Evidence is mounting that a poor diet plays an important role in the development of age-related macular degeneration (AMD), a leading cause of blindness in the United States.
A large collaboration of researchers from the European Union investigating the connection between genes and lifestyle on the development of AMD has found that people who adhered to a Mediterranean diet cut their risk of late-stage AMD by 41 percent. The new research is now online in Ophthalmology, the journal of the American Academy of Ophthalmology.
A Mediterranean diet emphasizes eating less meat and more fish, vegetables, fruits, legumes, unrefined grains, and olive oil. Previous research has linked it to a longer lifespan and a reduced incidence of heart disease and cognitive decline. But only a few studies have evaluated its impact on AMD.
But combining this earlier research on AMD with the latest data reveals diet has the potential to prevent a blinding disease.
For this latest study, researchers analyzed food-frequency questionnaires from nearly 5,000 people who participated in two previous investigations — the Rotterdam Study, which evaluated disease risk in people age 55 and older, and the Alienor Study, which investigated the link between eye diseases and nutritional factors in people aged 73 and older.
Patients in the Rotterdam study were examined and completed food questionnaires every five years over a 21-year period, while patients in the Alienor Study were seen every two years over a 4-year period. The researchers found that those who closely followed the diet were 41 percent less likely to develop AMD compared with those who did not follow the diet.
They also found that none of the individual components of a Mediterranean diet on their own — fish, fruit, vegetables, etc. — lowered the risk of AMD. Rather, it was the entire pattern of eating a nutrient-rich diet that significantly reduced the risk of late AMD.
Said Emily Chew, M.D., a clinical spokesperson for the American Academy of Ophthalmology, who serves on an advisory board to the research group conducting the study. “I believe this is a public health issue on the same scale as smoking. Chronic diseases such as AMD, dementia, obesity, and diabetes, all have roots in poor dietary habits. It’s time to take quitting a poor diet as seriously as quitting smoking.”
The Art of Embracing Change
As we enter 2019, artificial intelligence and robot use in medicine has made a giant step beyond the early adoption stage. The progenitor of surgical robots, the hulking Da Vinci system for minimally invasive surgery, is nearly two decades old.
Now, newer devices, like the Axsis, which has shrunk the size of its prototype robot down to the size of a soda can, manipulate tools as small as 1.8 mm in diameter. We also have robots that can be swallowed or inserted inside the eye and don’t forget the major leaps that have taken place in the development of an artificial eye.
It’s natural that us humans feel threatened. Everyone from factory workers to physicians are left wondering if they will become obsolete. The answer, depending on who you talk to, is good, bad, or neither. Artificial intelligence and bots will be the most disruptive technology to intersect with humans since cavemen used fire.
There’s much to celebrate here. Innovations in surgical robots will enhance procedures for doctors and surgeons alike. The expertise of the surgeon remains paramount, but robotics like motion scalers and minimally invasive access may lead to better outcomes. Another possibility is new procedures made possible by robotics.
Work is already progressing in the direction with intraoperative imaging and automated anterior segment surgery with a femtosecond laser-enabled keratoplasty.
And cataract surgery assisted by a femtosecond laser has improved the safety of procedures like dense nuclei, pseudoexfoliation, and patients with Fuchs dystrophy. It’s exciting to consider how these tools will evolve in the future.
Advancements in today’s camera viewing systems allow for surgery using 3-D high-resolution monitors. Integrating OCT imagery and ultrasound can even allow procedures on structures too tiny for a surgeon’s eye to resolve.
Making machine learning work for surgeons
Artificial intelligence has enabled robots to accomplish amazing feats at superhuman speeds. When it comes to eye surgery, however, you’ll need to train it. The EventuMachine is designed to mimic complex movement patterns.
Combining cameras and OCT simultaneously, a machine can calculate the precise direction and vacuum needed to pull an epiretinal membrane; or applying vacuum to the cortical lens material.
The nature of work is bound to change for everyone. But there will never be a substitute for a surgeon who can respond in real time to a crisis. And, as of yet, there’s no program for empathy. So, embrace the new technology where it can help you overcome human limitations, and you can take part in a new world of healing.
Scientists at the University of Birmingham are one step closer to a breakthrough treatment for age-related macular degeneration (AMD).
Affecting 200 million people worldwide, AMD is the leading cause of blindness in the developed world, with the condition.
The current treatment regimen involves an ophthalmologist injecting vision-saving medication into the eye. Now, thanks to the foundational work of biochemist Dr. Felicity de Cogan, from the University of Birmingham’s Institute of Microbiology and Infection, eye drops may soon be available as a new delivery system for AMD.
Dr. de Cogan said: “For several years, our team has focused on the challenge of delivering drugs to the back of the eye.
“From the outset, we realized that delivering drugs through eye drops would mean that patients can administer their treatment themselves, and this would be less costly, save time for patients and healthcare providers, and reduce the potential complications that can arise from injections.
Laboratory research, published in Investigative Ophthalmology & Visual, showed the eye drops perform similarly to the injected drug in rats.
The latest study, also published in IOVS, demonstrates that eye drops can deliver a therapeutically effective dose to the retina of the larger mammalian eye.
The eyedrops work through a cell-penetrating peptide that delivers the drug to the retina. Patents are held by Macregen Inc, so keep a lookout for a new range of therapies for AMD and other eye diseases.
Clinical trials may start as early as spring 2019.
We often think of robots in the rough and tumble world of manufacturing, where they effortlessly grab and weld pieces of steel together. But there’s a new army of robots on the march at the opposite end of the spectrum.
The first procedure with one of these mini machines was performed by Robert MacLaren, an ophthalmologist and professor at Oxford University. His patient, a 70-year-old priest had membrane in his retina that caused his vision to distort as “in a hall of mirrors.”
The priest’s vision was restored by a robot inserted through a tiny incision in the eye. Maclaren piloted the robot, R2D2, with a joystick and a camera feed. The Robotic Dissection Device lifted the wrinkled membrane no more than a hundredth of a millimeter thick to restore the patient’s vision back to normal.
Since then, R2D2 has assisted with at least five additional procedures. One is particularly notable because it would not have been possible through conventional surgery. A virus used in gene therapy was planted on the retina to counter retinal degeneration.
MacLaren explains, “My movements were improved and finessed by the robot. I could even let go and the robot would hold everything securely in place.”
The use of larger surgical robots like the Da Vinci system has already been used in millions of procedures, from cardiac valve repair and hernias to hysterectomies and prostate cases. The R2D2 operates at the other end of the scale on a lens, for example, that is less than 10 millimeters across. In fact, the cables that enable the bot to navigate are less than 10 microns thick.
The hallmark of these devices is that they extend the capabilities and reach of the surgeon. The market for medical robots is projected to be more than $17 billion by 2020. Even so, if you bump into a robot on rounds, keep in mind it’s not after your job, but it may not hurt to play nice, either.