CLINICAL: diversify your portfolio
diversify your portfolio
Supplements for AMD
One supplement does not fit all.
Jeffry D. Gerson, O.D., F.A.A.O.
Just as we prescribe more than one type of glaucoma drug, we must tailor AMD supplements to our patients, too.
Here, I discuss the supplement categories, the factors involved in prescribing and how to sell them in your practice.
The AMD supplements and their uses can be divided into:
1. Preventative products. These are for individuals who have a family history of the disease, have known risk factors, such as obesity or smoking, or just want to be preventative yet have no obvious AMD signs.
2. Early disease products. These are for individuals who don’t yet have the AREDS2 level of AMD. They have a few small or intermediate drusen and/or mild RPE changes.
3. Disease treatment products. These are for individuals who have moderate to advanced AMD or have worse disease in at least one eye and fall into the AREDS2 category. AREDS2 products are generally labeled as such.
When deciding on a preventative product, science reveals there may be a compelling case for a number of different supplement options depending on the patient. Whether it is something that includes B-complex for the prevention of AMD in women, to carotenoid-based supplements (lutein and zeaxanthin) for improvement of macular pigment optical density and overall visual function, or just a general “eye vitamin,” numerous options exist.
In addition, pharmacogenetics, or using genetic information to guide pharmacologic choices, can play a role here. Specifically, research points to specific genetic mutations that may have better outcomes in regard to conversion to wet AMD with or without zinc. To take advantage of pharmacogenetics, perform genetic testing in the office via a cheek swab, and send it to a lab. (Visit www.macularisk.com.)
Choosing a supplement for advanced disease is easier, as these are based on the AREDS2 findings. AREDS2 gave us a formulation similar to the original AREDS formula, but with the addition of lutein and zeaxanthin and without beta-carotene. (Due to the latter, no need to worry about smokers who have AMD.)
The NEI’s official AREDS2 recommendation does not include omega-3, as it was not significantly beneficial statistically in the study. In addition, fish oil may be causative of prostate cancer. However, we should not completely forsake fish oil, as it may be beneficial in other AMD stages and has benefits beyond the disease, such as dry eye.
You may want to consider selling supplements in your office. To determine which ones you can sell, contact the companies directly.
In terms of deciding which supplements to sell, given the information in this column, one could make the strong case for anywhere from two all the way up to seven or eight. That said, it may be easiest to start with two and expand as you become familiar and comfortable with the nuances of the science behind the options.
It’s not aspirin
Prescribing an AMD supplement is not as simple as prescribing an aspirin. You must be aware of the diverse portfolio of options to best serve your patients. OM
Optometric Management, Volume: 49 , Issue: February 2014, page(s): 39