We are in the midst of an incredible paradigm shift that paves the way for placing Nutritional Therapy Practitioners with eye care professionals. Amazingly, the government and the American Medical Association are behind this move. The bottom line means more job placement opportunity for emerging Nutritional Therapy Practitioner professionals in a relatively new profession. The occupation of Nutritional Therapy Practitioner is still in its infancy. Lifestyle education, nutrition, supplementation, and complementary therapies are escalating exponentially around us providing tremendous opportunities. We can create a position for ourselves where none existed before with eye care professionals who are not accustomed to having an NTP on staff or doing nutritional work in practice. It takes far ranging vision to spot developing trends – like the paradigm shift we are in the middle of – thinking and acting creatively to solve future needs. “Finding needs and filling them” is one of the great definitions of success. NTP’s are true pioneers in an industry that is ripe for the picking and the eye care industry is a profession in need of assistance, but many doctors still don’t realize it or they haven’t fully acknowledged the paradigm shift on a practical working level with their patients. As a whole, the eye care profession is currently on the cutting edge of integrating nutritional therapy into medical practice. Implementing nutritional strategies is where we come in. Medicare and the AMA are actually promoting this integration through a new initiative we will discuss momentarily.  Who is ready to fill this vital need for busy doctors? Who better than us as we are trained to restore balance and function by supporting each organ system? When we support ocular health, we improve the total body. In many ways, the eye really is the window not only of the soul, but of the whole body as it functions as an “early warning signal” to identify disease by early detection. Web like interconnections of multiple organ systems are able to be accessed through the eye. The Ophthalmologist and Optometric Physician, because of their unique ability to see blood vessels in the eye without cutting into the body, are at the front line in creating a higher level of health system wide. The eye becomes an open window into the body’s intricate and integrated systems whereby disease processes are seen much earlier than waiting for them to manifest in other parts of the body, such as the vascular network.  The ocular vasculature actually reflects not only the health of the cardiovascular system, but also the blood sugar regulatory systems and others. In fact, the health and appearance of the eye is affected by multiple organ systems such as the heart, vascular system, pancreas and endocrine system, liver and gallbladder. During the eye examination, by using sophisticated magnified, 3D imaging lasers that photograph the macula (the center of vision) macular edema can be observed. Macular swelling can be the result of rising blood glucose levels. The patient incorporating nutritional therapy may choose to embark on a course of treatment to control blood glucose at this point before the potential diagnosis of diabetes is determined by his or her primary care physician. The eye has always been tied very closely with liver function, such as in the case of the sclera revealing jaundice in hepatitis.  Assessments can even be made about the digestive system’s integrity when the patient presents with ocular allergy. By observing the vessels in the retina, elevations in blood pressure can be seen revealed in “nicking” where blood vessels cross which lead to ocular hemorrhages. In cases of atherosclerosis the retina presents with “tortuous vessels” when normally the vessels are straight. We can observe adrenal function indirectly through the pupil’s response to a pinpoint of light directed into it.  The pinpoint light test reveals photophobia, extreme light sensitivity, as well. So we can see by these examples our web like interconnection between bodily systems; how one affects the other. The eye affords unique preliminary detection of potential interruption in the functional health of these systems. Lifestyle changes,  embracing healthful habits and the use of supplementation can often radically affect the outcome of disease states or foster prevention. Indeed for Macular Degeneration, there is currently no medical treatment, but implementing a nutritional and lifestyle protocol can prevent and actually reverse this potentially blinding disease. What does this mean for us? Specifically we have the possibility of a previously untapped source of employment or path of service by initiating a consulting practice alongside the doctor’s practice. And ultimately creating a dispensary in the practice so the supplements prescribed by the doctor can be sent home with the patient. We can also contract our services out to several eye doctors simultaneously, in a traveling NTP scenario, even with a portable dispensary. Additionally, we can train office personnel so the staff and doctor engage with patients referencing the same nutritional knowledge base. Medicare has tremendous regulatory power in the eye care industry. It recently instituted the Provider Quality Reporting Initiative (PQRI) in July 2007 which uses billing and coding modifiers to reflect when a patient has received nutritional counseling based on the AREDS study. This groundbreaking study will be discussed later in the next series or you can access it online at the National Eye Institutes’ website www.nei.nih.gov. AREDS in a nutshell: The 2001 clinical trial called the Age-Related Eye Disease Study (AREDS) — was sponsored by the National Eye Institute (NEI), one of the Federal government’s National Institutes of Health. They were studying patients with Age Related Macular Degeneration.  It is currently the leading cause of blindness in the elderly and a potentially blinding disease where central vision is progressively lost. Scientists found that people at high risk of developing advanced stages of Age Related Macular Degeneration (AMD) lowered their risk by about 25 percent when treated with a high-dose combination of vitamin C, vitamin E, beta-carotene, and zinc. In the same high risk group — which includes people with intermediate AMD, or advanced AMD in one eye but not the other eye — the nutrients reduced the risk of vision loss caused by advanced AMD by about 19 percent. Medicare’s request for nutritional counseling documentation relates specifically to those receiving a diagnosis of Macular Degeneration.  