David W. Nelson, OD
E-mail: amoptbddwn@aol.com
Dr. Nelson is Senior Vice President of Professional Relations for Eye Solutions Inc. ESI is responsible for the introduction of Macula Risk for the eye care industries. Dr. Nelson also serves as a consultant for Optos, Optovue, LA Consultants, and is a member of the advisory board for Kodak Signet Armolite.
Take-Home Message
New genetic test can help you identify patients who are at the highest risk of developing vision loss due to age-related macular degeneration (AMD). This allows the optometrist to begin prescribing a treatment plan including nutritional supplementation accompanied with lifestyle counseling early on. Carotenoids such as lutein, zeaxanthin, and meso-zeaxanthin provide the most benefit in preventing or delaying the onset of vision loss caused by the disease according to resent research.
Genetic test, carotenoid supplementation provide new weapons against AMD
By Ron Rajecki
Reviewed by: Tammy Leonard
LAS VEGAS — A new genetic test that identifies patients at high risk for developing vision loss contributed by age-related macular degeneration (AMD) now allows optometrists to prescribe nutritional supplementation therapy and provide counseling for recommended lifestyle changes early on to perhaps prevent or delay the consequence of the disease, according to David W. Nelson, OD, a private practitioner at Eye Contact in Madison, WI. Dr. Nelson was speaking here at Vision Expo West.
The new test (Macula Risk, Arctic Diagnostics, Inc.) is a prognostic, cheek-swab DNA test that optometrists can perform in their offices. The test is designed for patients who have suspect drusen, early or intermediate AMD. It categorizes patients into five levels of risk: levels one and two being low risk, and levels three, four, and five being average, above average, and high risk, respectively, for experiencing vision loss caused by AMD.
“This test is very sensitive and specific — roughly 83% — successful prediction for vision loss associated with macular degeneration”, Dr. Nelson said. “This knowledge allows the optometrist to follow the AMD protocol and confidently prescribe according to the tailored treatment plan based upon the patient’s risk level.”
“You can’t pick your parents well enough, and genetics cause 70% of the attributable risks for AMD,” Dr. Nelson said. “The environment causes secondary problems, but once we’ve established the patients most at risk we can control many of the environmental ramifications. For example, UV exposure presents an environmental concern; optometrists should prescribe sunglasses to all patients however for those patients who are at risk of vision loss, sunglasses become part of the treatment plan. Lifestyle behavior changes should also be suggested; exercise, eat healthier, and stop smoking. Additionally, a carotenoid supplement must be considered because has been shown to have a protective benefit for macular function.”
Dr. Nelson said he prescribes both dietary changes and supplementation to increase high-risk patients’ intake of carotenoids, such as lutein, zeaxanthin, and relative newcomer meso-zeaxanthin, which is an isomer of lutein.
“I recommend vegetables in general, and green leafy vegetables in particular,” he said. “But realistically, it can be challenging for a patient to change his diet, and we know it is sufficient for patients to ingest the nutrients they need from a quality nutritional supplement.”
Dr. Nelson said when he sees a patient who is at the highest risk of developing AMD (the patient has a family history of AMD and genetic risks levels are higher than average risk); he prescribes a supplement (MacuHealth) that contains 10 mg of lutein, 2 mg of zeaxanthin, and 10 mg of meso-zeaxanthin. For purposes of comparison, an entire cup of diced red peppers contains about 1 mg of zeaxanthin.
Meso-zeaxanthin, which was discovered in 2003, appears to have antioxidant properties superior to lutein and zeaxanthin, according to Dr. Nelson. “Meso-zeaxanthin is the most protective carotenoid out there, and is always included in the nutritional regimen I prescribe.” he said. “Most all carotenoids have protective antioxidant properties for the eye; we want to prescribe right ones for the patient’s specific risk level.”
Dr. Nelson is also a fan of fish oil supplementation. He advises supplementation with a combined 2,000 mg of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)
“Fish oils benefit both dry eye patients as well as AMD patients,” Dr. Nelson said. “A daily dose of 2,000 mg, administered for 30 days, cuts dry eye symptoms in half for about 80% of patients. It has been my base treatment plan for dry eye patients for the past four or five years, and it’s probably the best thing I’ve ever prescribed since I’ve been in practice. It lowers cholesterol, reduces joint pain, and virtually eliminates dry eye.”
A new study by Harvard researchers found that women may be less likely to develop age-related macular degeneration (AMD) if they regularly ingest omega-3. Those female study participants who ate the greatest amount of omega-3 fats showed a 39 percent lower risk of developing AMD. (March 15, 2011)
Ultimately, Dr. Nelson said he would like to see more doctors become familiar with nutritional counseling and prescribing. Nutritional counseling can greatly benefit patients, especially once they have become inflamed with disease, he said. And patients like to hear — and are even expecting to hear — from their doctors what they should or shouldn’t be doing in the areas of supplementation. There’s no real regulation in the world of vitamins and supplements, so patients need a trusted source.
