CLINICAL

  NUTRITION

GROW MEDICALLY

ACHIEVE THIS BY PROVIDING NUTRITION AND LIFESTYLE COUNSELING

LAURIE CAPOGNA, O.D.

ANY OPTOMETRIST in a medical practice knows that most of the day is spent managing and treating ocular disease. For the first 17 years of my career I practiced with an ophthalmologist, and everyday I was a “reactive warrior,” providing my patients with therapeutic solutions.

Through the years, I noticed that patients began asking how their diets and lifestyles affected their ocular health. This made me realize I needed to implement nutrition and lifestyle assessments into my already-busy practice. I achieved this by integrating counseling and holistic programs into every treatment plan.

Here are some specific examples under each and how doing so grew the medical portion of my practice.

COUNSELING

Two examples:

1. Dry Eye Disease (DED). I ask these patients how many times per week they eat wild salmon, rainbow trout, sardines and mackerel. The purpose: To see whether they receive 850mg per day of DHA and EPA, both of which can help alleviate the symptoms of DED and support retinal health. Patients need to eat approximately four servings of one of these fish per week.

Once I get a sense of the amount of omega-3s a DED patient is obtaining from his or her diet, I often recommend supplementation with a high-quality omega-3 product from a reputable supplier that has quality controls in place and that sources small fish from clean waters. I recommend between 1000 mg and 2000 mg of DHA and EPA, depending on the severity of the patient’s DED and his or her current diet.

Consider asking patients who have diabetes to keep a food and physical activity journal.

2. Diabetes or diabetic retinopathy. I initiate the conversation about healthy body weight and its relationship to ocular health. Most of our patients are aware that excess weight gain is linked to complications with overall health. However, few know that high body weight can affect their ocular health. To approach the subject in a sensitive and effective manner, research shows that people respond best to “weight” and “BMI” vs. “overweight” and “obese.” Here is an example of how to approach the topic:

“Trish, I am concerned about your weight and the impact that it may have on your ocular health. I would like to discuss this relationship with you today; are you OK with that?”

Next I ask, “What kinds of things have you done in the past to change your eating habits?” and “What type of physical activities do you enjoy?” to increase the patient’s motivation for weight loss. Finally, I refer the patient to a trusted dietitian, weight loss support group, gym or fitness club.

HOLISTIC PROGRAMS

Two examples:

1. Diabetes care program. I have these patients complete a food and physical activity journal for one week before their next appointment. I also acquire a macular pigment optical density measurement to assist in making appropriate supplementation recommendations and to track the efficacy of the plan. Also, I utilize OCT and retinal photography and review the images with my patients to educate them about how specific nutrients reside in the macula and support macular health, as well as blood vessel function. Finally, I collaborate with a dietitian or naturopath, either in-office or through a referral, to provide food and nutrition counseling to best support balanced blood sugar levels and weight loss.

2. Inflammation care program. Many ocular conditions, such as DED, are manifested from underlying inflammation, I refer these patients to nutrition professionals for anti-inflammatory diets.

GROWTH

The medical segment of my practice has grown because my patients have become billboards for my practice, promoting the fact that I provide proactive vs. reactive health care. OM

DR.CAPOGNA is is an active partner in Peninsula Vision Associates and operates a low vision clinic. In addition, she is a member of the Ocular Nutrition Society and co-author of “Eyefoods: A Food Plan for Healthy Eyes and Eyefoods for Kids: A Tasty Guide to Nutrition and Eye Health.” E-mail lcapogna@cogeco.ca, or send comments to optometricmanagement@gmail.com.