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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report a new genetic defect in the lecithin:cholesterol acyltransferase (LCAT) gene associated with classical clinical and biochemical features of fish eye disease. The 63-year-old Australian female proband also suffers from non-insulin-dependent (type II) diabetes mellitus. She presented with corneal opacities, markedly reduced HDL-cholesterol (0.1 mmol/L; < 10% of normal controls), and elevated plasma triglycerides. The presence of diabetes did not explain the lipoprotein profile, which differed markedly in comparison to two female hypertriglyceridemic diabetic subjects. Cholesterol esterification in HDL-like particles was minimal but plasma cholesterol esterification was maintained due to LCAT activity in non-HDL-containing lipoprotein fractions. DNA sequence analysis of the proband's LCAT gene showed two C to T transitions resulting in the substitution of Thr123 with Ile and Tyr144 with Cys. Allele-specific PCR amplification procedures were used to confirm the presence of the mutations in this proband and to screen for additional carriers in her family. Three first degree relatives (mother, brother, son) were heterozygous for the Thr123 --> Ile mutation and her daughter had the Tyr144 --> Cys mutation. Apart from a reduction in HDL-cholesterol levels to half the normal concentration and a 20% reduction in apoA-I levels, their plasma lipids were unremarkable. The proband's son and daughter were further investigated. Both had normal cholesterol esterification rates in plasma and VLDL/LDL-depleted plasma, but reduced LCAT activity (50% that of normal). Thus, the biochemical and phenotypic expression for fish eye disease in the heterozygote subjects was similar, irrespective of the underlying LCAT mutation.
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PMID:A new molecular defect in the lecithin: cholesterol acyltransferase (LCAT) gene associated with fish eye disease. 882 Jan

A screening program for diabetic eye disease was established in Iceland in 1980. Diabetics involved in the screening program have a low prevalence of blindness, 1% in type 1 and 1.6% in type 2. We examined ways to make the screening program more efficient by identifying subgroups at low risk of developing eye disease that require treatment and therefore need less frequent screening. We studied whether diabetic eye disease screening programs may be trimmed by excluding children and examining diabetics without retinopathy biannually. Our results indicate that diabetic children under the age of 12 years do not need regular screening for eye disease. Biannual examinations seem to suffice in type 1 and 2 diabetic patients without retinopathy. However, in a setting where the eye clinic is located apart from the diabetes clinics, biannual examinations present practical problems which could result in a less effective screening for diabetic eye disease.
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PMID:Screening for diabetic retinopathy. Initiation and frequency. 901 77

Diabetic retinopathy is a common complication in people with diabetes. General practitioners can arrange annual screening for diabetic eye disease to detect early changes and prevent severe damage. Due to an ageing population the number of people with type II diabetes will increased dramatically during the next 20 years. This article outlines how general practitioners can prevent progressive loss of vision in their patients.
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PMID:The eye in diabetes. Key points for the general practitioner. 911 10

Chronic hyperglycemia may cause growth factor alterations that are likely to participate in tissue remodeling typical for diabetic late complications. However, few details of such events are known. The ocular vitreous fluid allows studies of growth factor levels in human eyes (after vitrectomy). The vitreous is highly inert and protected by the blood-retina barrier and thus probably reflects growth factor production by the normal retina. Vitreous from patients with proliferative diabetic retinopathy (PDR) was compared with vitreous obtained from patients with nonproliferative eye disease and with vitreous from patients without diabetes but with marked neovascular proliferations due to ischemia. This design permits us to distinguish diabetes-related from non-diabetes-related alterations. Insulin-like growth factor I (IGF-I), IGF-II, IGF binding protein 2 (IGFBP-2), and IGFBP-3 were elevated 3- to 13-fold in nondiabetic retinal ischemia and 1.5- to 3-fold in PDR, indicating that the changes were not restricted to diabetes. These changes may partially be explained by leakage of serum into the vitreous, since IGFs and IGFBPs are 20- to 50-fold higher in serum than in vitreous, and vitreous protein content was 1.5-fold elevated in PDR subjects and 5-fold in ischemia patients compared with control subjects. TGF-beta is a proposed antiangiogenic factor in the eye. TGF-beta2 was the predominant subtype in vitreous, and its total amount was not altered in PDR patients. More importantly, the active fraction of TGF-beta was decreased by 30 and 70% in PDR and nondiabetic retinal ischemia patients, respectively. Since plasmin may control TGF-beta activation, the serum protein alpha2-antiplasmin was measured and found to be significantly elevated to 150 and 250% of control values in PDR and ischemia patients, respectively. Thus, influx of serum proteins due to microvascular disturbances and hypoxia is proposed as a possible cause for vitreous alterations of IGF-I and of active TGF-beta. These changes seem to occur late in the sequence of events leading to PDR and are not specific for diabetes, but they were also observed in other diseases characterized by retinal hypoxia.
Diabetes 1997 Sep
PMID:Growth factor alterations in advanced diabetic retinopathy: a possible role of blood retina barrier breakdown. 928 95

