEI), which was organized primarily to evaluate the effects of high-dose vitamin and mineral supplements on cataract and AMD. As the American population ages AMD prevalence is expected to rise, and many patients will concurrently develop cataract; both diseases can cause blindness if untreated.

“Earlier epidemiology had suggested cataract surgery might worsen AMD, so the data from the AREDS cohort study were evaluated to answer this important question,” said Emily Y. Chew, MD, who led the study for NEI.

The cohort, comprising 1,939 eyes (1,244 patients) with various stages of AMD, was evaluated for visual acuity (sharpness) after cataract surgery. On average, patients with AMD, ranging from mild to advanced, gained visual acuity after cataract surgery; the best gains were in patients with vision worse than20/40 before surgery. No difference in improvement was noted between patients with “wet” (neovascular) or “dry” (central geographic atrophy) AMD. About one year later vision gains remained statistically significant in the 865 eyes available for follow-up. Results for the primary focus of AREDS, regarding the effect of nutritional supplements, showed that high doses of vitamins C, E and beta-carotene did not affect the development or progression of cataract, but this vitamin combination plus zinc did reduce the risk of progression to advanced AMD by 25 percent in the five years of the study.

Steroids Helps Diabetic Macular Edema Patients When Other Treatment Fails

A five-year study based at the University of Sydney, Australia, found that intravitreal triamcinolone (IVTA) effectively improved vision in patients with DME, a form of diabetic retinopathy, whose eyes had continued to deteriorate despite receiving standard laser treatment.

“The majority of patients who improved with IVTA after initial treatment continued to enjoy better vision at the five year conclusion of our clinical trial, and no new safety concerns were found in these patients,” said lead researcher Mark Gillies, PhD. “We believe treatment with IVTA may be considered in carefully selected advanced DME patients when standard treatment has failed to improve vision,” he added.

In the first three months after treatment, the patients initially treated with both IVTA and laser showed significantly better gains in vision than control group patients, who were treated with laser only. After two years, patients in the original control group were also treated with IVTA. The beneficial effects persisted in most IVTA-treated patients throughout the five-year study; however, 80 percent of patients in the initial IVTA group developed elevated intraocular pressure and 56 percent of them required glaucoma therapy. Also, two-thirds of all patients required cataract surgery during the study period. Similar outcomes have been noted in other studies of steroid-based treatment and thus were not considered new safety concerns by Dr. Gillies’ group.

What Do People Ask About in Online Eye Health Forums

To identify the topics of highest interest to people who access eye health information on line, John C. Hagan, MD, and colleagues analyzed 4,485 questions over six months (September 1, 2008 to March 1, 2009) posted on the “Ask a Doctor: Ophthalmology” and “Eye Care Community” forums sponsored by the Academy on MedHelp (http://www.medhelp.org), one of the 10 largest health information websites. Dr. Hagan and three other ophthalmologists provide free, timely advice to a large and growing number of people with eye health and vision problems through these forums. Serious problems, such as life-threatening retinoblastomas in babies, have been caught and treated in time thanks to these forums, as have thousands of other eye and vision problems.

Concerns related to the retina topped the list at nearly 20 percent of all questions; many people asked about “flashes,” “floaters,” or retinal detachment. About 19 percent of questions were related to the cornea, the clear outer surface of the eye that helps focus light to make vision possible. Cataract and implanted lens questions were next in prevalence, followed by brain-eye problems (neuro-ophthalmology), children’s eye alignment (strabismus), eye cancers, and general discomfort or blurry vision. Two-to-three percent of questions related to each of three vision correction topics: refractive surgery (LASIK and others), eyeglasses, or contact lenses. A smaller number were related to eye care products or medical insurance. The analysis also found many people submit postings to express their gratitude for the medical advice provided.

Source:
Mary Wade

American Academy of Ophthalmology

Most people have taken a prescription medication at one time or another, but according to a report from the Agency of Healthcare Research and Quality (AHRQ) in Rockville, Md., not only do women take more medications during their lifetimes, women are more likely to suffer from adverse drug events than men.

As a result of this trend: “women should be proactive about their medication use,” explains Rosaly Correa-de-Araujo, M.D., M.Sc., Ph.D., senior advisor for women’s health at AHRQ.

An adverse drug reaction is a harmful, unintended reaction to a drug administered at a normal dosage. They can be classified as immunological and non-immunological. The majority of adverse reactions are caused by predictable non-immunological effects, which include: side effects from drug ingredient, drug-drug interactions and drug toxicity. A smaller number are caused by unpredictable effects, which may be immune related including: allergic reactions and serum sickness (a reaction similar to an allergy).

