- Email: [email protected]
Risk factors for age-related macular degeneration in Latinos
260
Risk factors for agerelated macular degeneration in Latinos Azen SP, Fraser-Bell S, Klein R, Varma R, Wu J, Los Angeles Latino Eye Study Group. Smoking, alcohol intake, estrogen use, and age-related macular degeneration in Latinos: The Los Angeles Latino Eye Study. Am J Ophthalmol 2006;141(1):79-87. Age-related macular degeneration (AMD) is a leading cause of permanent vision loss in the United States. Treatment options such as laser photocoagulation and photodynamic therapy may delay severe or progressing vision loss, but the modalities are only for those who present with choroidal neovascularization (CNV). To decrease the risk of loss in the general population, investigators have accentuated the identification of risk factors and promoted prevention. Modifiable risk factors such as lifestyle characteristics have the potential to play an important role in disease prevention. The association between smoking and AMD progression has been well documented. However, links to alcohol consumption and estrogen exposure have been documented with varying results. The majority of reported results have been taken from studies comprised mainly of white individuals. The Latino population represents the largest and fastest growing minority population in the United States. As such, there have been few reports with regard to advanced AMD and Latinos. This population-based study was initiated to gather data on smoking, alcohol use, and estrogen exposure with respect to its relation to advanced AMD in the Latino community. Eligible participants were of Latino descent, at least 40 years old, and evaluated via a standard questionnaire and comprehensive ocular examination. Particular attention was paid to smoking status, alcohol consumption, and exogenous estrogen use. Any level of AMD that was uncovered was graded on a modified version of the Wisconsin agerelated maculopathy grading system: Early AMD was categorized as drusen and retinal pigment epithelium abnormalities without evidence of advanced
Medical Abstracts AMD, and advanced AMD was classified by the presence of exudative or geographic atrophy. Statistical analysis of data was performed on 5,875 participants. The mean age was 54.9 years, and 42% of participants were men. Statistical analysis showed that people who had smoked were at a significantly higher risk for early AMD, mostly in the form of soft indistinct drusen. Current smokers were more likely to have retinal pigment epithelial abnormalities, especially female smokers. Those who had ever smoked had a greater than 2-fold-higher risk for having advanced AMD when compared with those who had never smoked. A history significant for any alcohol consumption was tied to a greater risk of soft indistinct drusen formation. Those who consumed more alcohol trended toward greater odds of having early AMD. In contrast, there was no dose-dependent relationship between amount of alcohol intake per week and odds of having advanced AMD. Consuming beer was associated with higher risk of having soft indistinct drusen, progression toward advanced AMD, and geographic atrophy. A history of wine consumption decreased odds of having increased retinal pigmentation. Frequent consumption of alcoholic beverages increased odds of having advanced AMD as well as retinal pigment epithelium depigmentation. Previous oral contraceptive use decreased the risk of AMD, especially soft indistinct drusen. This association was the only significant association between AMD lesions and exogenous estrogen use. The data collected from this investigation provide valuable insight toward the association of AMD with modifiable lifestyle characteristics in Latino individuals. The association of cigarette smoking and AMD was significant, especially when considering the development of advanced AMD. Consumption of beer carried increased risk of AMD as did heavy drinking, whereas consumption of wine appeared to be protective against AMD. The authors postulate that the high concentration of antioxidant phenolic elements in wine may be responsible for this effect, which has been shown similarly to protect against cardiovascular disease. Women who had ever taken
an oral contraceptive were shown to be at lower risk for early AMD. (It is thought that lack of estrogen in older women is responsible for breakdown of collagen in the retinal pigment epithelial basement membrane and Bruch’s membrane thus causing increased subretinal pigment epithelial deposition and thickening of Bruch’s membrane. Lack of estrogen may also lead to up-regulation of a specific protein [YKL-40], which is abundant in choroidal neovascular membranes.) These results are comparable with those obtained in other studies of AMD across other ethnicities, thus providing some common ground regarding AMD formation. As more evidencebased data are gathered on modifiable risk factors, perhaps the initial treatment of AMD may begin with patient education regarding lifestyle changes. Jason Price, O.D. doi:10.1016/j.optm.2006.03.007
Surgery for central retinal vein occlusion Opremcak EM, Rehmar AL, Ridenour CD, et al. Radial optic neurotomy for central retinal vein occlusion: 117 consecutive cases. Retina 2006;26(3):297-305. Central retinal vein occlusion (CRVO) is the second leading cause of vascular blindness next to diabetic retinopathy. There are no known evidence-based treatments for attempting to recover losses sustained secondary to CRVO. In addition, neovascularization of the iris (NVI) and anterior chamber angle leading to neovascular glaucoma are significant sequelae of the ischemic variation. Opremcak and team have hypothesized that the anatomy of the scleral outlet acts as a “bottleneck” in obstructing venous outflow. They have developed a surgical procedure to decompress the neurovascular solidity of the central retinal artery, central retinal vein, and the optic nerve head. The procedure, radial optic neurotomy (RON), involves a radial incision to the nasal side of the nerve made parallel to the nerve fiber layer. Incising the cribriform plate, scleral rim, and adjacent
