The New York Times, by Nicholas Bakalar — Reading in poor light, sitting too close to the TV, wearing the wrong prescription glasses and crossing your eyes — things your mother warned you would ruin your vision — are actually generally harmless. But a truly dangerous false belief is that there is nothing you can do to prevent the loss of vision.
According to Dr. Paul R. Lichter, a professor of ophthalmology and director of the Kellogg Eye Center at the University of Michigan in Ann Arbor, seeing an ophthalmologist regularly is essential, and not just to get a new pair of glasses. “In the way of preserving your sight,” he said, “it’s making sure you don’t have any hidden eye diseases.”
Dr. Lichter recommends an ophthalmologist’s examination before a child enters school, and if everything looks good at that point, then an exam every five years is enough. But it should be a thorough exam in which the doctor dilates the pupils and examines the optic nerve.
Although there are many eye diseases, there are three that together affect more than 10 percent of the United States population: an estimated 2.2 million people have glaucoma, more than 26 million have cataracts or related lens problems, and 2 million have macular degeneration.
Glaucoma is a group of diseases that cause damage to the optic nerve. The most common is primary open-angle glaucoma, in which the eye’s drainage canals are partly clogged. Most people have no symptoms, and the disease causes a gradual loss of vision. But if it is caught early enough, it can be treated successfully with medication or surgery.
A test for pressure inside the eye, or intraocular pressure, is one way to screen for the disease, but people with normal pressure can still have glaucoma. An examination of the optic nerve is the only sure way to tell.
Narrow-angle glaucoma, sometimes called angle-closure glaucoma, is much less common. This happens when the drainage canals become completely blocked, and symptoms can be vivid — blurred vision, headaches, eye pain and nausea. The usual treatment is surgery.
By the time people reach their 40s they begin to develop presbyopia, a natural part of aging in which the lens of the eye stiffens so that it cannot change shape enough to give the proper focus; the usual remedy is to buy reading glasses.
Sometimes, people run to the eye doctor when this problem crops up, and that can be a good thing, because by this age eye diseases become more common, and, Dr. Lichter said, exams every three years should be routine.
Age-related cataracts can start as early as the 40s, but it is most often after age 60 that such clouding of the lens begins to affect vision. The treatment is to remove the clouded lens and replace it with a permanent plastic lens. At one time, cataracts were removed only when they became intolerable, but with the development of effective permanent artificial lenses, Dr. Lichter said, people with otherwise healthy eyes should have cataracts removed as soon as they become bothersome.
After age 50, an exam every two years is recommended to search for, among other things, signs of age-related macular degeneration, a leading cause of blindness in older people. This disease is caused by hardening of arteries in the macula, the light-sensitive tissue in the center of the retina. It causes no pain, but as the cells in the macula die, vision in the central part of the eye can deteriorate quickly, but usually it happens so slowly that people notice little change.
While medications and laser surgery are effective for the wet form of the disease, in which delicate new vessels grow and then easily break and bleed, the more common dry form is very difficult to treat. Still, Dr. Lichter said, “It’s important for patients to know if they have the signs of the disease, even in its more common dry form, so that they can be advised about signs to look for that might warrant treatment. Considerable research into macular degeneration holds promise for future success in treating the disease.”
As for maintaining healthy eyes, diet and exercise are important, said Dr. James C. Tsai, chairman of the department of ophthalmology at Yale. Carrots, yes, really are effective — they have high levels of beta carotene, which can be converted into vitamin A, needed for good night vision.
Vitamins C and E and omega-3 fatty acids may reduce the risk of cataracts and prevent worsening of macular degeneration, and aerobic exercise can lower pressure in the eye. Smoking and excessive sun exposure increase the risk both for cataracts and macular degeneration. As for good diet, Dr. Tsai said, “It’s what your mother told you: fruits and vegetables.”
For routine preventive measures, Dr. Lichter suggests sunglasses and hats for protection against ultraviolet rays and safety goggles for yardwork and other activities that might endanger the eyes with flying objects. As for over-the-counter eyedrops for people who have no eye-related medical condition, he said: “They are typically a waste of money. Most people buying these things don’t get anything from them.”
Shocking Tofu News
While usually considered a healthy choice, new research shows excess tofu consumption may increase the risk of memory loss in the elderly. A new study out of Loughborough and Oxford universities of more than 700 Indonesian people ages 52 to 98 shows that those who ate tofu at least once a day, particularly those in their 60s, had an increased risk of dementia or memory loss.
FORBES.COM, by Allison Van Dusen — Maintaining mental acuity is a major concern for aging Americans–they want to make the most of their golden years rather than have to struggle through them. In fact, adults are more than twice as likely to fear losing their mental capacity as their physical capacity, according to a 2006 poll by Research!America, a nonprofit public education and advocacy alliance.
