THE EFFICIENT OPHTHALMOLOGIST

Winning over me, the nutra-skeptic

It took time to read the literature. Once I became informed, I wanted in, in myriad ways.

By Steven M. Silverstein, MD, FACS

Initially, I was skeptical about selling nutraceuticals. Like most of my colleagues, I recommended eye vitamins for my patients with age-related macular degeneration, and routinely suggested that my dry eye patients take omega-3 supplements, but that was it.

I took a generic omega-3 product but never properly researched the matter in regard to the correct dosage, product quality or potential benefits. I knew little more about the subject than a layperson. Furthering my skepticism were recent peer-reviewed studies published in major systemic and internal medicine literature suggesting that multi-vitamins add little or no value to human health.

A friend and fellow ophthalmologist has researched and produced his own nutraceuticals that he sells through his company, Doctor’s Advantage. He encouraged me to read up on the literature — both ocular and systemic — in order to develop a more educated and informed opinion.

A COMMON THEME

I read about cultures with poor social infrastructures that enjoy remarkably unexpected good health and longevity with little cardiovascular disease. They also have a significantly lower incidence of many neoplasms when compared to other aged-matched industrialized societies. The common theme connecting these different cultures was a diet rich in fish, especially wild salmon.

The literature discussed the potential benefits of omega-3, particularly with Norwegian salmon, for lowering the incidence of cardiovascular disease. Additionally, some soft data showed that omega-3 may provide protection against certain tumors. I read the data detailing the benefits of antioxidants in the AREDS and AREDS2 studies for patients with macular degeneration and their potential ability to lower the risk of more severe forms of the disease in certain demographics.

My colleague encouraged me to learn about the different sources of vitamins, and I was somewhat surprised to realize that the ingredients in these products vary, some being exceptional while others are of poor quality with unnecessary fillers and in dosages well below those recommended by the current literature. Indeed, the products I was taking (a multi-vitamin and omega-3) were of little or no benefit.

THE PERSONAL SIDE

Doctor’s Advantage produces AMD and dry eye vitamin supplements that are dispensed initially from the physician’s office, after which the patient is directed to call the company to establish an account. In this manner, the appropriate supplements ship directly to their home.

I am impressed with the commitment to the constant research this company performs, which keeps the quality of suggested dosing regimens and combinations of active ingredients in line with the current thinking in each respective field.

A number of companies are similarly dedicated to the current science in this field (Jodi Luchs, MD, in Wantagh, N.Y., developed a flavorful liquid form of an AREDS-based supplement, for example).

THE PROFESSIONAL SIDE

While my practice shows a modest financial benefit from selling these products, what I enjoy most is knowing that I am steering my patients toward quality products I have personally vetted and that I also use — I have switched my nondescript vitamin and omega-3 to this company’s products.*

Whether you are a skeptic or a believer in the potential benefits of nutraceuticals, I suggest you educate yourself about the differences in the sources of the ingredients and stay current with the recommended combinations and dosages.

If you elect to dispense, you will find it to be an easy addition to your practice. The physician recommends the product, and the transaction occurs at the checkout desk at the end of the patient’s appointment. My staff quickly adopted this opportunity, and patients feel more confident in taking a product recommended by the physician they trust, rather than the store clerk at the grocery store or pharmacy.

I am also a principle investigator in a dry eye study called the DREAM (Dry Eye Assessment and Management) study, which is sponsored by the NIH. The study will be definitively evaluating the role of omega-3 in patients with moderate to severe dry eyes. OM

* Dr. Silverstein is an unpaid adviser for Doctor’s Advantage.

Steven M. Silverstein, MD, FACS, is a cornea-trained comprehensive ophthalmologist in practice at Silverstein Eye Centers in Kansas City, Mo. He invites comments. His e-mail is ssilverstein@silversteineyecenters.com.