AGE-RELATED MACULAR DEGENERATION

AGE-RELATED MACULAR DEGENERATION

From the FMS Global News Desk of Jeanne Hambleton  News in Health NIH                                  NIH Fact Sheets Home > Age-Related Macular Degeneration

YESTERDAY

Age-Related Macular Degeneration (AMD) was an untreatable disease that caused central vision loss. It was a major cause of blindness and the leading cause of new cases of blindness in people over age 65.

AMD made it difficult, if not impossible, to read, recognize faces, drive a car, or perform even simple tasks that require hand-eye coordination.

AMD severely restricted mobility, forcing many otherwise healthy seniors to prematurely lose their independence and ultimately to be cared for in costly assisted living facilities.

From a research perspective, AMD was a poorly understood disease and the quest for treatments seemed daunting.


TODAY

With Baby Boomers poised to reach retirement age, AMD is increasingly being viewed as an oncoming epidemic that could affect millions of Americans.

Thanks to considerable research investment by the National Institutes of Health (NIH), the underlying causes of AMD are becoming understood and several treatments have emerged.

In 1991 the Macular Photocoagulation Study,  a large scale clinical trial funded by the NIH, established the value of laser treatment for advanced AMD to stabilize the condition.

In 2000, the Food and Drug Administration (FDA) approved the use of a photosensitive agent called Visudyne as another laser-based treatment to prevent progression of advanced AMD.

NIH researchers conducted a large scale clinical study called the Age-Related Eye Disease Study and found that a daily regimen of antioxidant vitamins and minerals delayed the onset of advanced AMD by 25 percent. Advanced AMD is the most sight-threatening stage of the disease.

Based on published data, an estimated 8 million older-age Americans are at high risk to develop advanced AMD. Of these 8 million, 1.3 million would develop advanced AMD within 5 years. However, now with the AREDS treatment, 300,000 of these patients could avoid the severe vision loss associated with advanced AMD over a 5-year period.

Abnormal blood vessel growth, also known as angiogenesis, is a hallmark of advanced AMD. These faulty blood vessels leak serum and blood, damaging the macula and causing catastrophic central vision loss. NIH-sponsored laboratory research has established that a protein known as vascular endothelial growth factor (VEGF) spurs the development of abnormal blood vessels.

New treatments that block the action of VEGF have been developed and two of these drugs, Macugen and Lucentis, have been approved by the FDA for treatment of advanced AMD.

Avastin, a drug that is chemically very similar to Lucentis but much less expensive, is being used off-label for patients who cannot afford the higher priced Lucentis. Although Avastin is thought to be effective in treating AMD, there is no clinical trial data to support its use. To address this issue, the NEI launched the Comparison of Age-Related Macular Degeneration Treatments Trial to assess the safety and effectiveness of Avastin and Lucentis.

NIH researchers also discovered a second protein, pigment epithelial-derived factor (PEDF), which blocks VEGF to prevent blood vessel formation. Early stage clinical trials evaluating a gene therapy approach with PEDF have shown promise.

NIH-supported researchers recently identified subtle alterations in two genes, complement factor B and H, which account for 75 percent of the risk of developing AMD. These factors function as part of the immune system and normally respond to pathogens to fight infection. Alterations in these genes may result in an inappropriate response of the immune system, causing chronic inflammation within the macula and surrounding tissues. Chronic inflammation is thought to start a cascade of pathologic events that result in AMD.

A large genome-wide association study identified three additional genes associated with AMD. Two of these genes are involved in cholesterol transport, suggesting a new biologic pathway to the development of AMD.

Many Americans must live with vision loss from AMD. The NIH’s low vision research program supports the development of low-vision aids and rehabilitation strategies to help patients maintain independence and mobility. Additionally, the National Eye Health Education Program (NEHEP)  operates a low vision public education program to increase awareness of low vision and its impact on the quality of life.
TOMORROW

The NIH is poised to make major discoveries in the diagnosis and treatment of age-related macular degeneration.

The NIH has invested substantial resources to understand the biologic mechanisms that inhibit and promote angiogenesis, including the isolation and characterization of key molecules and receptors in the process, the development of treatments, and the pre-clinical and clinical efforts to translate these findings into effective therapies. This knowledge has resulted in a fundamentally new way of treating AMD and many other diseases where angiogenesis plays a role. Several next generation antiangiogenesis agents have been discovered and new and improved treatments will emerge.

The discovery of genetic risk factors in AMD provides an opportunity to predict those who may develop the disease many years before the onset of vision loss.

These gene discoveries will also allow researchers to understand the fundamental nature of AMD. Knowledge of the underlying role of the immune system and cholesterol transport in the disease presents the possibility of developing treatments that preempt AMD long before it has a chance to damage vision.

NIH researchers are conducting the Age-Related Eye Disease Study 2 (AREDS 2), a large-scale clinical trial evaluating supplementation of two antioxidant carotenoids, lutein and zeaxanthin, and two long chain polyunsaturated fatty acids, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), to prevent the onset of advanced AMD. Previous NIH studies have found high concentrations of lutein, zeaxanthin and DHA in the macula. Moreover, several studies have found an inverse relationship between dietary intake of these compounds and AMD. AREDS2 is also evaluating these antioxidants in combination with the original AREDS antioxidant and mineral formulation. It is hoped that AREDS 2 results will offer a more effective treatment regimen to prevent the severe vision loss associated with advanced AMD.

