Staying Clear-Eyed: A Guide to OTC Ophthalmic Supplements

Supplements for age-related eye disease may be appropriate for some older patients.

Results from the 10-year clinical Age Related Eye Disease Study (AREDS) conducted by the National Eye Institute suggested that high levels of antioxidants, zinc, and copper can reduce the risk of developing advanced age-related macular degeneration (AMD) by approximately 25%.¹ A follow-up study, AREDS-2, is currently being conducted to investigate the potential benefits of xanthophylls and omega-3 fatty acids to eye health. Its initial results are expected to be released in 2013.

Raising Awareness

According to a statement from experts at the Ocular Nutrition Society (ONS), several nutrients including zinc, vitamins C and E, lutein, zeaxanthin, and long-chain omega-3 fatty acids, aid in promoting ophthalmic health as one ages.^2,3 The ONS panel also states that it is important to increase awareness of the critical connection between nutrition and ophthalmic health.^2-4

A recent survey of baby boomers found that approximately 50% do not receive annual eye exams, many do not know how diet can affect eye health, and few who have been diagnosed with age-related eye disease use supplements.⁴ The ONS experts also recommend that patients take supplements specifically designed to promote ophthalmic health because many multivitamin supplements do not contain adequate levels of the nutrients essential to ensure optimal eye health.⁴

Understanding Eye Disorders

Eye diseases can occur at any time, but the risk increases with age.⁵ Many individuals may notice vision changes in their 40s and 50s. It is important that pharmacists be familiar with the eye conditions with which patients, especially older patients, may present at the pharmacy:^6,7

• AMD—Ophthalmic disorder commonly associated with the aging process in which the macula is destroyed, resulting in a gradual decline in sharp central vision. Leading cause of vision loss in those 60 years and older.
• Cataracts—Causes cloudiness in the lens of the eye. Vision may present as blurry or cloudy. Some patients complain of problems with glare. Cataracts can develop at an earlier age in patients with diabetes.
• Diabetic eye disease—Leading cause of blindness. Diabetic retinopathy involves damage to the blood vessels in the retina. Affects an estimated 40 million people 40 years and older.
• Glaucoma—Caused by elevated intraocular pressure, it is the second leading cause of blindness. If untreated, it can lead to optic nerve damage and loss of vision.
• Dry eye—Occurs frequently as one ages, especially in women after menopause, and as a common adverseeffect of certain pharmacologic agents (ie, nasal decongestants and certain antihypertensives, Parkinson’s disease agents, and antidepressants).

Finding a Supplement

Among the many nutritional supplements designed to support ophthalmic health, a number are specifically formulated for those with moderate to advanced AMD. These products contain various nutrients that are beneficial in promoting and maintaining healthy eyes (Table 1^3-5,8-13 ).

Many ophthalmic supplements include the antioxidants lutein and zeaxanthin, as well as some omega-3 fatty acids. Lutein and zeaxanthin are classified as xanthophyll carotenoids and have antioxidant and light-screening mechanisms.^3-5,8,9 Research has demonstrated that lutein helps protect the retina and preserve visual function, whereas zeaxanthin protects against damage to the eye from light.^3-5,8,9

Many studies have also indicated that omega-3 fatty acids are not only key to maintaining overall health, but are also critical to eye health.^8,9 Some supplements contain higher amounts of vitamins such as vitamins A (beta-carotene), C, and E, as well as zinc and copper. Some formulations also contain other essential vitamins and minerals to provide support for overall health and eye health in a single supplement.

Table 2^11-13 provides examples of currently available OTC ophthalmic supplements.

Creating an Eye Health Regimen

Patients electing to use these supplements should be reminded to consult their primary health care provider before using them, especially if they are taking any other medications. Because many of these formulations have specific indications, pharmacists can aid patients in selecting the proper supplement. Patients who take other nutritional supplements should also be reminded to check for therapeutic duplications to avoid potential toxicities.

Pharmacists should always screen for potential drug—micronutrient interactions as well as possible contraindications. During counseling, patients should be reminded to wear sunglasses when outdoors to protect the eyes from UV rays and to take regular breaks when using computers, electronic tablets, readers, or cell phones to avoid eye strain.¹²

Because smoking can expose the eyes to high levels of oxidative stress, patients should also be encouraged to quit smoking.¹² Patients who continue to smoke should be advised to consult their primary health care provider about the risk associated with consuming beta-carotene and smoking.^12,14 Bausch & Lomb PreserVision has a formulation that substitutes for beta-carotene with FloraGlo Lutein.¹²

Patients experiencing vision problems should always be encouraged to seek further medical evaluation, and all patients should be reminded to get routine eye exams. As health care professionals, we should remind our patients that taking care of their eyes is essential to overall health, especially as they age.

Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.

References

• The AREDS formulation and age-related macular degeneration. NIH National Eye Institute website. www.nei.nih.gov/amd/summary.asp. Accessed December 5, 2012.
• Age-Related Eye Disease Study Research Group, SanGiovanni JP, Chew EY, Clemons TE, et al. The relationship of dietary carotenoid and vitamin A, E, and C intake with age-related macular degeneration in a case-control study: AREDS Report No. 22. Arch Ophthalmol. 2007;125(9):1225-1232.
• Chua B, Flood V, Rochtchina E, Wang JJ, Smith W, Mitchell P. Dietary fatty acids and the 5-year incident of age-related maculopathy. Arch Ophthalmol. 2006;124(7):981-986.
• Hitt E. Nutrients promote eye health in aging, says panel. Medscape website. www.medscape.com/viewarticle/762177. Accessed December 4, 2012.
• Vision loss from eye diseases will increase as Americans age. National Eye Institute website. www.nei.nih.gov/news/pressreleases/041204.asp. Accessed December 4, 2012.
• Information for healthy vision. National Eye Institute website. www.nei.nih.gov/healthyeyes/aging_eye.asp. Accessed December 4, 2012.
• Diabetic retinopathy defined. National Eye Institute website. www.nei.nih.gov/health/diabetic/retinopathy.asp#1a. Accessed December 4, 2012.
• Fighting vision loss with food. Medscape website. www.medscape.com/features/slideshow/eyefood#10. Accessed December 4, 2012.
• Nutrients and eye health. Occuvite website. www.ocuvite.com/en/Nutrients-and-Eye-Health. Accessed December 4, 2012.
• Bartlett H. An ideal ocular nutritional supplement? Ophthalmic Physiol Opt. 2004; 24(4):339-349.
• Why is eye health important? ICaps website. www.icapsvitamins.com/patient. Accessed December 4, 2012.
• Age related eye vitamins. Bausch and Lomb website. www.bausch.com/en/Our-Products/Eye-Vitamins/Age-Related-Eye-Vitamins-Landing/Preservision-eye-vitamins-lutein. Accessed December 4, 2012.
• Vitamins for general eye health. Bausch and Lomb website. www.bausch.com/en/Our-Products/Eye-Vitamins/Vitamins-for-Eyes. Accessed December 4, 2012.
• Tanvetyanon T. Bepler G. Beta-carotene in multivitamins and the possible risk of lung cancer among smokers versus former smokers: a meta-analysis and evaluation of national brands. Cancer. 2008;113(1):150-157.