Archive for June, 2010
Which drugs should you avoid so that you don’t get cataracts?
06.19.2010Cataracts are the leading cause of impaired vision. Cataracts occur when the clear lens of the eye becomes cloudy. A recent study found that one type of cataract, the cortical cataract, may be more likely to form when a patient has taken certain types of commonly used drugs. These types of drugs are all linked to sun-sensitivity.
Cortical cataracts form in the lens cortex and gradually spread their spokes from the outside of the lens to the center of the lens. This type of cataract is often found in diabetics.
The study, published in the? Archives of Ophthhalmology,? reveals that “sun-sensitizing” medications such as naproxen, ciprofloxacin, glyburide, amitriptyline and hydrochlorothiazide increased the risk by about 26 percent of a person developing a cortical cataract.
Researchers caution that much more research needs to be conducted to precisely measure drug dosage and duration and sun exposures before any trustworthy conclusions can be established.*
Andrea Schumann
Staff Writer
“Elsie’s Story” will make your skin tingle.
06.18.2010
Elsie Gerner's Garden
Dear Elsie,
I am delighted about your great news!
Here is something else to make you smile…color brochures with many of your vignettes, including two of your lovely photographs of your garden and the sea, were sent to our users of VisiVite. Already, people are discussing and relating to “Elsie’s Story.”
I’ve attached an electronic version of the mailed newsletter for you to enjoy. “Elsie’s Story” begins on page 6.
Thanks again for keeping me informed about your progress.
Dr. Krawitz
Another reason to diet – Women who eat healthy foods require fewer cataract surgeries.
06.17.2010A healthy diet can have positive effects on many aspects? of a person’s overall health. A recent study concludes that there is an association between a healthy diet and a decreased risk of nuclear cataracts in women. The results of the study can be found in the June issue of Ophthalmology.
Nuclear cataracts form in the center of the eye’s lens. This type of cataract is caused by changes occurring due to the natural aging process and it can be seen as it forms. Nuclear cataracts are the most common form of cataract in the United States.
Participants in the Women’s Health Initiative Observation were included in the assessment. Women aged 50 – 79 were assigned a 1995 Healthy Eating Index score based on their responses to food frequency questionnaires. The presence of nuclear cataracts was determined by slit lamp photographs and self-reports of cataract extractions. 1,808 women participated in the Cataract Age-Related Eye Disease Study.
Participants who had a high 1995 Healthy Eating Index score had the lowest incidence of nuclear cataracts among many risk factors studied. Those who had a higher incidence of nuclear cataracts were associated with other adjustable factors such as smoking and significant obesity and fixed factors such as myopia and having brown eyes.
Researchers concluded that a healthy diet which includes eating a variety of foods from different food groups rich in vitamins and minerals may prevent the formation of nuclear cataracts in women.*
Andrea Schumann
Staff Writer
Not everyone needs to take eye vitamins. Find out today if you need them or not.
06.16.2010At a recent lecture that I gave to the Family Practice Department at Huntington Hospital in Huntington, New York, one of the doctors asked whether all people with retinal drusen need to take eye vitamins. My letter to the doctor is below.
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Dear Doctor,
Thank you for asking an excellent question about supplements for macular degeneration during my retinal lecture. Specifically, you asked whether patients with mild macular degeneration required high dose nutritional supplements for their AMD. I am sorry that under the time constraints that I was not able to give you a detailed response to your question during the lecture.
Up to this date, there have been two approaches to this question. My approach is a third one which uses, I believe, the best evidence that we know.
The National Eye Institute?s Age Related Eye Disease Study, completed in 2001, concluded that patients with intermediate-sized or larger drusen showed less chance of progression if they were treated with high dose nutritional supplements when compared with placebo. Although the benefit was only a 25% reduction in progression, it was the first study showing benefit to vitamin usage, which was presumably due to the very high doses used in AREDS versus previous studies.
But, as you alluded, not ALL patients with intermediate-sized drusen will progress. So the treatment of everyone with intermediate and larger drusen is a bit like ?carpet bombing,? in which everyone gets the ?bomb? so that those who are going to progress will get the benefit of treatment as well, at least with the AREDS Formula. (Newer studies show more benefit when Lutein, Zeaxanthin and Omega-3 fatty acids are added.)
5 Year Rate of Progression of AMD
To cope with this dilemma, Neal Bressler of the Wilmer (Johns Hopkins) Eye Institute in Baltimore and one of the original AREDS investigators, did an analysis of the original data from AREDS that tried to predict who would progress (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1473206/). Dr. Bressler came up with a four-point scale based only on the presence of large drusen and pigmentary changes, which he showed had predictive value for the progression to either wet or geographic (diffuse dry) macular degeneration.
While Dr. Bressler?s article is helpful. I believe that it is a bit like closing the barn door after the horses have escaped. Patients who have large drusen and pigment have already progressed.
So how do we find the patients at an earlier stage of disease who have only a few intermediate-sized drusen and determine who will progress and lose vision without treatment over the course of a lifetime? True, they all meet the AREDS criteria for treatment but should we place all of these patients on high-dose nutritional supplements? That would seem to place both a high medical and cost burden on patients who would not progress without treatment.
The answer, I believe, is a hybrid approach.
For those patients who demonstrate high-risk findings as delineated in Dr. Bressler?s study, clearly those patients should be on supplements.
For patients with lesser findings, locating the ?needle in the haystack? can be determined by performing the Macula Risk test, a genetic assay for macular degeneration which we perform in our office by simply swabbing the inside right and left cheek. Even if a patient?s findings only include intermediate-sized drusen and no pigment ? patients who would score a zero on Dr. Bressler?s scale, – those patients should, in my opinion, be treated with macular degeneration vitamins if they score 3 or above on the genetic test 5-point scale.
Warm Regards,
