Treatment Plan

Beware of the Cumulative Effects of Poor Habits

BY LEO SEMES, OD, FAAO

We often lose sight of the fact that the harmful cumulative effects of insults can manifest with disastrous results. For instance, I noticed the other day that one corner of a rug in my home that is exposed to afternoon sunlight through a window had faded. It did not happen overnight; but, over time, the contrast became significant enough to notice.

See Beyond the Here and Now

How often do we consider the long-term effects of our patients’ poor habits? How often do clinicians consider lifestyle choices such as patients’ diets in the context of prevention?

Three modifiable behaviors have recently been identified as factors to minimize visual impairment (Klein et al, 2014). The Beaver Dam Eye Study is an ongoing project that evaluates a stable population in Olmsted County, Wis. The results of a 20-year prospective analysis of visual impairment revealed that smoking cessation, moderate alcohol intake, and physical activity were associated with reduced visual impairment. Armed with this information, it may now be easier to initiate the conversation about how these factors may influence vision loss from diseases such as age-related macular degeneration (AMD).

Centuries ago, Hippocrates gave us the first precept of medicine: “First, do no harm.” He is less remembered for stating, “Let food be thy medicine and medicine be thy food.” When we think about nutritional deficits causing medical issues, they may seem like historical problems (e.g., vitamin C deficiency and scurvy, or vitamin D deficiency and rickets). But, if we consider the cumulative effects of environmental sunlight exposure on cataract formation, the relationship hits a little closer to home. Similarly, the emerging association of short wavelength visible light and AMD focuses clinicians on the potential for modifying risk factors.

Discuss Poor Diet Effects

Systemic consequences of a poor diet are often very visible. We can see dietary influences from an individual perspective as well as in the obesity epidemic.

One perspective posits that diet-related health problems have resulted from sugars added to foods in response to the high-fat scare. Interventional cardiologist Aseem Malhotra (2013) presents a convincing case that what is substituted for saturated fat matters, and that sugar is the real culprit. Food labeling allows us to analyze this and other ingredients and provides an opportunity for us to discuss dietary recommendations with patients to minimize the impact on visual impairment.

The AREDS studies (Chew et al, 2014; AREDS2 Research Group, 2013) have offered guidelines for slowing the progression of advanced AMD; if early preventive interventions are effective, then the public health impact of visual impairment may be minimized. Considering the increasing lifespans of Americans, visual impairment will become an ever-increasing focus of eyecare providers and healthcare resources.

We should all take the opportunity to advise our patients of these developments and the preventive value of modifiable behaviors. A place to start may be the mantra that I have been offered: no food from vending machines, that can be purchased at a drive-through, or that is advertised on television.

While that may seem limiting, consider the consequences of vision loss. A lifetime of poor eating habits cannot be overcome in a month by taking a few supplements. CLS

For references, please visit www.clspectrum.com/references and click on document #223.

Dr. Semes is a professor of optometry at the UAB School of Optometry. He is a consultant or advisor to Alcon, Allergan, B+L, Sucampo, and Zeiss and is a stock shareholder in HPO and Arctic DX.