ocular nutrition questionnaire Your e depend on several nutrients to stay healthy see their best. Are your e getting eugh of these nutrients? Please take a moment to reflect on what you ate last week answer the following questions. OMEGA-3 rich foods Sardines / mackerel / rainbow trout / wild salmon (1 fillet the size of a deck of cards): Leafy greens (kale, spinach, swiss chard, rapini) (1 hful raw, ½ cup cooked): Eggs (1 egg): Green vegetables (broccoli, peas, green beans, brussel sprouts) (1/2 cup): Lutein-rich foods Zeaxanthin-rich foods Orange peppers (1/2 pepper): Beta-carotene rich foods Carrots, squash, sweet potatoes, canned pumpkin (1/2 cup): Antioxidant rich foods (vitamin C, vitamin E, anthocyanins, catechins, flavaids) Peppers, green tea, berries, kiwi, citrus, other fruit (1/2 cup or one medium fruit): -7 8-14 Do you have any food intolerances or allergies? Do you follow a special diet such as vegan, gluten-free? vegan Do you have diabetes? 15-21 gluten-free n/a How many hours a week of moderate-to high intensity physical activity do you do? -1 2-3 Are you a current smoker? Are you an ex-smoker? Scoring table - for office use only low 3. When did you quit? 1. omega-3 2. Lutein zeaxanthin 3. Beta-caortene 4. Antioxidants 5. Physical activity 6. Smoker high
Helps patient make connection between nutrition ocular health Helps doctor formulate nutrition plan We have included flowcharts at the end of the analysis to aid in your decision. Keep in mind that other factors such as general health, prescription medications, family history ocular will be important. Follow these simple steps to analyze the questionnaire: 1. Fill out the chart below with the answers from the questionnaire. 2. Transfer the ratings to the Scoring Table on the patient s questionnaire. 3. Consult the flow charts to determine the best supplements counseling for each patient. 4. Take into account any food allergies or systemic health conditions. OMEGA-3 rich foods Zeaxanthin-rich foods Omega-3/day (mg) 225 5 zeaxanthin/day (mg).75 1.5 2+ enter low or high 4. enter amount Lutein-rich foods Green Leafy Vegetables lutein/day (mg) 1.75 4. 6.+ 1 + 2 + 3 + 4 under 5 = low, over 5 = high Beta-carotene-rich foods beta-carotene/day (mg) 1.25 3. 5-7 5. 1. enter amount enter low or high Eggs lutein/day (mg) 2. enter amount.2.5. Antioxidant-rich foods Servings Rating -7 Low 8-14 Fair 14-21 Good enter low or high Green Vegetables lutein/day (mg) 3. enter amount.3 1. 1. Hours per week Rating Physical activity -1 Low 2-3 Fair 3. Good enter low or high 1
Dry eye or eyelid Increase fish intake or supplement with DHA + EPA 1 mg/day Increase fish intake supplement with up to 2 mg/day of DHA + EPA OMEGA-3 Keep up the good work! Dry eye or eyelid 1-15 mg/day of DHA + EPA If fish consumption rates high, counsel patient regarding contamination in fish. Recommended fish that are high in omega-3s low in contaminants: Wild salmon, sardines, rainbow trout, mackerel Resources: http://seafood.edf.org (Environmental Defense Fund Seafood Selector) Website App available Lutein from eggs is absorbed better than from other lutein-rich foods Kale is the highest source of lutein 2
Low risk patient High risk or performance vision Prevention vitamin Lutein Zeaxanthin Low risk patient AREDS 2 supplement Keep up the good work! High risk or performance vision Keep up the good work add prevention vitamin AREDS 2 supplement 3
Antioxidants /or Beta-Carotene AREDS 2 vitamin Keep up the good work! AREDS 2 vitamin Increase to 3 minutes/day of moderate to intense excercise for adults Physical Activity Keep up the good work! 4
Helpful Scripts: This questionnaire has highlighted nutritional deficiencies that can be affecting your visual performance your long-tem eye health. Would you like me to recommend a proper, high-quality supplement to fill the gaps? Remember, a supplement does t replace a proper diet. The synergy of the nutrients in food provides beneficial effects to your eye health overall health. Offer patients specific guidelines on what foods how much they need to eat. A hful of raw leafy greens per day 2 orange peppers per week, consume both raw cooked 4 eggs per week 4 fish per week (small is safe as small fish are low in contaminants) Helpful Tips: Eyefoods: A Food Plan for Healthy E is a great resource for patients includes the complete. http://www.eyefoods.com Refer the patient to a dietitian or nutritionist if a complex case, such as diabetes, weight loss, cardiovascular, GI. Consider offering genetic testing. This will determine whether the patient will benefit from supplements that include zinc or t. Consider measuring macular pigment optical density. This can identify high-risk patients, as well as measure the effectiveness of the treatment. Repeat revise yearly. 5