近视的糖尿病患者可能更不容易患糖尿病性视网膜病变

1、Diabetics who are nearsighted may be less susceptible to diabetic retinopathy26. 十月 2009 02:51 近视的糖尿病患者可能更不容易患糖尿病性视网膜病变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 在美国眼科学会（AAO）和泛美眼科协会（PAAO）2009联合会议于今天（10月26日）公布的科研成果中，有两项研究值得特别注意：一项由瑞士神经眼科学研究者从事的研究表明对于视力检查的异常结果，眼科医师应该怀疑是否是阿尔茨海默病的非典型病变；另一项由新加坡全国眼科中心从事的研究提供了新的证据，表明有近视的糖尿病患者可能更不容易发生糖尿病视网膜病变。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. 某些时候当一个病人告诉他的眼科医生说他“看不见”时，他真正要表达的意思是“我可以看见，但不能阅读或书写。”在阿尔茨海默病患者中，一小部分人发病首先表现为视力问题而不是记忆力或其他思维问题。但（仅根据视力问题做出阿尔茨海默病的）诊断

6、是很困难的，因为对这些病人来说，标准的眼科检查往往无法（对疾病）定性。瑞士Jules Gonin眼科医院的神经眼科医生Pierre-Francois Kaeser和Francois-Xavier Borruat对十个有不明原因失明的病人进行了检查和随访，最后这些病人均被诊断为阿尔茨海默病眼部病变（VVAD）。他们的研究提供了一些临床线索以帮助提高眼科医生发现VVAD的能力并进而推荐病人去做进一步的检查。如果病人能在疾病早期进行神经系统检查，接受治疗及家庭咨询，对所有相关人员来说，都会有一个更好的结果。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病人与典型的阿尔茨海默病病人相比，在许多方面都存在差异。与先发症状为记忆丧失的阿尔茨海默病人相比，许多以视力问题发病的病人更年轻。在Kaeser博士的研究中，病人平均年龄65岁，10个病人中只有

11、3个报告有记忆丧失。在全面的神经眼科检查中，尽管大多数病人都有足够的视敏度，但除一人外，所有人都有阅读困难，10个人中8个有书写困难，6个在基础计算方面有困难。10个人中8个有视野改变。所有病人虽然可以正确地说出颜色的名字，但在认出彩色数字方面有困难。重要的是，10个人中有8个在认出复杂画面并解释画面构成方面有障碍（称之为综合失认）。晚期阿尔茨海默病人由于有脑部损害而无法认出他们以前认识的人，也无法对他们熟悉的环境进行定位。而综合失认正是脑部损害发生的早期信号。MRI和PET扫描在所有病人身上均发现了符合VVAD的神经学改变。尽管VVAD病人的首发症状为视力问题，但最终大多数阿尔茨海默病人都会

12、出现记忆力与人格损害。"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." “眼科医生应当了解有不明原因视力问题尤其是有阅读障碍的病人有患有VVAD的可能。” Kaeser博士说，“当中老年病人视敏度检查正常但仍主诉有与年龄不相符的罕见或严重症状时，应当怀疑有VVAD的可能，并建议病人做神经学检查。”Does Nearsightedness Reduce the Risk of Diabetic Retinopathy? 近视会降低发生糖尿病性视网膜病变的风险吗？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. 为了更多地了解有可能降低糖尿病性视网膜病变（DR）风险的因素，皇家外科学院成员（MRCS）Laurence Shen Lim与新加坡全国眼科中心的同事研究了屈光不正（裸眼情况下视力低于20/20）与DR的发生及严重程度之间的关系。先前已有小样本研究提示近视对DR的发生具有保护作用，但该研究的结论缺乏说服性。Lim博士首次将眼轴长度（AL，眼球前方到后

17、方的距离）纳入研究，分析近视与DR之间的关联。约10%的糖尿病病人会发生DR。DR会损伤视网膜，而视网膜正是传输到大脑视觉中枢的图像形成的特殊组织。在世界范围内，DR是视力丧失的主要原因。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. 一些病人被发现患DR尤其严重DR的风险降低，而这些病人近视的原因是两个解剖方面的特征：较长的眼轴长度和较深的前眼房（前房深度，ACD）。研究发现这些病人都有不同程度的屈光不正。Lim博士的研究团队所评估的675名糖尿病病人来自于新加坡马来人眼科研究，后者是一项针对40到80岁之间的成年人的人群研究。"This DR-protective effect may