While many know the basics when it comes to keeping their minds sharp (stick with those crosswords), a crop of new research is showing that lifestyle choices may play an even bigger role than people realize, particularly in terms of memory. Factors–some positive, some negative–range from diet to unlikely medications and hormonal changes.
“Most people feel that they are victims when it comes to Alzheimer’s and memory loss,” says Dr. Vincent Fortanasce, author of the new book The Anti-Alzheimer’s Prescription.
But Fortanasce points out that there’s a difference between mental agility, which is our ability to multi-task and do things quickly, and mental capacity, which is our ability to reason and use our experience. When we age, just as we naturally lose physical agility, we lose mental agility. But you can do something about, even increase, your mental capacity as you grow older, Fortanasce says.
Fortanasce’s four-step method for staving off Alzheimer’s includes dietary advice that stresses the importance of balance in the foods you consume (one-third carbohydrates, one-third protein, one-third fat) as well as the order in which you eat them. By regularly gorging on the white bread that’s complimentary at restaurants, you’re spiking your insulin. You may also be causing the insulin-degrading enzyme that exists in the brain to work overtime removing insulin, rather than getting rid of beta-amyloid proteins, the toxic protein that produces Alzheimer’s disease. Carbohydrates are to the brain what cigarettes are to the lungs, Fortanasce says.
Research published in the latest issue of the journal Neurology also shows that eating fish may help prevent memory loss and stroke in healthy, older adults. The study looked at the brain scans of more than 2,300 people age 65 and older. It found that those who ate broiled or baked tuna and other fish high in omega-3 fatty acids (salmon, mackerel, anchovies) three or more times per week had a nearly 26% lower risk that the silent brain lesions would be linked to dementia and stroke.
There was no benefit for those who ate fried fish or skipped it altogether, says Dr. David Siscovick, study author and professor of medicine and epidemiology at the University of Washington.
The wrong dietary choices can have a significantly adverse impact. Consider a study out of Loughborough and Oxford Universities last month, funded by the Alzheimer’s Research Trust, concerning the high consumption of soy foods, such as tofu.
Of 700 elderly Indonesians, those who ate tofu at least once a day had an increased risk of dementia or memory loss, particularly if they were over age 65. Researchers believe the link might be due to soy products’ phytoestrogens, which may offer some neural benefits to the middle-aged and young but could harm those over 65.
The Estrogen Effect
The side effects of changes in estrogen in some midlife women may also explain their forgetfulness.
A new study out of the University of Illinois at Chicago shows for the first time that the more hot flashes a woman has, the worse her memory performance, or recollection of words, names, paragraphs and stories. By using monitors to record subjects’ hot flashes, researchers also found that women tend to underreport the number of hot flashes they experience by more than 40%. In other words, women may be frequently experiencing the menopausal symptom and its effects without realizing it.
“What comes from this is women can have the comfort of knowing this is really just a physiological event,” says Pauline Maki, University of Illinois at Chicago associate professor of psychiatry and psychology and the study’s lead author.
Medicine And The Mind
Another new study surprisingly shows that taking cholesterol-lowering statins may be good for the mind, possibly due to the drugs’ ability to lower high insulin levels in the brain that are associated with dementia. The research looked at Mexican Americans with metabolic conditions that put them at high risk for dementia, Alzheimer’s or cognitive impairment. Taking statins for five to seven years may cut a person’s risk of dementia by half, says Mary Haan, epidemiology professor at the University of Michigan School of Public Health and lead author of the study.
That’s not a good enough reason on its own to start taking statins yet, since the U.S. Food and Drug Administration hasn’t approved the medication for this particular use, and it’s not clear which statins might provide the most brain benefits. But the research shows how, often unknowingly, so many of our actions can impact our cognitive function and memory.
As Fortanasce says, “People have more control than they realize.”
More Memory News
If you want to stave off Alzheimer’s, consider cutting back on the carbs, says Dr. Vincent Fortanasce, author of The Anti-Alzheimer’s Prescription. Overdoing it on carbs causes your insulin to spike. In doing so you’re also causing the insulin-degrading enzyme that exists in the brain to work overtime removing insulin, rather than getting rid of beta-amyloid proteins, the toxic protein that produces Alzheimer’s disease.
© AP Photo/Mel Evans
New research out of the University of Michigan School of Public Health shows that people at high risk of dementia who took cholesterol-lowering statins were half as likely to develop dementia as those who did not take the prescription medications. One theory is that statins help lower the high insulin levels in the brain linked to Alzheimer’s.
