1Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine 2Municipal L. L. Hirshman Hospital no. 14, Kharkiv, Ukraine
Abstract. Risk factors for age-related macular degeneration (AMD) include age, diseases of the cardiovascular system (atherosclerosis and hypertension), smoking, excessive exposure to light and ultraviolet radiation, an unbalanced diet et al. The retina is involved not only in the implementation of the visual process, and performs energy-information function, since the momentum transfer from the incoming stream of light on it structures of the central nervous system.
Aim. The aim of the work was to study the production of the hormone melatonin, and features of a light evening and night mode of patients with AMD on the results of the survey.
Material and methods. A total of 230 patients with various stages of AMD were investigated using a specially designed questionnaire. In the same patients it was studied day and night excretion of the hormone melatonin.
Results. Analysis of the survey showed that in contrast with the control group of patients with various stages of AMD sleep disorders encountered in 3–4 times more likely, late falling asleep and sleeping in dimly lit rooms – more than in 4 times more likely, late watching television – almost in 3 times likely. Early falling asleep (“larks”) in the control group met on average 10 times higher than in patients with exudative АMD. The findings suggest that among the factors of violation of diurnal light conditions in patients with different stages of AMD the most important is the extension of the residence time in the conditions of artificial light in the evening and at night due to sleep late, sleep in the half lit room, late watching TV. The data that 21 people (26.9 %) of the control group with long hours browsing TV-shows have been identified without AMD, as well as smaller numbers of other violations of light daily regimen in people without AMD suggest that the factor of violation of the light regime is important but not the only provocative factor in AMD development. The observed decline in day and night excretion of the hormone melatonin in patients with different stages of AMD can be related both to overwhelming for the production of melatonin effect of artificial light in the evening and at night, and with factors such as patient age and others.
Conclusion. These data suggest that factor of mode light disorders can be an important factor in the provocation of AMD development. It can be considered promising in further studies on the relationship of AMD, light conditions and disorders of the neuroendocrine factors as production of the hormone melatonin.
Keywords: age-related macular degeneration, the hormone melatonin, light regime.
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The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine, Odesa, Ukraine
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The main objective of eye health care is to allocate the finite health care recourses in the most cost-effective way to promote well-being of the citizens. There is a need to face and learn to live with the reality of growing discrepancy between demand and recourses for health care services. Despite our sincere intentions and good will (as well as regardless how health care services are financed), it is not possible to guarantee all possible services to everyone, not now or in future. We need to understand that we are both part of the problem and the solution. E.g. health care systems increase their own demand.
The task of universities is to invent new interventions (despite societies not affording even the current ones), because citizens do not want pay more taxes etc.
There is also long-standing evidence indicating that simply spending more money and resources does not improve access and outcome of care, nor patient satisfaction. Instead of agonising and griping, or trying to escape the reality (which decreases both possibilities of finding solutions as well as wellbeing of both patients and health care personnel), we need to take the responsibility of both advantages and disadvantages of our decision making, including the costs, and make all efforts to develop sustainable eye care together with the patients, citizens and all parties involved.