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From Primary Care Optometry News:
http://www.pconsupersite.com/default.asp?ID=10367
You may have to register for the link to work.
PRIMARY CARE OPTOMETRY NEWS 5/1/2005
Age-related eye disease: potential benefits of supplements, nutrition
Panelists in a roundtable held at SWCO recommended discussing the benefits and side effects of supplementation with all of your patients.
DALLAS – Here at the Southwest Council of Optometry meeting, Primary Care Optometry News gathered a group of clinicians to compare their approaches to counseling patients on the role of nutrition and supplementation in preventing or slowing the progression of age-related eye diseases. The panelists discussed antioxidants, zinc and omega-3s and their effect on eye disease, including dry eye.
ROUNDTABLE PARTICIPANTS
James D. Colgain, OD, FAAO [photo]
James D. Colgain, OD, FAAO, is the clinical director for Whitten Laser Eye in Washington. He is also a lieutenant colonel with the Air National Guard. Bruce E. Onofrey, OD, RPh, FAAO [photo]
Bruce E. Onofrey, OD, RPh, FAAO, is director of primary eye care services, Lovelace Medical Center, Albuquerque, N.M., and a Primary Care Optometry News Editorial Board member. William Townsend, OD [photo]
William Townsend, OD, practices at Advanced Eye Care in Canyon, Texas, and is a consultant at the VAMC in Amarillo, Texas.
Gary E. Oliver, OD, FAAO [photo]
Gary E. Oliver, OD, FAAO, is the regional clinical director for TLC Laser Eye Center in Plymouth Meeting, Pa. Leo P. Semes, OD, FAAO [photo]
Leo P. Semes, OD, FAAO, is an associate professor of optometry at the University of Alabama at Birmingham School of Optometry, and a Primary Care Optometry News Editorial Board member. Robert S. Vandervort, OD, FAAO [photo]
Robert S. Vandervort, OD, FAAO, is the center director for the Omaha Eye & Laser Institute in Omaha, Neb.
Primary Care Optometry News: Let’s discuss the dietary and supplemental intake of antioxidants and the prophylaxis of age-related eye disease. Which antioxidants do you feel play a role?
Bruce E. Onofrey, OD, RPh, FAAO, FOGS: The Age-Related Eye Disease Study (AREDS) looked at 500 mg of vitamin C, 400 IU of vitamin E, 15 mg of beta carotene, 80 mg of zinc and 2 mg of copper. Patients taking these supplements were found to have an 8% decrease in progression of age-related macular degeneration (AMD) from category 3 to 4 and a 19% reduced loss of visual acuity in category 3.
Spotlight on Precention & Systemic Care [logo]
Gary E. Oliver, OD, FAAO: Both during AREDS and prior to AREDS, zinc was looked at for its antioxidant capabilities in AMD. However, practitioners need to be careful with the dosing of zinc. At high levels, zinc can cause toxicity and depletion of copper.
Leo P. Semes, OD, FAAO: The 80 mg of zinc per day used in the AREDS is a pretty high dose.
William Townsend, OD: And it’s important to remember that we should avoid beta carotene in smokers.
Dr. Oliver: Beta carotene should be avoided in anyone at risk for lung cancer, which also includes people with exposure to asbestos.
Dr. Townsend: And these are the people, especially the smokers, who have an increased risk for macular degeneration.
Dr. Semes: While some people say that beta carotene should only be avoided in current smokers, others say it should even be avoided after patients have stopped smoking for 5 or 10 years.
Proof of prevention?
James D. Colgain, OD, FAAO: If I have a 50-year-old patient who has parents with macular degeneration or a 45-year-old with a small amount of drusen, is there proof that giving antioxidants will slow progression?
Dr. Townsend: I don’t think there’s actually proof that it’s preventive.
Dr. Semes: Cho and colleagues, in a study published in the June 2004 issue of Archives of Ophthalmology, concluded that fruit intake was inversely associated with the risk of neovascular age-related maculopathy (ARM). However, they said that intake of “vegetables, antioxidant vitamins or carotenoids were not strongly related to either early or neovascular ARM.” The study involved nearly 80,000 women and more than 40,000 men at least 50 years old with no diagnosis of ARM or cancer.
Dr. Oliver: In terms of prevention, you’re really looking at lutein intake with antioxidants.
Robert S. Vandervort, OD, FAAO: What is everyone suggesting for patients with a normal macula but a family history of AMD?
Dr. Colgain: I tell patients that while we cannot draw the conclusion that supplements prevent progression, in the proper dosage they will not hurt you, and they may have protective effects.
Dr. Townsend: However, it’s important to remember that none of these are without side effects or interactions. For instance, I’m quick to tell people about the benefits of dark green leafy vegetables. But we’ve got to remember to tell people who are on a platelet-inhibiting drug that these vegetables can diminish the effect of these medications.