People who ate tuna and other fish high in omega-3 fatty acids three times or more per week had a nearly 26% lower risk of having the silent brain lesions that can cause dementia and stroke, compared to those who avoided fish, according to research appearing in the August issue of Neurology.
Middle-aged adults who smoke appear to be at an increased risk of having poor memory, according to a study published in the Archives of Internal Medicine in June. As if there weren’t enough reasons to quit already, the research also shows that long-term ex-smokers were less likely to have cognitive deficits in memory and vocabulary.
Memory loss is a common symptom of an underactive thyroid, according to the May issue of the Mayo Clinic Health Letter. That’s because hormones from the thyroid help control a host of bodily functions, ranging from heart rate to mood and memory. Older people with this treatable condition may exhibit only one symptom, such as memory loss or decreasing mental function.
A study published in the journal Neurology in 2007 shows that those who most often experience negative emotions, such as depression and anxiety, were 40% more likely to develop mild cognitive impairment than those who were least prone. A transitional stage between normal aging and dementia, mild cognitive impairment is associated with mild memory or cognitive problems.
Chronic pain not only affects a person’s ability to work, sleep and function on a daily basis, it can also impair memory. A 2007 University of Alberta study of 24 patients who had pain lasting six months or longer shows that, when tested, two-thirds showed significant disruption of attention and memory.
New research out of the University of Illinois at Chicago is finally confirming a link between hot flashes and poor verbal memory among women in mid life. In fact, the more hot flashes a woman has, the worse her ability to remember names and stories. A surge in the stress hormone cortisol, which usually accompanies a hot flash, is believed to be the cause.
New research out of Sweden suggests for the first time that mid-life marital status is related to late-life cognitive function. A Finnish study of more than 1,400 people in mid life and then an average of 21 years later showed that those who were living with a life partner in mid life were significantly less likely to show cognitive impairment compared to all other categories–single, separated, divorced or widowed.
The New York Times, December 4, 2008, by Lisa LaMotta — St. Jude Medical is now mending bad hearts all over Europe with its snazzy new device that regulates cardiac activity.
The St. Paul, Minn.-based heart device company announced on Wednesday that it received approval in the European Union for its implantable cardiac defibrillation device, which monitors heart rhythms and corrects unusual beats with an electric pulse. The AnalyST implantable cardioverter defibrillator with ST Monitoring gives physicians a better view of what’s going on in a patient’s heart–it shows the heart’s activity over a long period of time, compared with the brief snapshot taken by an electrocardiogram.
“This device provides new and valuable information about my patients’ ST segments that is otherwise not available, and it helps me deliver better and more timely care for my patients with arrhythmias and coronary artery disease,” said Professor Christian Hamm, Ph.D., from the Kerckhoff Klinik, who implanted the first AnalyST ICD in Bad Nauheim, Germany.
Shares of St. Jude Medical jumped 2.1%, or 61 cents, to $29.80, on Wednesday morning after the news. This is down from the 52-week high that St. Jude hit in mid-July.
The approval of the device comes just days after the company disappointed investors by lowering its guidance for the full-year 2009 to a range of $2.47 to $2.52 per share, from $2.62, below analyst estimates of $2.61. St. Jude said that the lowered outlook was largely due to the strengthening dollar.
On the contrary, Chief Financial Officer John Heinmiller said at a Piper Jaffrey investor conference this week that St. Jude expects to take a 33.0% share of the cardiac rhythm management market in the coming year. It currently competes with companies like Medtronic and Boston Scientific.
E. J. Stanley, 1901
The New York Times, by Tara Parker-Pope — For years, people with worn-out knees were told to wait as long as possible before opting for replacement. Wait until you are older, the thinking went, so the joint will outlive you.
But medical experts say doctors and patients are pushing the limits of their old joints too far. Improvements in artificial joint technology and surgical techniques mean replacements are lasting longer than ever — often 20 years or more. But doctors are still advising candidates for replacement to “wait until you can’t stand it.” As a result, some patients wait until the cartilage in their knees wears out completely, leaving them housebound and with painful bone-on-bone rubbing in their knees.
The problem is that patients who wait too long become so debilitated that recovery is harder and function is often not fully regained. “There’s definitely a point where there’s a diminishing return if you wait too long,” said Lynn Snyder-Mackler, a professor in the department of physical therapy at the University of Delaware. “You end up trading one set of impairments for another.”
About one in five adults has arthritis or chronic joint pain. As people age, cartilage begins to wear, and the resulting inflammation causes swelling, pain and stiffness. Jobs and sports that involve repetitive motion on a particular joint can increase the risk of developing arthritis in that joint. Family history and weight gain also play a role.