Diabetes mellitus is associated with severe microvascular complications (e.g., kidney disease and eye disease) and macrovascular complications (e.g., stroke and ischemic heart disease). These complications can result in severe long-term complications (e.g., amputation, disability, and blindness) and account for a substantial economic burden. This report uses data from CDC's National Health Interview Survey (NHIS) to examine trends in the incidence and prevalence of self-reported diabetes in the United States during 1980-1994. The findings document increases in both the incidence and prevalence of diabetes during this period and suggest that most of the increase was attributable to factors other than the aging of the U.S. population.
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PMID:Trends in the prevalence and incidence of self-reported diabetes mellitus -- United States, 1980-1994. 936 35

The numbers of elderly people in sub-Saharan Africa are growing rapidly with increasing life expectancy while at the same time the proportions of children in the populations are declining. The number of people 80 years and above increased tenfold in large parts of Africa since the 1950's, and the number of widows is growing fast. All this has several implications, including erosion of the social support by extended families and a dramatic change in the disease pattern. There will be increasing rates of cancer, liver cirrhosis, kidney failure, eye disease, osteoarthrosis, diabetes, mental illness and chronic degenerative illnesses such as cardiovascular disease. Multiple illness and permanent disability will become more common. African health care systems are ill-prepared for this transition, and social security for the elderly need to be improved in the coming years. Local and regional research into morbidity and well-being is important for policy formulation. The situation of different categories of chronically sick needs to be investigated. Improved health in childhood and middle age will probably be followed by improved health in old age, and this may offset the burden on the health care system of the growing number of elderly.
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PMID:Health and the elderly in developing countries with special reference to sub-Saharan Africa. 952 43