“When we’re prescribing anything, whether it’s short-term therapy for bacterial conjunctivitis or long-term therapy for glaucoma, we always specify the brand, type, dose, and duration, and that’s the way it should be done with nutraceuticals and supplements, too,” Dr. Nelson said. “Therapy with nutraceuticals and supplements should be doctor-directed and prescribed with confidence.”
LA Consultants takes a look at Total Focus...
As a result of increasing life expectancies, new preventive research, and a better understanding of disease mechanisms, patients and doctors are beginning to change their approach towards health care. A national Healthy People 2010 campaign was launched with the AOA playing a key role and adopting the theme Healthy Eyes, Healthy People. As a result of this new direction in health care, Optometrists have seized a part of a market that is becoming more and more vital to the average American nutritional supplement guidance.
The standard of care - Prevention-Diagnosis-Treatment - achieves the level of service patients are seeking while simultaneously increasing revenue opportunities for the Optometric practice. EDC Laboratories, Inc., Total Focus, provides pharmaceutical grade vitamins manufactured exclusively for optometrists and their patients. The therapeutic potencies of Total Focus products are designed and targeted for nutritional protocols and treatment.
Since early 2000 research released by JAMA, the National Eye Institute, the American Journal of Clinical Nutrition and Archives of Ophthalmology has indicated that eye diseases such as macular degeneration, glaucoma, cataracts, diabetic retinopathy and other eye related disorders may be prevented or progression slowed with a combination of specific nutrients such as Vitamin C, Vitamin E, Beta-carotene, Zinc, Alpha Lipoic Acid, Luetin and Zeaxanthin. Now, new research indicates that for patients diagnosed with AMD, the micro nutrient meso-zeaxanthin could have the most and best benefits to slowing and in some cases halting the progression of the blinding eye disease. Meso-zeaxanthin, is patent protected for now and is found only in quality products such as MacuHealth. MacuHealth is essential in your AMD treatment plan for patients whose Macula Risk® is level 3 or higher.
Total Focus Multiple Vitamin and Mineral is designed to target eye health needs with therapeutic potencies as well as meet the daily requirements for overall good nutrition. This formula is AREDS based and a good multiple vitamin to prescribe to the majority of your patient base. Compliance is the goal for helping to improve your patient's quality of life. To access research and learn more about the EDC Labs family of vitamins and/or other health solutions visit www.totalfocusvitamins.com.
All supplements distributed by EDC Labs, have been designed to support the eye care professional's needs, so you can prescribe confidently to your patients knowing you are prescribing the best supplements available. EDC Labs, Inc. will help you manage patient compliance by offering a direct purchase program for your office and an auto ship program for your patients.
Learn more about LA Consultants, Practicing Prevention© patient care protocol!
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REFERENCES
Macular pigment response to a supplement containing meso-zeaxanthin, lutein and zeaxanthin. Richard A Bone*1, John T Landrum2, Yisi Cao2, Alan N Howard3 and Francesca Alvarez-Calderon2
Augmentation of Macular Pigment Following Supplementation with All Three Macular Carotenoids: An Exploratory Study Eithne E. Connolly1,2, Stephen Beatty1,2, David I. Thurnham3, James Loughman4,Alan N. Howard5,6, Jim Stack2, and John M. Nolan1,2
Studies on the singlet oxygen scavenging mechanism of human macular pigment Binxing Li, Faisal Ahmed, Paul S. Bernstein * Department of Ophthalmology and Visual Sciences, Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
Werbach M, Nutritional Influences on Illness, 2nd Ed, Third Line Press, Tarzana, CA 1993
lron-Westerlund B, Norrby A, Cataracts, Vitamin E and Selenomethionine, ACTA Optham, April 1988; 237-8.
Gale CR, Hall NF, Phillips DIW, et al, Plasma Antioxidant Vitamins and Carotenoids and Age-Related Cataract, Ophthalmology, November 2001;108(11):1992-1998. 38476
VandenLangenberg GM, Mares-Perlman JA, Klein R, Klein BE, Brady WE, Palta M. Associations between antioxidant and zinc intake and the 5-year incidence of early age-related maculopathy in the Beaver Dam Eye Study. Am J. Epi 149;801-809, 1999
Lebuisson DA, Leroy L, Rigal G. Treatment of senile macular degeneration with Gingko biloba extract. Presse Med 15; 1556-1558, 1986
"A Randomized, Placebo-Controlled, Clinical Trial of High-Dose Supplementation With Vitamins C and E, Beta Carotene, and Zinc for Age-Related Macular Degeneration and Vision Loss: AREDS Report No. 8," Age-Related Eye Disease Study Research