Nutrition and eye health

NUTRITION AND EYE HEALTH Nutrition advice for patients now

Why? When? What?

Now is the ideal time to be proactive with nutrition advice, for both patients and your practice, write Steph Moore and Alex France

Figure 1: Nutrof Total provides key ingredients for eye health

In the June issue of Vision Now, we looked into how having a proactive approach to nutrition, supplements and eye health can make a big difference to patient care, and to your business. We spoke to two eyecare professionals about their approach to addressing risk factors, and how they believe conversations about lifestyle and supplementation are central to a modern optometry practice.

This article continues the conversation about why now is the time to be engaging with patients on nutrition and their eye health care, and why you should make this central to your business in 2020 and beyond.

IMPACT OF THE PANDEMIC The Covid-19 pandemic has led to patients being increasingly aware of their general health and wellbeing. In just one example, the Couch to 5k running app experienced a 92 per cent increase in downloads between March and June this year versus the same period last year. However, there are some impacts of the pandemic that could adversely affect patients’ eye health.

Ophthalmology is normally the busiest department in the NHS, with more than eight million out-patient appointments every year; this is the highest of any department, including trauma. Cataract surgery is the most commonly performed surgical procedure, with 414,000 operations being carried out in England in 2017/2018, and 20,000 in Wales.

As a result of the pandemic, and the resultant backlog from three to four months of no routine ophthalmology services, it is arguably essential that we start talking to patients about self-care – and do our part to be proactive in trying to keep patients out of ophthalmology departments. Another change the pandemic has brought is to our food shopping habits. In a world where patients are now reducing their number of visits to the supermarket, it is particularly important to remind them about the importance of nutrients for eye health; in particular, the regular consumption of fresh fruit, vegetables and fish throughout the week.

WHAT MAKES A GOOD EYE SUPPLEMENT? Previously, we have explored what is important to patients when it comes to choosing which nutritional supplement to recommend, and that simplicity is key. An all-in-one formulation, such as Nutrof Total (Figure 1), provides this – but with many ingredients within (Figure 2). Why are these ingredients chosen for eye health supplements? And how can we communicate their benefits to patients?

Nutrients are key vitamins and minerals essential for health, and often only obtainable through what we eat. The following vitamins and minerals are known to support eye health...

Vitamin D UK government guidance is that daily supplementation with vitamin D is a good thing for us, and has re-emphasised this advice in recent months, where more time has been spent indoors. What your patients probably don’t know about is the role vitamin D deficiency plays in eye diseases such as age-related macular degeneration (AMD) (Annweiller 2016).

Very few foods naturally contain vitamin D (some can be found in some oily fish and eggs) so many countries, including the UK, fortify foods such as cereals and milk. The protective effect that vitamin D has on the retina is centred around inhibiting oxidation and reducing inflammation and angiogenesis. Zinc An important nutrient to tell your patients about is zinc, a mineral found in high concentration in the retina itself and which occurs naturally in shellfish. Discussions currently are centred around its role in normal immune function, although increased zinc intake has been associated with decreased risk of both early and late stage AMD (Ho 2011). Zinc is known to be a co-factor of many metabolic processes in the eye, which are important in protecting the retina from oxidative damage.

Vitamin E Vitamin E is a powerful antioxidant that helps protect the membranes of cells from free radicals; these are damaging molecules that are a metabolic by-product. Vitamin E can be found naturally in nuts and seeds, particularly in sunflower seeds and almonds. Research suggests that vitamin E may help reduce the worsening of AMD in patients who show early signs of the disease.

However, vitamin E is easily stored by the body, it can accumulate and cause potentially unwanted side effects, so caution should be taken before ingesting very high quantities. A supplement such as Nutrof Total, containing 83 per cent of a patient’s nutrient reference value (NRV), means it is safe to recommend for all patients – alongside a healthy diet.

Selenium Selenium is a key antioxidant and supports the action of vitamin E and zinc. It is found naturally in nuts, meat, fish and some seeds, and plays a key role in regulating oxidative stress in the cornea and surrounding tissue. Combined with vitamins C and E, selenium may reduce the risk of advanced AMD.