A highly novel drug and drug delivery method to prevent progression of AMD is being evaluated in clinical trials supported by the NIH. The treatment involves the use of cells that have been genetically engineered to produce ciliary neurotrophic factor (CNTF), a naturally occurring protein that has shown promise in animal models with retinal degenerative diseases. The cells are encapsulated in an implantable device that allows CNTF to diffuse into the retina. The drug delivery technology, known as Encapsulated Cell Technology, offers long-term administration of CNTF. Sustained drug delivery is essential in treating chronic eye diseases like AMD.

NIH researchers have developed a high resolution imaging technology called optical coherence tomography (OCT) that allows clinicians to see fine cellular and tissue detail. This technology will be helpful in evaluating the response to treatments in clinical trials and more accurately diagnose AMD in its earliest stages.

The NIH-sponsored National Eye Health Education Program (NEHEP) plans to create a new program to inform the public about the importance of early detection and timely treatment of age-related eye diseases, including AMD.

For Additional Information contact: The National Eye Institute Communications Office at 301-496-5248 or 2020@nei.nih.gov. 

WHAT ARE THE ADVANTAGES OF BEING MARRIED TO A PHYSICIAN?

University of Michigan Medical School study shows strategies for success amid career demands

From the FMS Global News Desk of Jeanne Hambleton Released: 13-Aug-2014 7:00 AM EDT
Source Newsroom:
University of Michigan Health System  Citations Academic Medicine

 

Newswise — ANN ARBOR, Mich. – Physicians tend to marry later and their marriages last longer even as they face the challenges, like others with demanding professions, of giving time and attention to their partners and families.

The University of Michigan Medical School interviewed 25 physicians and spouses to learn how “medical marriages” succeed and the resulting report is rich with data and anecdotes about live-in in-laws, role definition, financial security and the advantage of avoiding the emergency room because Mom or Dad knows how to stitch a bad cut.

Published by the Association of American Medical Colleges, the U-M report revealed the following strategies for success when one or both spouses are physicians:

We rely on mutual support.
• We recognize the important roles of each family member.
• We have shared values.
• We acknowledge the benefit of being a physician to our relationships.

The report was co-authored by Monica Lypson, M.D., whose partner is a physician, Rachel L. Perlman, M.D., who shares her life with another faculty member, and Paula Ross, Ph.D., a project manager and sociologist in the Office of Medical Student Education at the U-M Medical School.

“Physicians and their spouses experience challenges to their relationships, some of which are shared with the general population and others of which are unique to the field of medicine,” says Lypson, a professor of internal medicine and learning health sciences and assistant dean for graduate medical education at the U-M Medical School. “Trainees and junior faculty members remain curious about how they will balance their careers alongside marriage and family obligations.”

Navigating a work-life balance is an important topic to integrate into formal courses in medical education, authors say. The research data could also be useful when counseling physicians who struggle to achieve fulfillment both at home and at work.

“Being in a medical marriage is an experience I share with many others in academic medicine, which helped me realize the importance of this study in helping not only my colleagues and trainees, but also myself,” says Perlman, chief of nephrology at Ann Arbor Veterans Affairs Medical Center and assistant professor of internal medicine at the University of Michigan Health System.

In interviews, participants appreciated having role definition – knowing what they needed to do around the house and knowing what duties their partner would perform.

Many of the physicians and partners interviewed relocated far from families for their medical careers. Physicians earnestly acknowledged that support from extended family and partners made a difference in their ability to do their jobs, according to authors.

“Noting the important role of support provides insight into the ways in which physician relationships manage to remain resilient amid ongoing career demands,” says Ross.

 

PARENTING BEYOND PINK AND BLUE

From the FMS Global News Desk of Jeanne Hambleton   Released: 14-Aug-2014
Source Newsroom: University of Kentucky

 

Newswise — LEXINGTON, Ky. — From the first day of their lives, most boys and girls are treated differently. Those differences begin with a pink versus blue nursery, clothes with laces rather than ribbons, sports equipment or dance lessons, and on and on right through to “manly” careers versus “feminine” jobs.

Across the country, devoted parents routinely treat boys and girls differently because their parents, sundry child rearing experts and psychiatrists, and ultimately all of society has taught us to believe that boys and girls are fundamentally and radically different.

But what if we are all wrong? What if treating boys like boys and girls like girls is not a good approach to bringing out the best in every child?

In “Parenting Beyond Pink and Blue: How to Raise Your Kids Free of Gender Stereotypes” author Christia Spears Brown bridges what she knows as a developmental psychologist with what she faces as the mother of two very different kids, who both happen to be girls, in a culture obsessed with fitting everyone into his or her prescribed color box.

“When we put together all of the research on gender differences, the complete picture is less dramatic than a Mars-Venus mindset suggests,” said Brown, associate professor of developmental psychology and Gender and Women’s Studies at the University of Kentucky College of Arts and Sciences.

“Seeing gender differences in adult men and women doesn’t tell us anything about the ways we are innately different or about children,” she said. Citing copious studies, she focuses on the often-striking similarities between boys and girls, from infancy through adolescence. Rather than advocate extreme gender-blind parenting, Brown offers concrete, realistic, encouraging advice to help parents recognize how they habitually use gender to explain their children’s behavior, stop relying on stereotypes, and truly embrace, validate and cultivate their children’s unique strengths.

“Basically, ‘Parenting Beyond Pink and Blue’ aims for a little less focus on gender and a little more focus on individual children. With this approach, children can be more secure, happier, more well-rounded, and better able to reach their full potential,” said Brown. “And it can be a lot more fun for parents.”

See you tomorrow Jeanne

“You are  only given one little spark of madness. You must not lose it”  –  Robin Williams.   A sad loss – brilliant actor – he will be missed

 

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