BLOG: The good, the bad and the ugly in optometry news
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Optometry in the 21st century has moved strongly toward evidence-based medicine, with the American Optometric Association even publishing a 14-step process to assist in the development of an evidence-based practice.
However, for those of us in the trenches, we also rely on new information, which is often available at a fast-and-furious pace.
I like to get information about new studies and therapeutic options as they become available. I depend on several news feeds, including Healio, that are sent to my email for quick updates on new research, industry news and opinion.
News on the use of common drugs has come to my attention this summer and merits discussion. I’ll put it in three categories: the good, the bad and the ugly.
First, the good news
On July 9, Healio reported that melatonin — an inexpensive, over-the-counter supplement — is associated with lower risk for the development and progression of age-related macular degeneration. This news is from a large retrospective study and was reported in JAMA Ophthalmology.
After 40 years as co-director of the low vision service at Wills Eye Hospital, I can tell you that this is not only good news but great news. I have worked with many patients who have this life-changing condition, as well as their family members, who are distraught over the risk that they, too, may develop this vision problem with age. Although more research is needed, if I had macular drusen or a family history of AMD, I would be taking this supplement.
In other good news, a new study has confirmed and strengthened the work of the National Eye Institute in the AREDS and AREDS2 studies. Published in the July issue of Ophthalmology, a small retrospective study of AREDS and AREDS2 data found that the recommended supplements also decrease the progression of geographic atrophy. Steven Ferrucci, OD, FAAO, made some nice comments on this in a report featured in Healio.
Now ... the bad news
As published in JAMA Ophthalmology this summer, a secondary analysis of the ASPREE clinical trial found that low-dose aspirin has no effect on the development or progression of AMD. Given the inflammatory root cause of this disease and the powerful anti-inflammatory nature of aspirin, this is a bit of a surprise and a disappointment.
However, given the good news on melatonin, we still may have a simple low-cost alternative to intravitreal injections.
And, finally, the ugly news
In the July 3 issue of JAMA Ophthalmology, a retrospective study by a group of neuro-ophthalmologists found that patients using semaglutide to manage diabetes have a 8.9% incidence of developing nonarteritic anterior ischemic optic neuropathy (NAION). Conversely, the non-semaglutide cohort had only a 1.8% incidence.
In the group of patients who were not diabetic and using this medicine for weight loss, the incidence was 6.7% vs. 0.8% in the control group. This is shocking news, given the number of people who are using this medication for weight loss, some even getting it from offshore suppliers without medical evaluation.
We see these patients every day. As primary care providers, we counsel patients on the risks for long-term eye problems and vision loss associated with obesity. We provide annual eye examinations for all of our diabetic patients. Given the sudden onset and devastating vision loss from NAION, we must now add this information to the risk-benefit ratio of using semaglutide.
Patients with a “disc at risk” or crowed nerve with a small cup-to-disc ratio should be counseled about being particularly high-risk. We may also want to mention this new information to the primary care community, as they may not be following ophthalmic literature. This is especially critical for patients with one eye and those who have lost vision in one eye from NAION.
Keeping up with the literature and applying new information to the daily practice of optometry is an important part of our profession. Fortunately, resources are now available to make this possible. Take advantage of this by adding an optometry news feed to your daily routine.
References:
- Evidence-based optometry practice. https://www.aoa.org/practice/clinical-guidelines/evidence-based-optometry-process?sso=y.
- Hathaway JT, et al. JAMA Ophthalmol. 2024;doi:10.1001/jamaophthalmol.2024.2296.
- Jeong H, et al. JAMA Ophthalmol. 2024;doi:10.1001/jamaophthalmol.2024.1822.
- Keenan TDL, et al. Ophthalmology. 2024;doi:10.1016/j.ophtha.2024.07.014.
- Robman LD, et al. JAMA Ophthalmol. 2024;doi:10.1001/jamaophthalmol.2024.1584.
- Raizada K, Margolin, E, eds. Non-Arteritic Anterior Ischemic Optic Neuropathy. StatPearls Publishing; 2022.
For more information:
Scott A. Edmonds, OD, FAAO, specializes in vision-based neurorehabilitation at Edmonds Eye Associates in Philadelphia. He can be reached at scott@edmondsgroup.com.
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