Diet and Exercise, From an Ophthalmic Perspective

August 28, 2014

Written by Paul B. Freeman OD, FAAO, FCOVD

Much research has been done to address the risk factors associated with specific ophthalmic diseases such as macular degeneration. While there are non-modifiable risk factors such as age, gender, ethnicity, and genetic factors, significant modifiable risk factors have also been identified. These include diet (including weight and alcohol), some health conditions (eg, hypertension, high cholesterol), light exposure, and smoking. Anti-VEGF injections currently treat wet macular degeneration only.

A recent article by Hong and colleagues published in the American Journal of Ophthalmology¹ takes a slightly different approach and looks at the 10-year incidence of visual impairment, correlating that with the modifiable factors of diet and exercise, using the Dietary Guidelines for Australian Adults² and self-reported information using questions from the Australian National Heart Foundation Risk Factor Prevalence surveys.³ The dietary components that the authors looked at are worth reiterating for those who want to use this data in discussion with patients: vegetables, legumes, and fruit; cereals; meat and meat alternatives; milk, yogurt, and cheese; and optimal food choices (as recommended by the Australian Guide to Healthy Eating) including whole-grain cereals, lean red meat, low-fat or reduced-fat milk, and fish, as well as lower intakes of saturated fats, sodium, alcohol, sugar, and extra foods that do not provide essential nutrients the body needs (eg, energy-dense but nutrient-poor foods). The researchers then came up with a Total Diet Score to determine the correlation between diet and exercise and visual impairment. Importantly, the authors removed smoking from the study, as it is a known risk factor, and they were looking specifically for diet as the primary variable.

The authors concluded that the overall quality of diet (and exercise) is correlated with “a 40% reduction in the long-term risk of visual impairment among persons aged 65+ years…” These outcomes were based on those who consumed healthier food choices and, as a result, had a higher Total Diet Score. The beauty of this study is that it highlighted diet rather than specific supplements or foods as a way to minimize the risk for visual impairment (visual acuity worse than 20/40), and did not consider a specific disease, but instead the overarching classification of visual impairment.

We know that the diet of an individual can be influenced by general health, mental status, and socioeconomic factors such as age, level of education, and income as well as comorbid conditions, including stress. Unfortunately, these influences are evident by the fact that 6% of community-dwelling seniors are malnourished.⁴ As eye care providers and as members of the healthcare community, when we take on the responsibility of trying to decrease the risk for visual impairment, diet needs to be addressed, not only from an ophthalmic perspective, but from a public health viewpoint as well. At the very least, diet should be discussed during a summary of a comprehensive eye health and vision evaluation. As the effects of these modifiable risk factors appear to be cumulative, those discussions should happen early on in the healthcare process.

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