Research shows ocular nutritional supplementation plays a significant role in decreasing ocular disease progression risk, yet research also shows low patient adherence to such supplements.1 One reason for this is a lack of patient education on the seriousness of their disease. In fact, one study on patient knowledge regarding age-related macular degeneration (AMD) shows, “a large percentage of patients seemed to lack information,” prompting the study’s researchers to conclude, “well-informed patients would be better able to follow their physician’s instructions and would have a better understanding of their disease, particularly for the sake of therapy.”2
October (this month’s issue) is Health Literacy Awareness Month, and poor health literacy is linked with poor patient adherence.3 In this article, I discuss the specific patient education I provide that has resulted in increased compliance with ocular nutritional supplements.
“There’s a link between diet and ocular health.”
Patient understanding of the connection between diet and ocular health is the foundation of patient education regarding ocular nutritional supplementation. To instill this understanding in patients whose intake forms reveal shortcomings in daily servings of fruits, vegetables, and fish, I focus on these two areas:
• Macular carotenoids. As I review the patient’s retinal photography and ocular coherence tomography findings, I discuss that lutein and zeaxanthin are nutrients specifically delivered to the retina for eye health via ingestion alone. Additionally, I explain that the nutrient meso-zeaxanthin is rarely accessible through diet:4
“Our bodies do not make macular carotenoids, so we must obtain them. Macular carotenoids are so important for eye health, that they are found 1,000 times in higher concentration in the macula — a part of the retina that provides our central vision — than in other parts of the body. Unfortunately, most North Americans are deficient in lutein and zeaxanthin, obtaining roughly 2 mg/day, when 6 mg to 14 mg daily is shown to decrease the risk of AMD, as well alleviate symptoms.”5
• Omega fatty acids. I tell my nutrition-deficient pa-tients that omega-3 fatty acids optimize the photoreceptors (the retina’s light-detecting cells), the integrity of the retina, visual function,6 and address the inflammation linked with dry eye disease (DED),7 respectively:
“For this reason, ingesting omega-3 fatty acids is integral to both ocular health and visual function. Also, gamma-linolenic acid from omega-6 fatty acids assists in improving DED signs and symptoms.8
“Ocular nutritional supplements contain macular carotenoids and omega fatty acids”
As each patient’s ocular health needs and dietary intake are unique, I create personalized treatment plans based on the patient’s intake form. An additional benefit in taking this approach is that personalizing this information enhances patient engagement with the plan, which I have found reinforces the importance of adhering to the personalized plan.
Some examples of treatment plans personalized for patients based on their patient intake form and how I discuss said plans:
• A patient with a family history of AMD. “Diet is very important for patients who have a family history of AMD because research consistently shows that dietary intake of carotenoids and antioxidants, such as vitamins C and E, as well as fish consumption, can be beneficial in lowering AMD risk. Based on your patient intake form, I think ocular nutritional supplementation, which contains macular carotenoids and omega fatty acids, could be beneficial. That said, ocular nutritional supplements do not replace a healthy diet.”
• A patient who has moderate or advanced non-neovascular AMD. “I’m prescribing for you a specific supplement that can decrease the risk of your AMD progressing to neovascular AMD. Neovascular AMD occurs when abnormal blood vessels grow beneath the macula — a part of the retina that provides our central vision — and can leak, causing sudden and severe vision loss. It is important to make this part of your daily habit, in also keeping in mind that the ocular nutritional supplement will not replace a healthy diet.”
• A patient who has DED. “Omega-3 fatty acids play an integral role in our overall health and ocular health. They are present in every cell membrane in our body, part of the vision signal, and are anti-inflammatory. Fish is the best food source of omega-3 fatty acids, and most North Americans do not consume much fish. DED is an inflammatory condition. If you are not consuming fish regularly, an omega supplement is important.” (See “Emphasize the importance of adherence to the specific supplement prescribed, below.)
Emphasize the importance of adherence to the specific supplement prescribed
Patients, unlike optometrists, do not know that both the quality and quantity of ingredients in ocular nutritional supplements vary by manufacturer, affecting efficacy. Thus, if left to their own devices, patients will purchase, for example, an “omega-3” supplement that’s not effective.
As a result, it is crucial ODs emphasize that they are prescribing (insert brand) because (insert brand) is what they’ve deemed effective, based on vetting research. (Another factor to consider is whether the patient is on a vegan diet or has a fish allergy):
“The ocular nutritional supplements we provide in the practice are comprised of the appropriate amount of each nutrient based on scientific studies. Armed with this knowledge, I can best advise you on the proper dosage.”
A great way ODs can ensure their AMD or DED patients acquire the specific supplement prescribed is to offer it in their optical. Additionally, patients appreciate the convenience of being able to do so, which I have found enhances patient compliance to my ocular nutritional supplement prescriptions.
Enhancing adherence
While 100% compliance to our prescriptions is impossible, ODs can significantly improve adherence to ocular nutritional supplementation by providing patient education in the areas outlined above. This proactive approach enhances treatment efficacy, as it empowers patients to play a role in management. OM
References:
1. Hochstetler BS, Scott IU, Kunselman AR, Thompson K, Zerfoss E. Adherence to recommendations of the age-related eye disease study in patients with age-related macular degeneration. Retina. 2010:1166-70. doi: 10.1097/IAE.0b013e3181cea5c6.
2. Burgmuller M, Cakmak N, Weingessel B, Vecsei C, Vecsei-Marlovits PV. Patient knowledge concerning age-related macular degeneration: an AMD questionnaire. Wien Klin Wochenschr. 2017;129(9-10):345-350. doi: 10.1007/s00508-016-1044-3.Epub 2016 Jul 25.
3. Baryakova TH, Pogostin BH, Langer R, McHugh KJ. Overcoming barriers to patient adherence: the case for developing innovative drug delivery systems. Nat Rev Drug Discov. 2023; 22(5): 387–409.Published online 2023 Mar 27. doi: 40.1038/s41573-023-00670-0
4. Bernstein PS, Li B, Vachali PP, et al. Lutein, Zeaxanthin, andmeso-Zeaxanthin: The Basic and Clinical Science Underlying Carotenoid-based Nutritional Interventions against Ocular Disease. Prog Retin Eye Res. 2016; 50: 34-66. doi: 10.1016/j.preteyeres.2015.10.003
5. Ma L, Liu R, Du JH, Liu T, Wu SS, Liu XH. Lutein, Zeaxanthin and Meso-zeaxanthin Supplementation Associated with Macular Pigment Optical Density. Nutrients. 2016 Jul; 8(7): 426. Published online 2016 Jul 12. doi: 10.3390/nu8070426
6. Querques G, Forte R, Souied EH. Retina and Omega-3. J Nutr Metab. 2011; 2011: 748361. doi: 10.1155/2011/748361
7. Wang WX, KO ML. Efficacy of Omega-3 Intake in Managing Dry Eye Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med. 2023: 7026. Published online 2023 Nov 10. doi: 10.3390/jcm12227026
8. Vasquez A. Reducing pain and inflammation naturally. Part II: new insights into fatty acid supplementation and its effect on eicosanoid production and genetic expression. Nutritional Perspectives: J Counc Nutr Am Chiro Assoc. 2005;28(1):5-16.”