Dr. Vandervort: I always tell patients to inform their family physicians about any supplements I ask them to take. It’s important to keep everyone in the loop.
Dr. Semes: It’s been recommended that eye care practitioners should ask all patients about the use of vitamins and herbs, because a study by West and colleagues published in the March 2005 issue of the American Journal of Ophthalmology found that 58% of 397 patients surveyed took daily vitamins, while 8% of them used herbal products on a daily basis. According to the study, 26% learned about vitamins from their primary care physician and only 2% from their ophthalmologist, while 35% discussed their use with their primary care physician and 5% with their ophthalmologist.
Dr. Townsend: If a patient has macular degeneration that has reached the edge of the macula, is there any reason to tell him or her not to take supplements? I know doctors who are still recommending these for patients who are 20/400, with no macula left. Is it judicious or ethical to continue to prescribe these vitamins? Some of these people are on limited budgets, and these vitamins are not inexpensive.
Dr. Colgain: If it’s not going to hurt them, I let them continue.
Dr. Vandervort: This population of patients is so vulnerable. They’re devastated by this disease, and they go from doctor to doctor. If you tell them not to take supplements, in essence, you’re kind of acquiescing to the disease. The patient is likely to switch to another practitioner unless you’re being aggressive in low vision. They’re searching for the magic cure, and they’re desperate.
Dr. Oliver: Remember that AREDS was fairly specific in the types of patients in whom benefits can be seen. Early prevention was not something they documented.
Dr. Colgain: That’s a challenge. It did not address prevention, and it did not address the severe individuals. It slowed down the progression of the disease, but nothing reversed. Patients are looking for something to return their loss of vision.
Dr. Semes: Researchers in the United Kingdom conducted a literature search to determine what vitamins would make up an effective ocular supplement that would be “suitable for those with a family history of glaucoma, cataract or AMD or lifestyle factors predisposing onset of these conditions such as smoking, poor nutritional status or high levels of sunlight exposure” as well as those with early stages of age-related ocular disease. Hannah Bartlett and Frank Eperjesi concluded that vitamins C and E and lutein/zeaxanthin should be included in their “theoretically ideal ocular nutritional supplement” (Ophthal Physiol Opt 2004;24:339-349).
continued next post...
From Primary Care Optometry News:
http://www.pconsupersite.com/default.asp?ID=10367
You may have to register for the link to work.
PRIMARY CARE OPTOMETRY NEWS 5/1/2005
Age-related eye disease: potential benefits of supplements, nutrition
Panelists in a roundtable held at SWCO recommended discussing the benefits and side effects of supplementation with all of your patients.
DALLAS – Here at the Southwest Council of Optometry meeting, Primary Care Optometry News gathered a group of clinicians to compare their approaches to counseling patients on the role of nutrition and supplementation in preventing or slowing the progression of age-related eye diseases. The panelists discussed antioxidants, zinc and omega-3s and their effect on eye disease, including dry eye.
ROUNDTABLE PARTICIPANTS
James D. Colgain, OD, FAAO [photo]
James D. Colgain, OD, FAAO, is the clinical director for Whitten Laser Eye in Washington. He is also a lieutenant colonel with the Air National Guard. Bruce E. Onofrey, OD, RPh, FAAO [photo]
Bruce E. Onofrey, OD, RPh, FAAO, is director of primary eye care services, Lovelace Medical Center, Albuquerque, N.M., and a Primary Care Optometry News Editorial Board member. William Townsend, OD [photo]
William Townsend, OD, practices at Advanced Eye Care in Canyon, Texas, and is a consultant at the VAMC in Amarillo, Texas.
Gary E. Oliver, OD, FAAO [photo]
Gary E. Oliver, OD, FAAO, is the regional clinical director for TLC Laser Eye Center in Plymouth Meeting, Pa. Leo P. Semes, OD, FAAO [photo]
Leo P. Semes, OD, FAAO, is an associate professor of optometry at the University of Alabama at Birmingham School of Optometry, and a Primary Care Optometry News Editorial Board member. Robert S. Vandervort, OD, FAAO [photo]
Robert S. Vandervort, OD, FAAO, is the center director for the Omaha Eye & Laser Institute in Omaha, Neb.
Primary Care Optometry News: Let’s discuss the dietary and supplemental intake of antioxidants and the prophylaxis of age-related eye disease. Which antioxidants do you feel play a role?
