EDITORIAL

Sumba –West Timor

In May 2007 Dr Workman was part of a team of surgeons, optometrists and nurses who traveled to Sumba in West Timor. Sumba is part of Indonesia and one of its most easterly points. It is a very poor area where the average income is $2 a day. There had never been an Australian team of eye surgeons there before. The visit had been widely advertised and when the team arrived there was an immediate crowd.

It was soon discovered that there would be no possibility of doing all the work that was needed. Not only was the volume too large, but the team simply didn’t have the equipment to deal with some things. Therefore, surgery was only offered to those with very poor vision (ie blind) who stood to benefit from the surgery that was available.

It is very different surgery from that which the surgeons were used to in Australia. They had to perform their own anaesthetics, and the range of lens implants was quite restricted. Nonetheless, the joy of seeing peoples’ reactions when the pad was taken off the next day is something that will remain with the team members for ever.

Over eighty operations were performed which is only a drop in the ocean compared to what is needed. We hope to go back next year.

Because this was the first trip, we were accompanied by a photographer. The link to her photos is below.

http://www.news.com.au/heraldsun/story/0,21985,20602897-5008200,00.html

Vitamin Supplements in Age Related Macular Degeneration

The retina is the "film in the camera" which allows light entering the eye to form an image, which can then be sent to the brain by the optic nerve. The macula is the central part of the retina - this is the part we use whenever we are looking directly at something. We use it for reading, driving, recognizing faces and even watching TV.

Age Related Macular Degeneration (ARMD) is a condition of older age where the macula degenerates. In the early stages there may be no effect on vision, but if it progresses to the end stage, vision can be catastrophically affected. It never leads to complete blindness, as the peripheral vision is unaffected - only the central vision deteriorates.

There are two types of ARMD - wet and dry. The wet type can come on suddenly and has a severe effect on vision in a short space of time. It is less common than the dry type. Laser treatment may be of use if caught early enough. The dry type progresses much more slowly, but is much more common. Until recently, there was no treatment for the dry type. However, a large research study from America has suggested that certain vitamin supplements may help to slow progression of the dry type of ARMD.

The Age Related Eye Disease Study (AREDS) looked at 3640 subjects over a period of seven years who were divided into four groups. The first group was given antioxidants (vitamin C, Vitamin E and betacarotene), the second group was given zinc (and copper, because zinc supplements can lead to a copper deficiency), the third group was given both antioxidants and zinc and the fourth group was given a placebo. There were no statistically significant adverse effects from the treatment in any of the groups.

The risk of progression to advanced ARMD was reduced by 20% in the antioxidants alone group, by 25% in the zinc alone group and by 28% in the antioxidants and zinc group. Interestingly, in patients who had moderate or advanced ARMD (in one eye), only the combination group showed any reduction in the risk of progression to advanced ARMD in the fellow eye (27%).

In smokers, there is an increased risk of developing lung cancer if betacarotene supplements are taken within 10 years (perhaps even 20 years) of giving up smoking. Therefore, smokers should not use this supplement. This needs to be considered in terms of the life expectancy of the patient. Ocuvite Preservision provides antioxidant supplements without betacarotene. Other sources may be available.

It should be noted that the doses of supplements studied are quite high. For instance, the dose of zinc in the study was 80 mg a day. An upper limit of supplementation of 40 mg a day has been recommended in the past, but this was due to the risk of copper deficiency. To reduce the risk of this, a copper supplement needs to be added. It should also be emphasized that the population requiring this supplementation is older and that no adverse effects were noted from the treatment over the seven year period.
The normal macula has yellow pigment to help protect it from blue light. Blue light is thought to be a risk factor for ARMD. The two pigments are called lutein and zeaxanthine. People with ARMD often have low levels of these pigments. It is not known whether this is "chicken or egg". They are obtained from leafy green vegetables. There is some suggestion that taking supplements of these may help to protect those people with very early ARMD from progressing. This is very early information and is not statistically proven, however, there are no known risks from using these supplements.

If you wish to read the research, the reference is Arch Ophthalmol. 2001;119(10):1417-1436