Advice about diet and smoking for people with or at risk of age-related macular degeneration: a cross-sectional survey of eye care professionals in the UK

Abstract

BackgroundIn the absence of a cure, there has been considerable interest in attempts to prevent or reduce the progression of age-related macular degeneration (AMD) by targeting particular modifiable risk factors. The aim of this study was to conduct a cross-sectional survey of the current practice of UK eye care professionals in relation to advice given on diet and other lifestyle modifications for patients with or at risk of AMD.MethodsOptometrists and ophthalmologists on the membership databases of professional organisations for the two professions were invited to participate in an online survey. The survey was open for 12 weeks between July and September 2012.ResultsA total of 1,468 responses were received (96.3% from optometrists and 3.7% from ophthalmologists). The response rate of those receiving the invitation was 16.2% (1,414/8735) for optometrists and 6% (54/1460) for ophthalmologists. A majority of respondents reported that they frequently provide dietary advice to patients with established AMD (67.9%) and those at risk of AMD (53.6%). Typical advice consisted of a recommendation to eat plenty of leafy green vegetables and eat more oily fish. The decision to recommend nutritional supplements was based on the risk of progression to advanced AMD, with approximately 93% of respondents recommending supplementation in a patient with advanced AMD in one eye. However for the majority, the type of supplement recommended did not comply with current best research evidence, based on the findings of the Age-related Eye Disease Study (AREDS). Only one in three optometrists regularly assessed smoking status and advised on smoking cessation.ConclusionsWithin a large sample of eye care professionals, consisting predominantly of optometrists, who responded to a cross-sectional survey, there was active engagement in providing nutritional advice to patients with or at risk of AMD. However, the results demonstrate a need to raise awareness of the evidence underpinning the use of nutritional supplements together with an increased involvement in targeted smoking cessation.

Patient Tobacco Use in Optometric Practice

“…The results are consistent with previously published studies assessing optometrists in North America 20,31 and the United Kingdom, 37 where most practitioners reported that they did not regularly assess tobacco use with their patients, and fewer still discussed cessation with their patients.…”

Controversies in the Use of Nutritional Supplements in Ophthalmology

“…The well-publicised results of large National Eye Institute (NEI)-funded trials in the US (Age-Related Eye Disease Study (AREDS) and AREDS2), demonstrating the value of antioxidant supplements in reducing the risk of developing advanced age-related macular degeneration (AMD), may have further contributed to their widespread use and promotion in the elderly. Recent surveys of optometrists and ophthalmologists have revealed that nutritional supplementation is now part of routine clinical practice for patients with or at risk of AMD [10,11] although these recommendations are frequently not evidence-based [10]. The aim of this mini-review is to consider evidence for the value of nutritional supplementation in three Published in Current Pharmaceutical Design http://www.ncbi.nlm.nih.gov/pubmed/26350529 common age-related eye diseases: AMD, cataract and dry eye.…”

Nutrition and Age-Related Macular Degeneration

“…A recent survey of eye care practitioners in the United Kingdom found that approximately two-thirds of respondents reported frequently offering dietary advice to patients with established AMD and over half made recommendations to patients that were considered ''at risk'' of developing the condition. 62 The most common recommendation was to consume ''plenty of leafy green vegetables'' 62 ; the rationale being that these foods are naturally rich in lutein and zeaxanthin.…”

“…Recent evidence suggests that, as a profession, optometrists may not be adopting a consistently proactive approach to documenting patients' smoking history or advising on smoking cessation. 62 The decision to recommend that a patient consume antioxidant supplements must balance the possible risks with the benefits of the intervention. 73 As discussed, there is evidence from clinical trials funded by the National Cancer Institute that the risk of lung cancer is significantly increased with high-dose beta-carotene supplementation in current and former smokers.…”