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Optometrists examine people of all ages and from all walks of life including those who are healthy and chronically ill. We are medically trained, conveniently located, and sometimes the only doctor a person visits. Our scope has advanced quickly from the invention of the phoroptor to the use of diagnostic pharmaceutical agents, then to therapeutic pharmaceutical agents and lasers, and now injections and minor surgeries. So what’s next?
Epigenetics! This is an exciting field that transforms optometry into whole-body care. This valuable emerging science is up for grabs because it is within every doctor’s scope. Our current medical system provides costly “sick” care that translates to “acute symptom management.” There is a great desire to replace that model with value-based personalized medicine aimed at the prevention of disease and attainment of wellness. This is what the principles of epigenetics provide. In the future, we may look back and agree that this paradigm shift changed the entire economics of medical care and cemented our relevance as primary health care doctors.
Epigenetics is what allows us to control genetic expression without changing our DNA. It is the integration of genetics, food choices, targeted nutraceuticals, hormones, lifestyle, and health history. The goal is to create a personalized care plan to optimize our physiology despite the genetics with which we were born.
Epigenetics includes nutrigenomics, which precisely uncovers which foods should be avoided, eaten in moderation, or in abundance, based solely on one’s genetics.1 In addition, it integrates the knowledge of one’s food allergies. Food choice is one of the most important epigenetic influences, and it can determine whether genes get turned on or off. What we eat affects all 50 trillion cells in our body including the cells in our eyes. Eating precisely according to one’s genetics and biochemistry provides the core of a self-care plan that may reduce inflammation in the eye and body, and symptoms as varied as gastrointestinal upset, dry eye, fatigue, and migraine.
Epigenetics includes optimization of the methylation pathway.2 This pathway has been the focus of more than 20,000 literature articles including many about the most common eye diseases. Testing of methylation is medically necessary to improve our management of age-related macular degeneration, background diabetic retinopathy, cataract, and glaucoma. Having said that, all patients need their methylation genetics tested, but the need escalates when any systemic disease is present. This biochemical pathway creates our neurotransmitters, produces glutathione, and controls the activation of all our genes. The list of illnesses related to this pathway is long because it is crucial for optimal genetic and cellular function.
Epigenetics includes hormone evaluation and bioidentical hormone balancing.3 Hormones are critical to maintain optimal cellular physiology because they work at the genetic level. Hormonal decline affects men and women starting at around age 35. Although nothing good comes from hormonal decline, it is a normal part of aging. We must not ignore it because it contributes to vision loss.
Epigenetics also includes childhood experiences, lifestyle choices, exposure to toxins, exercise, getting proper rest, and managing stress. These factors are just as critical to overall health as knowing what foods to avoid and which supplements are necessary.
Epigenetics is cellular. By its very nature it is “holistic.” You cannot use it just for the eye because it benefits all cells in the body simultaneously. Optometrists can prevent migraines and neurologists can help age-related macular degeneration. This is the paradigm shift. Epigenetics is universal and does not discriminate by medical specialty. Involvement with epigenetics will position optometry as a necessary player in an integrative health care system.
Epigenetics is multimodal, which is why it achieves results. We must stop wrongly assuming that one vitamin or one drug is the solution. Epigenetic care plans are similar to strategies for playing chess. Chess is not played with one piece and cannot be won with a single move. Similarly, isolating nutrition or nutraceuticals in a study will not allow valid conclusions to be drawn. We must put an end to single-modal care because the body is complex and requires a multimodal approach.
HOW xRMD IMPLEMENTS EPIGENETICS INTO PRACTICE
A company called xRMD Personalized Health provides a collaborative care team composed of medical doctors, doctoral degree holders, optometrists, and dieticians to bring personalized medicine into optometry practices. The company provides a method for doctors to incorporate a fully integrated program that covers all the bases including testing, interpretation of the results, and treatment recommendations. The results are delivered to the patient via a private portal using a sophisticated telemedical system. It includes precise nutritional advice and targeted nutraceuticals based on test results. The xR medical team is empowering its national network of doctors to help patients make smart choices to improve their quality of life and lower their health care costs.
Ocular health is ultimately cellular health so it makes sense for this to be in the realm of the eye doctor. No other specialty is as focused on evaluating cells and cellular health. Eye doctors examine the cells in the eye including those in the cornea, lens, and retina. Nuclear sclerosis is a measure of oxidative stress. Leakage is from vascular endothelial cell dysfunction. Ganglion cell loss and diseases of the retinal pigment epithelium are cellular by definition. Genetic testing allows one to gather information about the patient’s cellular functioning–all of their cells, including the ones in their eyes. With that information, xR optimizes biochemical pathways and, among other things, lowers inflammation in the eye and body.
It starts with a DNA test. This is a simple cheek swab test performed by the doctor (or patient at home) to find genetic mutations in the methylation pathway (Figure 1). Next, the doctor (or patient) performs a food sensitivity test with a prick of the finger to understand how the body responds to particular foods from an inflammatory standpoint (Figure 2).
After xR receives the test information, it provides the physician with an easy-to-understand nutrigenomic report called the “Nutritional Genius” Report (Figure 3). The report details what foods the patient should avoid and what foods to eat in moderation and abundance. The company also provides the doctor with a nutraceutical program for the patient based on the results of the genetic and food allergy tests, and patient history. More can be done depending on the patient’s health status. This includes blood work for hormone evaluation and other tests as needed based on their history. The goal is to optimize physiology, minimize inflammation, and change gene expression.
Epigenetics is Good for Your Patients, Practice, and Profession
Genetics and epigenetics are the future of all medicine. Epigenetics has already shown to be of benefit in diseases of the eye and the rest of the body.4 The results in migraine are groundbreaking.5 Armed with epigenetics, an optometrist can take a patient, years before he needs expensive, acute, medical care, and prevent a future condition. Bringing this concept into your practice has the power to generate revenue from your entire patient base for testing, nutraceuticals, medical office visits, and referrals.
Epigenetics brings optometry into the era of personalized medicine. This capability is extremely valuable in light of the megatrends happening with emerging models of health care. This approach allows optometry to provide a more comprehensive type of eye and systemic care. Best of all, there is no scope battle to fight—especially given xR’s collaborative medical team. Epigenetics differentiates and unifies our entire profession while putting us in the best position not just to survive but to thrive.
2. Matzke MA, Mosher RA. RNA-directed DNA methylation: an epigenetic pathway of increasing complexity. Nature Reviews Genetics. 2014;15: 394-408.
3. Raha P, Thoms S, Munster PN. Epigenomics. Future Medicine. 2011;3:451-470.
4. Liu MM, Chan CC, Tuo J. Epigenetics in ocular diseases. Curr Genomics. 2013;14(3):166-172.
5. Yan B, Yao J, Tao ZF, Jiang Q. Epigenetics and ocular diseases: from basic biology to clinical study. J Cell Physiol. 2014;229(7):825-833.
Scott L. Sedlacek, OD
• Owner of The Eye Place in Olmsted Falls, Ohio
• (216) 534-5386; firstname.lastname@example.org
• Financial interest: Dr. Sedlacek is the director of optometry for xRMD; he disclosed no direct financial compensation from the company but acknowledged indirect revenue from testing and treating his own patients