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    <recommendedItem id="20090101_19_3442"
                     title="AAO: Myopia May Minimize Diabetic Eye Damage (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAO/tb/16671?impressionId=1265781332000"
                     
      &lt;p&gt;SAN FRANCISCO  --  Nearsightedness may paradoxically reduce the chances of retinopathy for patients with diabetes, researchers affirmed.&lt;/p&gt;
&lt;p&gt;The more myopic the eye, the lower the risk of any severity of diabetic retinopathy (&lt;em&gt;P&lt;/em&gt;=0.041 to &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), Laurence S. Lim, MD, of the Singapore National Eye Centre, and colleagues reported here at the American Academy of Ophthalmology meeting.&lt;/p&gt;
&lt;p&gt;In their population-based study, myopia of -0.5 diopters or worse was associated with a significant 37% reduced risk of diabetic retinopathy overall and 53% lower risk of moderate retinopathy compared with farsightedness.&lt;/p&gt;
&lt;p&gt;These results for the first time confirm what most ophthalmologists have long suspected, Lim said. &quot;It&apos;s a very common clinical impression.&quot;&lt;/p&gt;
&lt;p&gt;Rather than a circumstantial link, his group speculated that the shape of the eye can be protective.&lt;/p&gt;
&lt;p&gt;As the eye gets longer, the retina gets stretched out and can atrophy. While this would cause vision problems under other circumstances, atrophy lowers the metabolic needs of the retina  --  a plus under diabetic conditions with reduced blood flow supplying oxygen to the retina.&lt;/p&gt;
&lt;p&gt;&quot;It matches the blood supply better,&quot; Lim said, noting that insufficiency can stimulate neovascularization.&lt;/p&gt;
&lt;p&gt;Other contributors may be the greater frequency of posterior vitreous detachment and vitreous syneresis in myopia, which &quot;removes the vitreous scaffold for neovascularization and also improves oxygen circulation in the vitreous cavity.&quot;&lt;/p&gt;
&lt;p&gt;The researchers analyzed findings from the Singapore Malay Eye study, which was a population based, cross-sectional study of adults ages 40 to 79.&lt;/p&gt;
&lt;p&gt;Among the 3,280 participants in the study, 20.6% had diabetes identified from physician diagnosis, self-reported use of antidiabetic medications, or a blood glucose level of at least 200 mg/d.&lt;/p&gt;
&lt;p&gt;As refractive error declined across the range from farsighted to normal to mild and then moderate nearsightedness, the risk of any diabetic retinopathy  --  determined from retinal photographs  --  dropped by 41% (&lt;em&gt;P&lt;/em&gt;=0.009 for trend) and that of moderate severity by 82% (&lt;em&gt;P&lt;/em&gt;=0.015).&lt;/p&gt;
&lt;p&gt;Vision-threatening retinopathy  --  defined as severe nonproliferative diabetic retinopathy, proliferative diabetic retinopathy, or clinically-significant macular edema  --  showed the same pattern, although the drop was not significant.&lt;/p&gt;
&lt;p&gt;Another first from the study was the correlation between retinopathy and the actual dimensions of the eye, rather than just vision categories.&lt;/p&gt;
&lt;p&gt;Every diopter decrease in spherical equivalent was linked to a 10% drop in overall diabetic retinopathy risk (&lt;em&gt;P&lt;/em&gt;=0.002), a 17% lower risk of moderate retinopathy (&lt;em&gt;P&lt;/em&gt;=0.001), and a 23% reduced risk of vision-threatening retinopathy (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Likewise, longer axial length was associated with up to a 23% reduced risk of diabetic retinopathy overall, with a 14% lower risk with every millimeter increase (&lt;em&gt;P&lt;/em&gt;=0.041).&lt;/p&gt;
&lt;p&gt;And the deeper the anterior chamber, the lower the risk, although the change was significant only for the more severe, moderate (&lt;em&gt;P&lt;/em&gt;=0.001 for trend), and vision-threatening (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for trend) forms of diabetic retinopathy.&lt;/p&gt;
&lt;p&gt;Each millimeter increase in depth was associated with a 68% lower risk of moderate retinopathy and an 86% lower risk of vision-threatening retinopathy (both &lt;em&gt;P&lt;/em&gt;=0.001).&lt;/p&gt;
&lt;p&gt;The results suggested that nearsighted patients with diabetes may need less frequent screening for retinopathy, Lim said.&lt;/p&gt;
&lt;p&gt;&quot;Ultimately we hope to come up with a risk score so the clinician can decide how closely to follow the patient,&quot; he said.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the National Research Council in Singapore.&lt;/p&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_4080"
                     title="Intravitreal Steroids Show Benefit in Diabetic Retinopathy (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Ophthalmology/GeneralOphthalmology/tb/17519?impressionId=1265781332000"
                     
      &lt;p&gt;Intravitreal triamcinolone acetonide reduced progression of diabetic retinopathy more than laser photocoagulation, analysis of data from a randomized trial found.&lt;/p&gt;
&lt;p&gt;The cumulative probability of progression from nonproliferative to proliferative diabetic retinopathy at two years was: &lt;ul&gt; &lt;li&gt;Photocoagulation, 31%&lt;/li&gt; &lt;li&gt;1 mg triamcinolone, 29%, &lt;em&gt;P&lt;/em&gt;=0.64 compared with the laser group&lt;/li&gt; &lt;li&gt;4 mg triamcinolone, 21%, &lt;em&gt;P&lt;/em&gt;=0.005 compared with the laser group&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Still, corticosteroids cannot be recommended at this time because of the exploratory nature of this analysis and the heightened risk of glaucoma and cataracts, Neil M. Bressler, MD, of Johns Hopkins, and colleagues wrote in the December &lt;em&gt;Archives of Ophthalmology. &lt;/em&gt;&lt;/p&gt;
