近視的糖尿病患者可能更不容易患糖尿病性視網(wǎng)膜病變

1、Diabetics who are nearsighted may be less susceptible to diabetic retinopathy26. 十月 2009 02:51 近視的糖尿病患者可能更不容易患糖尿病性視網(wǎng)膜病變Two studies are of particular note in today's Scientific Program of the 2009 Joint Meeting of the American Academy of Ophthalmology (AAO) and the Pan-American Association of Oph

2、thalmology (PAAO): a report by Swiss neuro-ophthalmic researchers about vision exam clues that should make ophthalmologists suspect an atypical variant of Alzheimer's disease; and new evidence from a Singapore National Eye Center study that diabetics who are nearsighted may be less susceptible t

3、o diabetic retinopathy. 2009年10月26日 02：51 在美國眼科學會（AAO）和泛美眼科協(xié)會（PAAO）2009聯(lián)合會議于今天（10月26日）公布的科研成果中，有兩項研究值得特別注意：一項由瑞士神經(jīng)眼科學研究者從事的研究表明對于視力檢查的異常結(jié)果，眼科醫(yī)師應(yīng)該懷疑是否是阿爾茨海默病的非典型病變；另一項由新加坡全國眼科中心從事的研究提供了新的證據(jù)，表明有近視的糖尿病患者可能更不容易發(fā)生糖尿病視網(wǎng)膜病變。The AAO-PAAO meeting is in session October 24 through 27 at the Moscone Center, San

4、 Francisco, CAJules Gonin Eye Hospital, Switzerland, examined and followed 10 patients with unexplained vision loss who were ultimately diagnosed with the visual variant of Alzheimer's disease (VVAD). Their study describes clinical clues that may improve ophthalmologists' ability to detect V

5、VAD and refer patients for further tests. When patients receive neurological assessment, treatment and family counseling early in the disease, outcomes may be better for all concerned. 某些時候當一個病人告訴他的眼科醫(yī)生說他“看不見”時，他真正要表達的意思是“我可以看見，但不能閱讀或書寫?！痹诎柎暮Ｄ』颊咧校恍〔糠秩税l(fā)病首先表現(xiàn)為視力問題而不是記憶力或其他思維問題。但（僅根據(jù)視力問題做出阿爾茨海默病的）診斷

6、是很困難的，因為對這些病人來說，標準的眼科檢查往往無法（對疾?。┒ㄐ?。瑞士Jules Gonin眼科醫(yī)院的神經(jīng)眼科醫(yī)生Pierre-Francois Kaeser和Francois-Xavier Borruat對十個有不明原因失明的病人進行了檢查和隨訪，最后這些病人均被診斷為阿爾茨海默病眼部病變（VVAD）。他們的研究提供了一些臨床線索以幫助提高眼科醫(yī)生發(fā)現(xiàn)VVAD的能力并進而推薦病人去做進一步的檢查。如果病人能在疾病早期進行神經(jīng)系統(tǒng)檢查，接受治療及家庭咨詢，對所有相關(guān)人員來說，都會有一個更好的結(jié)果。VVAD patients differ from typical Alzheimer'

7、;s patients in a number of ways. At the time they report visual problems, many are younger than those for whom memory loss is the tell-tale sign. In Dr. Kaeser's study the median patient age was 65, and only 3 of 10 reported memory loss. In comprehensive neuro-ophthalmic exams, even though most

8、patients' visual acuity was adequate, all but one had difficulty with reading, 8 of 10 with writing, and 6 of 10 with basic calculations. The visual field was altered in 8 of 10 patients. All had trouble identifying colored numbers despite being able to name colors correctly, and, importantly, 8

9、 of 10 patients had difficulty recognizing and interpreting components of a complex image (simultagnosia). This is an early indicator of the brain damage that prevents later-stage Alzheimer's patients from recognizing people they know and navigating familiar surroundings. MRI and PET scans revea

10、led neurological changes consistent with VVAD in all study patients. Though VVAD patients' first symptoms are visual, Alzheimer's memory and personality impairments eventually occur in most. VVAD病人與典型的阿爾茨海默病病人相比，在許多方面都存在差異。與先發(fā)癥狀為記憶喪失的阿爾茨海默病人相比，許多以視力問題發(fā)病的病人更年輕。在Kaeser博士的研究中，病人平均年齡65歲，10個病人中只有

