Unless a serious threat of vision loss exists, it can be challenging to achieve compliance with prophylactic recommendations for eye health. It also can be difficult for patients to fully understand the intricacy of their eyes and their relation to the body as a whole. One solution I have found effective is to discuss eye care in terms of health and wellness, as many patients seek options for a healthy lifestyle.

For example, I educate patients that smoking, diet and exercise can have an incredible impact on eye health¹, for example increasing their risk for AMD, just as these items impact other health concerns, such as diabetes and heart disease. As such, our practice has incorporated a system for addressing eye wellness, specifically as it relates to macular health, with patients. Here are the key steps:

ASK RELATED QUESTIONS

 In our practice, I include health and wellness questions in my pre-appointment paperwork. Specifically, we ask: “What is your vegetable intake per day?” “Are you a current or former smoker?” or “Do you use a computer, tablet or device for more than three hours a day?”

From there, I include follow-up questions to dig in to what could be changed to improve overall health. These might be: “Are you planning to make any changes to your diet or exercise routine?” or “How many cigarettes do you smoke a day?” or “Have you noticed your eyes feel more dry or strained after looking at a computer screen?”

Asking such questions adds a minute or two per appointment, having little impact on patient flow. Additionally, the answers provide a starting point to the most appropriate interventions.

GATHER QUANTITATIVE DATA

 In our practice, I also measure macular pigment optical density (MPOD). Specifically, in our pre-appointment paperwork, we ask questions that identify people who may be at-risk of having a low MPOD score. Questions include: “Do you have light-colored eyes and/or skin?” “Do you have an outdoor occupation or spend more than two hours a day in front of a computer?” or “Do you have cardiovascular disease?”

I explain to patients: “Macular pigment is a protective layer found in the center of the retina that helps protect the eyes from harmful blue light emitted by the sun and digital devices.”

I’ll continue by explaining to patients that the density of this pigment degrades over time, and we need to support it through nutritional intake.^2,3 Getting high amounts of the macular carotenoids has been proven to increase MPOD, and having a dense macular pigment has been demonstrated to improve visual functions, such as acuity, contrast sensitivity and photophobia.^4-13

We also take blood pressure, if a patient is over a certain age or if we see anything in the retinal exam that’s concerning. I don’t actively take a BMI, but I also have discussions with patients regarding diet solutions.

PROVIDE SOLUTIONS

 Perhaps the most important similarity between eye health and whole-body health is the fact that catching a problem early or before it develops is critical to prolonging health. I am honest with my patients that it’s difficult to eat healthy every day, especially when it comes to nutrition for the eyes. Macular carotenoids, antioxidants important for eye health, are particularly scarce in the standard American diet.^14,15 Some foods that contain these nutrients include paprika, orange bell peppers, leafy green vegetables, such as spinach, kale and collard greens, corn and broccoli.

I tell patients: “If you really want to support your eyes for years to come, you should take an eye vitamin that gives you all the important ingredients in the amounts your eyes need.” Then, I make my vitamin recommendations based on their lifestyle and their eye needs. For example, if a patient has occasional dry eye, I may recommend a vitamin that has high-quality omegas and other soothing ingredients. If I were working with an athlete, I might suggest they try an eye vitamin that has high levels of zeaxanthin because that’s been demonstrated to improve reaction time.¹⁶

Additionally, I’m not afraid to talk to patients about diet and nutrition in general. For example, I love to cook, so sometimes the conversation starts with me going over a recipe.

For exercise, I recommend 30 minutes a day of walking. I’m a huge proponent of walking outdoors, specifically because it’s also good for your mental health. I also recommend the 20-20-20 rule, but not just taking a break from screens, getting up and stretching to help with circulation.

VISION PROTECTION

 Incorporating eye health and wellness into patient care can be challenging in terms of compliance, as patients tend to react more strongly when there is an imminent threat to vision. However, presenting the options provides patients a chance to take an active role in prevention and protection! OM

