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Br J Ophthalmol. 2007 August; 91(8): 1098.
PMCID: PMC1954831

From the Library

“Two centuries earlier, a Persian scholar, Ibn Sina (980–1037), born near Bukhara, had laid the basis for a study of logic, science, philosophy, politics and medicine. He was critical of Aristotle's Logic, regarding it as too remote from everyday life and therefore inapplicable. His skills as a physician let his employees, the native rulers of Khurasan and Isfahan, to seek his advice on political matters. Here, like Machivelli after him, he gave advice that annoyed some of his patrons. This meant that he often had to leave the city of his employment in a hurry. In these periods he disappeared from public life, earning his living as a physician. His Kanun fi'l‐tibb (Medical Canon) was a summary of existing medical knowledge together with his own theories and cures developed through many hours of regular clinical practice. This became the major textbook in medicine throughout the medical schools of the Islamic world and sections of it are still used in contemporary Iran.” (Ali T. The Clash of Fundamentalisms. New York, Verso. 2002;53.)

Can we trust drug‐company‐sponsored trials. Researchers recently reviewed studies of statins and noted the results were 20 times more likely to favour the drug made by the company that sponsored the study. To say that this is grotesque is an understatement. With such distorted results one wonders if peer‐review journal should publish drug‐company‐sponsored trials. (medicine.plos‐journals.org)

Most mammals perceive the world as limited to yellows, blues and greys. This is of

course comparable to patients who have red‐green colour blindness. Scientists have recently introduced a single human gene into mice and have apparently induced a full colour spectrum in these mice. The insertion of the gene was into the mouse X chromosome. Despite the fact that mice are not used to perceiving the full spectrum of colour their brains apparently were able to rewire and handle the additional stimuli. (Sci Amer 2007;296:38)

Visual symptoms are common and often an early complaint in patients with Alzheimer's disease. Various investigators have suggested that the origin of these complaints may be due to changes within the visual association cortex and/or optic nerve. A study from Boston has recently documented that in early Alzheimer's disease a specific pattern of retinal nerve fibre loss occurs in association with narrowing of retinal veins and decreased retinal blood flow in these veins. The authors emphasise that at least part of the visual loss in Alzheimer's disease appears to be of retinal origin. (Invest Ophthalmol Vis Sci 2007;48:2285–89)

The potential therapies for statins continue to be expanded. Among the many positive effects of statins appears to be its ability to lower blood pressure. This response appears to be unrelated to age, serum cholesterol changes or the duration of the trial. Effects were greatest in patients with the highest baseline blood pressure. (Hypertension 2007;49:792–8)

The harmful effects of hormone replacement therapy are significant. A recent report suggests that hormone replacement therapy is associated with an increased risk of ovarian cancer in post‐menopausal women. Although the risk is small, the authors contended it was potentially important and would add one extra ovarian cancer for every 2500 women taking hormonal replacement therapy over a 5‐year period. (Lancet 2007 doi: 10.1016/SO140‐6736(07)60534‐2)

Many studies have documented that reducing sodium intake lowers one's blood pressure and in some cases prevents the onset of hypertension. Now, a study of patients who reduced dietary sodium intake has documented that by doing so these patients reduced their long‐term risk of adverse cardiovascular events. The authors conclude that at public health programs aimed at lowering dietary sodium intake in the general population could have a significant effect on preventing cardiovascular disease. (BMJ 2007;334:885–8)

Ophthalmologists are now aware of the intraoperative floppy iris syndrome being associated with systemic alpha‐blockers. When unrecognised this can cause an increased risk of cataract surgery complications. In a prospective multi‐center non‐randomised observational series surgeons documented that the intraoperative floppy iris syndrome occurred in 90% of eyes enrolled in the study. Nevertheless, experienced surgeons could anticipate the syndrome and employ compensatory surgical techniques resulting in low complication rates and excellent visual outcomes. (Ophthalmology 2007;114:957–64)

Dysmetropsia is a disorder of visual perception, in which there appears to be modification of the size of perceived objects. It is commonly associated with retinal pathology although it has also been reported in association with extra‐ cerebral visual pathways. Investigators from Korea have now described the syndrome of hemimacropsia in association with medial temporo‐occipital infarction. This is in contrast to patients who have been reported with hemimicropsia in whom the lesions are usually located in the lateral aspect of the temporo‐occipital lobe. (J Neurol Neurosurg Psychiatry 2007;78:547)

At the present time there is no proven therapy to prevent the development of advanced age related macular degeneration. The use of high dose antioxidant vitamin therapy has been recommended by some. The question of lifestyle risk factors in age related macular degeneration has been addressed by several studies. The Age Related Eye Disease Study has now reported on the association of dietary lipid intake and the risk of age related macular degeneration. In this study a higher intake of long chain polyunsaturated fatty acids and fish was associated with a decreased likelihood of having neovascular age related macular degeneration. (Arch Ophthalmol 2007;125:671–9)

Carpal tunnel syndrome is a common finding in many populations. Although it has been suggested in the past, it may be associated with systemic disease, investigators have recently studied 516 consecutive patients with carpal tunnel syndrome. They found only four patients in whom systemic disease was associated with the problem. Two patients were found to have diabetes mellitus and two were hypothyroid. (J Neurol Neurosurg Psychiatry 2006 doi:10.1136/jnnp.2006.102145)

“But Groopman reserved some of his most bitter criticism for his colleagues within academic medicine. They had fostered a belief that anyone can take care of patients. This arrogance has created a culture at academic centres where research is applauded and teaching is taken for granted, where writing scientific papers (for journals like the Lancet) take precedence over developing clinical skills.” (Horton R. What's Wrong with Doctors. NYRB 2007; LIV: 16‐20)


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