11、3個報告有記憶喪失。在全面的神經(jīng)眼科檢查中，盡管大多數(shù)病人都有足夠的視敏度，但除一人外，所有人都有閱讀困難，10個人中8個有書寫困難，6個在基礎(chǔ)計算方面有困難。10個人中8個有視野改變。所有病人雖然可以正確地說出顏色的名字，但在認出彩色數(shù)字方面有困難。重要的是，10個人中有8個在認出復(fù)雜畫面并解釋畫面構(gòu)成方面有障礙（稱之為綜合失認）。晚期阿爾茨海默病人由于有腦部損害而無法認出他們以前認識的人，也無法對他們熟悉的環(huán)境進行定位。而綜合失認正是腦部損害發(fā)生的早期信號。MRI和PET掃描在所有病人身上均發(fā)現(xiàn)了符合VVAD的神經(jīng)學改變。盡管VVAD病人的首發(fā)癥狀為視力問題，但最終大多數(shù)阿爾茨海默病人都會

12、出現(xiàn)記憶力與人格損害。"Ophthalmologists should be aware of the possibility of VVAD in patients with unexplained vision problems, particularly difficulty with reading," said Dr. Kaeser. "Suspect VVAD when a patient tests well for visual acuity, but has vision complaints that are unusual or severe

13、 for late middle age. Refer him for neurological evaluation." “眼科醫(yī)生應(yīng)當了解有不明原因視力問題尤其是有閱讀障礙的病人有患有VVAD的可能?！?Kaeser博士說，“當中老年病人視敏度檢查正常但仍主訴有與年齡不相符的罕見或嚴重癥狀時，應(yīng)當懷疑有VVAD的可能，并建議病人做神經(jīng)學檢查?！盌oes Nearsightedness Reduce the Risk of Diabetic Retinopathy? 近視會降低發(fā)生糖尿病性視網(wǎng)膜病變的風險嗎？To learn more about factors that may

14、reduce diabetic retinopathy (DR) risk, Laurence Shen Lim, MRCS, and colleagues at the Singapore National Eye Centre, studied how refractive error (vision worse than 20/20, without glasses) relates to the presence and severity of DR. Earlier, smaller studies had suggested a protective effect for near

15、sightedness (myopia), but were inconclusive. Dr. Lim's study is the first to include axial length (AL, measured from the front to back of the eye) in an analysis of the myopia-DR relationship. About 10 percent of people with diabetes develop DR, which damages the eye's retina, the specialize

16、d tissue where images are focused for relay to the brain's visual cortex. DR is a major cause of vision loss worldwide. 為了更多地了解有可能降低糖尿病性視網(wǎng)膜病變（DR）風險的因素，皇家外科學院成員（MRCS）Laurence Shen Lim與新加坡全國眼科中心的同事研究了屈光不正（裸眼情況下視力低于20/20）與DR的發(fā)生及嚴重程度之間的關(guān)系。先前已有小樣本研究提示近視對DR的發(fā)生具有保護作用，但該研究的結(jié)論缺乏說服性。Lim博士首次將眼軸長度（AL，眼球前方到后

17、方的距離）納入研究，分析近視與DR之間的關(guān)聯(lián)。約10%的糖尿病病人會發(fā)生DR。DR會損傷視網(wǎng)膜，而視網(wǎng)膜正是傳輸?shù)酱竽X視覺中樞的圖像形成的特殊組織。在世界范圍內(nèi)，DR是視力喪失的主要原因。Reduced risk of DR, especially severe DR, was found in patients whose myopia resulted from two anatomical characteristics: longer axial length and deeper anterior eye chamber (anterior chamber depth, ACD).

18、The findings held true for all degrees of refractive error in these patients. The 675 diabetics evaluated by Dr. Lim's team were drawn from the Singapore Malay Eye Study, a population based study of adults aged 40 to 80. 一些病人被發(fā)現(xiàn)患DR尤其嚴重DR的風險降低，而這些病人近視的原因是兩個解剖方面的特征：較長的眼軸長度和較深的前眼房（前房深度，ACD）。研究發(fā)現(xiàn)這些病人都有不同程度的屈光不正。Lim博士的研究團隊所評估的675名糖尿病病人來自于新加坡馬來人眼科研究，后者是一項針對40到80歲之間的成年人的人群研究。"This DR-protective effect may