By Dr. Lisa Lex
Offering guidance to our patients when there is either a family history of age-related macular degeneration (AMD) or evidence that a patient has clinical signs of the disease is sometimes challenging.
I always begin with the non-controversial advice: wear UV protection (wrap-around style for true outdoor enthusiasts) and a brimmed hat when outside. I remind them “that the sun does to your eyes what it does to your skin–prematurely ages them.”
If they smoke I discuss the effects their habit has on ocular health, tripling the risk of AMD. I encourage them that if they have tried to quit before that they should keep trying as evidence shows that the more attempts at quitting, the more likely they are to eventually succeed.
Recommending patients take a systemic supplement can have potential consequences, however. I prefer to keep things as simple and safe as possible. Betacarotene in large amounts has the potential to increase lung cancer in those who are smokers. It also interferes with the absorption of two other important carotenoids, lutein and zeaxanthin. Vitamin E in amounts higher than recommended (22.5 IU or 400-800 mixed tocopherols) are suspected to increase the risk of hemorrhagic strokes as well as prostate cancer. It also can interfere with the absorption of statins and increase the risk of heart failure in diabetics. Zinc’s recommended daily requirement of 15 mg is far exceeded in vitamins targeted for eye health and can cause genitourinary and gastrointestinal disorders. So what’s an eye doc to do?
I inquire specifically of the patient, in addition to their medications, what supplements they are taking. The list can be alarmingly long and I remind them to share that list with their doctor. In an attempt to offer what I know to be safe, and potentially effective, I encourage my patients to eat good amounts of colorful fruits and vegetables. We know kale, spinach, eggs (yolks), corn, orange peppers and grapes are excellent sources of ingredients that help maintain macular health. It may also be helpful to take a 6-20 mg capsule of lutein in a formula with zeaxanthin, preferably 2 mg. For those who are deficient, the AREDS2 study found both a slowing of the progression of AMD and a decrease in cataract in those supplementing these two carotenoids. A multivitamin may also be beneficial, but better if they find one that contains little to no betacarotene.
Most importantly, I write down my recommendations and advise the patient of the confusion that awaits them in the vitamin aisle. There are SO many choices and if directions and ingredients are not looked at carefully, there is a chance that a little good could do a lot of harm.
February is AMD Awareness Month
… a good time to think about nutrition in eyecare
By: Larry A. Hookway
I tend to spend time speaking to my patients about nutrition. I think nutrition education is a major failing of our health care education and is often either, at best, ignored by most health care providers or, at worst, bad advice is given. In addition, the media constantly often reports sensational results of new studies that are often contradictory which makes it hard for our patients to know what to do.
The supplements that I discuss with patients are in the following list:
- Eat spinach, kale, collard greens, orange bell peppers, egg yolks and cold water fish. These provide lutein, zeaxanthin, and omega 3 from whole foods (always the best way).
- Mild Dry AMD
- Good Lutein 10mg Zeaxanthin 2mg
- Better One of the supplements sold only in doctors’ offices (MacuHealth, Restore, MaxiVision, etc)
Explanation to patient: These supplements build up the macular pigment level to an optimal level. The macular pigment is a yellow filter that filters out high energy blue light and not only helps protect the delicate photoreceptors but also improves vision by reducing the glare caused by the blue light. (Like having yellow sunglasses built right into the retina).
- Moderate to Severe AMD AREDS 2 formula
Explanation to patient: The largest study shows that people with moderate to severe have 25% less vision loss if they take this supplement. There is a controversy now about whether zinc is good for all patients. The jury is still out on this with some experts saying that we need to do genetic testing to determine if it is safe.
- Good: 1000 to 2000mg of Omega 3 in Fish Oil
Explanation to patient: Dry eye is a chronic inflammatory process in the eyelids. Fish oil is anti-inflammatory and also helps the eye produce its normal oil layer. As a bonus fish oil lowers bad LDL cholesterol and triglycerides and increases HDL (good) cholesterol. (do not use if taking Coumadin).
