Therapeutics

Understanding ophthalmic use of Nutritional Supplements

Vitamins and diet awareness are growing trends. Here’s what you need to know.

By Jeffrey Anshel, OD, FAAO, Carlsbad, CA. and Carol Boerner, MD, Reading, VT.

Nutritional support for visual disorders is a rapidly growing area of interest in eyecare. Practices should recognize both the patient interest in the field and the potential benefit of complementary vision care when paired with traditional methods. However, they should also recognize common misconceptions about nutritional supplements as well as understand how to talk to patients about diet and its impact on eye health. Often, the role of discussing these matters in detail is left to nurses and technicians. This article outlines the need-to-know elements of nutrition and ophthalmology.

Start with nutrition counseling

Educating patients about how a high trans-fat and sugar diet increases their risk of macular degeneration may help them prevent the disease from developing. While conventional medications certainly have their place, many practices choose to integrate nutrition counseling, which can serve to support the treatments. This philosophy neither rejects conventional medicine nor accepts alternative therapies uncritically. Some patients prefer natural, effective and less-invasive interventions whenever possible. This process also shows that you are being respectful of your patients, listening to their health concerns and taking their concerns seriously, as well as using good medical judgment.

The Dietary Supplement Health and Education Act (DSHEA) was enacted in 1994 and defines a dietary supplement as “a product taken by mouth that contains a dietary ingredient that may include vitamins, minerals, herbs or other botanicals, amino acids and substances such as enzymes, organ tissues, glandular and metabolites.” However, these products must have a disclaimer: “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, cure, prevent or treat any disease.” This means that these products are regulated more as foods than drugs. The manufacturer is still responsible for safety and effectiveness, but it is not required to be proven prior to public release.

Evaluating patients

To successfully evaluate patients for nutrient deficiencies, it would be helpful to assess their nutrient intake. That sounds like a daunting task and one best left for professional nutritionists. However, you can usually get a good sense of a patient’s basic diet by asking just a few general questions:

1. How many servings of fruits and vegetables do you eat on a daily basis? (Note: one serving is a ¼ cup or a “handful”). Also, be aware that people will usually overestimate this amount (and French fries do not count as a vegetable serving.).

2. How many times a week do you eat fish (and what kind)? We now realize that smaller, fatty fish (sardines, herring, salmon, tuna, etc.) at least three times a week are best for adequate Omega-3 intake.

3. Do you eat baked goods? These contain simple sugars and “bad” carbs. Substituting complex carbohydrates such as fruit or walnuts is better.

4. Do you take a full-spectrum multiple vitamin and mineral supplement? A balanced diet alone doesn’t always provide adequate vitamin intake.

5. Do you limit the portion of food that you eat at each meal? Often, people eat until the plate is empty. Limiting portions can allow you to eat better, more nutrient-dense foods.

Review all products

The practice should review nutritional products by companies who specialize in supplements for eyecare needs. Their products should have a valid and current scientific rationale available for anyone to review, as well as a website that puts science first before price and marketing.

Offer products in-office

The office protocol for approaching the patient should be done in a caring manner. First, the diagnosis and options should be carefully explained to the patient. Then, if a supplement is recommended, hand the patient a brochure that fully explains the product. If they decide to purchase it right away, have it available to dispense. If they want to consider it later, simply let your front office staff know (via a routing slip) that you have discussed this product with the patient. They can again ask the patient at check-out if they wish to make the purchase at the initial visit or at a later time. OP