Everyone knows that smoking is bad; even our patients that smoke. Most of us have no problem counseling our patients to stop smoking. We can point to numerous studies that quantify the associations between smoking and sight-threatening and life-threatening diseases. Why do we have more difficulty counseling our patients about diet? The AREDS studies have certainly helped start these conversations.  Eyecare practitioners are embracing the use of vitamins and supplements in the treatment of macular degeneration. But two recent publications make it very clear that we need to make a change in our approach to patient education. It is time to start talking to our older patients about eating a healthy diet to prevent eye disease and visual impairment. A healthy diet also has a positive influence on quality of life and the ability to perform activities of daily living (ADLs).

The Blue Mountains Eye Study followed almost 2000 older adults over 10 years. A comprehensive vision examination was performed at baseline with re-examinations at 5 and 10 years. Participants completed a questionnaire to quantify the types and amounts of food they consumed. A Total Diet Score was calculated which reflected adherence to the Dietary Guidelines for Australian Adults. No surprises here; the guidelines stress consumption of vegetables, lean meats, low-fat dairy, whole grains, and the avoidance of saturated fat, alcohol, sugar and junk food.

The authors concluded that “higher levels of adherence to dietary guidelines….was associated with a nearly 40% reduction in the long-term risk of visual impairment among persons aged 65+ years.” This reduction in risk was also, notably, independent of other known risk factors for visual impairment including diabetes and smoking.


And here’s the kicker: A subset of the participants also completed a survey to assess quality of life at the 5-year mark. Adherence to the dietary guidelines was also associated with a 50% reduced risk of Instrumental Activities of Daily Living (IADL) disability.   The authors postulate that a better quality diet reduces chronic inflammation. This in turn slows down decline in physical performance, quality of life, and the onset of disability (including visual impairment).

Most diseases result from a combination of factors. Many of these risks factors, such as those coded in our DNA, cannot be changed (at least not yet). But many of them can be eliminated or at least modified. You can prevent forest fires AND visual impairment and disability. Educate patients to make positive changes in these behaviors. Change is good!


Gopinath B, Russell J, Flood V, Burlutsky G, Mitchell P. Adherence to dietary guidelines positively affects quality of life and functional status of older adults. J Acad Nutrition Dietetics 2014;114:220-9.

Hong T, Flood V, Rochtchina E, Mitchell P, Russell J, Wang JJ. Adherence to dietary guidelines and the 10-year cumulative incidence of visual impairment: the Blue Mountains Eye Study. Am J Ophthalmol 2014;158:302-8.

Freeman P. Diet and exercise from an ophthalmic perspective. Practice Update

Available at: www.practiceupdate.com/expertopinion/1190