By Nancy Lapid
(Reuters) – Hello Health Rounds Readers! Today we highlight long-term data that found a laser procedure has significant benefits over the current standard treatment for the most common form of glaucoma. We also report on the latest evidence of treatment inequities between white and Black patients in the U.S., and a study that found limited benefits of adding fluoride to water supplies in high-income nations.
Laser procedure slows glaucoma progression better than drops
New data support a change in management of the common eye disease glaucoma from eye drops, the current standard of care, to a laser procedure, researchers reported at a medical meeting this week.
The laser procedure had already been shown to be at least as effective as eye drops in a clinical trial of 700 recently diagnosed patients.
Six years later, progression of the disease was found to be 29% slower in trial participants who underwent selective laser trabeculoplasty than in those who received eye drops, according to data presented at the American Academy of Ophthalmology meeting in Chicago.
The laser-treated patients were also less likely to need glaucoma surgery.
“Selective laser trabeculoplasty should not only be considered an effective and safe alternative to medications as a first-line treatment for primary open-angle glaucoma, but can also offer an advantage in reducing vision loss,” study leader Dr. Giovanni Montesano of Moorfields Eye Hospital in London said in a statement, referring to the most common form of the disease.
Glaucoma is a chronic eye disease in which fluid builds up in the eye, causing pressure that damages the optic nerve and can result in vision loss or blindness.
The American Academy of Ophthalmology has said selective laser trabeculoplasty can be used as a replacement for eye drops or in addition to them.
A recent analysis published in JAMA Ophthalmology estimated that as of 2022, some 4.2 million U.S. adults age 40 or over had glaucoma, with Black individuals disproportionately affected.
Anesthesia doctors report inequities for Black patients
Multiple teams of researchers are reporting on some largely unrecognized racial health inequities at the American Society of Anesthesiologists meeting in Philadelphia.
For example, severely injured Black, Asian and Hispanic children and adults are less likely than white patients to receive potentially life-saving helicopter ambulance services, according to U.S. data.
“Current efforts to expand helicopter ambulance programs have yet to result in equitable care for patients of different races and ethnicities,” study leader Dr. Christian Mpody of Montefiore Medical Center in New York said in a statement.
Using data from more than 900 trauma centers, his team analyzed hospital transport records for 307,589 adults and 42,812 children who required urgent surgery or ICU admission for life-threatening injuries between 2017 and 2022.
All of the injuries had occurred more than 15 miles (24 km)from the nearest trauma hospital. Overall, 82.4% of patients transported by helicopter ambulance survived compared with 80.6% of those transported by ground ambulance.
After accounting for insurance status and other factors that might influence the decision to call for a helicopter, the researchers found that rates of air transport were 25.4% among white adults versus 12.6% among Black adults, 13.5% among Asian adults and 15.9% among Hispanic adults.
Air transport rates were 33.6% among white children, 20% among Black children, 22.4% among Asian children and 24% among Hispanic children.
Separately, a review of medical records presented at the meeting found that Black patients are less likely than white patients to receive multiple pain management options after surgery.
Multimodal analgesia, which uses multiple types of pain medication to reduce pain, is more effective at treating postsurgical pain than a single medication alone, particularly after complex surgeries such as lung or abdominal cancer surgery and hernia repair, the researchers noted.
The researchers reviewed data on 2,460 white patients and 482 Black patients treated in their hospital’s intensive care unit after complex, high-risk surgeries. They found that Black patients were 29% less likely to receive multimodal anesthesia using a combination of four drugs than white counterparts.
“We know that multimodal analgesia provides more effective pain management with less need for opioids, which are highly addictive,” study leader Dr. Niloufar Masoudi of Johns Hopkins University in Baltimore said in a statement. “It should be standard practice, especially in high-risk surgical patients.”
Adding fluoride to water provides little benefit today
The benefits of adding fluoride to water supplies may be minimal now that most toothpastes contain fluoride, new research suggests.
The practice has long garnered controversy, although the U.S. Centers for Disease Control and Prevention in May said panels of international experts “have not found convincing scientific evidence linking community water fluoridation with any potential adverse health effect.”
A federal judge in California recently ordered the U.S. Environmental Protection Agency to strengthen regulations for fluoride in drinking water, although he did not conclude with certainty that adding fluoride to drinking water presents unreasonable risks to developing brains.
Since the mid-1940s, governments worldwide have been adding fluoride to public drinking water supplies to prevent tooth decay. In the mid-1970s, toothpaste manufacturers also began to add fluoride to their products.
As reported in the Cochrane Database of Systematic Reviews, researchers reviewed data from 157 studies comparing communities that had fluoride added to their water supply with those that do not.
“Studies conducted in 1975 or earlier showed a clear and important effect on prevention of tooth decay in children” from adding fluoride to drinking water.
More recently, studies show that while water fluoridation may still slightly reduce tooth decay in children, a large benefit “is unlikely,” the researchers said.
They were unable to determine whether there would be effects on tooth decay if fluoride is removed from a water supply or whether fluoride reduces differences in tooth decay in lower-income nations.
The contemporary studies were conducted in high-income countries, and the impact of community water fluoridation in low- and middle-income countries is less clear, the researchers said.
(Reporting by Nancy Lapid; editing by Bill Berkrot)