- Better: Supplements like BioTears, MaxiTears and EZ Tears. These have Omega 3, some have black currant seed oil which is an anti-inflammatory Omega 6 (GLA ) and some have turmeric, Vitamin E and green tea leaf extract. BioTears also has lactoferrin which helps prevent infections by viruses and bacteria.
- High Fiber Diet: A study by the University of Texas Southwestern Medical Center showed that people who increased their fiber to 24 to 50mg daily dramatically improved blood sugar levels. This was as effective as some diabetic medications. (13 servings per day of a mixture of fruits, vegetables, beans, brown rice, and whole grain bread or pasta)
- Cinnamon: A study by the Human Research Center in Bettsville, Maryland showed that one-half teaspoon of cinnamon daily makes cells more sensitive to insulin. After 40 days the patients experienced lower sugar spikes.
- EyePromise DVS: This elatively new supplement for diabetics was designed by Paul Chous, O.D., a leading speaker and researcher on ocular nutrition. It is designed to maintain healthy blood vessels. To see the complete ingredient list go to eyepromise.com.
- In Ohio we should be remind our patients to supplement with Vitamin D in the winter. Vitamin D has large role in immune health, bone and muscle health and is involved in preventing cancer formation. Some studies estimate that over 50% of adults are deficient. The minimum daily requirement is 400 IU but this is expected to be increased. 2000 to 4000 IU is considered safe. The body makes 10,000 units in 30 minutes in the summer around noon with a lot of skin exposed and no sunscreen. In the winter in Ohio even if you had skin exposed the body would not make Vitamin D.
We are on the verge of big changes in medicine. The human genome will enable us to personalize our treatment of our patients. It is also likely that the epidemic of diabetes will lead to research on how to prevent or delay onset of diabetes.
If you are interested in nutrition I recommend ONS (Ocular Nutrition Society) web site: www.ocularnutritionsociety.org
For seventeen years, the Ohio Optometric Association has flourished under the guidance of its Executive Director, Mr. Rick Cornett. It is difficult to quantify the number of lives that he has influenced during his tenure, from the Presidents and Board Members that have served with him, to The Ohio State College of Optometry and its students and faculty, to the General Assembly at the Statehouse, and most importantly, the patients of Ohio for which we care. We all have been well served.
In anticipation of his retirement later this spring, the OOA Board of Directors is establishing The Rick Cornett Endowed Scholarship in Optometry at the Ohio State University College of Optometry. Third or fourth year students exhibiting strong leadership and legislative potential will be eligible to receive the scholarship. The burdensome debt with which optometry students graduate was a constant concern of Rick’s; The OOA Board feels establishing a scholarship to defray this debt is a fitting tribute to our captain.
We are seeking the support of fellow “Friends of Rick”. Tax-deductible donations and/or pledges can be made via the attached gift form or online at https://www.giveto.osu.edu/makeagift/OnlineGivingDonation.aspx (instructions below). Rachel Childress, the Director of Development at the College, is available if you have questions regarding your donation. Her contact information is below. Thank you in advance for your consideration of this lasting tribute to Rick and his visionary stewardship of our Association.
Terri A. Gossard, O.D., M.S.
Ohio Optometric Association President
*On Sunday, March 29, 2015, the OOA will host an afternoon reception in honor of Rick’s retirement at JLiu’s Restaurant 6880 High St., Worthington OH, 43085 from 2:00-4:00 remarks will be starting at 3:00. Please contact Linda Fette at 614-781-0708, or via email at firstname.lastname@example.org by March 15th, 2015.
Instructions to donate online:
1) Click link above
2) On the right side of the form is a blue “search” button click on it
3) Enter the following # 482751 (or search for Rick Cornett)
4) Click select, now the form will be populated for the Rick Cornett Scholarship Fund.
Printable Gift Form
Rachel Childress, Director of Development
The Ohio State University
College of Optometry, Development and Alumni Affairs
A415 Starling Loving | 338 West 10th Avenue, Columbus, OH 43210 614-292-2100 Office | 614-571-1696 Mobile | 614-247-8355 Fax