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Analysis of Accommodation Capacity in Presbyopic Patients with Low Body Mass Index

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Analysis of Accommodation Capacity in Presbyopic Patients with Low Body Mass Index 294ARTIGO ORIGINAL Análise da capacidade de acomodação em pacientes présbitas com baixo índice de massa corporal Analysis of accommodation capacity in presbyopic patients with low body mass index Nadyr Antonia Damasceno1, Eduardo de França Damasceno2 RESUMO Objetivo: Correlacionar o índice de massa corporal com condição de baixo peso como possível fator de influência sobre a presbiopia. Métodos: Estudo transversal envolvendo 1030 pacientes com acuidade visual de 20/20 emétropes, com faixa etária entre 36-40 anos, 51-55 anos e 60-65 anos, sendo excluídos pacientes com cover testes positivo, anisometrópicos, com insuficiência de convergência ou alta correlação de convergência / acomodação. Avaliação do índice de massa corpórea de todos os pacientes, como variável pesquisada de presença ou ausência de baixo índice de massa corporal. Resultados: Não houve diferenças estatísticas significativas entre baixo peso e pesos maiores, quando se comparam os dois grupos em relação ao sexo e faixa etária. Houve significância estatística quando se correlacionou indivíduos de baixo peso corporal (IMC < 18,5) e menor expressão de presbiopia em indivíduos com faixa etária entre 51- 55 anos e na faixa etária entre 60-65 anos. Conclusão: Conforme demonstrado pela análise estatística há uma correlação significativa entre baixo peso corporal definido como índice de massa corporal abaixo de 18,5 e menor incidência de presbiopia ou retardo de sua instalação e evolução com a idade. Descritores: Presbiopia; Baixo peso corporal; Índice de massa corporal ABSTRACT Purpuse: To determine the correlation between presbyopia and body mass index. Methods: Cross-sectional study involving 1030 patients with visual acuity of 20/20 emmetropy, aged between 36-40 years, 51-55 years and 60-65 years, excluding patients with positive test cover, anisometropy with convergence insufficiency or high correlation convergence / accommodation. Assessment of body mass index of all patients, Results: Cross-sectional study involving 1030 patients with visual acuity of 20/20 emmetropy, aged between 36-40 years, 51-55 years and 60-65 years, excluding patients with positive cover test, anisometropy with convergence insufficiency or high correlation convergence / accommodation. Assessment of body mass index of all patients Conclusion: As demonstrated by statistical analysis there is a significant correlation between low body weight defined as a body mass index below 18.5 and a lower incidence of presbyopia or delay its onset and progression with age. Keywords: Presbyopia; Low body weight; Body mass index 1Hospital Naval Marcilio Dias – Rio de Janeiro (RJ), Brasil; 2Professor Adjunto de Oftalmologia da Universidade Federal Fluminense (UFF) - Rio de Janeiro (RJ), Brasil. Vencedor do 41º Prêmio Varilux na Categoria Pesquisa Clínica Refração Os autores declaram não haver conflitos de interesse Recebido para publicação em 15/5/2013 - Aceito para publicação em 2/7/2013. Rev Bras Oftalmol. 2013; 72 (5): 294-300 RBO-V72-N5.pmd 294 31/10/2013, 11:55 Análise da capacidade de acomodação em pacientes présbitas com baixo índice de massa corporal 295 INTRODUÇÃO Um dos fatores correlacionados com a presbiopia, e ainda não pesquisado, é o índice de massa corporal (IMC). Esta condi- ção é objeto de estudo nesse trabalho, como um possível fator acomodação do olho se refere às alterações na refra- correlacionado com a presbiopia. ção do cristalino para que a imagem chegue na retina O IMC é definido como uma medida internacional usada de forma exata, independentemente da distância do A para calcular se uma pessoa está no peso ideal. Trata-se de um objeto visual. método fácil e rápido para a avaliação do nível de gordura de A presbiopia é definida como a perda da acomodação do cada pessoa, ou seja, é um preditor internacional de obesidade cristalino relacionado à idade, resultando na inabilidade de foca- adotado pela Organização Mundial da Saúde (OMS). lizar e observar objetos a curta distância. Esta é conhecida como O IMC é determinado pela divisão da massa do indivíduo a mudança fisiológica visual de ocorrência mais comum no de- pelo quadrado de sua altura, onde a massa está em quilogramas correr da vida adulta. As pessoas acometidas de presbiopia fre- e a altura está em metros. Sua classificação é baseada em seis quentemente se queixam de cefaléia e incômodo ocular progres- escalas: menor que 18,5 - baixo do peso, de 18,6 ate 24,5 - peso sivo, em decorrência da crescente dificuldade de focalização para normal, de 25 ate 29,9 - sobrepeso, de 30,0 ate 34,9 - obesidade visão de perto(1). moderada, de 35 ate 39,9 - obesidade severa e maior de 40,0 - Sua fisiopatologia é baseada nas hipóteses de perda de elas- obesidade mórbida. ticidade das estruturas da cápsula do cristalino e fibras da zônula Segundo Kuang et al. (2005), há diferenças destas classifi- de