While the July 2007 request was voluntary, more permanent enforcement is under review in a year’s time. Here is our opportunity to provide counsel and treatment plans for eye doctors. This fills their need and ours as well while we broaden the capacity in which we create employment opportunities for ourselves. If that priceless counsel saves the eyesight of just one person who implements the AREDS protocol, it is complete success. Here is where the paradigm shift comes in: This move by Medicare is coupled with the American Medical Association’s reversal of their long held position on supplement use, where they previously stated supplements were not necessary. In 2002 they did an about face and stated that “everyone needs a multivitamin and mineral supplement daily” (JAMA, 2002). We see a movement toward the recognition of the role supplementation  plays in affecting disease processes as Medicare takes the PQRI reporting action. This is of major consequence, and not to be overlooked. It represents a gigantic paradigm shift in the medical community. Every month there are new studies supporting nutrition, lifestyle and supplementation positively affecting outcomes of ocular disease. The fact that macular degeneration was formerly considered an untreatable disease makes the AREDS and related studies very valuable. But the information must be shared to create the desired result: vision preservation.  I remember well the day I counseled a retired doctor who never used vitamins or minerals. His diagnosis?  Macular degeneration. What a great feeling to offer him hope in nutrition and supplementation, backed by double blind, placebo controlled studies, even though it ran counter to everything he believed in. When we speak from research and studies, we hold incredible hope and power. Medicare is currently providing a 1.5% reimbursement incentive to the doctor for performing AREDS based nutritional counseling and it is being tracked, by the use of the modifier. Medicare is proposing a greater standard of care which has the potential to set the future standard of care. This request by Medicare creates dramatic potential to add to our current levels of NTP education providing a wider scope of practice and a desperately needed service to busy eye care professionals. It opens a whole new arena of practice to our profession. It’s a win-win-win! So what exactly do these potentially blinding diseases entail? We will discuss them in the following newsletters. www.nei.nih.gov has information if you want to research now. But first let’s see what filling this urgent need for eye doctors in a counseling capacity would look like in a clinical setting. The PQRI move creates an open door for Ophthalmologists, Optometric Physicians and Nutritional Therapy Practitioners alike to either gain certification as NTP’s or use their own profession in resourceful and profitable ways. Dr. Donald A. Carroll, Optometric Physician was the first Optometrist to graduate the NTA program in June of 2004 as a Nutritional Therapy Practitioner. As his wife, graduating at the same time from the program, we have both been on the cutting edge of integrating nutritional therapy into medical practice. (Actually we have been doing it for years without the designation afforded by the NTA.) We also established a small, but profitable and highly effective dispensary into the clinic to service both our patients and the general public. Our community was clearly ready for treatment that did not require drug therapy. Even though Dr. Carroll still regularly prescribes for various eye diseases and complaints, our office is counseling on alternative therapies and providing on site solutions in the form of supplements and homeopathic remedies along with lifestyle intervention. Often the patient requests a trial period in which alternative therapies are introduced before a drug regimen is instituted. We encourage our patient’s participation in their own healthcare by giving them several treatment options. Is the dispensary client base confined to predominately ocular patients? Absolutely not. Word of mouth advertising by satisfied patients insures that we have a steady stream of new patients and clients interested in getting help to achieve total wellness, eye related or not. Nutritional therapy works through restoration of health and function, rather than simply controlling signs and symptoms. Current NTP’s have a ready answer for those doctors who would prefer to hire out their consultations by employing a NTP in office or subcontracting our services. Having qualified staff equipped to provide basic information along with specialized staff possessing proper certification ensures that the office has much more to offer than less progressive offices still practicing in the old paradigm. We now see a need developing for NTP’s to educate existing staff in eye doctor’s offices so all support staff is “on the same page”. There are several opportunities presenting themselves due to nationwide changes in Medicare reporting! Even for those professionals who do not accept Medicare, and several do not, the precedent is now set and a new standard of eye care is emerging. To fail to comply with basic standard of care is professional suicide. We are trying to ensure that this doesn’t happen for the sake of the professional and those that will receive healing, restorative information though AREDS based counsel. Since the AMA reversed its position publicly in 2002 on supplements, and now advises everyone to use a daily multivitamin and mineral formula, we cannot even say practices are “traditional” anymore when they don’t offer lifestyle and nutritional counseling and/or supplementation to their patients. These practices are at risk of appearing archaic in light of the AMA’s new stance on supplement use, as well as Medicare’s interest in tracking nutritional counseling in a practice. The times aren’t merely changing. They have changed! Busy doctors delegate tasks; we are in the position to provide a great service to an eye care professional by agreeing to consult all their ocular disease patients as well as providing preventative counsel to the general patient population. These patients could conceivably all be scheduled in a template or time block fashion or be consulted on a few days of the week. Inevitably, counseling should extend to all patients for prevention or remediation of diseases or ocular conditions so NTP work would most likely grow to include most or all of the doctor’s daily patients depending on how the office schedules. The personal fulfillment of serving people in our own locale, or even taking our