Marion County Medical Center

Health Shorts

January 2007

LASIK Surgery vs Contacts
Surgery always involves some risk, but LASIK surgery to correct vision may carry less risk than the wearing of contact lenses, according to a letter by three ophthalmologists published in the Archives of Ophthalmology [October, 2006].

The lifetime risk of vision loss is 1 in 10,000 for LASIK, compared to a risk of 1 in 2,000 for contact lens wearers, according to the letter. “It’s not that contacts aren’t good,” the ophthalmologists wrote. “Laser surgery is as safe, and probably safer, than long-term use of contact lenses.”

The letter evoked controversy among eye doctors with responses centering around adverse effects such as glare, haloes and dryness associated with LASIK surgery. New wavefront techniques may eliminate some of these effects.
[SOURCE: John Murphy, “Which Is Safer: LASIK or Contacts?” Review of Optometry, November 15, 2006]

Stent Results: 6 Months vs 5 Years
The five-year follow-up of the RAVEL study indicated changes that caused some doctors to reassess how widely the new generation of drug-coated stents should be used.

At six months, 0 percent of arteries treated with drug-coated stents had re-narrowed versus 26.6 percent of those treated with bare-metal stents. The rate of major heart-related events was 5.8 percent compared to 28.8 percent for bare-metal stents.

After five years, the number of deaths associated with late-developing blood clots had increased among patients given the drug-coated stents, but there was still no significant difference between the two groups. The rate of re-narrowing remained lower (10.3 percent versus 26 percent). The gap between the two in major heart-related events had narrowed even more (25.8 percent versus 35.2 percent). This study, along with other evidence, prompted an expert panel in late 2006 to warn against off-label use.
[SOURCE: Patrick W. Serruys, MD, PhD, “RAVEL: Sirolimus-Eluting Stent vs Bare-Metal Stent in Simple Lesions–5-Year Clinical Follow-up,” European Society of Cardiology, World Congress, Barcelona, September 2-6, 2006]

Contacts for Kids? Pro and Con
If your child needs corrected vision, you’re likely to hear arguments for and against contact lenses. On the plus side, contact lenses fit well with an active child’s lifestyle. Glasses are a nuisance on the soccer field or basketball court and some children are embarrassed at the “four eyes” or “nerd” stereotypes.

Some doctors oppose the idea of contacts before the age of 12. Children may be less likely than adults to practice proper hygiene and remove the lenses at night, creating a risk of infection. At least some of this risk has been removed with the introduction daily disposable contacts and continuous wear lenses that allow oxygen to permeate to the eye.
[SOURCE: Jeffrey J. Walline, “Why Fit Children with Contact Lenses?” Ophthalmology Times, May 15, 2006]

Exercise Good for Aging Eyes
Middle-aged and older Americans who exercised at least three times a week had a 70 percent reduced risk of developing the most advanced “wet” form of age-related macular degeneration, a disease that progressively destroys central vision, according to a population-based study of 3,874 residents of Beaver Dam, Wisconsin.

Researchers believe the exercise helped reduce inflammation and endothelial dysfunction of blood vessels in the eyes.
[SOURCE: British Journal of Ophthalmology; “Physical Activity May Help Protect Aging Eyes,” Tufts University Health & Nutrition Letter, January, 2007]

Total Carbs More Important than Type
Simple sugars and starches cause a rapid rise in blood sugar while foods rich in fiber have a stabilizing or lowering effect immediately after a meal. All are carbohydrates.

A high-fiber diet is recommended for diabetes treatment as well as for overall health. For controlling blood sugar over the long term, however, most research suggests that the total amount of carbohydrate consumed is more important than the source or type.
[SOURCE: M.J. Franz, et al, “Evolution of Diabetes Medical Nutrition Therapy,” Postgraduate Medical Journal, January, 2003]

High Protein Diets Risky for Diabetics
Diabetic meal plans, like some popular weight loss diets, frequently call for some degree of carbohydrate counting. Controlling spikes in blood sugar requires limited intake of carbohydrates, particularly sugars and starches.

Low carbohydrate programs, such as the Atkins diet, however, often allow high intake of protein–25 to 30 percent of daily calories–which could put a diabetes patient at increased risk of kidney disease.
[SOURCE: Zachary T. Bloomgarden, “Diabetes and Nutrition,” Diabetes Care, October, 2002]

Sensible Approach To Diabetic Eating
As opposed to strict dieting, diabetic patients today are usually advised to make sensible meal plans, with moderate intake of carbohydrates throughout the day balanced by consistent exercise to keep blood sugar in check. Other guidelines include:

eating a variety of foods from all food groups,
limiting portion size,
avoiding salty foods such as chips, pickles and deli meats,
cutting back on intake of saturated and trans fats.

