Vitamins and Macular Degeneration in Women

B vitamins reduce macular degeneration - UPI.com

Taking a combination of vitamins B6 and B12 and folic acid appears to decrease the risk of age-related macular degeneration in women, U.S. researchers said.

William G. Christen of Brigham and Women's Hospital and Harvard Medical School in Boston and colleagues conducted a randomized, double-blind clinical trial involving 5,442 women age 40 and older who already had heart disease or at least three risk factors.

Of these, 5,205 did not have age-related macular degeneration at the beginning of the study. In April 1998, these women were randomly assigned to take a placebo or a combination of folic acid -- 2.5 milligrams per day, pyridoxine hydrochloride -- vitamin B6, 50 milligrams per day and cyanocobalamin -- vitamin B12, 1 milligram per day. Participants continued the therapy through July 2005 and were tracked for the development of age-related macular degeneration through November 2005.

Over an average of 7.3 years of treatment and follow-up, 137 new cases of age-related macular degeneration were documented, including 70 cases that were visually significant -- resulting in a visual acuity of 20/30 or worse.

Women taking the supplements had a 34 percent lower risk of any age-related macular degeneration and a 41 percent lower risk of visually significant age-related macular degeneration.

"The beneficial effect of treatment began to emerge at approximately two years of follow-up and persisted throughout the trial," the study authors said in a statement.

Visual Problems Often Accompany Hearing Loss in Childhood

PITTSBURGH, Feb. 16 -- Vision problems are common among children who already have sensorineural hearing loss, researchers found.

The occurrence of ophthalmologic findings in children with sensorineural hearing loss was 21.7%, including refractive problems in 10.2% of the children and nonrefractive abnormalities in 12.8%, David H. Chi, M.D., of the Children's Hospital of Pittsburgh, and colleagues reported in the February issue of the Archives of Otolaryngology -- Head & Neck Surgery.

This rate of ophthalmologic abnormalities in the retrospective study was significantly higher than the 14.0% found in an earlier screening study of elementary school students in the general population (P=0.02).
Action Points

* Explain to interested patients that some conditions that cause sensorineural hearing loss, such as congenital rubella, also increase risk of loss of visual acuity.

* The American Academy of Pediatrics recommends ophthalmologic evaluation for all children with sensorineural hearing loss.

"Especially early in life, sensorineural hearing loss is associated with delays in language, speech, and cognitive and social development," the researchers said.

Because children with hearing loss rely heavily on their other senses, unrecognized ophthalmologic abnormalities that limit visual acuity could have further detrimental effects on development, they noted.

Dr. Chi's group recommended routine ophthalmologic examination for all children with sensorineural hearing loss in order to make an early diagnosis and start interventions to maximize visual acuity.

Their retrospective medical record review included all 226 children ages 18 and younger with sensorineural hearing loss and ophthalmologic evaluation at Children's Hospital of Pittsburgh from 2000 through 2007.

Most of the patients had bilateral sensorineural hearing loss (76.9%) and more than 55 dB of hearing loss (8.8% moderately severe, 15.9% severe, and 33.2% profound).

Ophthalmologic examination revealed that 21.7% had an ophthalmologic abnormality: 10.2% had refractive errors, such as myopia, hyperopia, and astigmatism, and 12.8% had nonrefractive conditions, such as strabismus or retinitis pigmentosa.

Syndromic causes of sensorineural hearing loss were found for 4.8% of patients, including Waardenburg syndrome, Stickler syndrome, and Usher syndrome.

In some cases, "the ophthalmologic examination was helpful because it suggested or confirmed the diagnosis of the respective syndromes," which the researchers said is another advantage of early ophthalmologic examination. "Knowledge of the cause can be comforting to patients and family members while providing relevant prognostic information."

The prevalences of ophthalmologic abnormalities were not significantly different for the 29.2% of children whose sensorineural hearing loss was initially detected by newborn screening compared with those whose hearing loss was detected later.

Likewise, vision problems were similar regardless of severity and laterality of hearing loss.

