MICHAEL BUCKLEY: Hello, I’m Michael Buckley with the BrightFocus Foundation. Welcome to, or welcome back to, the BrightFocus Chat. Today’s topic is “Nutritional Supplements, Dietary Patterns, and Age-Related Macular Degeneration,” and we have just a fantastic guest today, Dr. Emily Chew. She is one of the top vision researchers at the NIH—the National Institutes of Health. Dr. Chew is the deputy director of the NEI—the National Eye Institute (which is one of the research centers at the NIH campus in Bethesda, Maryland). She is a past winner of the Helen Keller Prize for Vision Research (which many people consider the Nobel Prize of vision), and it’s an award that BrightFocus is happy to help present every year. Earlier this month, Dr. Chew gave the major address at the nation’s gathering of ophthalmologists, so it’s just a tremendous opportunity to have Dr. Emily Chew today.
Dr. Chew, thank you so much for joining us. Would you like to start off by telling us a little bit about what you do at the National Eye Institute?
DR. EMILY CHEW: Thank you, Michael. It’s a great pleasure to be here, and thank you for inviting me. I’ve been at the National Eye Institute for almost 3 decades, and my primary goal is to help patients. I’m a clinician at heart, and I do see patients at least about 1 or 2 days a week, but the rest of the time I spend really looking at research projects, especially clinical trials. I’m the chief of the clinical trials. Clinical trials are where we set up this test of treatment or strategy, or a test to see whether it works or not, and we toss the coin and put patients in one bin versus another to see whether the therapy or the test will be effective or not. So that’s one of my primary goals. I do a lot of work in clinical trials in macular degeneration, as well as in diabetic retinopathy, and we also do a fair amount of mentoring because we have young students—medical students—who come, as well as physicians who’ve already finished their residency program are here to learn more about the eye. We’re super specialized, so the fellowship program focuses on the back of the eye or the retina. It’s a combination of doing scholarly work and research, providing care, and also providing guidance and mentorship for the young trainees coming up.
MICHAEL BUCKLEY: Well, that’s wonderful. What a great service. Just sort of the big picture, why did you want to become involved in vision health and science?
DR. CHEW: That’s a very good question. I had set up in my mind that I’d become a pediatrician. I went to medical school, but it’s interesting how role models are so important in how we choose our careers. I met a wonderful woman named Brenda Gallie. Dr. Brenda Gallie is a top researcher in retinoblastoma, which is an eye tumor that occurs in children. And I was a very young medical student, and what she did was so fantastic.
She really impressed upon me how important vision is and how important it is to research. We could treat patients one at a time and be very gratified by it, but to do research meant that we would be able to affect many more people rather than just one at a time. So, I put that to heart and I really valued her advice; we’re still good friends. So I think role models are really important.
I also realized that ophthalmology is a fantastic field. We can do many things to help our patients, and we’re learning. The research is abundant, and there are very bright people in it. So, it really attracts people who are interested in helping people maintain their vision. Vision is really important, because your quality of life is important. At the other end, mortality may be related somewhat to vision—people who have vision problems and who fall, for example. It’s all related in a cascade, so keeping the vision of our nation, of our people, is so important for their general health.
MICHAEL BUCKLEY: I agree and see your point about the overall quality of life. In sort of the big picture, in your experience, is vision an inevitable part of aging?
DR. CHEW: Well, you could say it may be, but there are lots of things you can correct. So, as we get older our arms are never long enough to read. . When you’re really small, when you’re a young child, you can read up to your nose, and my parents would say, “Don’t do that, that’s bad for your eyes!” But they’re just jealous because they can’t do that. It’s what we call presbyopia, the inability to read up close, so we have to wear reading glasses. We adapt to that.
Almost everybody, if they live long enough, will develop some form of cataract. A cataract is the calcification of the lens inside the eye, and that increases over time and with age, and that would also decrease your vision. But, as we know, cataract surgery is one of the most common things done, and it has really brought a lot of people great vision afterwards. So, these are correctable types of things. And, of course, your refraction might change because your lens is changing, and you may have to change your glasses.
Those things are all very correctable types of vision loss. The ones that are more difficult are related to chronic diseases, such as glaucoma, which again is related to age, and if you’re African American you may have a higher risk at a younger age, and if you have a family history of it. The other one, of course, is diabetic retinopathy. Diabetic eye disease can occur, and about 30 percent of people with diabetes will actually have some form of retinopathy or eye disease, and that is really quite treatable. And again, the importance is getting eye exams; the same as glaucoma. Get an eye exam so you get checked out early, as well as those with diabetes.
