Subjective clinical recommendations.
RP
OSTEOPENIA OR OSTEOPOROSIS
Patients with RP and their doctors may want to know what is recommended for nutritional supplementation in RP based on this study. When data are complex and do not directly answer all questions of clinical relevance, different investigators who are presented with the same data may draw different conclusions and make different recommendations. Therefore, the rest of this section should be considered opinion rather than direct inference.In our practice, we have stopped recommending vitamin A supplementation for patients who present with new diagnoses of RP. For patients already on vitamin A, there have been a range of approaches in our practice. One physician’s approach has been to recommend cession immediately or at least by the next visit for all patients, while another physician’s approach has been to allow for continuation under certain circumstances. For example, for patients who have been on vitamin A for many years and feel they are doing well, we have noted a natural tendency for them to want to continue. This seems reasonable as long as yearly liver function tests are performed, but becomes more concerning in the setting of osteopenia or osteoporosis since there is some evidence that high vitamin A intake can worsen bone density (Regarding the potential negative effect of vitamin A supplementation in the subgroup of RP associated with For children, retrospective nonrandomized data suggest a significant benefit on progression rate in children with typical RP (While this speculation is admittedly subjective and not at all certain, we have stopped recommending vitamin A supplementation for children with RP as well.For vitamin E, we still recommend avoiding high-dose supplementation (>30 IU/day). Such supplements are typically marketed as strong antioxidants.This study does not have any direct impact on the potential effects of DHA or lutein supplementation (In summary, we currently do not recommend vitamin A or E supplementation for patients with RP. It is possible that further research in subsets of individuals with biochemically distinct mutations would provide additional data. For context, it should be emphasized that other gene-independent, neuroprotective strategies for treatment of patients with IRDs are under study, including rod-derived cone viability factor (