However, genetic testing results were significantly linked to the presence of coexisting vision and hearing loss.

Among the many genes associated with nonsyndromic sensorineural hearing loss, the GJB2 mutation has been found in at least 50% of hereditary cases in whites.

In Dr. Chi's study, the 18.8% of children with biallelic mutations in GJB2 were significantly more likely to have visual problems than the 7.6% with a single allele mutation in the gene (3.7% versus 0%, P=0.04). But even the bilateral GJB2 group had substantially lower rates than children without any GJB2 mutation (20.7% versus 3.7%, P=0.04).

The researchers cautioned, though, that the study might have been subject to selection bias because families with concerns about visual impairment were probably more likely to follow recommendations to see an ophthalmologist. Also, some patients may have had more thorough ophthalmologic evaluation than others.

By Crystal Phend, Staff Writer, MedPage Today
Published: February 16, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine

Primary source: Archives of Otolaryngology -- Head & Neck Surgery
Source reference:
Sharma A, et al "Ophthalmologic findings in children with sensorineural hearing loss" Arch Otolaryngol Head Neck Surg 2009; 135: 119-123.

Exercise and your Eyes

Interesting article from the Los Angeles Times:

Why exercise is good for the eyes

Cataract Surgery Doesn't Worsen AMD

Understanding that after cataract surgery, the eye loses its natural protection from UV radiation - a known major contributor in AMD. Interesting that in the following study no correlation was found after cataract surgery.

- Dr. Martinelli, Jr.

---

Cataract surgery doesn't hasten vision loss in people with age-related macular degeneration (AMD).

That's the conclusion of a new study that challenges the findings of several large epidemiological studies that suggested a link between cataract surgery and accelerated AMD progression.

AMD and cataracts are leading causes of vision impairment in the United States. Both are related to aging and share other risk factors. AMD affects the retina and leads to loss of central vision. Cataract is cloudiness in the eye's lens that interferes with clear vision.

For the new study, Dr. Emily Y. Chew, of the U.S. National Eye Institute, and colleagues analyzed data from 4,577 participants (8,050 eyes), ages 55 to 81, who took part in the Age-Related Eye Disease Study (AREDS). The researchers compared the risk of advanced age-related macular degeneration in people who had surgery to remove cataracts and in those who didn't have the surgery.

Chew and her team found little evidence that cataract surgery influences AMD progression. The study was published in the February issue of the journal Ophthalmology.

"These data may provide some reassurance to patients with AMD who are considering cataract surgery," Chew said in an American Academy of Ophthalmology news release.

Several possible factors may explain the conflicting conclusions of this new study and previous population-based research, Chew said. The most likely factor is that earlier studies may have had unintended biases or confounding variables. Chew also noted that cataract surgery and lens replacement techniques have advanced, and the AREDS participants' procedures were performed more recently than people included in earlier studies.

-- Robert Preidt
SOURCE: American Academy of Ophthalmology, news release, Feb. 2, 2009
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Can eye color change as you get older?

For those of you who have always wondered...

Eye color can change as we age, but sometimes what is perceived as a change is really just reflection of color from outside the eye. Age-related changes in eye color do occur among 10 to 15 percent of Caucasians (who have lighter eyes than other races). In these cases, eyes become lighter as a result of the progressive decrease in the number of pigment granules in the connective tissue (stroma) of the front layer of the iris.

Eye color changes in about 43 percent of children between the ages of 3 months and 6 years as the iris is exposed to light to which the pigment granules react. The one study I was able to find on changes in eye color after early childhood concluded that genetics are responsible. It looked at 693 sets of twins and their mothers. The researchers found that over the course of the 40 years of the study, 17 percent of the twins and 11 percent of their mothers had eye color lighten or darken by at least two shades. The changes were more likely to occur at the same time and with the same rate of change in identical twins than in fraternal twins, and so appeared to be genetically determined.

(Rarely, eye color changes can also accompany diseases of the eye, including macular degeneration, pigmentary glaucoma, and Horner's syndrome.)

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