And finally, I’m going to talk about macular degeneration, which is a chronic condition that affects really an increasing number of people who will have this disease. By the time you’re 80, something like 30 percent of people, especially women, may have that condition. So, these are chronic conditions that are somewhat preventable, but the other things I talked about are things that are correctable. So yes, aging is associated with some changes in the eye, but much of it is correctable. But then there are diseases that we really need to have a good handle on, and the number one thing would be getting a good eye exam to make sure that you’re getting those checked out and some prevention can be given for some of these.
MICHAEL BUCKLEY: That’s great advice. So, Dr. Chew, you mentioned the chronic diseases of the eye. Linking that to your main area of research lifestyle, how do diet and exercise affect or influence age-related vision diseases, such as AMD?
DR. CHEW: Well, I think AMD is a very good example where it can be affected by your lifestyle quite dramatically. People who smoke always have an increased risk of macular degeneration, and it increases almost like a dose response: The more you smoke, the more likely you’re going to get macular degeneration.
Luckily, that’s coming down, so that risk factor has really been attacked tremendously by the press and general health to reduce it not only for eyes, but for your heart, for your blood pressure, and everything else.
Diet is really an interesting aspect of this. We did a nutritional trial, but looking at the diets from this trial, we can see that people who eat a lot of green, leafy vegetables that contain a vitamin called lutein and zeaxanthin have a lower risk of having macular degeneration; and people who eat fish have a lower risk of macular degeneration. And this was borne up by a further study that we had recently done looking at the dietary habits of people—almost 8,000 people we looked at—and seeing what happens over a period of time 5 to 10 years later. It seemed like people who ate what we call a Mediterranean diet (which is full of a really good amount of vegetables, legumes, good wheat—grains, rather—and olive oil rather than the short fatty acids, and really low on red meat but a high amount on fish and chicken) that there was a protective effect. So, people who ate a good Mediterranean diet had an almost 25 to 30 percent reduced risk of having macular degeneration; specifically, the green, leafy vegetables and the fish really were very important.
MICHAEL BUCKLEY: Wow. That’s very interesting. It seems like that runs counter to a lot of diets here in the United States.
DR. CHEW: Unfortunately, that’s so true. We have a study called the NHANES, the National Health and Nutrition Examination Survey, that really monitors the dietary health of our nation, and it looks like people just don’t cook as much. Grandma used to do all of the green, leafy vegetables, and nobody’s eating collard greens and kale and things like that; although kale is making a comeback—it’s a superfood. But it’s quite true that I think in this busy world, people are not cooking as much and not getting all the nutrition that they really need.
MICHAEL BUCKLEY: Given those challenges, if someone has not had a vision-healthy diet up to whatever age they are currently at, is it too late to start now?
DR. CHEW: No, it’s never too late. In our studies, when we looked at patients who already have the disease and people who have early forms of disease, we find that even if they eat a good diet over the next 5 to 10 years, there were reductions, so it’s never too late. I think your cardiologist would be very happy to say to you, “You should be doing that for your heart and cancer and other things, as well.” So, all in all, it’s really important to have a good diet, and it’s never too late. You can start now, even though you’ve been diagnosed with it; it’s important to maintain that good diet.
MICHAEL BUCKLEY: Listeners to previous BrightFocus Chats have heard us talk about AREDS with a number of our prior guests, and so today, we have the opportunity firsthand about AREDS. So, Dr. Chew, could you tell us a little bit about the research? What led you to—I don’t know if discover is the right word—recommend the AREDS formula?
DR. CHEW: AREDS really stands for Age-Related Eye Disease Study, so AREDS is sort of the acronym we use for it. This was started in 1992. We had very little data looking at the natural history of the conditions for macular degeneration, as well as for cataracts, so this was designed mainly to look at the natural history and for the risk factors associated with progression of disease, what makes it worse, etc. During the course of the study, that was when a lot of studies were being done with nutrition for cardiovascular health and also for cancer. There were big studies on vitamin E and vitamin D, and more recently, beta carotene. So, when we looked at the data we thought, well you know, maybe’s there’s…especially for cataracts, we sort of had hints that diet might be important. So, we put together what was then a really popular type of formulation that was being tested for other diseases, and we came up with vitamin C of half a gram (which is a pretty large dose); vitamin E (400 international units), and beta carotene (15 mg).