&lt;p&gt;&lt;em&gt;&lt;/em&gt;Panretinal photocoagulation &quot;markedly reduces&quot; the rate of vision loss in diabetic patients with retinopathy when performed when the eye reaches the threshold for high risk (having three or four high-risk characteristics).&lt;/p&gt;
&lt;p&gt;However, the procedure can result in adverse outcomes, such as macular edema with visual loss, and close observation is needed for timely implementation. An alternative treatment therefore would be desirable, the investigators said.&lt;/p&gt;
&lt;p&gt;Numerous basic scientific findings support the hypothesis that treatment with an anti-inflammatory agent, such as a steroid, could reduce the risk of retinal neovascularization and progression to the high-risk threshold.&lt;/p&gt;
&lt;p&gt;For example, steroids exhibit antiangiogenic properties, and they can downregulate vascular endothelial growth factor.&lt;/p&gt;
&lt;p&gt;To test their hypothesis, Bressler and colleagues analyzed data from a randomized trial conducted by the Diabetic Retinopathy Clinical Research Network that included 840 eyes in 693 patients, divided almost evenly by gender.&lt;/p&gt;
&lt;p&gt;Participants&apos; mean age was 63 years. Some 95% had type 2 diabetes.&lt;/p&gt;
&lt;p&gt;Eyes were randomized to focal/grid photocoagulation or triamcinolone acetonide in a dose of 1 mg or 4 mg as often as every four months.&lt;/p&gt;
&lt;p&gt;The original study&apos;s primary finding was that photocoagulation was more effective at two years, and had fewer side effects than either 1 mg or 4 mg of triamcinolone in the treatment of diabetic macular edema.&lt;/p&gt;
&lt;p&gt;In the exploratory analysis, patients were considered to have had progression if they experienced vitreous hemorrhage, worsening of two or more levels on the diabetic retinopathy scale, or the decision was made to proceed with photocoagulation.&lt;/p&gt;
&lt;p&gt;The one-year cumulative progression was: &lt;ul&gt; &lt;li&gt;Photocoagulation, 21%, &lt;em&gt;P&lt;/em&gt;=0.71&lt;/li&gt; &lt;li&gt;1 mg triamcinolone, 19%, &lt;em&gt;P&lt;/em&gt;=0.03&lt;/li&gt; &lt;li&gt;4 mg triamcinolone, 14%, &lt;em&gt;P&lt;/em&gt;=0.08&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;And the three-year cumulative progression was: &lt;ul&gt; &lt;li&gt;Photocoagulation, 37%, &lt;em&gt;P&lt;/em&gt;=0.73&lt;/li&gt; &lt;li&gt;1 mg triamcinolone, 35%, &lt;em&gt;P&lt;/em&gt;=0.02&lt;/li&gt; &lt;li&gt;4 mg triamcinolone, 30%, &lt;em&gt;P&lt;/em&gt;=0.07&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The investigators noted that during the second year most eyes randomized to the steroid groups did not receive the drug as often as every four months, and fewer than half received the drugs at all during the third year because the study had been closed.&lt;/p&gt;
&lt;p&gt;&quot;Theoretically, it is possible the reduction in risk of retinopathy progression may have been even greater if intravitreal triamcinolone had been given more frequently,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;On the other hand, they suggested, the injections may have been discontinued because the retinopathy was less severe, edema had resolved, and the eyes were generally healthier.&lt;/p&gt;
&lt;p&gt;They pointed out that interpretation of the results must be tempered by recognition of the higher rates of cataract extraction at two and three years, respectively, with steroid treatment: &lt;ul&gt; &lt;li&gt;Photocoagulation, 13% and 21%&lt;/li&gt; &lt;li&gt;1 mg triamcinolone, 23% and 35%&lt;/li&gt; &lt;li&gt;4 mg triamcinolone, 51% and 64%&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Strengths of the investigation include the prospective collection of data and randomization of treatment. Also, some patients had one eye randomized to laser treatment and the other to steroids, which would control for systemic factors that could influence progression.&lt;/p&gt;
&lt;p&gt;But the investigators noted that the study also has weaknesses: It was not designed to investigate the progression of retinopathy, data for many patients were censored before completion of the study, and comparative progression of retinopathy was not a primary or secondary outcome of the original design.&lt;/p&gt;
&lt;p&gt;Therefore, despite the potential benefits of corticosteroid treatment, investigators concluded that it is not warranted at this time because of the risks, although further investigation of the pharmacotherapy does appear warranted.&lt;/p&gt;
&lt;p&gt;&quot;Any treatment to be used routinely to prevent [proliferative diabetic retinopathy] likely needs to be relatively safe because the condition already can be treated successfully and safely with [panretinal photocoagulation],&quot; they wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the National Eye Institute and the National Institute of Diabetes and Digestive and Kidney Diseases.&lt;/p&gt;&lt;p&gt;Bressler has received research grants from multiple pharmaceutical companies, including Allergan. Financial disclosures for all Diabetic Retinopathy Clinical Research Network investigators is available on the group&apos;s public Web site, at &lt;a href=&quot;http://public.drcr.net/FinDisclosures.aspx&quot; mce_href=&quot;http://public.drcr.net/FinDisclosures.aspx&quot; target=&quot;_blank&quot;&gt;http://public.drcr.net/FinDisclosures.aspx&lt;/a&gt;.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_2_726"
                     title="Fenofibrate May Protect Against Diabetic Retinopathy"
                     score="-0.005"
                     href="