Joint replacement is not inevitable once arthritis sets in. Treating the pain and inflammation early on can help people maintain function longer. Over-the-counter and prescription pain relievers as well as supplements like glucosamine and chondroitin may offer relief. Maintaining a healthy weight lowers risk for arthritis in the knees. Moderate exercise can also help.
As for surgery, women appear more likely than men to wait too long before opting for it. It may be that they are more inclined to accept the limits of weakened knees. Doctors may discourage women from surgery because they typically live longer than men.
In research published last fall in The Journal of Bone and Joint Surgery, Dr. Snyder-Mackler and colleagues studied 95 men and 126 women who were to have knee replacements. They found that even after controlling for gender differences in strength and agility, the women had far higher levels of impairment before choosing surgery than the men had.
And earlier this year, The Canadian Medical Association Journal reported that doctors recommended surgery more often for men than for women. University of Toronto researchers selected one man and one woman, both 67, who had identical levels of knee osteoarthritis. They each went on separate visits to 29 orthopedic surgeons and 38 family doctors. Although they both described similar symptoms, two-thirds of the doctors recommended knee replacement for the man, while only a third thought it appropriate for the woman.
After years of suffering, Craig Mason, 65, of Whittier, Calif., insisted that her doctor refer her for a knee replacement. Ms. Mason could get around only using a walker. She said that when she was “truly incapacitated,” her doctor still wanted her to postpone surgery.
“My primary physician kept putting it off and putting it off, and finally I almost had to threaten and say, You’ve got to do something about this,” she said. “He just wanted me to get older.”
Last year, Ms. Mason underwent surgery. Recovery was painful, she said. But unlike the chronic pain associated with her knee, the pain of surgery and physical therapy eventually disappeared. “When I woke up from surgery I said, This was a big mistake,” she said. “But they say it’s like childbirth — you forget the pain. I should have had it done a long time ago.”
Total knee replacements are not for everyone, and doctors say patients in their 40s and 50s may still want to consider partial knee replacements or other interim surgical procedures.
Sometimes patients themselves insist on delaying surgery because they worry about long recoveries and giving up favorite activities that they now suffer through with braces and medication. Doctors say, however, that many patients can resume normal activities, although it depends on the person’s fitness and disability levels before the surgery.
Johnson & Johnson is taking advantage of the credit crunch to acquire a niche competitor.
FORBES.COM, The New Brunswisk, N.J.-based pharmaceutical company announced Monday that it would purchase Omrix Biopharmaceuticals for $25.00 per share, or $438.0 million, in cash. The deal is expected to close by the end of the year and is subject to antitrust clearance in Israel. The $25 per share deal represents an 18.1% premium to Omrix’s Friday closing price of $21.16 on the New York Stock Exchange.
While this is a relatively cheap move for Johnson & Johnson, it shows that it’s taking advantage of the rough global economy to buy assets at a discount. From a high of $38 in the last year, Omrix shares fell to $11.62 in October. Omrix is a producer of biosurgical products that will fit with J&J’s Ethicon. It will operate as a stand-alone company under Ethicon, which already has distribution rights in the U.S. and European Union for two of Omrix’s products.
“We view this acquisition as highly strategic … J&J’s Ethicon division has been partnered with Omrix on biosurgical products since 2003,” Leerink Swann analyst Rick Wise wrote in a note to investors. “As part of the partnership, Ethicon realizes sales from these products but also pays clinical trial/regulatory expenses and half the personnel expense related to these products. With this acquisition, J&J can improve Ethicon margins a bit and strengthen its position in the biosurgical market.”
Shares of J&J gained 1.3%, or 76 cents, to close at $59.11on Monday evening. It hit a 52-week high of $72.76 that it hit in early September.
Wise added, “With over $14.0 billion in cash on hand as of the third quarter and generating over $4.0 billion in free cash flow per quarter, J&J is well-positioned to take advantage of more attractive and still-contracting valuations in this volatile market.”
J&J expects to incur a one-time, after-tax charge of $120.0 million related to R&D and the acquisition. It expects the transaction to break even or be slightly dilutive to J&J earnings per share in 2009.
“Our partnership with Omrix has already expanded our capacity to provide innovative, next-generation products that raise the standard of surgical care,” said Alex Gorsky, company group chairman for Johnson & Johnson with responsibility for Ethicon. “We believe this transaction will further enhance our efforts to bring new, science-based products to patients and the health care professionals who treat them.”
Morningstar analyst Lauren Migliore said in a note to clients on Monday that the deal makes sense for Omrix because it “will complement Johnson & Johnson’s biosurgical product portfolio” and “benefit from its extensive commercialization network.”