Bruce E. Onofrey, OD, RPh, FAAO, FOGS: The Age-Related Eye Disease Study (AREDS) looked at 500 mg of vitamin C, 400 IU of vitamin E, 15 mg of beta carotene, 80 mg of zinc and 2 mg of copper. Patients taking these supplements were found to have an 8% decrease in progression of age-related macular degeneration (AMD) from category 3 to 4 and a 19% reduced loss of visual acuity in category 3.
Spotlight on Precention & Systemic Care [logo]
Gary E. Oliver, OD, FAAO: Both during AREDS and prior to AREDS, zinc was looked at for its antioxidant capabilities in AMD. However, practitioners need to be careful with the dosing of zinc. At high levels, zinc can cause toxicity and depletion of copper.
Leo P. Semes, OD, FAAO: The 80 mg of zinc per day used in the AREDS is a pretty high dose.
William Townsend, OD: And it’s important to remember that we should avoid beta carotene in smokers.
Dr. Oliver: Beta carotene should be avoided in anyone at risk for lung cancer, which also includes people with exposure to asbestos.
Dr. Townsend: And these are the people, especially the smokers, who have an increased risk for macular degeneration.
Dr. Semes: While some people say that beta carotene should only be avoided in current smokers, others say it should even be avoided after patients have stopped smoking for 5 or 10 years.
Proof of prevention?
James D. Colgain, OD, FAAO: If I have a 50-year-old patient who has parents with macular degeneration or a 45-year-old with a small amount of drusen, is there proof that giving antioxidants will slow progression?
Dr. Townsend: I don’t think there’s actually proof that it’s preventive.
Dr. Semes: Cho and colleagues, in a study published in the June 2004 issue of Archives of Ophthalmology, concluded that fruit intake was inversely associated with the risk of neovascular age-related maculopathy (ARM). However, they said that intake of “vegetables, antioxidant vitamins or carotenoids were not strongly related to either early or neovascular ARM.” The study involved nearly 80,000 women and more than 40,000 men at least 50 years old with no diagnosis of ARM or cancer.
Dr. Oliver: In terms of prevention, you’re really looking at lutein intake with antioxidants.
Robert S. Vandervort, OD, FAAO: What is everyone suggesting for patients with a normal macula but a family history of AMD?
Dr. Colgain: I tell patients that while we cannot draw the conclusion that supplements prevent progression, in the proper dosage they will not hurt you, and they may have protective effects.
Dr. Townsend: However, it’s important to remember that none of these are without side effects or interactions. For instance, I’m quick to tell people about the benefits of dark green leafy vegetables. But we’ve got to remember to tell people who are on a platelet-inhibiting drug that these vegetables can diminish the effect of these medications.
Dr. Vandervort: I always tell patients to inform their family physicians about any supplements I ask them to take. It’s important to keep everyone in the loop.
Dr. Semes: It’s been recommended that eye care practitioners should ask all patients about the use of vitamins and herbs, because a study by West and colleagues published in the March 2005 issue of the American Journal of Ophthalmology found that 58% of 397 patients surveyed took daily vitamins, while 8% of them used herbal products on a daily basis. According to the study, 26% learned about vitamins from their primary care physician and only 2% from their ophthalmologist, while 35% discussed their use with their primary care physician and 5% with their ophthalmologist.
Dr. Townsend: If a patient has macular degeneration that has reached the edge of the macula, is there any reason to tell him or her not to take supplements? I know doctors who are still recommending these for patients who are 20/400, with no macula left. Is it judicious or ethical to continue to prescribe these vitamins? Some of these people are on limited budgets, and these vitamins are not inexpensive.
Dr. Colgain: If it’s not going to hurt them, I let them continue.
Dr. Vandervort: This population of patients is so vulnerable. They’re devastated by this disease, and they go from doctor to doctor. If you tell them not to take supplements, in essence, you’re kind of acquiescing to the disease. The patient is likely to switch to another practitioner unless you’re being aggressive in low vision. They’re searching for the magic cure, and they’re desperate.
Dr. Oliver: Remember that AREDS was fairly specific in the types of patients in whom benefits can be seen. Early prevention was not something they documented.
Dr. Colgain: That’s a challenge. It did not address prevention, and it did not address the severe individuals. It slowed down the progression of the disease, but nothing reversed. Patients are looking for something to return their loss of vision.
Dr. Semes: Researchers in the United Kingdom conducted a literature search to determine what vitamins would make up an effective ocular supplement that would be “suitable for those with a family history of glaucoma, cataract or AMD or lifestyle factors predisposing onset of these conditions such as smoking, poor nutritional status or high levels of sunlight exposure” as well as those with early stages of age-related ocular disease. Hannah Bartlett and Frank Eperjesi concluded that vitamins C and E and lutein/zeaxanthin should be included in their “theoretically ideal ocular nutritional supplement” (Ophthal Physiol Opt 2004;24:339-349).
continued next post...
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