Nutrition and Eye Health

Lifestyle factors and the role of optometrists: patients’ perceptions and experiences

Tobacco smoking, nutrition and ocular health

Tobacco smoking and nutrition are key lifestyle factors that are established to have long-term effects on ocular health. Tobacco smoking is the most important modifiable risk factor for age-related macular degeneration (AMD)1, with current smokers having an at least twofold increased risk of developing AMD compared with individuals who have never smoked2,3. In addition, there is epidemiological evidence that diets rich in certain nutrients, in particular the macular carotenoids (lutein and zeaxanthin) and omega-3 fatty acids, are associated with a decreased risk of late-stage AMD4.
However, little is known about patients’ perceptions and experiences in these areas in relation to the care provided by optometrists, being major providers of primary eye care in the community. The major aim of this study was to survey patients’ perceptions and prior experience regarding the role of optometrists in enquiring and providing advice about tobacco smoking and nutrition.

The perceptions and experiences of 220 patients with respect to optometric care

An anonymous survey was distributed to adults who were attending an eye test, with an optometrist at, the University of Melbourne eye care clinic, Parkville, Victoria, Australia. Survey respondents provided demographic and other relevant information (e.g., age, gender, length of time since last eye examination, country of most recent eye examination, smoking status and nutritional supplement intake) and indicated their level of agreement, on a five-step Likert scale, with several statements relating to the care provided by optometrists in the areas of general health, smoking and nutrition. The statements assessed the perceived scope of optometric practice and the extent to which the survey respondents expected, and felt comfortable, discussing these topics with their optometric care provider. A total of 220 completed surveys were included in the analysis.

For one in three respondents, their optometrist had questioned them about their diet

More than 80 percent of survey respondents agreed that they visit their optometrist to measure their refractive error and to assess the health of their eyes. Two out of three survey respondents indicated that they expect their optometrist to ask about their general health, with almost half expecting their optometrist to communicate with their general medical practitioner. About one-third of respondents indicated that their optometrist had routinely questioned them about their smoking status, diet and nutritional supplement intake. This was despite about half of respondents expecting their optometrist to question them about these factors and almost three out of four respondents indicating that they felt comfortable talking with their optometrist about these lifestyle behaviours.

This study provides the first insight into patients’ perceptions and experience with Australian optometric practice, in the areas of tobacco smoking and nutrition. We find that most people attending an eye examination in Australia expect their optometrist to examine their eye health, ask them about their smoking and diet habits, and are comfortable discussing these topics with their primary eye care provider. These findings demonstrate that patients recognize the expertise of optometrists in providing care that includes the evaluation of eye health. Our study findings also highlight that brief advice interventions relating to tobacco use and diet are likely to be acceptable to deliver in optometry consultations.

Concerning nutrition counselling, optometrists are well positioned to provide simple advice on healthy dietary behaviours to their patients. The Macular Disease Foundation of Australia encourages a healthy, balanced diet including the intake of coloured vegetables daily. More complex, nutrition-focussed healthcare could then be achieved through appropriate co-management with general practitioners and/or other health professionals, such as dieticians, to achieve desirable lifestyle changes.

Based upon: Downie LE, Douglass A, Guest D, Keller PR. What do patients think about the role of optometrists in providing advice about smoking and nutrition? Ophthalmic Physiol Opt. 2017 Mar;37(2):202-211.

  1. Thornton J, Edwards R, Mitchell P, Harrison RA, Buchan I & Kelly SP. Smoking and age-related macular degeneration: a review of association. Eye (Lond) 2005; 19: 935–944.
  2. Smith W, Assink J, Klein R et al. Risk factors for age-related macular degeneration: pooled findings from three continents. Ophthalmology 2001; 108: 697–704.
  3. Tomany SC, Wang JJ, Van Leeuwen R et al. Risk factors for incident age-related macular degeneration: pooled findings from 3 continents. Ophthalmology 2004;
    111: 1280–1287.
  4. Downie LE & Keller PR. Nutrition and age-related macular degeneration: research evidence in practice. Optom Vis Sci 2014; 91: 821–831.
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