Editors' Note: Most physicians can relate to the challenges of the direct funduscopic examination, likely including the emergency department (ED) physicians included in the study by Thulasi et al. As the authors highlight, the ED physicians picked up 0% of fundus abnormalities on direct funduscopic examination vs 46% when reading fundus photographs. This seems argument enough for more widespread use of this technology. Drs. Shubhakaran et al. expand on the topic by describing the use of the funduscopic examination in infectious disease.Megan Alcauskas, MD, and Robert C. Griggs, MD
Langer-Gould et al.1 demonstrated a strong association between pediatric multiple sclerosis (MS)/clinically isolated syndrome (CIS) risk and weight. This association may be explained by vitamin D deficiency as it is widely recognized as an environmental risk factor for MS. Obese adolescents have been shown to be at particular risk of vitamin D deficiency.2 Vitamin D is a fat-soluble vitamin with a reduced bioavailability in obese individuals due to its sequestration in body fat.3 A US study of 68 multiethnic obese adolescents found low vitamin D status in 100% of girls and 91% of boys,4 greater than in adolescents in general.5 We postulate that the association between weight and risk of MS/CIS may be a consequence of greater vitamin D deficiency in obese individuals, which confers increased MS/CIS risk. Less likely, there may be a shared underlying risk factor in vitamin D deficiency. Elucidating the mechanism of this association and particularly the role of (preventable) vitamin D deficiency may become an important public health issue in light of the emerging childhood obesity epidemic which, as the authors note, may predict a rising incidence of pediatric MS/CIS.
- © 2013 American Academy of Neurology
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