In So Many Words is a timely chat with an ophthalmic industry thought leader.

Zac Denning has spent the past 19 years with nutraceutical company ScienceBased Health, where he serves as product science specialist and project manager. In this interview, he provides perspective on the past, present and future of the company, and of the nutraceutical field.

Ophthalmology Management: You joined ScienceBased Health in 1999, two years after the company’s founding. What did the ophthalmic community think of nutraceuticals/nutritional supplements then, and how does it view them now?

Mr. Denning: This has changed a lot. Before SBH started, supplements were not part of clinical practice in eye care. Demand for supplements was exploding but patients were basically ‘left alone in the wilderness.’ There would be hundreds of bottles of supplements at the grocery store, and, without physician guidance, patients often made poor choices.

As the first eye supplement company, SBH was founded with the goal of bringing nutritional supplements into the medical realm, by providing evidence-based formulations that eye doctors could trust.

When results from the AREDS clinical trial were released in 2000, the opinion of doctors towards supplements was further changed. We were the first to bring a product to market based on this study. Supplements are now well accepted by the eye care community.

OM: How is research conducted on nutraceuticals, and their effect on patients?

Mr. Denning: Supplement studies use the exact same tools used for testing drugs or medical devices, such as double-masked, randomized, clinical trials. The difference here is that supplements are fundamentally different from pharmaceuticals, which are designed as a single action agent.

A nutrient like zinc is multi-factorial and is involved in hundreds of reactions in the body ­— and the effects are often more subtle. This makes it more of a challenge to study supplements, and to address that we’ve designed rigorous parameters for testing SBH’s products. An example of this was the 2013 HydroEye trial, published in Cornea, which examined HydroEye’s effect on dry eye in postmenopausal women. In that study, John Sheppard, MD, and Stephen Pflugfelder, MD, found the formula helped improve ocular irritation symptoms, suppress inflammatory markers and maintain corneal smoothness when compared with placebo.¹

In addition, just published in the March issue of Acta Ophthalmologica is a study that examined the effects of our optic nerve formula antioxidant supplement on measurements of ocular blood flow.²

OM: Are there plans to change any of SBH’s product formulas or develop new ones?

Mr. Denning: We’re looking at new product areas but focusing more on product improvements. SBH has updated its multivitamin and macular products six times in the last eight years, to better reflect the most compelling scientific research available. We look for prospective evidence whenever possible, like a large-scale clinical trial that shows a clinically meaningful benefit for patients. For example, we updated our macular and multiformulas after an NEI-sponsored study suggested that three B vitamins — B6, B12 and folate — may significantly reduce AMD risk in women.³

OM: How do you think your market will change in the near future?

Mr. Denning: Just like eye care in general, I think you will see larger pharmaceutical or device companies buying supplement companies. SBH is privately owned so we can focus on scientific innovation, product development and doctor education.

Outside of the business area, I think we will see growing interest in antioxidants as an eye health adjunct, since oxidative stress appears to contribute to numerous eye conditions. I think there will also be more interest in the role of epigenetics or how certain gene functions can be turned on or off, since the building blocks for regulating gene expression come from nutrients like B vitamins.

Supplements will never replace standard treatments, but, in general, you can expect the role of supplements to become more integral to eye care as time goes on.

OM: Nutraceuticals can be expensive — what would it take to lower their prices?

Mr. Denning: There is always a balance to providing something that is clinically meaningful and something that a patient can afford. If you look down your supermarket aisles, you’ll find very cheap supplements that may offer token levels of nutrients but are basically ‘window dressing’ for the label — they are unlikely to do anything meaningful for your health. So, the cheapest options usually offer a terrible value to the patient.

We’re aware of the effect pricing can have on patients, as people who must choose between a supplement and paying their electrical bill are less likely to follow through on compliance.

Compared to other doctor-dispensed products, our products are always among the lowest in price — while still offering meaningful levels of nutrients. We accept very low margins on our products, so we can deliver as much value as we can to patients. OM

REFERENCES

1. Sheppard, Jr. JD, Singh R, McClellan AJ, et al. Long-term supplementation with n-6 and n-3 PUFAs improves moderate-to-severe keratoconjunctivitis sicca: A randomized double-blind clinical trial. Cornea. 2013; 10:1297-1304.
2. Harris A, Gross J, Moore N, et al. The effects of antioxidants on ocular blood flow in patients with glaucoma. Acta Ophthalmol. 2017; DOI:10.1111/aos.13530. e237-e241.
3. Christen WG, Gleynn RJ, Chew EY, Manson JE. Folic acid plus B-vitamins and age-related macular degeneration in a randomized trial in women. Invest Ophthalmol Vis Sci. 2007; 13:1152.