Vitamin C Otherwise known as ascorbic acid, vitamin C is something that we are used to hearing that as a population we need more of in our diets, but it’s a conversation worth recapping with patients. It’s often forgotten that we cannot store vitamin C, any daily excess is excreted, so a regular daily supply is important. Vitamin C is used to form and maintain connective tissue, including the collagen found in the cornea, and it helps promote health blood vessels, such as the tiny capillaries to the retina.

Omega 3 Omega 3 is a nutrient that patients are used to being told that they need more of and are often aware of its benefits for overall health, but may not know that several studies have also shown that omega 3 can be beneficial for eye health. Several studies also suggest that omega 3 fatty acids may help protect adult eyes from macular degeneration and dry eye disease, as well as prevent cataracts (Merle 2011).

Resveratrol Resveratrol benefits tend to be less well known. Although many people have heard that red wine and dark chocolate are good for you, patients won’t know why, nor be aware of the relevance to eyes. They both contain a substance called resveratrol, which has powerful antioxidant, anti-inflammatory and anti-angiogenic properties.

For example, a report on resveratrol-based supplementation observed a short-term effect similar to that found with anti-VEGF (vascular endothelial growth factor) treatment, including anatomical restoration of the retinal structure, improved retinal pigment epithelium function, and suggested improved choroidal blood flow (Richer et al 2014)

HOW CAN NUTRITIONAL ADVICE BENEFIT YOUR PRACTICE? As eye health professionals, we routinely discuss the latest technologies to educate and protect our patients, and certainly encourage the wearing of sunglasses to protect against UV damage. An important distinction to make is that supplementation is also one way to ‘protect’ eye health from within, whereas limiting the exposure to sunlight and pollution are important ways to protect eyes from the outside.

Research has shown that giving a patient a number that is a measure of their health status can greatly improve the likelihood that they make changes to their diet and lifestyle (Margolis 2013). Instruments that indicate macular pigment levels directly, or indirectly, can be useful here. Even presbyopia onset, or a normal optical coherence tomography result, can be turned into a conversation about how to maintain healthy eyes and vision into old age, even when no symptoms or signs are present.

Presbyopia is often the point when patients experience the first physical signs of ageing. Patients may have noticed their sight deteriorating with increased screen use through lockdown, so reading glasses are an obvious recommendation. However, a conversation about supporting their sight long-term through nutrition is often something unexpected, but can leave patients feeling empowered about supporting their own vision.

BUILDING A BETTER BUSINESS We have explored the benefits of recommending eye health supplements in terms of increased service offering, and encouraging patients to make positive changes to improve their eye health – but what effect can offering a supplement have on your business?

The average dispense value sits at around £200, with patients returning every two-anda-half years – resulting in an average revenue of £80 per year. With the recommendation of

HEAR FROM THE EXPERTS

Thea is hosting an evening with a selection of experts from across the optical sector – discussing why now is the time to talk about the importance of nutrition in eye health with your patients. Sign up at https://www.theapharmaceuticals.co.uk/events/letstalk-nutrition

Figure 2: Nutrof Total ingredients and their benefits

an eye health supplement, such as Nutrof Total, and the commitment from the patient to purchase monthly, yearly revenue becomes £260. If we can ensure you are happy with your clinical guidance, eye health products can form a stable and regular income, to support your practice through periods of uncertainty.

Your recommendation to patients can be very powerful, with 43 per cent of patients saying they would take a supplement if it was recommended to them by a health care professional (20:20 Vision Report), so proactivity is key. 2020 has so far been a year focused on health and wellbeing, and patients are more aware than ever before about the role nutrition and supplementation have to play in this. The right advice now could bring positive changes for both patients and practice for years to come.

We are here to support you and your practice, either in person or remotely with training and tools to help make recommending nutritional advice and supplements a success in your practice. Please contact your Thea area sales manager for more information, or call 01782 381698.

Steph Moore is area sales manager for the South West, and Alex France is area sales manager for the West Midlands at Thea Pharmaceuticals.