Nutrition and the Eye

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It’s estimated that more than 43 million Americans will develop age-related eye diseases by 2020, according to The American Academy of Ophthalmology. Currently, approximately 1.7 million Americans have some form of age-related macular degeneration, according to the National Eye Institute, and approximately 100,000 are blind from the disease. Of the 8,000 Baby Boomers who turn 60 every day, more than half will develop an age-related eye disease, according to Lighthouse International.

To help address this trend, the eyecare industry is setting its sights on preventive measures—one of which in particular is nutrition’s role and the use of nutraceuticals in preserving vision, which is quickly gaining in popularity.

Many organizations, like the National Eye Institute, are recommending that the public “eat right to protect sight” with nutrient-rich foods, including dark leafy greens such as spinach, kale or collard greens, and fish like salmon, trout or halibut. These foods deliver important eye healthy nutrients—lutein, zeaxanthin and omega-3s, for example.

Unfortunately, it’s widely known that most Americans do not follow a healthy, nutritious diet. The typical American diet is too high in saturated fat, sodium, and sugar and too low in fruits, vegetables, whole grains, calcium and fiber, according to the Center for Science in the Public Interest. This is where eye nutraceuticals can help as they can be supplemented into one’s diet to fill the nutritional gap and protect vision. “Nutraceuticals” is a term used to describe specially formulated supplements and functional foods and beverages that support specific health conditions.

In addition to the Baby Boomers who are interested in maintaining their health and preventing or reversing eye disease, the Millennial generation is also generating interest in this small but growing niche in eyecare. Even larger in number than the Baby Boomers, Millennials, with their interest toward living healthy lifestyles, are also driving growth in this fledgling category that is quickly gaining traction.

According to The Food Institute, Millennials take a more self-reliant approach to health care. “Efforts toward healthier living by Millennials are evidenced across a range of rituals,” according to The Food Institute, whose recent SymphonyIRI study on Millennial Shoppers determined that 22 percent of 18- to 34-year-old consumers eat five servings of fruit/vegetables per day, 30 percent take multivitamin/vitamin supplements and 34 percent eat whole grain foods.

In response to this multi-generational demand to address preventive health and eyecare with nutrition, a cadre of passionate eyecare professionals is seeking ways to help their patients through diet and nutritional supplements. The fact that many ECPs are taking an interest is evidenced by the growth of the Ocular Nutrition Society (ONS).

According to the ONS, “The demand for vision services is expected to flood the health care system by 2015 due to age-related eye disease and the diabetes epidemic. As the Baby Boomer generation is aging, research shows that the number of people in the U.S. with impaired vision, including blindness, could increase by at least 60 percent over the next three decades. Therefore, disease prevention, including lifestyle modification, attention to dietary intake and micronutrient supplementation must become more of a focus of primary vision care.”

In response to this growing demand among ECPs and their patients, suppliers of nutritional supplements are now actively targeting optometric offices.

All of this is supported by the National Eye Institute’s 2001 landmark Age-Related Eye Disease Study (AREDS) that found nutritional supplementation can reduce the risk of developing advanced age-related macular degeneration (AMD). In 2006, NEI began a second study, AREDS2, to improve the original AREDS formulation. The result is a combination of vitamin C (500 mg.), vitamin E (400 IU), lutein (10 mg.), zeaxanthin (2 mg.), zinc (80 mg.) and copper (2 mg.) that has become the standard of care for many optometrists in reducing the risk of AMD.

A Practice Building Opportunity

The strong correlation between good nutrition and healthy vision is not being ignored by consumers as products geared toward eye health are growing in popularity. According to Packaged Facts’ “Nutritional Supplements in the U.S., 6th Edition,” eye health has become one of the fastest growing categories within condition-specific supplements, with sales of eye health supplements in the multi-outlet channel up 9 percent in 2012 and up a further 10.5 percent in 2013. In fact, eye health supplements, along with joint health, were the largest condition-specific supplement categories in 2013, comprising almost one-third of all condition-specific supplement sales (see pie chart, “ Multi-Outlet Condition-Specific Supplement Sales, 2013.”)

With sales of eye nutraceuticals continually outpacing market growth, offering guidance on nutrition is a pertinent eyecare service and a way for ECPs to enhance the value they offer patients.

It then stands to reason that eyecare professionals are seeing the wisdom and opportunity from merely recommending nutraceuticals in the retail store to offering this value added service in their own practices. “Eyecare providers are missing the boat if they do not offer these products to their patients,” said John Wiley, vice president of sales of Macular Health, based in Gardendale, Ala. “After an eye doctor recommends a product, patients are usually inundated with choices at the retail store, which can be overwhelming. All too often, they grow frustrated and buy something that may not be what the doctor actually recommended, or worse, they walk out of the store with nothing at all.”

Pamela Damsen, marketing consultant for Houston-based ScienceBased Health, agrees, noting that there can be hundreds of products on the retail shelf and thousands of products to sort through online. “When left on their own, many patients become confused about which product to select,” she said. “A specific product recommendation by the practitioner can be helpful, but the product recommended may not be available or may be difficult to find.”

Adding these products in the office is not only convenient for patients; it’s also easier for doctors to ensure patient compliance. Monique Wellise, the education and professional sales manager at Nordic Naturals, said, “Patients tend to be compliant when their ECP hands them the bottle and tells them exactly how much to take each day.” Without specific guidelines from the ECP, patients will likely buy something of lesser quality and with levels of nutrients that are simply not effective.

