Synapse News: April                                                                                   View this email in your browser
The good news
If chocolate is your prevailing memory of the Easter weekend, fear not. JAMA Ophthalmology reports that    2 hours after eating dark chocolate, our VA and contrast sensitivity are significantly higher than after eating milk chocolate. The theory is that the highly vascularised macula benefits from the increased metabolic supply resulting from the polyphenol flavanols in the dark chocolate.
Even better news, the researchers say that further study is required. Where do I sign up?
The bad news - or not?
The Dry Eye Assessment and Management (DREAM) study is the first large scale (n=535), randomised clinical trial to look into long term (12 months) efficacy and safety of omega-3 in relieving symptoms (using the Ocular Surface Discomfort Index or OSDI) and signs (conjunctival and corneal staining, BUT and Schirmer's) of dry eye disease. Daily doses of either 2000 mg of EPA plus 1000mg of DHA versus a placebo of olive oil flavoured with fish concentrate, found that both groups improved, with no significant difference between the groups. Before you stop recommending supplements, 
2 questions:
  • Is olive oil really a placebo when it is known to have anti inflammatory properties?
  • What kind of omega-3 was used? Remember the controvery about re-esterified or not? So which is this?
In May, look out for posts you can share for Star Wars Day, Mother's Day and Teacher's Day. 
More bad news - or not?
Some patients taking the AREDS supplements actually get worse, progressing from dry to wet AMD. What? Why? It depends on their genotype. Those with high complement factor H (CFH) and no age related maculopathy susceptibility 2 (ARMS2) risk alleles show increased progression to wet AMD while taking antioxidants and zinc. While the concept of personalising treatment is not new, the American Academy of Ophthalmology does not currently recommend routine genetic testing before prescribing supplements for AMD. The 'Macula Risk' has been available in the USA for several years - a simple in-office mouth swab. 
Synapse Academy (online CPD) members may wish to complete
  • Introduction to AMD
  • Diagnosis & management of AMD
  • Technology in AMD
And finally, watch this 85-year-old skier, blind from AMD, still loving her skiing. Inspiring stuff!
This was the most liked Facebook post during April.
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Thank you to those of you who have responded to the monthly Synapse News. We enjoy hearing from you. Please send in anything interesting, quirky or completely side-splitting that you come across... eyecare related, of course. If you have enjoyed this issue, please forward to a colleague. 

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