March 2012




Honing in on nutrition and eye health

by Vanessa Caceres EyeWorld Contributing Editor


Study finds baby boomer interest in topic but lack of knowledge

Source: Digital Vision/Getty Images

A patient asks if lutein can help with dry eye. Another patient might ask if eating more carrots will help with general eye health. Yet another has no awareness of the connection between nutrition and eye disease prevention.

These familiar-sounding scenarios relate to a growing awareness of the importance of nutrition and eye healthand the simultaneous lack of knowledge that some patients have regarding what nutrients can really help their eyes.

A survey released in October 2011 by the Ocular Nutrition Society found that although 78% of baby boomers rank vision as the most important of their five senses and 55% worried about vision loss almost as much as they worried about heart disease or cancer, almost 60% of those surveyed were not aware of the beneficial role of omega-3 fatty acids in eye health. Additionally, 66% were not aware of the role of lutein and 89% were not aware of the role of zeaxanthin. Nearly 50% of respondents did not have an annual eye exam.

"There's a disconnect," said Jeffrey Anshel, O.D., F.A.A.O., president, Ocular Nutrition Society, and in private practice, Carlsbad, Calif. "Eye diseases can progress slowly, so it's not a screaming issue." For this reason, the general population may want to take good care of their eyes but may not consider how nutrition and regular eye exams play a role.

The survey, called Eye on the Boomer, culled results from phone interviews with about 1,000 men and women between the ages of 45-65 to assess their eyecare habits and level of understanding on the relationship between nutrition and eye health. The study was sponsored by Bausch + Lomb (Rochester, N.Y.) and promoted by the Ocular Nutrition Society, which helps eye doctors support the role of nutrition in eye health. The Society has been around for about 4 years and has approximately 700 optometrist and ophthalmologist members, Dr. Anshel said. The survey also found that only 18% of those interviewed took supplements to support eye health, compared with a little over half who took supplements to protect their joints, bones, or heart health. The survey helps to reveal what patients generally know about nutrition and eye health, Dr. Anshel said. Of course, that does not mean the information they obtain is always accurate, he added.

A comparison

To some extent, the survey results seem to match what clinicians find when speaking with patients. It wasn't until 2001 with the results of the Age-Related Eye Disease Study study regarding age-related macular degeneration (AMD) that the link between nutrition and eye health really emerged, believes epidemiologist Cecile Delcourt, Ph.D., Bordeaux, France. "Until then, even ophthalmologists would not think nutrition had any effect on the eye. This field has really been developing in the last 10 years." Dr. Delcourt has worked with research groups tracking the relationship between certain nutrients and AMD. Her latest work is with the Alienor study, which confirms a decreased risk for AMD in subjects with higher omega-3 consumption.

However, some ophthalmologists treat a different subgroup of patientsthose who are hyperaware of nutrition. "This comes up fairly often," said dry eye specialist Robert Latkany, M.D., founder and director, Dry Eye Clinic, New York Eye and Ear Infirmary, New York. "I get patients, usually educated females, who want to tackle their problem from multiple ways. These patients want no drops or plugs, and they want something natural." Although Dr. Latkany warns these patients that taking fish oil for omega-3s won't miraculously cure their dry eye, it can certainly help. "I try to treat the patients as a whole and look at their nutritional intake," he said, in addition to evaluating patients' environment, co-morbid diseases, and medication use.

John D. Sheppard, M.D., professor of ophthalmology, microbiology, and immunology, Eastern Virginia Medical School, Norfolk, Va., finds that patients, particularly those with AMD or with family members who have had AMD, want to comply with nutrition advice, but they may not be aware of what they are takingor should take. "Depending on how you stratify it socioeconomically, I think that the AMD population is well aware of something they're supposed to take for their eyes," Dr. Sheppard. "However, they just know that they need to take the blue pill every morning." They may not necessarily know the specific nutrients from food or supplements that will help shield them against certain eye ailments, he said.

Clinical implications

It will take efforts from eye doctors to steer patients toward the right supplements and diet, Dr. Anshel said. The Ocular Nutrition Society does not manufacture supplements, but the group does have sponsors that sell eye health supplements, he said. Patients also need to know that it's not just supplements that will help protect them against dry eye, macular degeneration, or other diseases.

"You can't throw pills at a bad diet," Dr. Anshel said. "It's a change of lifestyle and diet."

Making that change naturally means that eye doctors need to be knowledgeable on this topic and make the time to broach it with patientstwo potentially difficult issues.

"Many [ophthalmologists] are more surgeons and see the eye as something more technical and almost feel it exists and does not need the rest of the body," Dr. Delcourt said. "I know many French ophthalmologists are skeptical about this, while others are interested but don't feel comfortable talking with patients about nutrition because they are not trained. There is also a time issue."

Basic information at conferences or other doctor-geared settings would be a good place to spread accurate information about eye health and nutrition, Dr. Delcourt said.

A relationship with a local nutritionist is another way to bridge the informational gap, Dr. Anshel said. He has referred certain patients with glaucoma, cataracts, and diabetic retinopathy to nutritionists. Dr. Sheppard's practice once considered having a dietician on staff but decided it would not be the right fit. However, Dr. Sheppard sometimes gives out the business card of a trusted local dietician. He also sends letters to patients' internists to recommend changes in nutrition as necessary. Dr. Latkany occasionally refers patients to nutritionists; those patients usually have rosacea or allergies.

Dr. Sheppard's office also sells popular ocular nutritional supplements; although patients can order those supplements online or buy them at a pharmacy, some prefer to go out of their way and get them right from their doctor's office, he said. Even though chair time is always a concern for doctors, there is a small thing they can do to push eye health and nutrition, Dr. Sheppard said. "I don't believe there is anything better we can do than to say to patients that they should take 2,000 mg of omega-3 fatty acids a day. We have 110 employees, and [I bought] each of them a bottle of fish oil for Christmas. It's a no-brainer," he said.

Editors' note: Dr. Anshel is president of the Ocular Nutrition Society. Dr. Delcourt has financial interests with Bausch + Lomb, Novartis (Basel, Switzerland), and Pfizer (New York). Dr. Latkany has financial interests with Alcon (Fort Worth, Texas). Dr. Sheppard has financial interests with Alcon, Allergan (Irvine, Calif.), Bausch + Lomb, and Vistakon (Jacksonville, Fla.).

Contact information

Anshel: 760-931-1390
Delcourt: 33-5-57-57-48-95,
Latkany: 212-689-2020,
Sheppard: 757-622-2200,

Honing in on nutrition and eye health Honing in on nutrition and eye health
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