One of the by-products of the COVID-19 pandemic is an increased interest in supplements, according to a Global Trends Study, published in Nutrients, as well as a COVID-19-focused consumer survey released by the Council for Responsible Nutrition. While this interest has primarily been related to boosting the immune system, optometrists may find that patients are more familiar with and receptive to hearing about ocular nutritional supplements. Indeed, a study from McKinsey & Company, a manufacturer of consumer packaged goods, shows that a majority of consumers plan to increase their spending in the wellness category.

“I think most people want to be proactive with their health, and the pandemic has only turbocharged that way of thinking,” says Michael Lange, O.D., C.N.S., founder of Lange Eye Care and Associates and The Lange Eye Institute, The Villages, Fla. Dr. Lange is also the creator of Fortifeye Vitamins and host of the syndicated talk show Ask the Dr. “More than ever, patients want to know how they can prevent or manage health concerns in a more natural way.”

In addition to the heightened overall interest and awareness in proactive health measures, like taking supplements, there also has been increased concerns over screen time and its impact on eye health, reports Clinical and Experimental Optometry, among other scientific journals. Laurie Capogna, O.D., founder of Eye Wellness, Niagra Falls, Ont., and author of Eyefoods: A Complete Eye Health and Nutrition Guide, says she believes that has led to more questions about supplements for dry eye disease, in particular.

Dr. Lange agrees. He says that more patients are complaining of eye strain or fatigue — and asking for supplements that might protect their eyes from blue light.

Here, O.D.s discuss how to meet these, among other, patient expectations, communicate the value of and, ultimately, offer ocular nutritional supplements in-office.

SUPPLEMENTS BY AGE

Percentage breakdown by patient age of supplements sold in office over three years at Louisville Eye Center. This excludes AREDS supplementation.

 

 

MEET PATIENT EXPECTATIONS

Mentioning ocular nutritional supplements is now the bare minimum, says Dr. Capogna. For many patients, she says, it will be an expectation, akin to discussing sunglasses and UV health. In Dr. Capogna’s practice, she says she meets this patient expectation by reviewing her patient intake forms, which typically reveal her patients are already taking a variety of supplements; this knowledge opens the door to the ocular nutritional supplements conversation.

“Our patients are increasingly health conscious and expect this type of guidance,” Dr. Capogna says. “Some patients with a number of comorbidities may have been advised against certain supplements. So, as a general rule, I’ll connect with the primary care physician after my recommendations.”

Mark Roark, O.D., F.A.A.O., of Allisonville Eye Care Center, Inc., Fishers, Ind., says that because he’s already communicating with the primary care physicians (PCP) of his diabetic patients, for example, he includes a detailed list of any supplements he recommends.

“This also presents an opportunity for us to bring nutrition to the forefront of the discussion with the primary care audience,” he says.

In addition to diabetic patients, other patient populations that would specifically benefit from co-management with the PCP are patients who are using any anticoagulants or have a history of clotting issues, notes Aaron McNulty, O.D., F.A.A.O., of Louisville Eye Center, Louisville, Ky.

COMMUNICATE THE VALUE

As interest in supplements rises, so too does the consumer’s desire to understand the nature of their wellness products, according to the McKinsey & Company report. As such, it’s imperative that optometrists take the time to do their research to communicate with and educate patients on their recommendations.

“The best thing that we can do as optometrists is to understand the supplements that we’re recommending to our patients — including the research and studies behind them,” says Ryan H. Powell, O.D., of Vision Source Eyecare, Pleasant Hill, Mo. “Then, we can speak to the difference between the products we believe in (and possibly even carry).”

Dr. Powell admits that’s not a simple feat. He says that he accomplishes it through a multi-faceted effort that includes Googling the latest research related to carotenoids, omega-3 and omega-6 and other supplements, so that he can stay up-to-date with what’s out there. Additionally, he says he reads studies put out by supplement manufacturers.

“I also have the advantage of knowing a couple of Ph.D. researchers, so I am able to pick their brains often,” Dr. Powell adds. “And there are good publications that help gather this information, including Optometric Management and the AOA newsletter.”

“With supplements remaining unregulated by the FDA, it’s a time-consuming challenge to keep up with the research,” he continues. “But it’s one we must take on to be able to confidently make recommendations.”

Dr. McNulty says that many of his patients do understand the vast quality differentiations of products on the market.

