Nutrition and eye health

NUTRITION AND EYE HEALTH We need to talk about nutrition

Steph Moore explores how you can empower your patients when it comes to nutrition for eye health

A proactive approach to nutrition and eye health can make a big difference, both to patient care and for your business. Traditionally, conversations around diet and lifestyle have not been a primary role for an eyecare professional. They can also be deemed difficult to start, time-consuming or maybe even non-essential. This article shares approaches that can help you to refine your approach to eye health conversations, and therefore give your patients the best advice.

Two million people in the UK are already living with poor vision. By 2050, the number of people living with cataracts and glaucoma will double, while macular degeneration will almost triple (Pezullo et al, 2018). With this in mind, and the ever-increasing strain on the NHS, conversations about how to maintain vision and care for ageing eyes are both clinically and economically important. This can also be a key consideration for a successful practice, from both a financial perspective and for building trusted, longterm relationships with your patients.

IMPROVING KNOWLEDGE AND UPTAKE When a group of 126 ECPs (Nutritional Advice in Optometry Survey, 2019) were asked if they took a nutritional supplement for themselves, 52 per cent replied yes. However, when the question was asked about recommending a supplement for eye health to their patients, only 22 per cent replied that they would recommend such a supplement to most patients. So, what more can be done to give patients the best possible advice when it comes to protecting their eyesight in the long term?

We talk to Jean Oldbury, optometrist at Oldbury and Cruickshank in Macclesfield, and Leanda Beynon, a dispensing optician working at Nixon and Shaw Opticians in Wiltshire. Both take a very proactive approach to offering lifestyle and nutrition advice to their patients. Jean started to offer lifestyle and nutrition advice because she felt it was “a duty of care as an optometrist to give advice about a healthy lifestyle, and include advice on nutrition, especially if the optometrist is aware of any risk factors, including family history of age-related macular degeneration [AMD] or smoking.”

Leanda takes a holistic approach to her patients’ eye health. She says: “I feel passionately that it should be part of the dispensing process for dispensing opticians; we can offer so much more than spectacle sales. Talking to the patient about their eye health can be included in the hand-over, or when the dispensing optician is discussing the needs of the patient.”

Leanda also finds that moving the conversation onto risk factors can be a good

Prevention is always better than cure

pathway into discussion about what patients can do to support their own eye health. Research has shown that giving patients a number that is a measure of their health status can greatly improve the likelihood of actually making changes to diet and lifestyle – and being compliant with those changes (Margolis et al, 2013 and Chen et al, 2019).

“Optical coherence tomography [OCT] allows us to explore patients’ eye health in more depth, and to show any changes happening over time to structures such as the macula,” Leanda explains. “It also presents us with the opportunity to discuss signs of conditions such as AMD, but also to advise patients on how to maintain healthy vision when no symptoms are present.”

Jean finds that “while having an OCT scan, the patient is more tuned in to what the OCT results may tell us. So whilst having a scan can be a ‘conversation’ piece, again, it’s also another way to keep healthy and live longer. Plus, it’s also something to drop in when talking about the advantages of having OCT and its results.”

Leanda keeps it simple and takes the time to demonstrate to patients the risks without the use of OCT. She explains: “I use the Thea nutritional questionnaire to demonstrate to the patient their risk and follow this with a conversation with knowledge of nutrition and supplements.” She adds: “Having confidence in the product you are recommending is invaluable.”

A common objection to recommending a nutritional supplement is the perception that the evidence is weak for their use. However, the evidence is actually strong around key nutrients that have been shown to support eye health, and therefore any product recommendation should include carotenoids (lutein and zeaxanthin), zinc,

vitamin D, omega three fatty acids and antioxidants such as vitamin E or resveratrol. Nutrients such as selenium and copper are also often added to supplements to complement the vitamin E and zinc components, respectively.

WHERE, AND HOW, TO BEGIN A good place to start introducing nutritional eye health supplements to your practice is to consider what is important to the patient. A supplement is most effective when patients remember to take it every day – a once-a-day formula is an advantage there. When patients do take it, it needs to be palatable and easy to swallow. Finally, consider a product with quality ingredients, with a formulation specifically for all aspects of eye health.

So how does the advice change when recommending to patients who meet one or more of the eye health risk factors, but do not have moderate AMD and therefore an AREDS formulation is not necessarily required? These two patient groups can have different sets of needs. While supplement and lifestyle information can be adapted for each, Leanda explains that taking the time to explain to AMD patients that the condition can be hereditary is particularly important to her, as well as advice on how to access further help, should they need it.

Leanda goes on to say: “The goal of prevention is always better than cure, and although there are no certainties, a wellinformed patient can make their own choices. This also builds loyalty to the practice through reputation.” Leanda recommends Thea’s Nutrof Total as an eye health supplement. “It is great for all-round eye health, including smokers, for whom it’s safe to use.”

She adds: “Introducing the idea of supplements goes hand in hand with discussions about eye health management, and quite naturally follows on. I often talk to patients about the large amount of a food type they would have to eat to get the same benefit as a supplement.” Jean also keeps the messaging simple for her patients, including advice that keeping yourself healthy means enjoying a longer,

The whole team can be involved with nutrition conversations

healthier life. “An easy way to do that,” she says, “is with nutritional supplements, rather than having to eat so much curly kale.”

OVERCOMING PATIENT OBJECTIONS Patient objection can be a common occurrence when opening up the conversation about nutrition, and in particular supplements. These are often valid questions and taking the time to answer these concerns are key to patients fully understanding the importance of your recommendation.

The most common push back is about the cost to the patient. Simple responses from, “Can you put a price on your eyesight?”, the quality of the ingredients, to breaking down the cost of the supplement per day (for example, Nutrof Total works out at 50p per day to the patient) will often sway their views and help them to understand the value of what you are recommending. been shown, nutrition is a topic that patients often have lots of questions about, and are willing to have a conversation about, so the whole team being confident on advice and products is key to a good customer relationship.

Another objection is often: “I eat a healthy balanced diet anyway, can I not get what I need through that?” To counter this, emphasis can be put on levels of lutein and zeaxanthin that the macula requires. Five-and-a-half portions of broccoli, 71 eggs or 83 carrots per day is really not achievable in any diet, so a little extra help is needed to protect our eyes in the long run. On this, Leanda adds: “I often give patients some literature to take away and have a read at home, and follow up with a phone call after a few days. Don’t be pushy, build confidence and rapport.”

In the same way that the whole team will be involved in conversations about OCT, presbyopia and sunglasses, lifestyle and nutrition is an equally important topic to have the whole team involved in. As has “Thirty-two years ago, it was a rare, or nonexisting conversation, now it should be commonplace. Eye health and supplements are an important part of the modern practice. My advice would be to embrace this, learn something new and offer more for your patients.”

Nutrition and lifestyle advice have not traditionally been considered a problem for optometry. However, the profession is perfectly placed to be able to offer sound, scientifically backed advice and products to help protect your patients’ eyesight in the long run.

Leanda concludes: “Thirty-two years ago, when I first qualified as a dispensing optician, there were no supplements, no nutritional advice or discussions about dry eye or AMD. Our knowledge and understanding have increased considerably over the years, and we owe it to our patients to offer the best service, advice, and products that we can.

With thanks to Leanda Beynon and Jean Oldbury for their valuable knowledge and insight.

For further information on nutrition, training or copies of the nutritional questionnaire, please contact your Thea area sales manager, or call 01782 381698 or email marc.smith@theapharma.com

Steph Moore BSc is an area sales representative for Thea Pharmaceuticals.