And there was a small study done at Utah looking at the role of zinc. Zinc was given mainly because it’s very high in the eye, and that was the main reason, and so this researcher used the zinc in very high doses. And to really combat or reduce any risk of having the zinc cause anemia—because it could take over and people can become anemic to it—so they add copper because zinc competes with the copper, so we actually add zinc and copper to it.
We thought this would be really important perhaps for cataracts, but much to our surprise, at the end of the study (which averaged 6 and a half years), we found patients who had at least what we call intermediate AMD. In other words, they’ve had signs of disease, not people who don’t have AMD. There was a 25 percent reduction in the risk of progressing to the more vision-threatening type: people with the wet form or the dry form of macular degeneration. So, 25 percent is not a cure. It’s not huge, but it’s a modest effect that’s very important, because this is a common condition. If you have heart disease, even a 10 percent reduction would be very significant, so here a 25-percent reduction can reduce the number of people from going to late disease and requiring injections and that sort of thing. So, that’s where the AREDS formula came from.
It was 1992 to 2001, somebody stopped this study and realized that this was beneficial. We followed patients for another 5 years, mainly because this is like watching your grass grow. It’s a very, very slow condition. We want to be able to quantify and look over time at what happens. Even at 10 years, and we stopped the study, we still saw beneficial effect. Patients who were originally assigned to the treatment had a better outcome than those who were not, so there’s a 5-year lag, but we still found that patients really did well with this. So, this has become the standard therapy until we did another study, which was AREDS 2. Should we talk about AREDS 2 a little bit, Michael?
MICHAEL BUCKLEY: Yeah, that would be great. Thanks.
DR. CHEW: AREDS 2 is, again, Age-Related Eye Disease Study 2, so it’s a sequel to our AREDS. We were interested in doing that because at the time when we did AREDS, we knew that lutein/zeaxanthin was important, but it was not commercially available. We could only do beta carotene (which was a close cousin to it), but beta carotene was found to increase the risk of lung cancer in two other studies that were supported by NIH. We looked at patients who were smokers both in Finland and also across the United States, and giving beta carotene actually increased the risk of lung cancer by about 28 percent, and people actually had a higher rate of death, as well, so that certainly is not a good thing. And these are all in smokers. So, at the time of our study, we were very concerned; we actually took patients off of it, and we did a number of assignments of the treatment. In the end, we just decided the AREDS supplement was not good for smokers. We wanted to see whether we could replace beta carotene, so lutein/zeaxanthin was the ideal vitamin for us to work with. And it was also, as you heard, the importance of fish. If you eat fish, you had less macular degeneration, so we thought, well, maybe it’s the omega-3; omega-3 is found in fish. So, the AREDS 2 actually added the lutein/zeaxanthin and the omega-3 to the AREDS supplement, and we looked directly between beta carotene and lutein, etc.
So, what did we find? In the end, after another 5-year study with about 4,000 participants, we found that the new formulation— which now has lutein/zeaxanthin, because we found it during this study with AREDS 2—also had an incremental effect. It improved the final effect of the AREDS supplement, and what’s more important is that we found that beta carotene, even in our study that was given to people who are no longer smoking, actually increased the risk of lung cancer—doubled the risk of lung cancer in our AREDS 2. That was mostly found in patients who were former smokers, so even if you’re a former smoker, the risk is somewhat there. So, for good reason, we took away the beta carotene and put in lutein/zeaxanthin.
Now, omega-3 was another story. We were expecting this to be great, because you eat fish, it should be good. Well, we found it was neither harmful nor beneficial. It did not have an effect in any way, and that’s been true probably across the board for omega-3 for a number of other diseases. For cognitive function, for cardiovascular disease, we found that omega-3 did not have that initial shine that we thought would be really important, so we did not add omega-3 to the actual formulation, so AREDS 2 now does not have beta carotene. It has vitamin C, vitamin E, lutein/zeaxanthin, and zinc. It’s interesting that, even though you eat fish and fish is important, omega-3 was not important. But that was our legacy of AREDS 2, which I think really helped to contribute to even a better formulation.