[SOURCE: Carole Mensing, R.N., M.A., “Personal Reporter: Answers about Diabetes,” WebMD Personal Reporter, July 2, 2003]

Family History Affects Cancer Risk
Six percent of Americans will develop colon or rectal cancer at some time in their lives, and the risk goes up substantially for persons with a family history of the disease. If one of your parents has been diagnosed with colon cancer, your risk is double that of other persons. If you have two close relatives with a diagnosis, your risk increases five- or six-fold.
[SOURCE: Carol Burke and James M. Church, “Colon Cancer Update with the Cleveland Clinic,” WebMD Live Events Transcript, March 15, 2005]

Music Eases Colonoscopy Discomfort
Patients listening to music needed less anesthesia to achieve the same level of comfort during colonoscopy, according to researchers at Temple University. The genre or kind of music did not affect results.
[SOURCE: Tuned Up for Colon Test,” Nursing Standard, October 18, 2006]

Negative Colonoscopy Is Good News
Colonoscopy is the best method now available for detecting pre-cancerous polyps, and persons with negative findings on even one colonoscopy have a very low risk of colon cancer–74 percent lower than that of persons who have never had a colonoscopy.
Even with up-to-date equipment and experienced examiners, however, colonoscopy misses some polyps.
[SOURCE: Negative Colonoscopy Predicts Low Risk of Colorectal Cancer,” Nursing Standard, October 18, 2006; Mirandi Hitti, “Colonoscopy Doesn’t Find All Polyps,” WebMD Medical News, September 6, 20064]

Many Seniors Pass on Colonoscopy
The number of colonoscopies performed on older Americans has increased substantially since 2001 when Medicare started covering the procedure. Even so, fewer than half of eligible seniors are screened.

For a person at average risk, Medicare provides reimbursement for one colonoscopy screening every 10 years. For persons at high risk, one colonoscopy every two years is covered.

Doctors are sometimes reluctant to recommend colonoscopy in patients age 80 and over because of an increased risk of complications and lack of evidence that screening at this age lowers mortality.
[SOURCE: Caroline Wellbery, “Is Colon Cancer Screening Beneficial in Older Patients?” American Family Physician, September 15, 2006; “Colon Cancer Screening Less Useful after 80,” Healthy Years, August, 2006]

Don’t Stop Anticlotting Drugs Too Soon
A study published in Circulation [June 20, 2006] found that nearly 14 percent of 500 patients who had a drug-coated stent implanted in their coronary arteries quit taking anti-clotting medications such as clopidogrel within 30 days. And patients who quit their medications too soon were nine times more likely to die within the next 11 months.

Both bare-metal stents and the new drug-coated ones carry a risk of clotting, but the risk drops off much quicker with the bare-metal stents. With drug-coated stents, the risk of clotting continues for a year or longer, requiring longer use of the medications.
[SOURCE: “A New Caution for Patients with Drug-Coated Stents,” Heart Advisor, August, 2006; Circulation, June 20, 2006]

Drug-Coated Stents Still Do Their Job
Drug-coated stents have become controversial because of the risk of clotting and sudden death that may occur a year or longer after implantation. Implanted in certain patients during balloon angioplasty, drug-coated stents are nevertheless still considered effective in preventing the re-narrowing of arteries. The re-narrowing rate with these stents is less than five percent compared to more than 25 percent for bare-metal stents.

Re-narrowing often occurs because of the growth of scar tissue around the stent. By preventing this growth, the new stents also delay healing, requiring use of anticoagulant medications for an extended period.
[SOURCE: “Stents with a Difference: Drug-Coated Stents Are Potent Weapons in the War on Heart Disease–But They Aren’t for Everyone with Clogged Arteries,” Healthy Years, June, 2006]

Heart Disease Is Still No. 1 Killer
Heart disease is still the number one killer of Americans, accounting for about one third of all deaths in 2004, according to an American Heart Association report published in Circulation [January, 2007]. The highest rates of death from heart disease were in Mississippi, Oklahoma, Alabama, Tennessee and West Virginia. Twice as many angioplasties are performed in Southern states as in other areas of the country.
West Virginia has seen slight declines in death rates from stroke over the past year, attributed in part to fewer young people smoking, a greater awareness of heart disease and prevention efforts.
[SOURCE: Tom Breen, “Heart Disease Still Big Problem in South,” Associated Press, December 31, 2006; Circulation, January, 2007]