It is well known that chronic disease is a driving force for doctor visits today and comprises a large component of health care expenses. However, it has been found that a strong link exists between preventing chronic illness and proper education on smoking cessation, alcohol consumption, physical activity, and nutrition.

Overall wellness involves not just the physical aspects of one’s health, but the mental and social as well.The concept of an integrated health care team is becoming even more essential in the management of patient care.  

As optometrists-in-training, we have the knowledge to educate and guide our patients towards the right information and resources needed to achieve optimum wellness. Optometry in particular is especially unique in that the doctor-patient relationship created from examining the eyes sets up an opportunity to offer preventative health advice. Patient education on nutrition is just one important component in the multimodal approach to the management and prevention of chronic health problems. However, what healthful information we tell our patients is just as important as how we present it to them. In this article, we’ll talk about why optometrists are in a critical position to influence disease prevention, how to open up conversation about health to our patients, and what pieces of nutritional advice we can provide during patient education.  

In optometry school, we are taught to gather information along every step of the comprehensive exam: beginning with the key elements of a thorough patient history and ending with a complete vascular and neurologic assessment of the back of the eye. We get to know our patients’ personalities and lifestyles by asking targeted questions and using careful listening to deeply understand the entirety of their complaint and condition. By the end of the exam, we have a wholistic picture of our patients’ mental and physical wellbeing. This unique perspective places optometrists in a critical position to be able to impact the health of our patients. However, the manner in which we communicate with our patients is a crucial step in initiating change in their lives.  

Patients with chronic health conditions may feel overwhelmed and rarely motivated to act when given a laundry list of health checks they must meet.

Adopting a patient-centered approach by showing empathy, carrying open, non-judgmental conversation, and seeing the patient’s perspective is important in order to leave them feeling empowered to change.

Motivational Interviewing (MI) techniques have been found to be an effective mode of communicating to increase intrinsic motivation, particularly in diabetics. Below is a list of example questions, some of which have been adopted by the MI technique, that can be used to spark open conversation about health and establish rapport during patient education, a concept shown to leave patients feeling more confident about taking charge of their health.  

• “With your permission, I’d like to propose a plan…” or “If you don’t mind, may I share a bit of information with you…”1  
• Replace “I think…” or “You should…” with “Perhaps you could start with…” or “One option you may consider…”1 
• “Tell me what you prepare for breakfast in the morning…” 
• “Patients in the past have found that…”1 

With the immense amount of health literature that we have access to today, it can be difficult to narrow down the most important take-home message regarding nutrition and health. Vitamins, minerals, and antioxidants play a critical role at the micronutrient level at impacting our metabolism, microbiome, and cognitive function as well as preventing eye diseases like age-related macular degeneration and diabetic retinopathy. While patients may have a generalized understanding that proper nutrition can affect their physical health and weight, not many are aware of the nutrients essential to eye health. Patients often respond the best when given a single piece of advice, and are surprised to hear that such small changes can make a large difference in their overall health.  Included below is a list of important elements in nutrition and eye health to steer patients towards healthier habits. 

• Lutein & zeaxanthin. Xanthophylls are one of the two categories of carotenoids, antioxidants that play a role in protecting the health of the macula, ocular surface disease, cognitive function, and skin health. Add 1 cup steamed or 2 cups raw spinach to your meal each day. This could be in the form of a smoothie, a salad, or sautéed into your dinner. Sidekicks are kale, collard greens, swiss chard, arugula, and bok choy.2  
• Carotenes. The second of two categories of carotenoids. Color your plate with red and yellow peppers, sweet potatoes, squash, cantaloupe, apricots, peas, and broccoli.2  
• Vitamin C is a water– soluble, potent antioxidant that plays a role in immune function and wound healing, among others. The most abundant natural sources include guavas, kiwis, and bell peppers, though a dissolvable supplement in a glass of water may be necessary in order to reach adequate levels.  
• Vitamin D is a prohormone that has a supportive role against autoimmune disease, fractures and falls, depression, heart disease, influenza, and type 2 diabetes.2 For fair– skinned individuals, spending a few minutes outside without sunscreen, or for darker pigmented skin, up to 15 minutes, would be enough.  
• Healthy fats, specifically polyunsaturated Omega-3 fatty acids (EPA, DHA, ALA), have been found to support ocular surface disease, fight inflammation, improve cognitive function, and contribute to hormone production. One handful of walnuts, five times per week, or incorporating wild salmon, Alaskan halibut, or canned, chunk, light tuna (1,000-2,000mg/day) is recommended.2  
• Absorption of vitamins with healthy fats. In order for proper absorption of vitamins, supplements or foods should be taken with or cooked in healthy fats including avocado, nut butters, and olive oil.  

While these are just a few aspects of health that we encounter during patient care, the optometric exam opens the door to caring for so many other areas of overall wellbeing. As largely a medical profession, we can positively impact our patients’ lives beyond their eyesight and significantly contribute to disease prevention in our community today.  

1. Welch, G., Rose, G., et al. (2006). Diabetes Spectrum. Motivational Interviewing and Diabetes: What Is It, How Is It Used, and Does It Work? 19(1). 6-8. 
2. Richer, S., Poteet, J., Summerton, S, et al. (2018). Review of Optometry. Wellness Essential for Clinical Practice. 1(1), 6-17.