Faculty Bibliography

Objective.-To evaluate the relationships between dietary intake of carotenoids and vitamins A, C, and E and the risk of neovascular age-related macular degeneration (AMD), the leading cause of irreversible blindness among adults. Design.-The multicenter Eye Disease Case-Control Study. Setting.-Five ophthalmology centers in the United States. Patients.-A total of 356 case subjects who were diagnosed with the advanced stage of AMD within 1 year prior to their enrollment, aged 55 to 80 years, and residing near a participating clinical center. The 520 control subjects were from the same geographic areas as case subjects, had other ocular diseases, and were frequency-matched to cases according to age and sex. Main Outcome Measures.-The relative risk for AMD was estimated according to dietary indicators of antioxidant status, controlling for smoking and other risk factors, by using multiple logistic-regression analyses. Results.-A higher dietary intake of carotenoids was associated with a lower risk for AMD. Adjusting for other risk factors for AMD, we found that those in the highest quintile of carotenoid intake had a 43% lower risk for AMD compared with those in the lowest quintile (odds ratio, 0.57; 95% confidence interval, 0.35 to 0.92; P for trend=.02). Among the specific carotenoids, lutein and zeaxanthin, which are primarily obtained from dark green, leafy vegetables, were most strongly associated with a reduced risk for AMD (P for trend=.001). Several food items rich in carotenoids were inversely associated with AMD. In particular, a higher frequency of intake of spinach or collard greens was associated with a substantially lower risk for AMD (P for trend<.001). The intake of preformed vitamin A (retinol) was not appreciably related to AMD. Neither vitamin E nor total vitamin C consumption was associated with a statistically significant reduced risk for AMD, although a possibly lower risk for AMD was suggested among those with higher intake of vitamin C, particularly from foods. Conclusion.-Increasing the consumption of foods rich in certain carotenoids, in particular dark green, leafy vegetables, may decrease the risk of developing advanced or exudative AMD, the most visually disabling form of macular degeneration among older people. These findings support the need for further studies of this relationship. $$:

PURPOSE: A case-control study was conducted to identify possible risk factors for idiopathic macular holes. METHODS: One hundred ninety-eight patients with idiopathic macular holes and 1,023 control subjects were identified at five clinical centers. Data were obtained through interviews, clinical examinations, and laboratory analyses of blood specimens. RESULTS: One hundred forty-three (72%) affected patients were women. Very few of a broad array of possible risk factors were statistically significant. In a logistic regression model that included both genders, higher plasma fibrinogen levels (P = .0007) and a history of glaucoma (P = .04) were associated with an increased risk of idiopathic macular holes. When the same model was used for women, with estrogen use and parity added as variables, a higher fibrinogen level (P = .002) was positively associated, and estrogen use (P = .04) was negatively associated with risk of macular holes. CONCLUSIONS: Of the two factors that stood out as possible risk factors for idiopathic macular holes, the increased risk for women has long been recognized. The association with fibrinogen level was unexpected, and it is unclear whether this is a chance finding or whether higher levels of fibrinogen can increase susceptibility to the forces of vitreous traction, perhaps by compromising the macular blood supply or by some yet unexplained mechanism.

The use of indocyanine-green videoangiography as an adjunctive technique to fluorescein angiography in the diagnosis of choroidal neovascularization has recently gained widespread attention. In January 1993, the first international symposium on indocyanine-green angiography was sponsored by the Manhattan Eye, Ear, and Throat Hospital. Approximately 300 retina specialists from all over the world convened at this meeting. Our current knowledge of indocyanine-green videoangiography is reviewed

Interferon alfa is used to treat various systemic disorders and recently has been suggested as a possible treatment for choroidal neovascularization. We report 10 cases of retinal ischemia associated with the use of interferon alfa for various illnesses. The retinal findings include cotton-wool spot formation, capillary nonperfusion, arteriolar occlusion, and hemorrhage. The retinal complications may sometimes be reversible when treatment is stopped. Our findings emphasize the need to have patients who are receiving interferon alfa therapy monitored for these retinal complications, which may rarely be associated with permanent loss of vision secondary to closure of retinal capillaries

The neovascular variant of age-related macular degeneration is amenable to laser photocoagulation treatment within well-defined guidelines established by clinical trials. However, only a limited number of patients meet eligibility criteria for this form of treatment, principally because of the ill-defined, or occult nature, of the choroidal neovascularization commonly seen. Previous studies have estimated that one half of patients with neovascular age-related macular degeneration have occult neovascularization at initial manifestation of the disease. We examined the initial findings of 67 patients with newly diagnosed unilateral neovascular age-related macular degeneration. Eighty-seven percent of these patients (58 of 67) had disease that did not meet Macular Photocoagulation Study Group guidelines for laser photocoagulation treatment. As so few patients are eligible for laser photocoagulation, further research into new techniques of diagnosis and treatment for this disorder is warranted