Bringing the sale of nutritional supplements into the practice not only ensures that patients will get the quality they require but also presents a revenue-generating opportunity for the ECP. According to New Hope Natural Media, U.S. sales of vision condition supplements during 2012 totaled $412 million, and 2013 sales are estimated to increase to $437 million, according to the most recently available statistics.

“If the doctor does not provide these products to their patients, the only entities generating any revenue are the retail chains and the companies making the supplements,” noted Wiley. “We want to put that revenue into the hands of the ECPs—where it belongs.”

Jeffrey Anshel, OD, FAAO, ONS president, gave “a few thousand dollars” as a “decent ballpark” figure for the amount of money a practice can generate per year by adding supplements.

The Management & Business Academy estimates that increasing revenues by selling only an additional $10 in nutraceuticals per complete eye exam (based on an average of 1.1 complete eye exams per OD hour) could add $22,000 per year to a practice’s revenue.

According to Laurie Capogna, OD, author of two books on “Eyefoods,” (see “ Feeding Your Eyes,”) if an ECP retails a three-month supply of supplements to three patients per day, it could lead to $60 per day in extra profit. This translates to $300 per week or $15,000 per year. If a patient returns to the office to purchase another three-month supply, this has potential to grow to a $30,000 extra profit per year.

In order to encourage future supplement purchases, Capogna suggests offering some sort of loyalty card. Once patients purchase a year’s supply, ECPs can offer patients a discount or gift card. “Once you start to promote nutrition to your patients, you will see your relationships with them grow, and this will ultimately lead to better patient care and practice growth,” said Capogna.

Sam R. Silverblatt, OD, practicing in Shreveport, La., has generated increased revenue from $500 to $1,000 per month by prescribing Juice Plus+, a supplement that includes juice powder concentrates from 25 different fruits, vegetables and grains, according to a June 2014 article in Review of Optometric Business.

There are lots of factors that contribute to the amount of business ECPs can generate from adding supplements to their practice, including size and number of offices, geography and number of patients. According to MedOp Health, it has practitioners making anywhere from $1,000 to over $30,000 per year on its MaxiVision supplements.

Eye Docs Focus on Nutrition

More eye doctors are getting involved in educating their patients on the benefits of nutritional supplements for eye health. Here are a few who have done so successfully.

As a practicing optometrist for 24 years, 21 of those in Florida, Kimberly Reed, OD, has been integrating nutrition for the last 13 or so of those years. “I’ve been incorporating nutrition principles in my practice since around 2001 when the original AREDS report was released, which showed that we could reduce the risk of progression to advanced macular degeneration by about 25 percent overall using high doses of nutritional supplements,” she said. “I have incorporated more and more of these principles as the science has expanded.”

Since introducing nutrition years ago into her practice, Reed has noticed a change in patients’ acceptance. “Patients were originally skeptical of the whole notion,” she said. “But now, more patients come into the office partially educated—having already read an article on how lutein can protect their vision, for example. They are asking important questions and are much more receptive to the idea of lifestyle and nutrition’s impact on improving health.”

Aleksandra Wianecka, OD, who practices at Vision for Life in Babylon, N.Y., has been recommending nutritional supplements for about eight years. “I believe you are what you eat, and unfortunately our food supply is depleted from vitamins and minerals, so we need to supplement what we eat,” she said. “Macular degeneration comes from nutritional deficiencies in the eye. Therefore it’s easy for me to talk to patients and get them to believe in it. I have turned some patients into health advocates,” she said.

According to Stuart Richer, OD, PhD, FAAO, who practices at Captain James A. Lovell Federal Health Care Center in Chicago, Ill., he has been practicing what is now known as integrative eyecare (including nutrition/nutritional supplements) for the last 30 years.

“Many of our World War II vets are doing quite well maintaining their vision at age 90 and beyond,” he noted. “Prescription of lutein and zeaxanthin, through diet or supplementation, can improve the visual function of most people in a short period of time, whether they suffer from AMD or not. This includes safer driving from a visual standpoint.”

For other ECPs looking to integrate nutrition in their practice, Reed advises to first be educated about appropriate and safe supplement practices. “Pick a company that has a reputation of building its products based on science with high-quality ingredients because there is such wide variability in supplements,” she said. “If people walk in discount stores and pick the cheapest one, they will get what they pay for because the better quality ingredients cost more. Independent content verification of supplements costs more for companies, justifying the price of the product.”

Wianecka believes the only way ECPs can successfully incorporate supplements into their practice is by taking these products themselves. “I take supplements, I recommend them to my children, and family (and even give them to my dog!), therefore it makes it credible and honest to recommend to my patients.” She also reminds other ECPs to have staff onboard to carry the “importance of nutrition in eye health” message.

Richer cautions other optometrists entering this area to move slowly and methodically in order to become an expert. “It will take constant study and commitment,” he said. “Aim to know the biochemistry and purpose of every supplement on the store shelf before committing yourself to stocking actual products.” As its research committee chair, Richer recommends the best way to learn about eye nutrition is to join the Ocular Nutrition Society, which educates ECPs on its role in systemic and ocular health.