Inconsistent practitioner advice leads to poor compliance in patients with AMD
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Lifestyle advice given to patients with age-related macular degeneration varies and often is not followed, highlighting the need for a better understanding of patient preferences, according to a literature review in Nutrients.
“This review highlights that there is still a need for further education for practitioners, specifically about the importance of smoking cessation advice,” Sonali Dave, BSc, MSc, a PhD candidate in optometry and visual sciences at London University School of Health and Physical Sciences, and colleagues wrote. “This is a key factor, as the evidence regarding the increased risk of AMD onset and progression associated with smoking is irrefutable.”
In a systematic review of 24 studies published since 2001 in CINAHL, MEDLINE, PsycInfo, PsycArticles, Embase and AMED databases, Dave and colleagues examined eye care practitioners’ lifestyle modification advice given to patients with AMD to help researchers better understand patient compliance.
Researchers found that 57.95% of patients included in the literature review did not recall receiving lifestyle advice from their eye care practitioner.
In addition, practitioners were more inclined to provide advice about nutritional supplements and diet than smoking cessation, citing “concerns about a negative effect on the relationship between patient and practitioner of asking questions which might be perceived as judgmental.”
Further, the main reason for poor compliance was lack of recommendation by eye care practitioners, a finding reported in 54.5% of patients.
“This highlights the potential scope for eye care practitioners to bring about a change in patient behavior through effective advice provision,” Dave and colleagues wrote. “The review highlighted a need for more patient-centered studies to understand the best ways of providing advice to patients, as well as research regarding how to overcome the eye care practitioner-perceived barriers to effective lifestyle advice provision to facilitate the translation of research to positive outcomes.”
Perspective
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This article evaluating the advice given to patients with AMD is very interesting. While it is really difficult to know if the results are accurate, they nonetheless are enlightening and may have an impact on how we educate our patients with AMD. Some of the key points:
There is good evidence from multiple studies that patients are not receiving sufficient lifestyle advice regarding the risk factors for AMD
Eye care practitioners tend to be more confident discussing advice regarding diet and nutrition, especially supplementation, than smoking cessation.
The main barrier to patients not taking supplements was not having them recommended to them.
This study highlights that we must discuss with our patients with AMD multiple times at multiple visits our recommendations for risk factor modification. Further, a frank discussion regarding smoking as the leading modifiable risk factor for AMD is imperative.
A few faults of the study are that it relies on patients recall, as well as self-reported studies asking what ECPs do in their practice, neither of which is free from inherent error. Also, some studies evaluate the practices of optometrists in European countries, where the training and scope of practice may differ from the U.S.
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