Letter to the Editor
Clinical history in ophthalmological patients treated with multivitamin complexes
La historia clínica en pacientes oftalmológicos tratados con complejos multivitamínicos
V.M. Asensio-Sánchez
, A. Martín-Prieto
Corresponding author
Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, Spain
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"apellidos" => "Rico Sergado" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669116300740" "doi" => "10.1016/j.oftal.2016.05.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669116300740?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579417300166?idApp=UINPBA00004N" "url" => "/21735794/0000009200000003/v1_201703010038/S2173579417300166/v1_201703010038/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Clinical history in ophthalmological patients treated with multivitamin complexes" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Sir</span>," "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "149" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "V.M. Asensio-Sánchez, A. Martín-Prieto" "autores" => array:2 [ 0 => array:4 [ "nombre" => "V.M." "apellidos" => "Asensio-Sánchez" "email" => array:1 [ 0 => "victor_asensio@orangemail.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Martín-Prieto" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La historia clínica en pacientes oftalmológicos tratados con complejos multivitamínicos" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Apart from food intake, vitamin supplements are the only protection against age related macular degeneration. However, said supplements are expensive and compliance is quite doubtful. In addition, manufacturers have different formulations which do not match the dosage recommended in clinical trials, some being too high and others too low. On the other hand, ophthalmologists routinely and sometimes compulsively prescribe said supplements/vitamin complexes for ocular surface diseases, glaucoma, diabetic retinopathy and myopia. In our mind we are under the impression that these supplements are not medicaments and therefore can be prescribed to all patients without fear of side effects. Clinic history is fundamental for prescribing any drug, and vitamins and trace elements must be regarded as such. Said supplements and/or complexes would not be indicated in patients with anticoagulants or anti-aggregates (in 2013, 24.6 million boxes of acetylsalicylic acid were sold in Spain) or in patients with a record of cerebrovascular accidents.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> Said complexes modify their pharmacokinetics when the percentage of fat is high, i.e., in obese patients with a BMI of 30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> or more.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> Due to poor absorption, said supplements would not be sufficiently effective in patients with chronic inhibition of gastric acidity<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> (in 2013 54.4 million boxes of omeprazole were sold in Spain with a medical prescription), or in patients with biliary pathway surgery history (cholecystectomy) or in individuals with diminished HDL. We have studied 500 consecutive patients that were taking vitamin complexes prescribed by an ophthalmologist. Of these, 136 were on anti-platelet agents, 78 were on anticoagulants, 19 had biliary surgery history, 16 had cerebral ischemia history in the past year (16 on anti-platelet agents), 160 were in treatment with proton bomb inhibitors (100 on anti-platelet agents, 15 on anticoagulants, 7 with biliary surgery history) and 26 patients were obese (5 on anti-platelet agents, one on anticoagulants, 6 with antacids and 4 with biliary surgery). This means that in 281 patients out of 500 the vitamin complex prescription was not indicated or directly contraindicated. Therefore it can be concluded that said supplements are prescribed indiscriminately without considering the clinic history or the potential adverse effects derived from their use. It must be borne in mind that said supplements/vitamin complexes are drugs and therefore capable of interacting with other drugs.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Asensio-Sánchez VM, Martín-Prieto A. La historia clínica en pacientes oftalmológicos tratados con complejos multivitamínicos. Arch Soc Esp Oftalmol. 2017;92:149.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dietary vitamin E supplementation inhibits thrombin-induced platelet aggregation, but not monocyte adhesiveness, in patients with hypercholesterolaemia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.C. Williams" 1 => "L.A. Forster" 2 => "S.P. Tull" 3 => "M. Wong" 4 => "R.J. Bevan" 5 => "G.A. 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