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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 1 ………………………………………….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 2 ………………………………………….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 3 ………………………………………….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) 4 ………………………………………….Richer & Anshel Special Topics AAO 2007 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 5 ………………………………………….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. 6