Diabetic eye disease is a major cause of blindness in the Western World and remains one of the most serious complications of diabetes mellitus. Retinopathy is the ocular complication of diabetes that most often leads to impaired vision. In recent years laser treatment has been introduced that can significantly decrease the likelihood of blindness in diabetic patients, if the eyes are treated at the appropriate stage of the disease. It remains a public health problem to make sure that each patient is treated at the optimal time in the development of the eye disease. Several types of screening programs have been designed throughout the world to meet this problem. We now report on our active screening program for diabetic eye disease and describe the sight and eye condition of the diabetic patients who have been involved in this program. In 1980, regular eye screening for diabetic retinopathy was initiated at Department of Ophthalmology, Landakot Hospital. The number of diabetic patients seen regularly has increased considerably since then, with 70-80% of type 1 diabetic patients in the country participating in the program in 1990, increasing to over 90% in 1994. About a fifth of type 2 diabetics in the country participated in the program in 1990. The patients have undergone annual eye examinations and fundus photography. Laser treatment is administered for proliferative retinopathy and diabetic macular edema according to the Diabetic Retinopathy Study and Early Treatment Diabetic Retinopathy Study criteria. In 1990, we embarked on a cross-sectional study to evaluate the prevalence of retinopathy and visual impairment of the type 1 and type 2 patients participating in our program. At the time of study, 205 insulin-taking patients, with age at diagnosis of less than 30 years, participated in our screening program. Out of those, retinopathy was present in 106 (52%), patients proliferative retinopathy in 26 (13%) and macular edema in 19 (9%). Visual acuity of 196 patients (96%) was equal or better than 6/12 in their better eye, 6 patients (3%) had 6/18-6/36 in their better eye, and 2 patients (1%) had equal or worse than 6/60 in their better eye, or legally blind. We concluded that the prevalence of retinopathy and visual impairment in type 1 diabetic patients in the country was low compared with other countries. In 1990, out of 245 diabetic patients with Type 2 diabetes, retinopathy was present in 100 patients (41%), proliferative retinopathy had been present in 17 (7%) and 24 (10%) had diabetic macular edema. A total of 224 patients (91%) had visual acuity equal or better than 6/12 in their better eye, 17 patients (7%) with 6/18-6/36 in their better eye, and 4 patients (1.6%) equal or worse than 6/60 in their better eye, or legally blind. We concluded that the prevalence of visual impairment of those type 2 diabetic patients participating in our screening program at the time of study was low compared with population-based studies from other countries. In 1992 we examined ways to make the screening program more efficient by identifying subgroups at low risk for developing eye disease that required treatment and therefore needed less frequent screening. We studied whether diabetic eye disease screening programs could be trimmed by excluding children and examining diabetic patients without retinopathy every other year. We examined all children under the age of 15 at the time of study and went through the files of all patients under age 15 examined from 1980 to 1992 at our diabetic eye screening program. We also followed for two years the type 1 and type 2 diabetic patients found to have no retinopathy in 1990, establishing their retinopathy stage two years later. Our results indicated that diabetic children under the age of 12 do not need regular screening for eye disease. Biannual examinations seemed to suffice in type 1 and 2 diabetic patients without retinopathy. (ABSTRACT TRUNCATED)
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PMID:Diabetic retinopathy. Screening and prevention of blindness. A doctoral thesis. 955 48

An apparent epidemic of diabetes is occurring in adults worldwide. This trend seems to be associated with socioeconomic and lifestyle changes. The population of developing countries and some communities within developing countries are at higher risk. Diabetic eye disease and its complications, especially diabetic retinopathy, are a leading cause of blindness and visual dysfunction in adults in economically developed societies. Epidemiological studies of the impact of diabetic eye disease in developing countries are scarce. Risk factors for the development and progression of diabetic retinopathy include, among others, hyperglycemia, genetic factors, race, duration of the disease, arterial hypertension, and proteinuria.
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PMID:The epidemiology of diabetes mellitus and diabetic retinopathy. 960 35

This study uses a theoretical model of health services utilization to assess the effects of predisposing, enabling, and need-for-care characteristics on recency of eye examinations among a sample of 998 elderly African-American persons. More than 64% of participants reported that they had had eye examinations within the last 12 months. Multiple logistics regression analysis explains 13.3% of the variance of eye examinations. This data indicates that recency of eye examination is related to health locus of control, private insurance, Medicare, insulin-dependent diabetes, and presence of eye disease. No significant relationship between recency of eye examination and self-rated health status, social support, vision impairment, and non-insulin-dependent diabetes were detected. The lack of association between non-insulin-dependent diabetes and the recency of eye examination suggests that the amount of preventive care in place may not be adequate. This data shows that the unique contributions of need characteristics account for a major variance of recency of eye examination. However, enabling characteristics play a significant role in sending the participants of this study to eye-specialists, even after need-for-care factors are held constant.
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PMID:Correlates of recency of eye examination among elderly African-Americans. 967 9

Patients with diabetes mellitus often have ophthalmic dysfunction, as diabetic eye disease can affect the majority of the ocular structures. The present study investigated contrast sensitivity (experiment 1) and glare sensitivity (experiment 2) using Pelli-Robson and Bailey-Lovie charts in normal and diabetic patients with a range of degrees of ischaemic retinopathy (n = 220). Contrast sensitivity thresholds reduced and glare sensitivity progressively increased throughout the range from normal to advanced stages of diabetic eye disease. However, the reduction in contrast sensitivity between adjacent groups was not significant (P > 0.10). Conversely, glare sensitivity was found to be greater in those diabetic patients who had received laser treatment (P = 0.001). The potential use of both tests is discussed.
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PMID:Contrast and glare sensitivity in diabetic patients with and without pan-retinal photocoagulation. 969 39


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