Article

LEADING OFF
O.D.s Provide Dry AMD Management Tips

AMD AWARENESS MONTH

BY JENNIFER KIRBY, SENIOR EDITOR

When a non-exudative (dry) AMD patient presents, O.D.s can effectively intervene to prevent disease progression by providing education on the importance of daily home Amsler grid use, creating a specific follow-up appointment schedule and informing the patient of the modifiable risk factors [High BMI, smoking, high cholesterol and low macular pigment optical density (MPOD)] and methods for reducing them.

Here, four O.D.s who see several of these patients provide tips on these methods:

  • High BMI. “I discuss the importance of a healthy diet as it relates to eye health, including green leafy vegetables, limiting processed foods and more,” explains Steven G. Ferrucci, O.D., F.A.A.O. “I’ll also inform patients they can substitute food items, such as red meat, for things like salmon.”
    Jeffry Gerson, O.D., F.A.A.O., adds to broach this uncomfortable topic in a matter-of-fact vs. a tentative tone, as he’s found the latter tends to offend patients:
    “When I say, ‘it’s important to pay attention to your weight,’ patients usually respond with, ‘Yeah, I’m trying to lose weight,’ or ‘I need to,’ so they’re acknowledging the issue,” he explains.
  • Smoking. “I ask these patients whether they’re familiar with smokefree.gov or our State website ‘Tobacco Free Florida,’ which are comprehensive websites containing information on a wide variety of resources, including medication information and arranging for in-person, online, app-based or telephone-based counseling,” explains Jessica Steen, O.D., F.A.A.O. “From there, I spend time in the exam room navigating through the website, highlighting areas which may be of interest to a particular patient.”
  • High cholesterol. Joseph J. Pizzimenti, O.D., F.A.A.O., recommends a healthy diet, daily physical activity and medical treatment for dyslipidemia, particularly HDL cholesterol (or HDL-C), which has recently been implicated in AMD. He adds, however, that studies on dyslipidemia reveal conflicting results.
  • Low MPOD. For patients with low MPOD, or who have early AMD, based on the AREDS criteria, Dr. Steen prescribes an increase in the intake of lutein and zeaxanthin, as well as omega-3 polyunsaturated fatty acids in the form of dark green leafy vegetables, like spinach and wild salmon, respectively, she says.

Close to 70% of U.S. smokers are interested in quitting this modifiable risk factor, reports the CDC.
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“For patients who meet the criteria for at least intermediate AMD as defined by AREDS, I recommend supplementation,” she explains. “It’s important for patients to understand that supplementation aims to slow the progression of AMD.”

Dr. Ferrucci reminds that Warfarin is a contraindication.

“Studies show that for most people, MPOD is well below what is considered normal,” says Gary Morgan, O.D. Dr. Morgan says he recommends a supplement that contains lutein, zeaxanthin and meso-zeaxanthin because research shows an average of a 73% increase in macular pigment volume with a formula that includes the three macular carotenoids. OM