MICHAEL BUCKLEY: That’s great. It’s great to hear this from the original source. Dr. Chew, when choosing the AREDS, can someone take AREDS proactively to avoid getting AMD?
DR. CHEW: No. This is what is called secondary prevention. We really don’t give it to people who don’t have macular degeneration. So, often the children of folks who are affected will say, “My parents have terrible macular degeneration; shouldn’t I be taking this?” And the answer is actually “no,” because we don’t know the effects on such people, and mainly because in our original study, we looked at people who had very early macular degeneration; it made no difference. It’s only when you have an intermediate form, which is signified by having what we call large drusen. For your doctor, they’ll be looking and say whether you should have it or not. But before that, it really doesn’t make any difference, so truly you have to have sort of an intermediate stage before it makes any difference. So, it is important to get that eye exam and to have that conversation with your doctor before you start anything on that.
MICHAEL BUCKLEY: That’s great, and to that point, is it a choice—a reasonable choice—if someone wanted to get those vitamins through their food or through supplements? Is that an either/or, or do you have a preference?
DR. CHEW: Well, there’s no question, it’s important to have a good diet. That’s very important. But the supplements really cannot be taken through the foods. I mean, to get that amount of vitamin C, you’d have to eat at least more than a dozen oranges a day, which nobody does. The vitamin E would be like a whole room full of wheat germ, so that’s harder to manage. So, these are really large doses, making it very difficult to obtain through the diet, but that doesn’t lessen the importance of having a good diet—that’s the Mediterranean diet we talked about being high in vegetables and nuts and all things. So, it’s important to eat well, but the supplements are required. You cannot just purely eat that much to make up for those supplements.
MICHAEL BUCKLEY: I think we’re all picturing the visuals of eating a dozen oranges a day, and we won’t go down that road. I understand recently you led a study about whether calcium increases the risk of macular degeneration. Can you tell us what you found?
DR. CHEW: Yes. We were spurred on to doing this study because other studies suggested that maybe calcium might be harmful, and many people are on calcium. I think 80 percent of our women in the participants were on calcium, and actually men are, and that’s because of bone health. People have been taking that for a long time. So, we took this opportunity to use our data to look and see whether calcium would be harmful. We did what we call a post-hoc analysis; that means we’d finished the study. We hadn’t planned on doing these analyses at all, and then something came up and we decided to use it, so these are like secondary analyses that we looked at. And again, it’s not a clinical trial. We didn’t flip the coin and say, “You take this and you take this.”
When you take calcium…it may be different people taking calcium than people who don’t take calcium. We know for sure people who take calcium have a better diet, for example. They actually have a higher intake of lutein and zeaxanthin, so we can’t make a blanket statement saying, “calcium does this, because we found this.” This is what we found. We found that for people who had either taken supplements at the baseline or actually have a higher intake in their diet, there was a less risk of having the late macular degeneration, especially the wet form.
Does that mean we use it as a treatment? Should we give calcium to everybody? The answer is “no.” We don’t have recommendations, mainly because of the way that the study is designed. There’s not a clinical trial. We know just by observing people, and just as I said, people who eat calcium might actually have a higher intake of other things, so again, this whole idea that healthy diets and things come in. I think what this study really does is to allay anyone’s fears that taking calcium for the osteoporosis would make their macular degeneration worse. We don’t think that’s the case. We think that you’re safe to take it, and you would be able to take it without harming yourself in terms of your eyes. Will we ever do a clinical trial on this to see whether calcium helps? I think it’s unlikely, because there are so many people who are on it and they need it for other reasons. So, if you need to have calcium for other reasons, don’t feel bad about taking it. It’s not going to harm your eyes, especially if you have macular degeneration, so people should feel really free to take the medical advice about taking calcium and not be concerned about the macular degeneration worsening with that.
MICHAEL BUCKLEY: Well, thank you. I’m sure that’s very reassuring for our listeners. We’re starting to get a few questions in about supplements. I was wondering, Dr. Chew, I think a lot of people may find the supplement aisle at a supermarket or at a pharmacy to be a little overwhelming and sometimes kind of expensive. There’s a questioner asking about something called “The Balance of Nature” formula or supplement.
How should one find the AREDS 2 on their pharmacy shelf, and then also, are there ways to bring down the costs to make this more of a long-term possibility for people?
