Eye Care Professionals Differ in Advice for AMD Patients

AUGUST 25, 2017
Ellen Kurek
Improving nutrition, stopping smoking, and addressing other modifiable risk factors could help to prevent age-related macular degeneration (AMD), according to some eye care professionals.

The results of the Age-Related Eye Disease Study (AREDS), which surveyed optometrists and ophthalmologists, indicated that supplementation with carotenoids and antioxidants may reduce the risk of vision loss substantially in patients with AMD, in addition to the nutritional and behavioral factors, but showed the 2 may give different advice.

A number of studies have assessed how scientific findings of AMD prevention and treatment have affected the advice that eye care professionals give their patients. However, the role of optometrists has been less investigated than that of ophthalmologists.

To determine how frequently eye care professionals recommend nutritional supplements, dietary changes, or smoking cessation to patients at risk of AMD or with signs of the condition, Lene Martin, COT, RN, PhD, (pictured) a chair professor of care sciences at the School of Health, Care and Social Welfare at Malardalen University in Eskilstuna, Sweden, surveyed all Swedish optometrists and ophthalmologists registered in the membership databases of their respective professional organizations.

Martin’s cross-sectional survey study included a questionnaire with 18 forced-choice questions and 1 free-text questions. The questionnaire was organized into 4 sections by topic:
  1. use of nutritional supplements,
  2. dietary advice,
  3. smoking and eye diseases, and
  4. the strength of evidence and information sources on interventions with nutritional supplements.
Martin received 371 full or partial responses to the questionnaire; 323 (87%; response rate 40%) were from optometrists, and 48 (13%; response rate 5%) were from ophthalmologists. According to Martin, 75% of respondents reported that they would recommend micronutrient supplements to a patient with advanced AMD in 1 eye and early AMD in the other.

In addition, she found that optometrists were more likely than ophthalmologists to recommend nutritional supplements for AMD in all scenarios. However, the greatest difference between eye care professionals occurred in their recommendations for patients with no signs of AMD but with genetic risk factors for it. Whereas half of the optometrists recommended supplements in this scenario, only 6% of ophthalmologists did.

Moreover, optometrists were more likely to recommend supplements with only macular carotenoids than ophthalmologists, while ophthalmologists recommended supplements with the AREDS formula of vitamins and minerals.

Martin interpreted her findings as indicating that ophthalmologists tend to be somewhat restrictive when recommending supplements, but optometrists seem overly enthusiastic about them and often recommend products not supported by evidence.

Optometrists also provided considerably more advice about diet than ophthalmologists did for both patients at risk of AMD and those with established AMD. Eye care professionals typically advised patients to eat more green leafy vegetables and to increase their consumption of oily fish to at least twice weekly. However, two-thirds of ophthalmologists and one-third of optometrists reported that they would never give dietary advice to patients who only had risk factors for AMD and not the disease itself.

Furthermore, ophthalmologists were more likely than optometrists were to take a smoking history of new patients, to educate patients about the link between smoking and eye disease, and to recommend that all patients stop smoking.

According to Martin, “More targeted education and implementation strategies may be needed for both optometrists and ophthalmologists.” The aim of these activities should be to decrease the delay between evidence generation and application and to establish a common evidence base for AMD management that all eye care professionals can follow.

A report on the study, “Targeting modifiable risk factors in age-related macular degeneration in optometric practice in Sweden,” appeared in April 2017 in Clinical Optometry.

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