By Dr. Katherine Bickle
Shortly before writing this, I had a conversation with a new patient regarding nutritional supplements. Her history was positive for pigmentary changes in the maculae, and she reported the use of a nutritional supplement. Since the patient is a current smoker, I discussed with her the importance of taking a supplement without beta-carotene. She recalled this conversation with previous optometrists, and we discussed the presence of beta-carotene in several formulations. From this conversation, both the patient and I developed a better understanding of the various commercially available formulations. The importance of these discussions with our patients cannot be overlooked. Not only can your patients learn from your expertise, but you can also expand your knowledge.
You may know the formulation of certain brands you commonly recommend to your patients. For those you aren’t familiar with, how do you easily distinguish among the marketed brands? What are we doing on a daily basis to provide our patients with optimal care while striving to improve each patient’s quality of life?
Discussion with your patient
Recommending the proper nutritional supplement for your patient with AMD, MGD, and/or dry eye disease requires a thorough medical history, examination, and discussion with your patient.
Questions to consider asking your patient include:
- Do you have a personal history of AMD, MGD, or dry eye disease?
- What has been the impact of previous and current condition(s) and treatment(s) on your quality of life?
- Which supplements, if any, have you used previously?
- Which supplements have resulted in bothersome side effects for you?
- How often do you take the recommended nutritional supplements (if previously prescribed)?
- What are your short and long-term goals related to vision, comfort, and health?
AMD, MGD, and Dry Eye
Practitioners have differing philosophies on prescribing nutritional supplements for conditions. The AREDS (Age-Related Eye Disease Study) and AREDS2 have provided us with valuable information that we can incorporate into our daily patient care. More information regarding the AREDS2 can be found at http://www.areds2.org. While the AREDS2 reported that the addition of omega-3 fatty acids was not beneficial in the treatment of AMD, the literature suggests that omega-3 fatty acids may be beneficial for those with MGD and/or dry eye disease. The International Workshop on MGD lists increasing dietary omega-3 fatty acid intake in the treatment algorithm for MGD. If you’re considering recommending omega-3’s to a patient, it is important to ask your patient about the use of blood thinners. Omega-3’s have been shown to cause additional anticoagulation effects when used with blood thinners. It is important to recommend an appropriate dose of omega-3’s that do not significantly raise the patients’ international normalized ratio (INR).
There are several commercially available supplements available for our patients. Do you have one supplement you recommend or do you give the patient options, and let the patient choose? Do you make your recommendations from reading the literature, speaking with colleagues, or from your personal experience? While supplements may be less expensive or have less side effects than some prescription medications, your patients may not perceive the value in taking these supplements unless you discuss the potential benefits with the patient. I encourage you to follow-up with your patients regularly regardless of your recommended treatment. When treating a patient for MGD and/or dry eye, discuss how their symptoms have changed since beginning the treatment. These are questions you can ask your patients directly or have your staff provide questionnaires for the patient to complete.
Patients appreciate the personalized care you provide them, the time you spend addressing their needs, and the appropriate treatment options you prescribe. Incorporating ocular nutritional supplements into your treatment plan can improve your patients’ ocular health and quality of life.