skills abroad in a mission sense, is immense. It is unthinkable that blindness can exist in 2007 when we have eradicated so many other threatening diseases. To be part in saving the precious resource of vision is no small accomplishment. We find this true particularly with the elderly who have experienced the loss of mobility or function in other bodily systems. Preserving sight becomes priceless particularly in these cases. The rewards of this profession are beyond any monetary bounds and begin to impart a sense of incredible satisfaction with our life’s chosen work. What do our patients think of our cutting edge method of practice? Our practice has tripled in as many years drawing people from over 100 miles away just to have access to this level of care; astonishingly, this occurred despite a locally depressed timber based economy! Our community lacked NTP services. We have experienced many walk-ins that are simply interested in purchasing from the on-site health store with a knowledgeable NTP on staff to consult with. This has ultimately resulted in an increased patient base due to exposure to the clinic in general and the added services specifically. We have received overwhelmingly positive feedback. The idea of creating healing outcomes without medication is extremely appealing. Or even being able to use less medication and gain further support with nutrition and supplementation. When patients see other longstanding conditions resolving that are not supposedly related to the eye, such as the fish oil prescribed for their glaucoma helping alleviate pain from arthritis as well, they are delighted. We witness the body’s interconnection every day as we apply nutritional therapy in medical practice. The most rewarding cases are those patients in nursing homes who have little or no control over their diet. When they see a few key supplements begin to raise their general level of health and wellbeing,  they are infused with hope and an optimistic outlook for their future. In short, implementing a nutritional therapy program is empowering on many levels. We have a program years ahead of its time in the Nutritional Therapy Practitioner certification. Now that we’ve discussed how a practice works with an NTP assisting in counseling and/or managing the dispensary, the next question is: how does one tap into an opportunity by preparing to offer a solution to the AREDS/PQRI question as well as providing additional counsel that is directed to general ocular diseases or prevention in a current practice or as a stand-alone counseling service to Optometrists? Obtaining the basic certification as Nutritional Therapy Practitioner is a firm foundation. Next, we must add to our knowledge base with special emphasis on the eye by reading. The web is full of current research and new studies are appearing all the time. One of my favorite sites for up to the minute research findings is Pub Med at http://www.ncbi.nlm.nih.gov/sites/entrez. Review of Optometry, www.revoptom.com, is good as well. The National Eye Institute’s website listed earlier is also valuable, among others. An understanding of basic ocular anatomy is crucial. Mosby’s Handbook of Anatomy and Physiology is good, as is Tortora’s book of the same title. Interning with professionals who are currently implementing nutritional therapy in their practice is another invaluable option. Several books have been instrumental in the development of the nutritional branch of our practice and creating the dispensary. Bill Sardi, Medical Reporter, writes my personal favorite User’s Guide to Eye Health Supplements. It is truly an important resource available at our Nutritional Visions dispensary bookstore.  Understanding how to support the health of the eye from a functional medicine approach is taught in the Textbook of Functional Medicine. This amazing textbook was released by the Institute for Functional Medicine in 2005 with emphasis on training professionals to understand and improve the patient’s functional core as the starting point for intervention. www.functionalmedicine.org has information for ordering a copy for your library. When our knowledge base is increased focusing on the care and feeding of the eye, we are ready to present our solution to professionals in our individual areas. We not only solve the AREDS/PQRI challenge but potentially create other opportunities. Most importantly, the patient will receive a higher quality of care through our knowledge, counsel, and clinical experience that potentially enables their vision to be preserved. Hopefully this is the intent of Medicare with the PQRI. This initiative has opened the door for a very dramatic entry into an untapped market to us as professionals, but only if we take the initiative to propel our education to an advanced level while being proactive in creating a new specialty niche for our practices. Several NTPs have called requesting information on protocol and treatment programs to assist the eye’s restoration to proper function in cases of dry eye, allergic conditions and styes that they have experienced in their own practice or with friends and family. Hopefully the information is pertinent and useful particularly as we understand the interconnectedness of our body’s systems. It’s our expectation that those interested in creating a specialty niche will be poised to capture the opportunities this considerable paradigm shift has afforded us as Nutritional Therapy Practitioners. The options of using our excellent training are literally limitless. In the next newsletter, we will present our Seven Foundational Pillars of Ocular Health that we use at Medical Vision Center’s clinic. In the last of the three part series we will discuss major disease and condition processes providing protocols to use in your practice.  Mastering this information so that you will be able to address patients professionally in a clinical setting under a doctors’ supervision, should you choose to do so, is our goal. Katherine A. Carroll, NTP President of Nutritional Visions, LTD 240 W. Main Street, Box AC, Morton, WA 98356 cell: (360) 790-2011  Office: (360) 496-5140   fax: (360)496-6039 https://www.medicalvisioncenter.com/ kat@nutritionalvisions.com Disclaimer: Statements made in these articles have not been evaluated by the Food and Drug Administration. These products or protocols are not intended to diagnose, treat, cure or prevent any disease or be used as a substitute for appropriate care of a qualified healthcare professional.  The ideas and options of contributing authors do not necessarily reflect those of the Nutritional Therapy Association SPC.