Delaying the onset of age-related ophthalmic diseases prolongs people’s quality of life, and shortens the time that they spend with visual impairment. There are also massive financial benefits to healthcare systems and society in general.
Postponing the day when dry AMD-related geographic atrophy begins to rob people of their vision by five to ten years would be an astonishing achievement. As Cécile Delcourt describes in her article in this month’s issue, lifelong nutrition plays a rôle. The majority of the public haven’t had an optimally nutritious and balanced diet from an early age, so for them, rest-of-life nutritional supplementation is currently their only option for prophylaxis. What they need is a pill; an ocular equivalent of statins for the prevention of cardiovascular events.
Statins have become the subject of a great deal of hue and cry in the media over their side-effect rates (miraculously small, relative to most other drugs) and the sheer number of people that could receive them: in the UK, 11 percent of the population are currently eligible to do so. Statins are also interesting to examine in terms of AMD; their use has been associated with delayed AMD development, and rumors exist of various post-statin drugs that interfere with cholesterol transport potentially being evaluated for prophylaxis against dry AMD. If they are effective, how likely is it that their side-effect profile will be as safe as statins? If it’s worse than statins, what will the tabloids like the Daily Mail or the Düsseldorf Express – and large sections of the public – make of it?
From my perspective, effective, widespread, population-level prophylactic interventions hold the potential to dramatically improve health and quality of life for the greatest possible number of people. But to make that happen, I forsee issues. If statin use can be assaulted by an ever-increasingly antagonistic press, then I can see a harsher reception for anything with a sub-statin safety profile. Having said that, vaccinations – the single best and safest public health intervention possible – attract highly-motivated campaigners against their use. So perhaps the biggest battle will be not against disease, but for people’s hearts and minds.