Because women are more likely to experience adverse drug reactions than men, it becomes even more important for women to take an active role in their healthcare. Medication is supposed to make you feel better, but if it isn’t taken correctly, it can have the opposite effect. Whether you are taking a prescription medication or an over-the-counter drug, you should keep the following guidelines in mind:

According to the American Academy of Family Physicians (AAFP), here’s a list of things you should know about each medicine you take:

– Name (generic name and brand name)

– Reason for taking it

– How much to take and how often to take it

– Possible side effects and what to do if you have them

– How long to continue taking it

– Special instructions (taking it at bedtime or with meals, etc.)

It’s important for women to inform their doctors and pharmacists about all medications or supplements that they are taking, any known allergies and if they are currently pregnant or planning on conceiving in the short-term.

In addition, to ensure that a medication is being taken safely and correctly, the AAFP encourages people to have a list of questions for their doctor about their medications which include:

– What does the medicine do?

– When and how should I take the medicine?

– What side effects (reactions your body may have to the medicine) could I have?

– Will the medicine react to any other medicines, foods or drinks?

– Should I avoid any activities while I’m taking the medicine?

– What should I do if I forget to take the medicine?

– How will I know whether the medicine is working?

According to Correa-de-Araujo, women should learn to research medications being prescribed for them. Also, instead of tossing instructional package inserts into the garbage, women should always read the instructions. Taking an active role in healthcare can help lower the risk of problems associated with prescription, non-prescription medications and supplements.

Source: Society for Women’s Health Research

Low levels of vitamin D may account for nearly 60 percent of the elevated risk of end-stage renal disease (ESRD) in African Americans, according to a report in the December Journal of the American Society of Nephrology (JASN). “Our study adds to previous evidence linking vitamin D deficiency to the progression of kidney disease and the need for dialysis,” comments Michal L. Melamed, MD, of Albert Einstein College of Medicine (Bronx, NY). “It also explains a fair amount of the increased risk of ESRD in African Americans.” Vitamin D is obtained from sun exposure, food and food supplements.

Melamed and colleagues analyzed a nationwide sample of 13,000 Americans, including measurements of the vitamin D metabolite 25(OH)D. Medicare data were used to identify participants who eventually required dialysis therapy for ESRD. “We found that the participants with the lowest 25(OH)D levels were 2.6 times as likely to end up on dialysis compared to those with higher levels,” says Melamed.

The researchers then tested whether 25(OH)D levels could contribute to the higher risk of ESRD in African Americans, compared to whites. “African Americans have lower 25(OH)D levels and a higher risk of ESRD,” Melamed explains. “We found that 25(OH)D deficiency was responsible for about 58 percent of the excess risk for ESRD experienced by African Americans.”

Vitamin D deficiency is a very common problem in the United States. In recent years, studies have linked low vitamin D to many different health problems, including cancers, and heart disease. The new results add to previous evidence that low 25(OH)D levels are an important risk factor for ESRD. “This is another good reason to make sure that people get enough vitamin D,” Melamed adds.

Although it can’t prove any cause-and-effect relationship, the study also suggests that vitamin D deficiency is a key contributor to the high risk of ESRD in African Americans. More research is needed to confirm these findings, and to determine whether treatment to raise low vitamin D levels can help to preserve kidney function. “We are currently in the process of enrolling for a clinical trial of vitamin D repletion in patients with chronic kidney disease to further test these hypotheses,” says Melamed.

Dr. Melamed’s research will also be presented as part of a Poster Session during ASN Renal Week on October 30, 2009. This poster presentation is entitled, “25-Hydroxyvitamin D Levels and Progressive Kidney Disease: Contribution to the Excess Risk of ESRD in Non-Hispanic Blacks” (F-PO1101).

Other authors included Paul Muntner, PhD (University of Alabama at Birmingham); Thomas Hostetter, MD (also of Albert Einstein College of Medicine); Erin Michos, MD; Brad Astor, PhD (Johns Hopkins School of Medicine); and Neil R. Powe, MD, MBA, FASN (University of California- San Francisco). Dr Hostetter has consulted for Bristol Myers Squibb, Eli Lilly, and Wyeth. None of the other co-authors reported financial disclosures.

The American Society of Nephrology (ASN) does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, ASN is the world’s largest professional society devoted to the study of kidney disease. Comprised of 11,000 physicians and scientists, ASN continues to promote expert patient care, to advance medical research, and to educate the renal community. ASN also informs policymakers about issues of importance to kidney doctors and their patients. ASN funds research, and through its world-renowned meetings and first-class publications, disseminates information and educational tools that empower physicians.

Source: American Society of Nephrology