REFERENCES

1. Knudtson, M D, et al. “Physical Activity and the 15-Year Cumulative Incidence of Age-Related Macular Degeneration: the Beaver Dam Eye Study.” British Journal of Ophthalmology, BMJ Publishing Group Ltd, 1 Dec. 2006, bjo.bmj.com/content/90/12/1461.abstract?sid=c857de1c-bdb5-48ad-a29d-f13db7159940 .
2. Landrum JT, Bone RA. Lutein, zeaxanthin, and the macular pigment. Arch Biochem Biophys. 2001;385(1):28-40. doi:10.1006/abbi.2000.2171
3. Richer, Stuart & Devenport, Jenny & Lang, John. (2007). LAST II: Differential temporal responses of macular pigment optical density in patients with atrophic age-related macular degeneration to dietary supplementation with xanthophylls. Optometry (St. Louis, Mo.). 78. 213-9. 10.1016/j.optm.2006.10.019.
4. Stringham, James M., et al. “The Influence of Dietary Lutein and Zeaxanthin on Visual Performance.” Journal of Food Science, vol. 75, no. 1, 4 Oct. 2009, doi:10.1111/j.1750-3841.2009.01447.x.
5. Richer S, Park DW, Epstein R, Wrobel JS, Thomas C (2012) Macular Re-pigmentation Enhances Driving Vision in Elderly Adult Males with Macular Degeneration. J Clin Exp Ophthalmol 3:217. doi: 10.4172/2155-9570.1000217
6. Ma, Le, et al. “Improvement of Retinal Function in Early Age-Related Macular Degeneration After Lutein and Zeaxanthin Supplementation: A Randomized, Double-Masked, Placebo-Controlled Trial.” American Journal of Ophthalmology, vol. 154, no. 4, 24 Apr. 2012, doi:10.1016/j.ajo.2012.04.014.
7. Hammond BR, Fletcher LM, Roos F, Wittwer J, Schalch W. A double-blind, placebo-controlled study on the effects of lutein and zeaxanthin on photostress recovery, glare disability, and chromatic contrast. Invest Ophthalmol Vis Sci. 2014;55:8583–8589. DOI:10.1167/iovs.14-15573
8. Davis RL. Preliminary results in macular pigment optical density associated with and without zeaxanthin and lutein supplementation. Adv Ophthalmol Vis Syst. 2015;2(6):190-194. DOI: 10.15406/aovs.2015.02.00066
9. Bernstein, Paul S., et al. “The Value of Measurement of Macular Carotenoid Pigment Optical Densities and Distributions in Age-Related Macular Degeneration and Other Retinal Disorders.” Vision Research, vol. 50, no. 7, 8 Oct. 2009, pp. 716–728., doi:10.1016/j.visres.2009.10.014.
10. Herman JP, Kleiner-Goudey SJ, Davis RL. Case Report of Dietary Supplements Improving Macular Pigment and Visual Function. Adv Ophthalmol Vis Syst 6(1): 00166. DOI: 10.15406/avos.2017.06.00166
11. Stringham, James M., et al. “Macular Carotenoid Supplementation Improves Disability Glare Performance and Dynamics of Photostress Recovery.” Eye and Vision, vol. 3, no. 1, 25 Oct. 2016, doi:10.1186/s40662-016-0060-8.
12. Stringham JM, O’Brien KJ, Stringham NT. “Contrast Sensitivity and Lateral Inhibition Are Enhanced With Macular Carotenoid Supplementation.” Investigative Opthalmology & Visual Science, vol. 58, no. 4, 21 Feb. 2017, p. 2291., doi:10.1167/iovs.16-21087.
13. Richer, Stuart P., et al. “Randomized, Double-Blind, Placebo-Controlled Study of Zeaxanthin and Visual Function in Patients with Atrophic Age-Related Macular Degeneration.” Optometry - Journal of the American Optometric Association, vol. 82, no. 11, 11 Nov. 2011, doi:10.1016/j.optm.2011.08.008.
14. Holden JM, Eldridge AL, Beecher GR, et al. “Carotenoid Content of U.S. Foods: An Update of the Database.” Journal of Food Composition and Analysis. 12(3):169–196. doi:10.1006/jfca.1999.0827. https://pdfs.semanticscholar.org/e4c6/b34198990277a996de37ac537083e4e0e827.pdf
15. “Chapter 2 - Shifts Needed To Align With Healthy Eating Patterns.” Current Eating Patterns in the United States - 2015-2020 Dietary Guidelines, Office of Disease Prevention and Health Promotion, Dec. 2015, health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/chapter-2/current-eating-patterns-in-the-united-states/ .
16. Bovier ER, Hammond BR. A randomized placebo-controlled study on the effects of lutein and zeaxanthin on visual processing speed in young healthy subjects. Arch. Biochem. Biophys. 572:54-57. http://dx.doi.org/10.1016/j.abb.2014.11.012

DR. SCLAFANI is vice president of professional affairs for SynergEyes and continues to see patients at SoLo Eyecare, a private practice in Chicago, and at the Illinois College of Optometry, where she also trains optometry interns. She is a member of the EyePromise Scientific Advisory Board. She has held leadership roles in the American Optometric Association, was awarded the status of diplomate by the American Academy of Optometry CCLRT, is a fellow of the Scleral Lens Society and associate member of the International Society of Contact Lens Specialists.