Risk factors for agerelated macular degeneration in Latinos Azen SP, Fraser-Bell S, Klein R, Varma R, Wu J, Los Angeles Latino Eye Study Group. Smoking, alcohol intake, estrogen use, and age-related macular degeneration in Latinos: The Los Angeles Latino Eye Study. Am J Ophthalmol 2006;141(1):79-87. Age-related macular degeneration (AMD) is a leading cause of permanent vision loss in the United States. Treatment options such as laser photocoagulation and photodynamic therapy may delay severe or progressing vision loss, but the modalities are only for those who present with choroidal neovascularization (CNV). To decrease the risk of loss in the general population, investigators have accentuated the identification of risk factors and promoted prevention. Modifiable risk factors such as lifestyle characteristics have the potential to play an important role in disease prevention. The association between smoking and AMD progression has been well documented. However, links to alcohol consumption and estrogen exposure have been documented with varying results. The majority of reported results have been taken from studies comprised mainly of white individuals. The Latino population represents the largest and fastest growing minority population in the United States. As such, there have been few reports with regard to advanced AMD and Latinos. This population-based study was initiated to gather data on smoking, alcohol use, and estrogen exposure with respect to its relation to advanced AMD in the Latino community. Eligible participants were of Latino descent, at least 40 years old, and evaluated via a standard questionnaire and comprehensive ocular examination. Particular attention was paid to smoking status, alcohol consumption, and exogenous estrogen use. Any level of AMD that was uncovered was graded on a modified version of the Wisconsin agerelated maculopathy grading system: Early AMD was categorized as drusen and retinal pigment epithelium abnormalities without evidence of advanced
Medical Abstracts AMD, and advanced AMD was classified by the presence of exudative or geographic atrophy. Statistical analysis of data was performed on 5,875 participants. The mean age was 54.9 years, and 42% of participants were men. Statistical analysis showed that people who had smoked were at a significantly higher risk for early AMD, mostly in the form of soft indistinct drusen. Current smokers were more likely to have retinal pigment epithelial abnormalities, especially female smokers. Those who had ever smoked had a greater than 2-fold-higher risk for having advanced AMD when compared with those who had never smoked. A history significant for any alcohol consumption was tied to a greater risk of soft indistinct drusen formation. Those who consumed more alcohol trended toward greater odds of having early AMD. In contrast, there was no dose-dependent relationship between amount of alcohol intake per week and odds of having advanced AMD. Consuming beer was associated with higher risk of having soft indistinct drusen, progression toward advanced AMD, and geographic atrophy. A history of wine consumption decreased odds of having increased retinal pigmentation. Frequent consumption of alcoholic beverages increased odds of having advanced AMD as well as retinal pigment epithelium depigmentation. Previous oral contraceptive use decreased the risk of AMD, especially soft indistinct drusen. This association was the only significant association between AMD lesions and exogenous estrogen use. The data collected from this investigation provide valuable insight toward the association of AMD with modifiable lifestyle characteristics in Latino individuals. The association of cigarette smoking and AMD was significant, especially when considering the development of advanced AMD. Consumption of beer carried increased risk of AMD as did heavy drinking, whereas consumption of wine appeared to be protective against AMD. The authors postulate that the high concentration of antioxidant phenolic elements in wine may be responsible for this effect, which has been shown similarly to protect against cardiovascular disease. Women who had ever taken
an oral contraceptive were shown to be at lower risk for early AMD. (It is thought that lack of estrogen in older women is responsible for breakdown of collagen in the retinal pigment epithelial basement membrane and Bruch’s membrane thus causing increased subretinal pigment epithelial deposition and thickening of Bruch’s membrane. Lack of estrogen may also lead to up-regulation of a specific protein [YKL-40], which is abundant in choroidal neovascular membranes.) These results are comparable with those obtained in other studies of AMD across other ethnicities, thus providing some common ground regarding AMD formation. As more evidencebased data are gathered on modifiable risk factors, perhaps the initial treatment of AMD may begin with patient education regarding lifestyle changes. Jason Price, O.D. doi:10.1016/j.optm.2006.03.007
Surgery for central retinal vein occlusion Opremcak EM, Rehmar AL, Ridenour CD, et al. Radial optic neurotomy for central retinal vein occlusion: 117 consecutive cases. Retina 2006;26(3):297-305. Central retinal vein occlusion (CRVO) is the second leading cause of vascular blindness next to diabetic retinopathy. There are no known evidence-based treatments for attempting to recover losses sustained secondary to CRVO. In addition, neovascularization of the iris (NVI) and anterior chamber angle leading to neovascular glaucoma are significant sequelae of the ischemic variation. Opremcak and team have hypothesized that the anatomy of the scleral outlet acts as a “bottleneck” in obstructing venous outflow. They have developed a surgical procedure to decompress the neurovascular solidity of the central retinal artery, central retinal vein, and the optic nerve head. The procedure, radial optic neurotomy (RON), involves a radial incision to the nasal side of the nerve made parallel to the nerve fiber layer. Incising the cribriform plate, scleral rim, and adjacent