DR. CHEW: I don’t know if people know, but if you’re part of the VA, the VA actually provides it for free and they provide the real thing—the AREDS 2 supplement that we tested. So, if you served the government and you can belong to the VA, you can get that for free, so that’s one thing. There are many knockoffs.. I find it confusing myself when I walk down the aisle. I always say look for the large, bold AREDS 2 right on the cover, not just somewhere in small print saying that this might be an AREDS 2, but that we know we trust because we know that’s been made to the specifications that we tested. That’s one thing that I always tell my patients to look for. And there are other names and other things, but unless they have that number of that lettering, I find that they may be getting something else instead of exactly what we tested.
As far as cost is concerned, I think there are a lot of “big box” places like Walmart and CVS and even Costco. They do carry big brands, so you can look for that. I know some of the pharma companies actually give out coupons that help quite a bit, and I think there’s even a program where you can actually write to and get some help with it. But obviously, I work for the government, so I don’t really know. I don’t have any recommendations other than look up what you can with the sales and things. I have no control over that. I know that in England they’re trying to convince their health care system to pay for this. Certainly, prevention is a lot easier than trying to treat at the other end, but we’re not there yet. But again, I just emphasize if you have any association with the VA and you’re eligible for the VA, they definitely give it to you for free there.
MICHAEL BUCKLEY: Great. Those are very helpful suggestions. We had a questioner, staying on supplements for the moment, wondering: Is there a danger to taking too many of these supplements and these vitamins that you mentioned?
DR. CHEW: Well, the dose we’re giving—and we wouldn’t go beyond what we recommend, which is on the label and everything, and I know that Michael’s going to give it, too, in the form of a pamphlet or some information—we don’t think it’s unsafe, because certainly we’ve followed patients for 10 years in AREDS 1 and AREDS 2, and the side effects are really quite minimal. Can you take one vitamin that’s too much? Yes. For example, beta carotene caused a lot of yellowing of the skin, and there’s concerns about zinc and other things, but we really haven’t done anything that’s been bad at all. Vitamin E at one point was thought to be harmful for people with cardiovascular disease. Again, that really hasn’t shown up, and we’ve looked at our data very carefully with the trials, seeing people on or off of it, and we didn’t really find anything major.
I think the one thing we found was in zinc. We found patients who took high doses of zinc or the doses of zinc had an increased risk, especially for men; they had an increase in their prostate—it was not prostate cancer or anything, but the prostate was enlarged.
But other than that, we really did not find anything. In terms of multivitamins, I know people take it, but there’s been very little to suggest that that is really that important. So, in our studies, we gave multivitamins because people were going to take them. We wanted to control that, so we gave them free multivitamins with our actual AREDS formulation. We found no difference with or without the actual multivitamins, so we think it’s safe to take with it, and that’s really about all we can say from our data.
MICHAEL BUCKLEY: Thank you. Let’s talk about clinical trials for a moment. You mentioned at the beginning that you help lead clinical trials, and you’ve mentioned some of the results that you and others have learned from clinical trials. I think a lot of people may have some concerns or not know too much about clinical trials. I was wondering: Why should someone consider volunteering in a clinical trial, and what are some questions that people should talk through with their doctor about clinical trials?
DR. CHEW: People who come to clinical trials are often very altruistic, because sometimes there’s nothing that would really benefit them in the end, but I think people always benefit because they’re being watched very carefully in a clinical trial—being monitored. Most of my patients come in, and they’re very altruistic and would like to learn for themselves, but not so much for themselves but for the next generation, whether it be their own children or other people in the world. Clinical trials are essential for us to understand whether treatment works or not. I could do those studies I talk about where it looks at the calcium when you take it or not, but there’s no control for other aspects that make people different.
A clinical trial is when you flip the coin and one person gets this and another person gets that, and that flipping of the coin is the most important feature of the clinical trial. It balances everything in life between the two groups, so that you’re really comparing that particular element that you’re looking for—the AREDS 1, people without AREDS 1 and with AREDS 1—so we’re quite certain. And when we look at the demographics, they’re almost identical in age or almost the same proportion of gender and race and everything else—and probably their health habits, whether they eat this way or that way. They’re well-balanced on both sides, and then you can really make a statement of whether that treatment works or not. So, only with a clinical trial can you do that.
