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HANDBOOK OFNUTRITION AND OPHTHALMOLOGY
ByRICHARD D. SEMBA, MD, MPHThe Wilmer Eye Institute, The Johns Hopkins Universityand Hospital, Baltimore, Maryland
Even prior to the invention of the ophthalmoscope in 1851, nutritional deficienciessuch as xerophthalmia were known as important causes of vision loss. Many of the toxiceffects of nutritional deficiencies on the eye had been described in case reports and seriesby the early part of the 20th century. However, it has only been more recently, beginningin the 1970s, that the interrelationships between nutrition and chronic ocular diseases,e.g., cataract, age-related macular degenerations (AMD) have been examined in largepopulation-based studies (e.g., the Beaver Dam Eye Study, the Blue Mountains EyeStudy) and randomized controlled clinical trials (e.g., the Age-Related Eye DiseaseStudy [AREDS]). This has, in part, been made possible by the development of standardizedprotocols to assess these conditions by grading of fundus and lens photographs, aswell as the development of more robust nutritional epidemiologic instruments to describethe intake of dietary nutrients and supplements.These studies have provided new insights regarding nutritional exposures and theprevalence of chronic eye diseases (e.g., associations of dietary saturated fats and leafygreen vegetables with AMD, the associations of dietary intake vitamin E, riboflavin andfolate with nuclear sclerotic cataract). Findings of associations between specific nutrients,especially deficiencies and ocular disease are also important in understanding thepossible pathogeneses of these chronic ocular conditions.Application of findings from these studies through dietary supplementation may havean impact on the incidence and progression of AMD and cataract although clinical trialsdata are necessary before any recommendation in favor of supplement use is made.Confirmation of nutritional epidemiological findings from observational studies by randomizedcontrolled clinical trials is critical because of the potential problem of uncontrolledconfounding. That is, the failure to measure and control for other exposures (e.g.,healthy lifestyles, physical activity) that may explain, in part, the earlier finding in cohortstudies of reduced risk of cardiovascular disease in association with hormone replacementtherapy (HRT) and the contrary finding in the large randomized controlled clinicaltrial, the Women’s Health Initiative, showing an increased risk of acute myocardialinfarction from such treatment. Confounding by indication, that is, taking a supplementor drug for a specific condition where an effect is ascribed to the treatment although it maybe due to the underlying disease for which the treatment is given may also be anotherproblem limiting the interpretation of data from observational studies. For example, zincsupplements were found to be associated with higher risk of incident late AMD in someepidemiological studies. However, the REDS showed that when an anti-oxidant multivitaminsupplement was given there was a statistically significant 28% reduction in therisk of progression to end stage AMD compared to those taking placebo.The application of findings from studies on nutrition and chronic eye disease e.g.,AMD and cataract have great importance as the population ages and the burden of suchconditions increase. At present, the strongest associations found in epidemiological studiesof chronic eye diseases have been with non-modifiable factors (e.g., age, geneticfactors, race with AMD). Only a few modifiable risk factors have been found (e.g.,smoking with AMD). Finding specific associations of dietary factors with AMD, cataractand other chronic eye diseases are important because diet is modifiable and such modificationsmay have the potential of reducing the burden associated with these diseases.With this in mind, the new book by Semba will be important to dieticians, ophthalmologists,optometrists, and the lay public interested in role of nutrition in eye disease. Itexamines the historical and recent evidence concerning the role of dietary changes inpreventing both acute and chronic eye disease.Dr. Semba’s text covers the broad field of nutrition and ophthalmology. The contentof the 12 chapters covers specific disease entities e.g., AMD and age-related cataract,diabetic retinopathy, and inborn errors of metabolism) and specific nutrients (e.g., vitaminsC, E, A, and B-complex, zinc, fatty acids) and their relation to ocular disease. It isa unique text, in that all chapters were written by one author and cover a large area ofmaterial ranging from an historical overview, epidemiology, pathology and treatment ofthe condition. There are three identified themes within the text, the first emphasizing theefficacy of long-term “healthy” diet, the second the importance of historical perspectiveof diet and eye disease, and the third the importance of two putative pathogenetic mechanisms,oxidative stress and inflammation. The text provides important and new authoritativeinformation on the relation of nutrition to ocular disorders which will reward thereader with a wealth of insightful information.
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beruzbashid@gmail.com
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قیمت هر کتاب فقط 800 تومان
:: برچسب‌ها:
پزشکی ,
تغذیه ,
چشم ,
بیماری چشم ,
NUTRITION ,
OPHTHALMOLOGY ,
humana ,
RICHARD D ,
SEMBA ,
MD ,
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تاریخ انتشار : چهار شنبه 5 ارديبهشت 1395 |
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