Eyeworld

I WHAT YOUR PATIENT IS TAKING AND ITS EFFECT ON THE EYE N FOCUS 52 | EYEWORLD | JANUARY/FEBRUARY 2020 Contact Epitropoulos: eyesmd33@gmail.com Matossian: cmatossian@matossianeye.com Perry: hankcornea@gmail.com Sheppard: jsheppard@vec2020.com antioxidants, ginkgo biloba, and other nutrients. Another supplement prod- uct for glaucoma is GlaucoCetin (Guardi- on Health Sciences), which contains cur- cumin, ginkgo biloba, grape seed extract, and other ingredients. Patients with glaucoma also can benefit from omega-3 supplementation due to the toxic effect of most IOP-lowering medications on their ocular surface, Dr. Matossian said. Dr Epitropoulos said that diabetic patients may benefit from a supplement known as Nuretin (Physician Recommended Nutriceuticals), which provides EPA and DHA in a 1:5 ratio to reduce the risk of diabetic retinopathy. Side effects from other nutraceuticals Patients may use nutraceuticals for other health conditions and find, inadvertently, that the products affect the eyes. One example is saw palmetto, used by some for urologic or prostate health. Saw palmetto has led to intraoperative floppy iris syndrome in some patients. Dr. Matossian asks patients before cataract surgery if they have used this supplement. If they have, she will have a pupil expansion device available during surgery, in case it's needed. Additionally, some nutraceuticals used by the general population may inadvertently be anticataract due to their ingredients, which include flavonoids, carotenoids, and ascorbic acids There are no medications or supplements that have been shown in the peer-reviewed literature to prevent cataracts, Dr. Epitropoulos, said, however there are reports suggesting that including certain naturally occurring foods and nutraceuticals may have a therapeutic effect in slowing or preventing cataract formation. 4 fish oil, Dr. Sheppard will prescribe flax- seed oil, a reasonably highly bioavailable plant-based ome- ga-3 source. "When combined with a gamma linolenic acid preparation, like black currant seed oil or primrose oil, omega-3 polyunsaturated fatty acids including flaxseed oil can be very effective," 3 he said. "This combina- tion is the strategy utilized in HydroEye." Omega-3 fatty acid supplementation is often used along with other medication-based or non-medication-based therapies. In patients specifically aiming to avoid medications, Dr. Sheppard will advise the use of punctal plugs and lid scrubs with hypochlorous acid. Dr. Sheppard also addresses other common sense health advice with dry eye or MGD pa- tients, including eating a healthier, anti-inflam- matory diet. "It's incumbent upon the provider to pay attention to the whole patient including supplementation, nutrition, and general health," he said. Supplements for other purposes Patients with other eye diseases and conditions can benefit from certain nutraceuticals. Age-related macular degeneration, for example, has published evidence showing that a combination of vitamins/antioxidants, omega- 3s, and zinc (known as the AREDS 2 formula) can help slow the progression of disease. Dr. Perry said he favors Eye Omega Advantage (Physician Recommended Nutri- ceuticals) because it has the omega-3 fatty acids and lutein and zeaxanthin, both touted to help macular health. It also contains vitamin D. "It's for dry eye, but I also use it for macular health," he said. Although not as well-known, there is a growing market for nutraceuticals for optic nerve disease, Dr. Sheppard said. One product he'll recommend is Optic Nerve Formula (Sci- ence Based Health), which contains omega-3s, continued from page 51 References 1. Epitropoulos AT, et al. Effect of oral re-esterified omega-3 nutri- tion supplementation on dry eyes. Cornea. 2016;35:1185–1191. 2. The Dry Eye Assessment and Management Research Study Group. n-3 fatty acid supple- mentation for the treatment of dry eye disease. N Engl J Med. 2018;378:1681–1690. 3. Sheppard JD, et al. Long- term supplementation with n-6 and n-3 PUFAs improves moderate-to-severe keratocon- junctivitis sicca: A randomized double-blind clinical trial. Cornea. 2013;32:1297–304. 4. Amandeep K. et al. Nutraceuti- cals in prevention of cataract – an evidence-based approach. Saudi J Ophthalmol. 2017;31:30–37. Relevant disclosures Epitropoulos: Physician Recommended Nutriceuticals Matossian: Physician Recommended Nutriceuticals Perry: Physician Recommended Nutriceuticals Sheppard: Science Based Health "I tell patients that not all omega-3s are the same." —Cynthia Matossian, MD

• Blank Page
• Blank Page (1)