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………………………………………….Richer & Anshel Special Topics AAO 2007
Integrative Medicine &
Nutritional Genomics:
The Present & Emerging Role of
Nutraceuticals
In the Primary Eyecare Practice
-----------------------------------------------------------------------------------------------------A 3 hour Special Topic s Discussion on the latest advances
In treating chronic eye disease (GO and PC)
Stuart Richer, OD, PhD, FAAO
Eye Clinic 112e
DVA Medical Center
North Chicago, IL 60064
[email protected]
224-610-5440
Jeffrey Anshel, OD
Corporate Vision Consulting
842 Arden Drive
Encinitas, CA 92024
[email protected]
760-944-1200
I.
What is Integrative Medicine?
a. Defining Primary Care Optometry
b. Therapeutic Eyecare
c. Principles of Integrative Medicine
d. How does this fit with Optometry?
e. Demographic trends
II.
What is Genomics?
a. Genomics and Environment
b. Association with Visual Impairment
c. Longevity Overview
d. Nutrition Quiz
III.
Nutritional Genomics
a. Definition
b. DNA/RNA genesis and interaction
c. Transcriptomics
d. Proteonomics
e. Metabolomics
f. The role of nutrition on gene expression
g. Cells and molecular nutrition
h. Genetic influences on chronic eye disease
i. Immunogenics
IV.
Basics
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………………………………………….Richer & Anshel Special Topics AAO 2007
a. The USDA Food Triangle
b. SuperFoods and ORAC scores
c. Metabolism and Exercise
d. Changing requirements with age
e. Requirements based upon gender
f. Stress
g. Sleep Deprivation and light
h. Concomitant disease states i.e. cancer
i. Effects of medications on nutritional status
j. Individuality and Nutritional Genomics
V.
Nutraceuticals and Functional Foods
a. What is a Nutraceutical?
b. What is a Functional Food?
c. Macromolecules
d. Vitamins
e. Minerals, trace minerals
f. Herbals and cultural eating patterns
g. Fiber and glycemic index
h. “Antioxidant network”
i. RDAs
j. The 1994 Dietary Health and Education Act
k. Side effects and safety
i. resources
VI.
Personalizing Nutritional Genomics
a. Microarray
b. Pharmanex® Scanner
c. SpectraCell WBC evaluation
d. Blood tests,
i. GSH/GSSG
ii. lipid peroxidation
e. Urine tests
i. DNA adducts
f. Hair (minerals)
VII.
Overview: Chronic Ocular Disease and Nutraceuticals
a. Inflammation
b. Dry Eye
c. Allergies
d. Atrophic Macular Degeneration
e. Age Related Cataract
f. Diabetic Macular Edema
VIII.
Specifics: The War on Inflammation
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………………………………………….Richer & Anshel Special Topics AAO 2007
a. The inflammatory response
b. Inflammation vs. infection
c. Types of inflammation
d. Setting up the battle lines
e. Natural anti-inflammatory agents
IX.
Specifics: The Dry Eye Disease Processes including inflammation
a. Working environment, humidity and allergens
b. Concurrent blepharitis in 60% of cases
c. Gender, age and hormonal associations
d. Medications- systemic and ocular
e. Disease associations
f. Contact Lenses & Computer Vision Syndrome
X.
Tear Film Biochemistry & testing for Dry Eye Syndrome
XI.
Traditional DES therapy – treating the eye
a. Artificial tears
b. Punctual plugs
c. Lipid layer dysfunction
d. Epithelial surface
XII.
New Developments in Topical Treatment
a. Anti-evaporatives
b. Seretagogues
c. Micromimetics
d. Anti-inflammatories / Immunosuppressants
e. Autologous serum tears
XIII.
Dry eye as a systemic essential fatty acid deficiency
a. EPAs
b. GLAs
c. Team player vitamins and minerals
d. Ocular dry eye formulations
i. Treatment Options- Overview
ii. Type of Product
iii. Action
iv. Cost
v. Effectiveness
XIV. Allergies
a. The allergic cascade
b. Environmental approaches to alleviating symptoms
c. Nutritional approaches to alleviate symptoms
d. Homeopathic formulations
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………………………………………….Richer & Anshel Special Topics AAO 2007
XV.
