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AIM: A case-control study was initiated to determine the risk factors for the development of age related macular degeneration (AMD). METHODS: Study participants, who were all white, aged 50-85 years, and were recruited from private ophthalmology practices. Each practitioner enrolled patients with bilateral AMD, who were then matched with controls for sex and age. Environmental factors and systemic and ocular histories were screened. All patients had bilateral red-free fundus photographs and fluorescein angiography. Photographs were classified into pigment epithelium alterations, drusen, geographic atrophy, and exudative AMD. Statistical analysis included the identification of risk factors for AMD. A multivariate analysis was performed at the end of the study. Analysis included the entire study population and was carried out for each stage of AMD. RESULTS: 1844 controls were compared with 1844 patients with AMD. Mean age was 71 years for controls and 72 for cases. Logistic regression identified six major risk factors for AMD (whole population): arterial hypertension (odds ratio (OR) = 1.28), coronary disease (OR = 1.31), hyperopia (OR = 1.33), light coloured irises (OR = 1.22), and lens opacities or previous cataract surgery (OR = 1.55). The significance of vascular risk factors was increased for late stages of AMD, especially the atrophic forms (coronary disease, OR = 3.19). CONCLUSIONS: This large case-control study confirms some of the risk factors previously identified and may contribute to the determination of methods for prevention of AMD.

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UNLABELLED: Drugs for long term administration have to prove their efficacy and safety. Previously published double blind controlled studies (from single dose to two months treatment) have already demonstrated the phlebotropic activity of Daflon 500 mg in chronic venous insufficiency (CVI). The aim of the study was to investigate the safety of this agent during one year of continuous administration. Two-hundred and fifteen out-patients suffering from CVI received Daflon 500 mg, 2 tablets per day. Therapeutic activity was evaluated every 2 months on: 1) venous symptoms (functional discomfort, cramps, evening oedema) assessed by a 0 to 4 scale; 2) supramalleolar and calf circumferences; 3) overall assessment of efficacy (excellent, useful, nil). Acceptability was assessed by recording the side effects and measuring laboratory parameters. RESULTS: 170 patients completed the study. Functional symptoms were statistically significantly improved as shown by the following: functional discomfort: 0.55 +/- 0.06 vs 2.63 +/- 0.06, supra-malleolar circumference in cm: 22.5 +/- 0.2 vs 23.1 +/- 0.2, and calf circumference in cm: 34.7 +/- 0.3 vs 35.2 +/- 0.3. This improvement in the symptoms quickly appeared from the first control (M2) and reached about 50% of the total decrease. Overall assessment of efficacy was evaluated as follows: excellent = 58%, useful = 33%, nil = 9% of the cases. Laboratory parameters remained constant during the 12 months. Side effects were essentially gastralgia (n = 7). According to these results, it appears the efficacy and safety of Daflon 500 mg are corroborated even after a one year administration.

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The Minimal Record of Disability (MRD) for Multiple Sclerosis (MS) evaluates impairment in MS through 4 sets of data: Demographic Data, Kurtzke Disability Status Scale (DSS), Incapacity Status Scale (ISS) and Environmental Status Scale (ESS). We assessed with the 1985 version of MRD 200 consecutive patients attending our MS clinic during a 6 months period. 170 were out-patients and 30 inpatients. Diagnosis was definite in 197 and probable in 3. ESS and ISS were rated by a medical student according to a planned interview. The validity and internal consistency of DSS, ISS and ESS were evaluated by dependence analysis of each item to the sum of all items, and multivariate analysis was carried out on the first 15 items of ISS. Main clinical data were: age 43.0 +/- 11.8 years; age at onset of MS: 27.3 +/- 10.3; sex ratio (F/M): 1.75/1; mean DSS score: 4.6 +/- 0.1. Administration of MRD was easy and general acceptance was good. Some refinement in wording is needed for 5 items of ISS--mainly for "mood and thought disturbances" and "mentation" which do not score adequate mood and intellectual impairment in MS--and for 2 items of ESS. These 2 scales are otherwise of practical use and cover all the area of disability and handicap in MS. The levels of internal consistency of DSS, ISS and ESS are high, as well as correlations between the 3 scales (p less than 0.001). Correlations with age and duration of MS were established for total scores of DSS but not ISS and ESS. Our data confirms the validity of MRD as an evaluation tool of MS patients; they show that MRD can be applied with minor modifications to MS patients and support its use in therapeutic trials, rehabilitation and socio-economic inquiries.

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