Highlights from the AAO-PAAO Joint Meeting 2009 Scientific Program for October 25th
October 27, 2009
I am not attending this meeting this year; however, this is information gathered from press releases from the meeting.
Patients with A Variant of Alzheimer’s Disease May Present with Vision Problems
Research presented at the annual meeting showed that for a minority of patients, Alzheimer’s disease shows up first as problems with vision rather than memory or other cognitive functions. Neuro-ophthalmologists Pierre-Francois Kaeser, MD, and Francois-Xavier Borruat, MD examined and followed 10 patients with unexplained vision loss who were ultimately diagnosed with the visual variant of Alzheimer’s disease (VVAD). Their study describes clinical clues that may improve ophthalmologists’ ability to detect VVAD and refer patients for further tests. When patients receive neurological assessment, treatment and family counseling early in the disease, outcomes may be better.
VVAD patients differ from typical Alzheimer’s patients in a number of ways. In this study the median patient age was 65, and only 3 of 10 of the participants reported memory loss. In comprehensive neuro-ophthalmic exams, all but one had difficulty with reading, 8 of 10 with writing, and 6 of 10 with basic calculations. The visual field was altered in 8 of 10 patients. Importantly, 8 of 10 patients had difficulty recognizing and interpreting components of a complex image (simultagnosia) which is an early indicator of the brain damage that occurs in later-stage Alzheimer’s patients. MRI and PET scans revealed neurological changes consistent with VVAD in all study patients. Alzheimer’s memory and personality impairments eventually occur in most of these patients.
Ophthalmologists should be aware of this variant of Alzheimer’s disease in order to refer patients with unexplained visual problems like reading difficulties for neurological evaluations.
Read the release here.
Myopia May Impact the Development of Diabetic Retinopathy
Researchers at the Singapore National Eye Centre evaluated how refractive error relates to the presence and severity of diabetic retinopathy. Earlier, smaller studies had suggested a protective effect for myopia, but were inconclusive. This study is the first to include axial length in an analysis of the myopia-DR relationship.
Reduced risk of DR, especially severe DR, was found in patients whose myopia resulted from two anatomical characteristics: longer axial length and deeper anterior eye chamber. The findings held true for all degrees of refractive error in these patients. The 675 diabetics evaluated by Dr. Lim’s team were drawn from the Singapore Malay Eye Study, a population based study of adults aged 40 to 80.
Though these conditions can cause vision problems in other circumstances, they may lower DR risk by reducing retinal metabolic needs and/or improving oxygen circulation in the back of the eye.
Read the release here.
Survey of Glaucoma Clinic Patients Highlight Problems in Follow Up
In the first study of its kind in the US, researchers asked San Francisco General Hospital (SFGH) glaucoma clinic patients about their reasons for missing follow-up appointments with their ophthalmologists. The study also investigated whether barriers were linked to ethnicity. Bradford W. Lee, MD led the joint project by Stanford and University of California, San Francisco, Department of Ophthalmology.
The most vexing issues were long clinic wait times and appointment scheduling difficulties, according to the 152 SFGH clinic patients surveyed from August 2008 to January 2009. Seventy-five percent of patients cited long wait times as a significant barrier. And even though SFGH provides medical interpreting services, 37 percent of Latino-ethnicity and 32 percent of Asian-ethnicity patients cited language and interpreter issues as significant barriers.
These issues suggest for researchers that new strategies to streamline appointment procedures for non-English speaking patients, and resolving wait time and interpreter issues should be top priorities for SFGH and similar glaucoma clinics.
Read the release here.
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