Overview of Macular Degeneration
a. Demographics of the condition
b. Types of ARMD
i. Dry AMD--- optometry
ii. Wet AMD--- ophthalmology
c. Predisposing Factors
d. Blue light hazard
e. Visual Function evaluation
XVI. Traditional Medical Treatments
a. Visudyne
b. Macugen®, Lucentis® etc
c. Intravitreal steroids and Retaane®
d. ThermoRadiation
e. Rheophoresis update
f. TENSMAC update and frequency tuning enhancements
XVII. Recent Nutritional Research
a. The AREDS & AREDS II Studies
b. The LAST, LAST II Studies
c. Homocysteine Study
d. Carotenoid Studies
e. Phototrope® Study
XVIII. Major Specific Nutrients for Retinal Health
a. Carotenoids
b. Omega III fatty acids
c. Vitamins A, E, C and Zinc
d. B vitamins
e. Magnesium vs. Calcium
f. Co-enzyme Q10
g. Lipoic Acid & Acetyl L carnitine
h. Others…..
XIX. Cataracts
a. Cataract development
b. Lens nutrition
c. Nutrient deficiency in aging cataractous lenses
d. Recent studies on nutritional supplementation
e. Effect of antioxidants
f. Effect of carbohydrates
g. Effect of weight
h. Effect of alcohol
i. Anti- cataract antioxidant / antiglycation eye drops (n acetyl carnosine)
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i. www.ocluvet.com (vetenarians)
XX.
Glaucoma
a. Dietary contributing factors
b. Magnesium
c. Hyaluronic acid
XXI. Diabetes
a. Definition and types
b. Inflammatory component
c. Glycemic Index
d. The role of nutrients in overall diabetic management
e. The role of nutrients in managing diabetic macula edema
Non invasive imaging of diabetic macula edema
Genistein OTC Nutritional (Bausch & Lomb)
Ascobaic acid and bioflavanoids
XXII. Multi - Vitamin Mineral Supplements and essential oils
a. What makes a good multiple vitamin
i. Dose
ii. Form
iii. Synergy
iv. Studies
b. The major essential fats
c. Treating more than just the eyes
XXIII. CODEX
a. What is CODEX?
b. How will CODEX affect nutritional supplements?
XXIV. Benefits of working with a registered Dietician or Nutritionist
a. USDA Food Triangle public access material
b. Reliable web resources
XXI. Benefits of Offering Nutritional Counseling?
a. Solving the patient’s main problem
b. Enhanced understanding of the patient’s overall health
c. Brings patients back to the office frequently
d. Better from you than the health food store clerk
e. Enhanced reputation
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………………………………………….Richer & Anshel Special Topics AAO 2007
Selected References
1. Pratt S Mathews K, SuperFoods Rx 1st Edition, Harper Collins 2004, ISBN 0-06053567-9
2. Willett W, Eat drink and be healthy, Simon & Schuster 2002, ISBN 0-68486337-5
3. Seddon JM, Cote J and Rosner B, Progression of age-related macular
degeneration: association with dietary fat, transunsaturated fat, nuts, and fish
intake, .Arch Ophthalmol. 2003 Dec;121(12):1728-37. Erratum in: Arch
Ophthalmol. 2004 Mar;122(3):426
4. Fletcher RH Fairfield KM, Vitamins for chronic disease prevention in adults:
clinical applications JAMA. 2002 Jun 19;287(23):3127-9.
5. Sardi B, The New Truth About Vitamins & Minerals by Bill Sardi, 192
pages;ISBN#: 0-9705640-8-2.
6. Griffith HW, Complete Guide to Vitamins Minerals & Supplements, Fischer
Books, Tuscon, AZ ISBN 1-55561-006-4, 1988.
7. Sardi B, User’s Guide to Eye Health Supplements, Basic Health Publications,
Basic Health Publications, North Bergen, NJ ISBN 1-59120-044-X, 2003.Holick
MF, 8. Sunlight and vitamin D for bone health and prevention of autoimmune
diseases, cancers, and cardiovascular disease.
Am J Clin Nutr. 2004 Dec; 80(6 Suppl):1678S-88S. Review.
8. Richardson JP, Vitamin D deficiency--the once and present epidemic, Am Fam
Physician 2005 Jan 15:71(2):241-2.8…. Richer S, Stiles W, Statkute L, et al.
9. Double-masked, placebo-controlled, randomized trial of lutein and antioxidant
supplementation in the intervention of atrophic age-related macular degeneration:
the Veterans LAST study (Lutein Antioxidant Supplementation Trial). Optometry
2004 Apr; 75(4):216-30.
10. MJ Reeves, AP Rafferty, Healthy lifestyle characteristics among adults in the US,
2000, Arch Intern Med 2005; 165:854-7.
11. MR Werbach, Nutritional therapy: Editorial: An important component of
integrative medicine, Alternative Therapies, July/Aug 2004; 10(4), 12-3, 96.
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