nutrition
Building Your Practice with Antioxidants
Prescribing this nutritional element is good for your patients and your practice.
BY RICHARD S. KATTOUF, O.D., D.O.S., Warren, Ohio

Editor's note: In June, Dr. James Thimons discussed nutraceuticals from a clinical perspective. This month, Dr. Kattouf looks at them from a practice management angle.

As a management consultant to both optometric and ophthalmic practices for many years, I've had the opportunity to go on site in hundreds of offices. A common denominator in optometry is the general mode of practice -- and if you're practicing as a generalist, then you're significantly limiting your net income. The reasons are simple:

• Profit margin from contact lens materials is low
• Managed care vision plans, which are more prominent, erode from your profit margins
• Many medical insurance plans are closed panels, which don't reimburse O.D.s.

Consider the alternatives

• Corneal refractive therapy
• Computer vision syndrome
• Low vision
• Orthoptics
• Medical optometry
• Developmental vision
• Prescribing antioxidants.

Obviously optometrists, just like ophthalmologists, have multiple options in which to specialize the services they offer in their practices.

Remember, you're a teacher

Before concentrating on the prescribing of antioxidants, think about your professional obligation to your patients:

• 50% rendering quality care
• 50% selling the quality care.

I define rendering quality care as not only practicing top clinical skills, but also educating patients regarding prevention to systemic and ocular conditions.

In my experience as a consultant, I've seen that nationally, patients seek out their eyecare professional every 2.9 years. This proves that optometrists and physicians are not educating their patients about preventive eye health care.

Eyecare professionals who don't communicate the preventive concepts for systemic and ocular health aren't rendering the utmost in quality care. Selling the quality care in this case is prescribing the proper antioxidants for preventive systemic and eye health care.

Green is good

Several manufacturers produce antioxidants for the prevention of and in some cases treatment of ocular disorders such as cataracts and AMD. I suggest that you take one of these antioxidants, such as Whole Body Maxi Vision (developed by Medical Ophthalmics) and compare it to a popular multivitamin supplement, such as Centrum and Centrum Silver. If we concentrate on just one ingredient, lutein, it's obvious that the percent of this vital antioxidant is low in Centrum Silver.

Lutein is found naturally in spinach, kale and other deep greens. It's most often hailed as a possible way to protect eyes from macular degeneration. A Dutch study of men showed that taking 10 mg of lutein daily for three months increased the thickness in the macula by 22%, presumably reducing its vulnerability to damage and loss of vision. A Harvard study found eating 6 mg of lutein a day (roughly 1/4 cup of cooked spinach) lowered odds of macular degeneration by 43%.

Evidence abounds

Several other studies indicated that proper ingestion of lutein seems to reduce the odds of cataracts by 20% to 50%. Tufts University and Korean investigators, for instance, revealed a dramatic 88% drop in breast cancer in women who had the highest blood concentrations of lutein. The University of Utah Medical School found that the highest consumers of lutein were 17% less likely to develop colon cancer than those who ate the least.

High lutein also has been linked to fewer lung, prostate and ovarian cancers. A University of Southern California professor, James H. Dwyer, compared the carotid arteries of middle-aged people. In 18 months, people who had the lowest blood lutein had four times the carotid thickening of people who had the highest levels. Cells bathed in lutein were less likely to help "bad" LDL cholesterol stick to artery walls.

Get them a connection

The above information supports the need for eyecare professionals to educate patients and to prescribe the proper antioxidants. The O.D. can prescribe or sell the antioxidants directly from the office. Some companies give adequate samples and your office simply sends the patient information back to them. The company tracks the direct sale of your office referrals and sends you a quarterly percentage of sales.

Make it happen

Taking the time to educate your patients to the needs of preventive vision care and selling the patient, or leading him to, the proper antioxidant is an obligation of every eyecare professional. Additionally, of course, selling antioxidants can serve as an excellent alternative profit center. Remember, to grow your practice, you must push out and make things happen. I observe most doctors letting things happen to them and not controlling their practice.

References available on request.