Why would you want to actually be in a study? Well, number one is I think is the close monitoring you get. Sometimes you have to balance the risk, so when you talk to a doctor about a trial, you want to see what the risks are compared to the benefits. If the risks far outweigh that, then you might be a little wary of it, but for most clinical trials, that’s really balanced well before it gets to you. We have what we call institutional review boards, which are on the side of the patient. They advocate for the patient and want to make sure everything is safe before you come on to that.
But it’s the power of that study that really allows us to decide whether treatment is good or not, and without our patients, we really cannot do that. So, I’m always grateful to the thousands of patients who dedicate their time to the AREDS 1 and AREDS 2 and other studies that we do. They truly are very altruistic. I think most of them enjoy being in the study, because they learn a lot about the disease, they learn a lot about what happens, and they’re often the first to know: “I’m in a better study where the treatment was given and it looks like it might be promising.” The people who are in this study may be getting it for free, so there are some benefits, but there’s not always benefits. You have to think of it as there may be something for me or there may not, so it takes very special people to do this and we’re always grateful for people who will join our clinical trials.
MICHAEL BUCKLEY: Great. That was very informative. We’ll have time for one more listener question on AREDS, and then we’ll turn to Dr. Chew for some concluding remarks. We have a caller that’s wondering: Is there any benefit or difference between taking a chewable AREDS 2, as opposed to other forms of AREDS 2?
DR. CHEW: We believe they’re quite similar. We believe that the blood levels are very similar. Either you swallow it as a capsule, or take it as chewing a gummy bear-type of thing. These are fairly large; it’s hard for people who are on in age to swallow so many pills, and we don’t think there’s any difference. They should be reassured that they can get the same from either the capsule or the chewable form.
MICHAEL BUCKLEY: Great. Thank you. Dr. Chew, I’d like to conclude today with some bigger thoughts or observations you’ve had in your time as a researcher and a clinician. As we head into the year 2020, I think that’s a nice hook to get people better educated on vision health. In your experience, what could do that? What do you wish people knew more or did more about their vision health, or what would help people take better care of this part of their own health?
DR. CHEW: I think it’s important that they understand that a regular eye exam is really important. People who are a certain age and people who have diabetes, for example, should have an eye exam at least on a yearly basis. People with a family history of diseases might want to be seen a little earlier. That eye exam can pick out a great deal. If you can treat things earlier on, rather than waiting until something bad happens, it’s so much better. And 2020 is coming up, so it’s a very auspicious year. We really have to educate our population that there are things that they can do for themselves, and a healthy lifestyle is important. Eating a good diet is really important, and then having that eye exam would really just help so much for the nation. And I know one of the things we didn’t talk about is refractive error—people who need glasses. I know most may actually need glasses, so having that checked. I know schools check the vision and things like that, but as you get older I think it’s essential to do all those things to keep yourself in good eye health and to keep up your quality of life.
MICHAEL BUCKLEY: Great. The last question as we head into what you termed the auspicious year, 2020: Are you hopeful for the future of AMD prevention and treatment?
DR. CHEW: Oh, I’m very hopeful. I’m hoping we can get some sort of more primary prevention and things that would prevent the earlier diseases from progressing. We’re trying to work through that. We’re doing genetic testing—really for research, not so much for care, because we believe that research for care is still difficult because people who have certain genes may not actually develop this disease because of the other influences of lifestyle and diet, etc., so, it’s not very reliable. But the genetic testing will help us in research polls to figure out what might be important for different pathways that the disease may occur, and we’re up in the area of big data. Big data means artificial intelligence—so-called deep learning—when you can show things and just show examples and not giving them any instruction, but by teaching them with examples, they can more accurately diagnose and even predict prognosis of disease.
So, I’m very hopeful that the future’s going to be very bright for us, both for research and hopefully for the better medical care of our patients.
MICHAEL BUCKLEY: I couldn’t think of a better way to end our conversation today. Dr. Chew, thank you for being so generous with your time. It was a great opportunity for our listeners to hear from one of the top eye researchers at the National Institutes of Health and your work at the National Eye Institute. Dr. Chew, on behalf of BrightFocus Foundation and the several hundred listeners that have been live on the call today, I just want to thank you very much for being with us, and most importantly, thank you for what you’ve dedicated your life to.
DR. CHEW: Well, thank you for having me. It’s always an honor to speak to you, and to all of the listeners out there. Thank you for your attention.
MICHAEL BUCKLEY: This concludes our BrightFocus Chat. Thank you.
