EVER International Meeting

The European Association for Vision and Eye Research (EVER) International Meeting - Crete, Greece, October 6-9th 2010

Following my PhD and postdoctoral work on neurodegeneration and brain repair at the University of Cambridge, I completed a fast-track medical degree (MB BS) at Barts and the London Hospital. I was then selected to complete an academic foundation training programme at the Severn Deanery in Bristol, where I completed a 4-month rotation in clinical research. I have a fascination with chronic disease and ophthalmology, and I worked with Professor Yoav Ben-Shlomo (Epidemiology and Public Health Medicine, Department of Social Medicine, University of Bristol).

OUR RESEARCH

Age-related macular degeneration (AMD) is progressive eye disease affecting the elderly, and is the leading cause of permanent blindness in the UK. It is the severest form of age-related maculopathy (ARM). As life expectancy in the developed world increases, the prevalence and incidence of blindness from this disease will undoubtedly rise unless preventive strategies or treatments are found. Despite this, there have only been a few large studies investigating the extent of the disease in the UK. Identifying those at high-risk of developing AMD is crucial in preventing irreversible visual impairment and blindness, and may lead to the implementation of preventative healthcare strategies.

We examined the prevalence of ARM and AMD in a large population-based study of men aged 45-59 from the Speedwell area of Bristol in the UK. They were recruited and examined in 1979-1982 and then re-examined in 1997 (18 years later) for evidence of AMD. Our aim was to examine whether a range of health, lifestyle, metabolic/blood and dietary factors measured at the start of the study were particularly associated or predictive of developing AMD. From our sample of 934 men, the prevalence of early ARM was 9.2% and AMD was 0.5%. This is a lower level compared to other studies worldwide, but may be due to relatively younger age of this sample (average age 71 years) compared to others. We also found that approximately 20% of the men had changes that put them at high risk of developing AMD in the future.

One idea is that the AMD follows a similar inflammation-driven disease pattern to heart disease, and consistent with this idea our finding that men who had developed AMD had higher blood levels of C-reactive protein, a general indicator of inflammation. This has been found in other studies. In addition, we showed these men also had higher blood pressures compared to those with no AMD. This finding is more controversial, with some studies showing an association and others not. Furthermore, we found that those with an unhealthy diet of fried food or use of lard/solid fats were more likely to develop AMD. Surprisingly, we found that lower levels of a fatty acid in the blood, triglycerides, were associated with a higher prevalence of AMD, which is counterintuitive to the idea that AMD is related to heart disease. We are not the first to report this intriguing finding, which at present remains unexplained. 

In summary, the prevalence of AMD was 0.5% in a group of elderly men from Bristol, UK. Many had macular changes that put them at higher risk of developing AMD over the next 5 years.  Increased age, raised C-reactive protein (a marker of inflammation), blood pressures and a higher intake of lard/solid fats were associated with an increased risk of ARM/AMD. Raised triglycerides were associated with a lower prevalence. Opportunities for screening those at risk of AMD and advice on possible risk factors should be explored to prevent disease progression and blindness.

This work poses the interesting question: will improvements in cardiovascular health result in an increasing burden of AMD in the community due to longer survival or will we see less AMD due to the beneficial effects of better cardiovascular disease control (if AMD and heart disease are related by similar risk factors)? Further long-term data on incidence rates of AMD will help confirm or refute a shared cardiovascular mechanism of disease.

THE CONFERENCE

The European Association for Vision and Eye Research (EVER) International Meeting Crete, Greece, October 6-9th 2010This conference really helped me to share  our work with international specialists with a wealth of experience and insight into AMD and this type of study. I also gained experience in the daunting prospect of presenting an eight-minute talk to 50-75 delegates in a large conference hall, and relished the chance to deliver, promote and defend my work. I ably answered questions from the audience relating to study design. Unbeknownst to me, the Head of the Bristol Eye Hospital, Professor Andrew Dick, was present, and gave me positive feedback on my presentation and commended my handling of the questions from the audience. Following this, I made contact with the session chair, Professor Catherine Creuzot, who also presented her preliminary study on the risks of AMD with stroke and heart disease. She showed great interest in what we had found and I asked about the progress of her work and how I could apply this to our study. She cordially invited me to Research Department to discuss projects and ideas. Directly from this, we are now in the process of re-analysing our data to look for associations of heart disease and AMD in our sample.

With the vital support of the Simon Wolff Charitable Trust who provided financial support to facilitate my attendance at this conference, I have gained invaluable experience and confidence at presenting my work, to large learned audiences. In addition, I was able to see firsthand the eye and vision research that is going on internationally, to stimulate new ideas for research and set-up collaborations to fuel the desire to find answers to innumerable questions in the quest to fight the devastating effects of eye disease and blindness. 

DR LAI-YEUNG NGAI (MB BS, PhD, BSc (Hons))

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