Clinical News
MEDICAL AND PRODUCT UPDATES

MICROVASCULAR DISEASE
Retinopathy and health problems

Retinopathy has now been associated with cognitive impairment and future development of diabetes:

Cognitive impairment. Research-ers in Singapore examined 8,734 middle-age subjects every 3 years from 1987 to 1998. After checking retinal photographs for microvascular abnormalities, the researchers tested subjects for cognitive impairment. (None of the subjects had previously had a stroke.)

The presence of retinopathy was associated with lower cognitive scores, even after adjusting for education, diabetes, hypertension, carotid intima-media thickness and other risk factors.

The study was reported in the June issue of Stroke, the journal of the American Heart Association.

Development of type 2 diabetes mellitus. Researchers using data from the Atherosclerosis Risk in Communities Study have found that microvascular disease may predict subsequent development of type 2 diabetes mellitus, even in patients with no documented risk factors.

Investigators identified 7,993 persons without diabetes, ages 49 to 73, who'd had retinal photographs taken. After a median follow-up of 3.5 years, 291 persons (3.6%) developed diabetes. Diabetes developed more often in patients with lower retinal arteriole-to-venule ratio. Incidence was:

• 2.4% in the highest quartile
• 3.1% in the second quartile
• 4.0% in the third quartile
• 5.2% in the lowest quartile.

Persons with the lowest ratio were 71% more likely to develop diabetes than those with the highest ratio.

The study appeared in the May 15 issue of The Journal of the American Medical Association.

CHRONIC OPEN-ANGLE GLAUCOMA
Eliminating H pylori improves outcomes

A study reported in the June 10 issue of the Archives of Internal Medicine suggests that H pylori infection is common in chronic open-angle glaucoma patients, and treating the infection may improve outcomes.

Researchers tested 41 glaucoma patients and 30 age-matched controls for H pylori infection. They found evidence of infection in 88% of the glaucoma patients, but only 47% of controls.

Glaucoma patients received stable antiglaucoma therapy for 2 years, while H pylori-positive patients also received omeprazole, clarithromycin and amoxicillin to eradicate the infection, which was successful in 83% of treated patients.

Patients whose infection was successfully treated showed improvement in mean IOP and visual field parameters over the 2-year period; the other patients did not.

ARTIFICIAL VISION
Eight blind people see

Eight patients with an array of platinum electrodes implanted on the visual cortex areas on both sides of the brain have achieved visual acuity estimated at five times the level achieved 2 years ago with an earlier version of the same system. The new system provides a much wider field of vision, can detect and follow motion far better than the original system and can distinguish edges of objects free of background clutter.

Two patients have been able to drive a car, negotiating around objects in a private parking lot, and four patients have been able to see in color.

Patient ages ranged from 27 to 77 years; they had been blind from 2 to 57 years at the time of surgery. None was a candidate for retinal implants.

The system, developed by William H. Dobelle, M.D., uses a miniature television camera mounted on the lens of the patient's sunglasses to send images to a microcomputer worn on a belt. The microcomputer processes the data and sends signals to a stimulator and then to the electrodes via percutaneous cables. (For further information contact Louise Castagna at [631] 864-1600 Ext. 212.)

OPTIC DISC HEMORRHAGES
A new drug connection

Researchers in Sweden have found that patients with previously undetected glaucoma who use platelet aggregation inhibitors for diabetes or general vascular disease are significantly more likely to have optic disc hemorrhages than those patients using antihypertensive agents, cholesterol-lowering medication or anti-diabetic agents.

Researchers examined optic disc photographs of patients with previously undetected glaucoma between ages 57 and 79 and analyzed the association between hemorrhages and the four drug classes. Researchers believe the correlation could indicate a relationship between platelet aggregation inhibitors and vascular disease, that the drugs prolong resorption of optic disc hemorrhages, and/or that the drugs predispose patients to optic disc hemorrhages.

The study was reported in a recent issue of The Journal of Glaucoma.