Zinn, bem como perda da capacidade de ação de fibras do cações de acordo com características populacionais de cada país, músculo ciliar para exercer a função da acomodação(2,3). e mesmo podendo ser modificadas de acordo com conveniências A amplitude da perda de acomodação visual é progressi- de evolução temporal e de saúde publica(8). va no decorrer da vida adulta, terminando por ser expressiva- O objetivo desta pesquisa é correlacionar o IMC, através mente notada na 4ª década de vida, ocasião na qual comumente de sua condição de baixo peso, como possível fator de influência se procura correção visual. Estímulos visuais dinâmicos e esta- sobre a presbiopia. Estas observações são avaliadas através de (4). tísticos de sua percepção fazem exacerbar a sua presença testes estatísticos no decorrer deste trabalho. A prescrição de óculos para leitura tem sido a indicação de correção mais comum para este tipo de problema há anos. Entretanto, alguns fatores parecem interferir neste tipo de pro- MÉTODOS cedimento, como exemplos: faixa etária, sexo e características sociais(5,6). Estudo transversal, envolvendo inicialmente 2897 pacien- Na atualidade, a possibilidade de correção cirúrgica, bem tes coletados através de prontuário digital eletrônico. Estes pa- como o uso de lentes de contato, fez ressurgir um maior interes- cientes foram atendidos entre de janeiro de 2008 e janeiro de se na pesquisa desta entidade, antes definida como de pleno co- 2010 num grande centro de atendimento privado oftalmológico nhecimento e sem pertinência de maior estudo(7). no Rio de Janeiro (Clinica de Olhos Octavio Moura Brasil). Diagrama 1 Sequência de coleta de dados desenvolvido na pesquisa Consulta à Confirmado NEGATIVO prontuário digital participação inicial Contato “Não quer (universo de mais (passível de telefônico participar da de 20.000) inclusão) pesquisa’”. POSITIVO Submetidos aos Marcado consulta de confirmação “Quer participar da fatores de inclusão e de dados e feito novo exame de: pesquisa’’ Informa exclusão, caso seja “Refração, Cover teste, seu peso e altura selecionado ou não acomodação\convergência”. corporal NEGATIVO Nova Consulta de rechecagem POSITIVO de dados com exame de: “Não incluído na “Incluído na pesquisa”. “Refração, Cover teste, pesquisa”. acomodação\convergência”. Rev Bras Oftalmol. 2013; 72 (5): 294-300 RBO-V72-N5.pmd 295 31/10/2013, 11:55 296 Damasceno NA, Damasceno EF Foram observados resultados dos exames de acuidade ram-se os valores de: Sem adição, +1.00D esf, +1,25 D esf, +1,50 visual com melhor correção através de tabela de Snellem e re- D esf, +1,75 D esf, +2,00 D esf, +2,25 D esf, +2,50 D esf, +2,75 D fração objetiva e subjetiva, realizando-se processo de sequência esf, +3,00 D esf e maior de +3,00 D esf. (Diagrama 1) de amostragem com os seguintes fatores : Após os critérios de inclusão e exclusão, os 1030 pacientes Após contato telefônico e aceitação de participar do estu- que efetivamente participaram do estudo realizaram a medição do, foram aplicados fatores de inclusão e exclusão no estudo. do peso e da altura, determinando assim a medida do IMC. Fatores de inclusão: Pacientes emétropes com 20/20 de O IMC foi dividido em < (menor) 18,5 e > (maior) 18,5, e acuidade visual em ambos os olhos e com idade entre 36 e 65 classificado como baixo peso ou não, respectivamente. anos. Foi efetuada a média e o desvio padrão de cada grupo de Fatores de exclusão: Pacientes estrábicos, com exame de faixa etária e estes correlacionadas com o IMC. Cover teste positivo, anisométropes, portadores de insuficiência Cada grupo etário foi subdvidido em relação ao sexo (fe- de convergência ou alta correlação de convergência/acomoda- minino e masculino) e correlacionado com IMC. ção. Foram também excluídos pacientes com faixa etária: 41 a A partir de cada grupo etário foi avaliado a frequência de 50 e 56 a 59 anos. Este artificio foi utilizado para realçar a hipó- cada nível de adição e correlacionado com o IMC de cada grupo tese defendida pelos objetivos deste trabalho. etário. Após aplicação de fatores de exclusão e inclusão, partici- Como análise de comprovação estatística se utilizou o tes- param efetivamente do estudo 1030 pacientes. O estudo teve a te qui quadrado para avaliação de dados não paramétricos (X2), liberação do CEP (Conselho de Ética em Pesquisa) e foi proje- teste T de Student para dados de média e desvio padrão, além de tado de acordo com as Diretrizes e Normas Regulamentadoras gráficos Box Plot e Barra (Erro e intervalo de confiança). Para de Pesquisas Envolvendo Seres Humanos (Resolução 196/ 1996 os dados não paramétricos ranqueados em escala progressiva do Conselho Nacional de Saúde). como critério de capacidade de acomodação e presbiopia atra- Todos os pacientes assinaram o termo de consentimento vés da graduação da adição refratométrica, foi utilizado teste de informado. Os pacientes foram separados em três grupos, segun- Mann-Whitney. O programa estatístico de software utilizado foi do a faixa etária: Grupo I (pré- presbitas) pacientes de 36-40 o SPSS Statistic versão 20.
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