“When you can walk into a pharmacy or grocery store and are overwhelmed by choices, it’s easy to see how patients become skeptical — and rightfully so,” he says. “We need to be able to have well-informed conversations with our patients about what the data supports. The general consensus with vitamins is that it’s a ‘go big or go home’ situation. Patients either need to take a really high-quality supplement or not waste their money. Low-quality vitamins just won’t deliver the results.”

Dr. McNulty says that the following points should be covered in this patient conversation:

• Getting nutrients as part of a healthy diet is always best. But in being honest, most people realize they can’t get a lot of these foods in their diet, so they would benefit from a high-quality supplement.
• High-quality and/or pharmaceutical-grade supplements likely have far greater bioavailability and a greater chance to move the needle.
• Address preconceived notions that patients may have about supplements and multivitamins.

OFFER SUPPLEMENTS IN-OFFICE

While recommending ocular nutritional supplements does not automatically mean doctors must carry them, many say there are benefits to doing so. For her part, Dr. Capogna says that her patients prefer it:

“It’s a huge part of our business model and something that I think patients appreciate,” she says. “Patients would rather be able to purchase the supplements that we recommend directly from us. At the height of the pandemic, patients were still calling us to purchase them through us.”

Additionally, those O.D.s interviewed reported that patients are purchasing supplements in larger quantities, so that they don’t have to return periodically to replenish their supply.

Dr. Capogna says the increased interest in bulk purchases has led her to consider offering package pricing in the future. She says she has also been contemplating a tracking system in which she could alert patients when they are running low.

Dr. McNulty says that, for his practice, supplements have never been a major revenue source. But, he still believes carrying them in the office benefits the patient by instilling confidence in the prescription and providing convenience.

“I think you’d have to do a substantially large volume for the revenue stream to pay off, but I still think it’s important to carry supplements in the office, so that patients can feel confident that they’re getting something worthwhile for their money,” he says. “It also enhances compliance when the patient can leave with the same product you’re recommending.”

OMEGAS IN THE AMERICAN DIET

The average American is consuming only about a fifth of the minimum dietary omega-3 recommended for cardiovascular health or, if diabetic, to reduce the risk of severe retinopathy.

 

 

Sources: Mark Roark, O.D., F.A.A.O, Cave C, Hein N, Smith LM, et al. Omega-3 Long-Chain Polyunsaturated Fatty Acids Intake by Ethnicity, Income, and Education Level in the United States: NHANES 2003–2014. Nutrients. 2020; 12(7):2045. doi.org/10.3390/nu12072045 and adult intake guidelines from the International Society for the Study of Fatty Acids and Lipids.

At the end of the day, optometrists say that offering ocular nutritional supplements can position the practice as more valuable to the patient.

“I think many more patients are cognizant of their lifestyle choices and how they impact their long-term health these days,” says Dr. Roark. “As optometrists, we need to be on board with that and look at the big picture. When we go beyond just their eye exam and start talking about nutrition and how it impacts not only their eye health but their health in general, we offer a lot of value to the patient. In my practice, we talk a lot about the Mediterranean diet from which patients can garner some of these valuable antioxidants. Still, most patients are realistic, knowing that their diet alone will fall short. That’s where we can be helpful and counsel the patient.”

Dr. Lange says that if doctors don’t carry supplements in the office, there’s a high probability that patients might end up with a different brand — potentially a product of lesser quality than what was intended at prescribing. Like Dr. McNulty, he agrees patients may forget to follow through at all. Dr. Lange recommends having a display on-hand that educates patients while they’re in the waiting room or checking out.

“One thing we’re doing more of now is offering a QR code that patients can scan and learn more about the supplements,” Dr. Lange says. “People are less comfortable touching brochures these days because of the pandemic, so that’s a simple solution.”

A DIFFERENTIATING FACTOR

Carrying ocular nutritional supplements can be a differentiator — which is a big deal in the crowded marketplace of optometry, Dr. Lange adds.

“Being able to offer high-quality and effective nutritional eye care is that differentiator,” he says. “Patients respond so well to it, and it has that proverbial snowball effect as they tell others.”

As patients only become more interested in their overall health and wellbeing — and how they can make positive changes — Dr. Lange says the desire for nutrition eye care will grow: “The bottom line is if you’re not the one offering it, someone else will. And that’s where your patients will go.” OM