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HANDBOOK OF

NUTRITION AND OPHTHALMOLOGY

By

RICHARD D. SEMBA, MD, MPH

The Wilmer Eye Institute, The Johns Hopkins University

and Hospital, Baltimore, Maryland

Even prior to the invention of the ophthalmoscope in 1851, nutritional deficiencies

such as xerophthalmia were known as important causes of vision loss. Many of the toxic

effects of nutritional deficiencies on the eye had been described in case reports and series

by the early part of the 20th century. However, it has only been more recently, beginning

in the 1970s, that the interrelationships between nutrition and chronic ocular diseases,

e.g., cataract, age-related macular degenerations (AMD) have been examined in large

population-based studies (e.g., the Beaver Dam Eye Study, the Blue Mountains Eye

Study) and randomized controlled clinical trials (e.g., the Age-Related Eye Disease

Study [AREDS]). This has, in part, been made possible by the development of standardized

protocols to assess these conditions by grading of fundus and lens photographs, as

well as the development of more robust nutritional epidemiologic instruments to describe

the intake of dietary nutrients and supplements.

These studies have provided new insights regarding nutritional exposures and the

prevalence of chronic eye diseases (e.g., associations of dietary saturated fats and leafy

green vegetables with AMD, the associations of dietary intake vitamin E, riboflavin and

folate with nuclear sclerotic cataract). Findings of associations between specific nutrients,

especially deficiencies and ocular disease are also important in understanding the

possible pathogeneses of these chronic ocular conditions.

Application of findings from these studies through dietary supplementation may have

an impact on the incidence and progression of AMD and cataract although clinical trials

data are necessary before any recommendation in favor of supplement use is made.

Confirmation of nutritional epidemiological findings from observational studies by randomized

controlled clinical trials is critical because of the potential problem of uncontrolled

confounding. That is, the failure to measure and control for other exposures (e.g.,

healthy lifestyles, physical activity) that may explain, in part, the earlier finding in cohort

studies of reduced risk of cardiovascular disease in association with hormone replacement

therapy (HRT) and the contrary finding in the large randomized controlled clinical

trial, the Women’s Health Initiative, showing an increased risk of acute myocardial

infarction from such treatment. Confounding by indication, that is, taking a supplement

or drug for a specific condition where an effect is ascribed to the treatment although it may

be due to the underlying disease for which the treatment is given may also be another

problem limiting the interpretation of data from observational studies. For example, zinc

supplements were found to be associated with higher risk of incident late AMD in some

epidemiological studies. However, the REDS showed that when an anti-oxidant multivitamin

supplement was given there was a statistically significant 28% reduction in the

risk of progression to end stage AMD compared to those taking placebo.

The application of findings from studies on nutrition and chronic eye disease e.g.,

AMD and cataract have great importance as the population ages and the burden of such

conditions increase. At present, the strongest associations found in epidemiological studies

of chronic eye diseases have been with non-modifiable factors (e.g., age, genetic

factors, race with AMD). Only a few modifiable risk factors have been found (e.g.,

smoking with AMD). Finding specific associations of dietary factors with AMD, cataract

and other chronic eye diseases are important because diet is modifiable and such modifications

may have the potential of reducing the burden associated with these diseases.

With this in mind, the new book by Semba will be important to dieticians, ophthalmologists,

optometrists, and the lay public interested in role of nutrition in eye disease. It

examines the historical and recent evidence concerning the role of dietary changes in

preventing both acute and chronic eye disease.

Dr. Semba’s text covers the broad field of nutrition and ophthalmology. The content

of the 12 chapters covers specific disease entities e.g., AMD and age-related cataract,

diabetic retinopathy, and inborn errors of metabolism) and specific nutrients (e.g., vitamins

C, E, A, and B-complex, zinc, fatty acids) and their relation to ocular disease. It is

a unique text, in that all chapters were written by one author and cover a large area of

material ranging from an historical overview, epidemiology, pathology and treatment of

the condition. There are three identified themes within the text, the first emphasizing the

efficacy of long-term “healthy” diet, the second the importance of historical perspective

of diet and eye disease, and the third the importance of two putative pathogenetic mechanisms,

oxidative stress and inflammation. The text provides important and new authoritative

information on the relation of nutrition to ocular disorders which will reward the

reader with a wealth of insightful information.

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نام کتاب درخواستی خود از انتشارات معتبر دنیا را به ایمیل زیر بفرستید.

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قیمت هر کتاب فقط 800 تومان

خرید و دانلود محصول

1394/08/23

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پزشکی , تغذیه , چشم , بیماری چشم , NUTRITION , OPHTHALMOLOGY , humana , RICHARD D. SEMBA , MD

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انتشارات : humana | تعداد صفحات : 506 | زبان : انگلیسی |

لینک محصول

http://kavoshgar.zepo.ir/post/20193

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