What are your patients reading?

One of my patients with Best’s vitelliform dystrophy read in our Faculty News about my research on a trial of DHA (docosahexaenoic acid) supplementation and decided to use it on his own. He described that the DHA seemed to improve his vision, but remarkably, when he stopped taking DHA, his vision got worse. He resumed the DHA, his vision improved, and so he decided to continue taking it. He said the DHA capsules gave him fishy breath, so he would take them at night. Occasionally he would awaken in the middle of the night with the cat sniffing his breath! DHA is readily available from natural food stores but, curiously, not from your local pharmacy. There are, however, a number of sources on the Net from which you can purchase DHA.

Patients commonly seek alternatives to medical care. The advice may come from anecdotes of friends or from the pharmacist. DHA is one of the major very long chain fatty acids found in the brain and retina. Fish can account for 80% of our dietary source of DHA. The strongest link between DHA and macular degeneration was provided in the Nurses’ Health Study and the Health Professionals Follow-up Study.1 The incidence of macular degeneration in this cohort was inversely related to DHA intake, and subjects who had more fish in their diet had a reduced risk of macular degeneration. So there must be something to my patient’s claims of improved vision.

The Nurses Health Study recently provided further interesting information on nutrition and eye health — this time on cataracts. For women under the age of 60, there was an inverse correlation between the duration of vitamin C supplementation and the incidence of cortical cataract.2 Antioxidants such as vitamin C have been advocated as protective against aging changes, including those in the lens.

Today’s cataract patient is well informed or at least has access to significant information on cataracts and cataract surgery. Two articles in this issue of the Journal touch on the delivery of cataract surgery. Lorne Bellan and colleagues studied the use of preoperative sedation and intraoperative music and their effects on outcomes and ability to communicate with the patient (see page 155). In a second article, Kenneth Romanchuk and associates report on the work of the Western Canada Waiting List Project (see page 145). Administrators’ and patients’ perceptions of waiting lists are very important in our now service-driven decision making in health care.

Ian M. MacDonald, MD, CM
Editor-in-Chief

References

1. Cho E, Hung S, Willett WC, Spiegelman D, Rimm EB, Seddon JM, et al. Prospective study of dietary fat and the risk of age-related macular degeneration. Am J Clin Nutr 2001;73:209–18.
2. Taylor A, Jacques PF, Chylack LT Jr, Hankinson SE, Khu PM, Rogers G, et al. Long-term intake of vitamins and carotenoids and odds of early age-related cortical and posterior subcapsular lens opacities. Am J Clin Nutr 2002;75: 540–9.