Speaker: Prescribe nutritional supplements carefully

Diana Shechtman, OD

SALT LAKE CITY — Clinicians who prescribe supplements to their patients should be aware of potential side effects, contraindications and dangers of overdosing, according to a speaker here at Optometry's Meeting.

When prescribing nutritional supplements as a result of the Age-Related Eye Disease Study, be sure you prescribe "the right vitamins and the right amount," Diana Shechtman, OD, told attendees at an Optometric Retina Society-sponsored symposium during Specialty Day.

"In regards to AREDS, there was a 25% decreased risk reduction in developing advanced AMD," she said. "These are not most of our patients; these are patients with advanced disease. We all have patients with just a few drusen."

In AREDS 2, beta-carotene is being removed and the levels of zinc are being decreased, Dr. Shechtman said. "Beta-carotene is not good for current or past smokers," she said. "Ask patients about passive smoking. High doses should not be used in passive smokers."

Patients taking blood thinners, with bleeding disorders or with liver or kidney dysfunction can be affected by high doses of vitamins A, C and E.

"Zinc alone decreases the progression of AMD by 21%," Dr. Shechtman said. "However, it interacts with tetracycline and may be associated with Alzheimer's disease and copper deficiency anemia."

She added that 7.5% of zinc-treated AREDS patients had urinary tract infections.

"Regarding omega-3s, it's the quality vs. the quantity," Dr. Shechtman continued. "You need to make sure there's 350 mg of DHA and 650 mg of EPA. If you're going to recommend it, do it appropriately. Have patients take it with a meal to add that extra fat."