MAY 2013

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52 EW CORNEA May 2013 Statins: A possible weapon in the fight against ocular inflammatory disease? by Vanessa Caceres EyeWorld Contributing Writer Study shows promising potential protective effect C ould statins help stave off ocular inflammatory disease? It's too early to say for sure, but a recently published study found a trend toward a reduction in the risk of new disease development in patients who had used statins. The study was published in the January issue of the Journal of Ophthalmic Inflammation and Infection. Although the results did not reach statistical significance, investigators said that larger clinical studies could help establish the effectiveness of statins to lower the incidence of diseases like uveitis. "It is too early at this point to make significant claims since we did not find statistical significance," said study investigator Russell W. Read, MD, PhD, professor, and director, uveitis/ocular inflammatory disease service, Callahan Eye Hospital, Uni- Larger clinical studies could help establish the effectiveness of statins to lower the incidence of diseases like uveitis (pictured here). Source: Manolette Roque, MD versity of Alabama at Birmingham. "However, if larger studies support that statins reduce the risk of developing uveitis, they could be considered as prophylactic therapy for individuals who have recurrent episodes or possibly as a therapy for chronic disease." Studies indicate that outdoor time could minimize nearsightedness in children N earsightedness in children may be prevented or minimized by spending time outdoors, according to studies recently published in the May issue of Ophthalmology. Two separate studies were conducted, one in Taiwan and another in Denmark. The first found that children's risk of nearsightedness was reduced when they were required to spend recess time outside. The Danish study was the first to show a direct correlation between seasonal fluctuations in daylight, eye growth and the rate of nearsightedness progression. According to a press release on the studies, nearsightedness in children can be corrected, but it can also lead to a more serious condition with age or risks for other eye disorders and diseases. The study in Taiwan compared myopia rates in children from one school from 2009-2010 to children at a control school. The first group of children participated in outdoor time for 80 minutes a day, while the control school's children were not required to have an outdoor recess. Both groups received eye exams at the beginning and end of the study, and fewer children who had been required to participate in outdoor recess ended up showing signs of nearsightedness. The study in Denmark was from a 2005 clinical trial, which split 235 Danish children into seven groups to account for the fluctuation of daylight hours in the country. The children in this study already had presence of myopia, and to determine its progression, the axial eye length was measured at the beginning and end of the study. An elongation of the eye is an indication that myopia is worsening, and in those children who spent more time in the daylight, there was less average eye growth than in those who had less access to daylight hours. Statins are already a well-known drug with cardiovascular protective effects. Other studies have tracked the possible effects of statins on autoimmune disorders and even in ophthalmic conditions like age-related macular degeneration, glaucoma, and diabetic retinopathy, the study investigators noted. It is not yet known how statins might affect ocular disease, they added. Study details Investigators performed a retrospective nested case-control study with men at the Birmingham Veterans Affairs Medical Center who were taking oral statins and later subsequently developed ocular inflammatory disease. They included all men with a new diagnosis of ocular inflammatory disease between 1997 and 2001, which led to the inclusion of 92 cases. The average age of those included was 58 years. The investigators decided not to include women because women were such a small portion of the existing patient population. They also included 10 agematched control subjects for each case—for a total of 920 controls— who did not have ocular inflammatory disease. The ocular diseases that investigators included were uveitis, retinitis, scleritis, iriodocyclitis, and other related diseases. Investigators controlled the results for comorbid conditions. Investigators found a two-fold reduction in the risk of disease development (an odds ratio of 0.50; 95% confidence interval 0.20 to 1.23, p=0.13). The risk reduction increased as the time of statin use increased. Although this study was limited to an older, male, veteran population and results were not statistically significant, there are still points to consider for follow up, the investigators noted. "Evaluation of larger databases with longer follow-up periods, such as insurance company claim files where both disease and pharmacy data are maintained, could provide a definitive answer," they wrote. A randomized clinical trial could also help establish if statins could be useful in the arsenal against ocular inflammatory disease, they added. Too early for clinical implications, but … Although the investigators note that it is too early to make clinical adjustments based on these results, Francis Mah, MD, Scripps Health, La Jolla, Calif., finds the study particularly thought-provoking. "It's an interesting concept. The longer that patients were on statins, the more of a protective effect they had," he said. "It sounds promising." Dr. Mah said that this issue was not on his radar screen before, although it is something he will consider now. He sees a number of patients with uveitis. It helps that statins are well accepted already for their strokeand cardiovascular-related protective effects, he added. "Statins are widely used for hypercholesterolemia, so if born out, an effect on uveitis would result in multiple beneficial effects for patients," Dr. Read said. The investigators are now working with epidemiologists at the University of Alabama at Birmingham to analyze a larger cohort of patients, Dr. Read said. They will likely access larger patient databases. EW Editors' note: The physicians have no financial interests related to this article. Contact information Mah: 858-554-7996, Mah.Francis@scrippshealth.org Read: rwr@uab.edu

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